Nine Steps to Take When Your Permanent Tooth Gets Knocked Out of...

Nine Steps to Take When Your Permanent Tooth Gets Knocked Out of Your Mouth

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Permanent Tooth Knocked Out Child
©Andrey Yurlov/Shutterstock.com

No matter how careful people are, there always seems to be a way to knock out a tooth. When a tooth gets knocked out, the technical name for this condition is called tooth avulsion. Unfortunately, when a tooth gets knocked out, panic ensues. There may be many people around who “know what to do” and want to help you save your tooth.

Teeth Can Be Knocked Out During Hockey GamesIt is true that once a tooth gets knocked out, it can successfully be re-implanted and return to normal function. However the key lies in what happens during the critical period while the tooth is outside of your mouth. Here, I offer nine simple steps to take when your tooth gets knocked out to keep it healthy so that it can return to its favorite past-time of chewing delicious meals.

Nine Steps to Take When Your Tooth Gets Knocked Out of Your Mouth

As a general rule, the sooner a tooth can get back into its socket inside the mouth, the better chance it has to survive long-term.

1. When a tooth gets knocked out, it is important to pick it up while only touching the crown of the tooth (the crown is the part of the tooth that is normally visible inside your mouth.)  If you can’t find the tooth try as hard as you can to find it.  Although aspiration rarely occurs, it is possible that the tooth could’ve been inadvertently breathed in by the accident victim.

2. Next, rinse off the tooth very gently with tap water, saliva (spit), or saline solution. It is important not to scrub the root of the tooth (the root is the part of the tooth that is normally hidden below the gums in your mouth and is more yellow than the crown.) Many people think it is important to scrub the tooth to get all of the germs off. However, if you scrub the tooth, you could scrub away the periodontal ligament or the cementum, which both help to hold the tooth in the socket. By scrubbing them away, you will reduce the chances of the tooth permanently re-attaching itself inside the mouth. Soap and chemicals such as bleach will damage the cells that are left on the tooth which could make successful re-implantation impossible.

3. Try to put the tooth gently back in its socket and steadily hold it there. Sometimes, people may not know exactly how to put the tooth back in or there may be doubts about how to put it back in. Other times, the person who had the tooth knocked out isn’t cooperative enough to allow the tooth to be re-implanted. In this case, go to step #4.

Before putting the tooth back in the mouth, make sure that you are dealing with a permanent tooth, you could end up damaging the developing permanent tooth if you try to re-implant a baby tooth back on top of it. If you’re not sure, it is best to not try to re-implant the tooth, simply go to step #4 below.

You also want to make sure that you have the whole tooth. If it fractured somewhere along the root, you might want to wait to have the dentist look at it first to see if the tooth can be saved. In this case, go to step #4 below.

4. If you can’t put the tooth back in for any reason, you need to put the tooth into an appropriate solution to keep it healthy. The goal is to keep the tooth moist. There are a variety of solutions that will work to store the tooth, however some are better than others.

The absolute best place to store a tooth is in aSave A Tooth Emergency Tooth Preserving System balanced salt solution.A good way to get a balanced salt solution is by purchasing the Save-A-Tooth Emergency Tooth Preserving System. Many schools and athletic facilities have the Save-A-Tooth or a similar system readily available in the event of an accident. You can learn more about tooth avulsion at this page.

The next best place to store the tooth is in milk because it is fairly biologically compatible with teeth and doesn’t contain too many bacteria. Milk has been proven to keep the periodontal ligament cells healthy in studies such as this one by Dr. Martin Trope.

You should avoid storing the tooth in pure water as this will cause the periodontal ligament cells to die. Another place to avoid storing the tooth is in your mouth since it contains a lot of bacteria, lacks the optimum electrolyte balance, and has an incompatible pH (acidity) for the periodontal ligament cells.

You should never dry the tooth off or store it in a towel or tissue since the cells on the root of the tooth need to remain wet in order to stay alive.

5. Go to the dentist. The dentist will be able to help you determine if the tooth is in good enough condition to return to full function. If the tooth looks good, then the dentist will take some x-rays to determine if optimum healing will be able to occur. The dentist will then be able to splint (attach) the tooth to the teeth next to it so it can be immobilized and have proper support for healing to take place.If the tooth has been out of the mouth for more than 20 minutes, then the dentist will need to soak the tooth in a balanced salt solution for about a half hour and then put it in an antibiotic before re-implanting it. The salt solution helps to keep the periodontal ligament cells alive and reduces the chance of them dying and your tooth attaching directly to bone (a condition known as ankylosis, which has a variety of problems associated with it — I’ll get into that in a future article.)

6. Take antibiotics and get a tetanus booster shot if you haven’t had one in the past five to ten years. Because it would be impossible to sterilize the tooth before re-implanting it without killing the cells in the tooth, you will probably end up introducing a small amount of bacteria into your body. To be on the safe side, your dentist will probably prescribe you 7-10 days’ worth of antibiotics. Also, if you haven’t had a tetanus booster shot in the past five to ten years, you should go to your doctor to get one.

