An avulsed tooth is a dental emergency where a tooth is completely dislodged from its socket, including the root. This injury is most common in children aged 7 to 11 and requires swift action. Immediate first aid, followed by professional dental care, can often lead to the successful reimplantation of a permanent tooth.
Immediate First Aid for a Knocked-Out Tooth
When a permanent tooth is knocked out, the first priority is to locate it. Once found, handle it with care, picking it up only by the crown, the white, visible chewing surface. The root should never be touched, as it is covered with fragile periodontal ligament cells. Damaging these cells significantly reduces the likelihood of successful reimplantation.
If the tooth is dirty, it should be rinsed gently for no more than 10 seconds. The best rinsing solutions are milk or a sterile saline solution; if neither is available, the person’s own saliva can be used to wash away debris. Do not use tap water, as its composition can cause the root cells to burst and die through a process called osmotic lysis. The tooth should never be scrubbed, dried, or cleaned with soap or other chemicals.
After rinsing, attempt to gently reinsert the tooth back into the empty socket, root-first. The tooth should be aligned with the other teeth and then held in place by having the person bite down on a clean cloth or gauze. If reinsertion is not possible, the tooth must be kept moist while being transported to the dentist. The best transport medium is Hank’s Balanced Salt Solution (HBSS), followed by cold milk. Alternatively, the tooth can be placed inside the person’s mouth, between the cheek and gum, as long as they are old enough not to swallow it.
Regardless of whether the tooth is reinserted or placed in a transport medium, seeing a dentist or visiting an emergency room is an urgent step. The chances of saving the tooth are highest if it receives professional care within 30 to 60 minutes of the injury. The longer the tooth is out of the socket, the lower the prognosis for long-term survival.
Professional Dental Treatment
Upon arrival at a dental office, the dentist will assess the patient and the injury. This includes examining the avulsed tooth, the empty socket, and the surrounding tissues for any other damage, such as fractures to the jawbone. They will likely flush the socket with a saline solution to gently remove any blood clot and debris before proceeding with treatment.
If the tooth has been transported correctly, the dentist will reimplant it into the socket. To ensure the tooth is stable and remains in the correct position during healing, a splint will be applied. This splint acts much like a cast for a broken bone, temporarily bonding the avulsed tooth to one or two healthy neighboring teeth with a flexible wire and composite resin. This stabilization is left in place for up to two weeks.
Once the tooth is splinted, an x-ray is taken to confirm it is properly positioned in the socket and to check for any other underlying damage, such as root fractures. To prevent infection, the dentist may prescribe a course of antibiotics, such as amoxicillin. The patient’s tetanus immunization status will also be checked and updated if necessary.
Follow-Up Care and Prognosis
Proper follow-up care is needed for the tooth to heal. Patients are advised to eat a soft food diet for about two weeks to avoid putting pressure on the splinted tooth. Gentle brushing with a soft toothbrush and rinsing with an antibacterial mouthwash, such as chlorhexidine, helps keep the area clean and reduce the risk of infection.
A reimplanted permanent tooth will require a root canal treatment. This procedure is performed within 7 to 10 days of the injury, often before the splint is removed. The dentist will continue to monitor the tooth for several months to years for signs of complications. The two most common complications are inflammatory root resorption, where the body’s immune system attacks and dissolves the tooth root, and ankylosis, where the tooth root fuses directly to the jawbone.
The long-term prognosis for a reimplanted tooth depends heavily on the initial first aid. One study reported an overall survival rate of 50% at 5.5 years, noting that storing the tooth in milk significantly improved the outcome compared to dry storage.
Managing Avulsed Primary Teeth
The first aid for a knocked-out baby (primary) tooth is different from that for a permanent tooth. An avulsed primary tooth should never be reimplanted. Attempting to force a baby tooth back into its socket can cause significant harm to the developing permanent tooth bud that sits in the jawbone directly underneath it. This damage can lead to problems with the eruption or formation of the adult tooth later on.
A child who has knocked out a primary tooth should still be taken to a dentist promptly. The dentist needs to examine the area to check for any damage to the socket, lips, or gums. An x-ray may be taken to confirm no tooth fragments remain and to assess the underlying permanent tooth. In some cases, the dentist may recommend a space maintainer to prevent adjacent teeth from drifting and to ensure the permanent tooth has enough room to erupt correctly.