Most dental emergencies involving knocked out “avulsed” teeth occur in children.  Typically kids are horseplaying, falling, or participating in sports where these types of injuries most commonly occur.  So if you or your child suffers trauma such that a tooth is knocked loose, what do you do?

 

First, let’s distinguish between baby “primary” teeth and “adult” permanent teeth.  If a baby tooth is lost, it cannot be put back into your mouth successfully.  Depending on the child’s age however, they should still be examined by an emergency dentist for damage to other teeth, and to determine if a space maintainer needs to be used.  If a baby tooth is lost prematurely, it may be necessary to place a space maintainer in the mouth to preserve the space caused by the missing primary tooth.  This will allow the permanent tooth the opportunity to properly erupt into the appropriate space and prevent other teeth from drifting into that space. 

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When a tooth is knocked out, time is of the essence...

 

One of the most important factors in the long term survival of a reimplanted avulsed tooth is the amount of time the tooth was gone from the mouth.  If a knocked out tooth is reimplanted back into the mouth or placed into a proper storage medium within five minutes of being lost, the chances of survival are very good. If less than 60 minutes have passed, the chances of tooth survival are still good.  However if a tooth is out of the mouth for more than one hour and is not properly stored, the rate of long term survival quickly diminishes. 

 

If possible, it is recommended to place the tooth back into the tooth socket...

 

Although it is essential you see an emergency dentist to reimplant an avulsed tooth, for the best chance to save the tooth, you should try to put the tooth back into the socket where it was knocked out from.  If the tooth hit the ground and has any sort of dirt or debris on it, simply rinse the tooth with water or milk.  It’s important not to wipe or scrub the tooth with anything because that would likely damage the important periodontal ligaments on the outside of the tooth.  

 

When you place the tooth back into the socket, its important not to touch the root portion.  To reimplant the tooth, pick it up by the crown (the chewing part of the tooth).  Use very light pressure to reinsert the tooth and then gently close your mouth to push the tooth back into its proper position. 

 

If the tooth cannot be put back into the socket, then what?

 

As mentioned above, a tooth has the best chance of survival if it is placed back into the socket or into an appropriate storage medium.  When it comes to this issue, its very important not to place the tooth into water.  Water can cause the cells to swell resulting in permanent damage or death.  Rather, milk is an ideal storage medium. Another possible strategy is to put the tooth in the mouth in between the tooth and gum. However this can be a risky strategy for kids because there is always a risk they will chew on the tooth or even swallow it. 

 

Milk is an ideal tooth storage medium because it contains certain substances that help the tooth survive such as antibacterial agents, proteins to maintain the right balance of acids, and sugars that the cells need to survive.  It’s best to put the tooth and milk in a small sealable ziplock-type back, or a small plastic container with a lid.  Some first aid kits, especially at schools, may have an emergency tooth preservation kit.  These are prefilled jars which help preserve a tooth before it can be reimplanted by an emergency dentist. 

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Will the tooth survive?

 

Once you have your tooth stored in milk, it is important to get to a dentist as soon as possible.  An avulsed tooth is not something you want to spend the night with.  If your dentist cannot see you the same day or requires a several day wait for an appointment, you need to find a dentist who accepts same day emergency patients.  For each hour that passes and the knocked out tooth is not reimplanted by a dentist, the less likely the tooth will reattach successfully to the surrounding tissue. 

 

Once at the dentist, the dentist will reimplant the avulsed tooth, then splint the tooth to adjacent teeth to stabilize it and minimize movement.  Generally a thin metal wire and white composite filling material are used to bond the newly reimplanted tooth to adjacent teeth. The teeth will remain splinted for a few months until the lost tooth has little to no mobility in it.  Often a reimplanted tooth will require a root canal at some point. 

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Survival rates 

 

On average about half of all reimplanted avulsed teeth remain in the mouth for longer than 5 years.  Older children up to 16 years old tend to have been better survival rates for reimplanted permanent teeth than do younger children whose tooth roots are not as advanced.  Storage of the avulsed tooth in milk also increases the survival of the tooth by nearly 50% when compared with when the avulsed tooth was left dry. 

 

If you or your child has had a permanent tooth knocked out, it’s important to see a dentist the same day.  At Emergency Dental of South Kansas City we have evening and weekend appointments available to treat dental emergencies such as avulsed permanent teeth.  If you have a dental emergency, please call us or text us at (816) 601-1817