7. After 7-10 days, go back to the dentist. The dentist will then remove the splint. Studies have shown that if the splint is kept on the teeth for more than 7-10 days, there is a good chance that cells in your body will start to eat away at the root of the tooth (a process known as root resorption).

However, there is an exception to this rule. If the tooth was knocked out of an adolescent, then there is a possibility that the pulp inside the tooth will also heal. To allow this to happen, it is recommended to keep the splint attached for three to four weeks in younger teeth.

8. Bite carefully until the tooth heals. The tooth will still be slightly movable when the dentist removes the splint. It is necessary to remove the splint this early because if the splint is left in too long, there are complications that can arise.

9. Hope for the best and return to your dentist often. If the tooth is young, the pulp may heal. If the tooth is a few years old and is fully formed, the pulp will probably not survive. In these cases, the tooth can still be successfully re-implanted, but it will need to have a root canal treatment performed where the dead pulp tissue is removed and replaced with a compatible material. Also, the tooth may get eaten away a little bit by the cells around the periodontal ligament.

The roots on teeth that have been re-implanted have a tendency to slowly dissolve, so it is important that your dentist take exam the tooth at six month intervals to monitor the status of the tooth.

Factors That Determine Successful Re-Implantation of the Tooth

There are three factors to that will determine if the tooth will be able to be re-implanted and return to normal function. They are the following:

  1. How long the tooth has been out of the mouth. If it’s been less than 30 minutes there is usually a good prognosis. However, if the tooth ash been out of the mouth for more than 2 hours, then there is a poor prognosis.
  2. The condition of the tooth and periodontal tissues. If the tooth has been knocked out of someone with periodontal disease or the tooth socket is not intact, then the prognosis is poor.
  3. How well the tooth is taken care of while it is out of the mouth. If the tooth has been taken care of and re-implanted immediately or soaked in a balanced salt solution, the prognosis is usually pretty good.

What About Baby Teeth?

Re-implanting baby teeth is a bit more complicated. For the most part, it is usually not recommended to re-implant baby teeth after they have been knocked out. I will talk about what to do when a baby tooth gets knocked out in my next article on Wednesday.

Conclusion

The most important factor to remember is that you need to get the tooth back in the mouth as soon as possible! If you can’t get it back in the mouth immediately, you have to find a way to keep it wet that will protect the tooth and keep it healthy.

It’s best to prepare in advance for emergencies like this so that no mistakes are made.

Have you ever had a tooth knocked out? Did it get put back in? If you have any experiences about teeth getting knocked out, please don’t hesitate to share them below in the comments. Thanks for reading!

7 COMMENTS

  1. Hi Tom
    My 10 yr old son had an accident on his scooter almost a year ago. His permanent top right front tooth snapped off about 3/4 of the way up (maybe a 3 mill stump) and his top left front tooth was split almost in two and continued up under the gum (you should see the photo, it’s a doozy!). He had the right tooth glued back on (not as straight as it was before) and the left one had to be removed. He was made a false tooth (to mirror the now crooked re-attached tooth) attached to a full plastic mouth plate which he is self conscious about as it makes him lisp and he doesn’t like to take it in and out to eat at school in front of the other children.
    I thought he would have to have a plate until he was 17 or so, but was told it is more likely to be until he is 20 and his jaw is fully formed that then he will be able to finally get implants. I just feel for him so much as although he is not that bothered about it at the moment, I am thinking more of when he is a teenager and beyond and interested in girls. I was wondering if in America (I’m in Australia) there is anything a bit more pioneering than what he has available to him here?

    Thank you for your time 🙂

    • If i removed two my top jaw tooth that is the fourth counting from the front (left and right) about 7-8 days ago but wanted to put it back, is it possible?

      Thank you for your time.

  2. My eight years old daughter knocked out her two front teeth . They were put back after 20 hours .. I kept the theeth in milk for about five hours and after that in saline water ! I’m very scared and devastated because I don’t know if she will be able to keep those theeth in ! Please let me know if you know anybody who had their theeth reimplanted after so long !

  3. I was in P.E and I knocked out my two front teeth I am 14 hopefully they have regrown and are fine but the dentist told me that I had to wait till I seen him again and my orthodontist says it’s coming along fine so I guess if it happens to you keep check to see if you can feel like a heartbeat in the tooth might suggest that the root has taken hold

  4. My sons 10 and his front tooth was knocked out by a baseball to his face. We immediately place the tooth back into socket and went to the ER. There they admitted him and the very next morning he had his tooth splinted and had a root canal. We are now just waiting to see what is they next step is.

  5. Thank you for explaining how to deal with a tooth being knocked out! My daughter had her baby tooth knocked out in a sledding accident, but it made me wonder how I would have dealt with a permanent tooth falling out. Are there usually emergency dentists available for situations like this?

  6. I was hit by a car when I was 10 years old, One of my perm top central tooth was knocked completely out. Over time my other teeth shifted closing the gap of the missing tooth, leaving my 1 central tooth that wasn’t knocked out directly in the middle of my mouth…no gaps at all. I’m now 43 and I’m very self conscious about it….Is this something that can be fixed and if yes what are some options without leaving my with a space in my mouth? I want my 2 front teeth verses the one that I have.

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