A knocked-out tooth, also known as an avulsed tooth, is a dental emergency where a tooth is completely dislodged from its socket. While alarming, it is often possible to save and reinsert the tooth. The success of replantation depends significantly on quick action and proper handling.
Immediate Steps for a Knocked-Out Tooth
If a tooth is knocked out, locate it promptly. Hold it only by the crown, avoiding the root. If the tooth is dirty, gently rinse it with water or milk, taking care not to scrub or use soap.
Next, if possible for an adult, gently attempt to reinsert the tooth into its socket, ensuring it is facing the correct way. If it slides back in, bite down gently on a clean cloth or gauze to hold it in place. If immediate reinsertion is not feasible or if it is a baby tooth (which should not be replanted to avoid damaging the developing permanent tooth), keep the tooth moist.
Suitable storage options include placing the tooth in milk, saline solution, or a specialized tooth preservation kit. If these are unavailable, the tooth can be kept in the mouth between the cheek and gums, ensuring it remains moist. Avoid using plain tap water for storage, as it can harm the cells on the root surface. Seek immediate dental care, bringing the tooth with you.
Critical Factors for Successful Replantation
Timeliness is a primary factor for successful replantation. The chances of success are highest when the tooth is reinserted within 30 to 60 minutes of the injury. This prompt action helps preserve the viability of the periodontal ligament (PDL) cells, which are tiny fibers connecting the tooth to the bone. These cells are crucial for the tooth to reattach properly.
The condition of the tooth’s root and surrounding bone also influences the outcome. Any damage to the root surface or existing bone fractures can complicate the replantation process. Handling the tooth by its crown, without touching the root, minimizes trauma to the delicate PDL cells.
The chosen storage medium plays a significant role in maintaining cell viability if the tooth cannot be immediately reinserted. Solutions like milk or saline are preferred over water because they help prevent the root surface cells from swelling and bursting. Milk, for instance, contains proteins, antibacterial substances, and sugars that support cell survival. Patient age can also impact success rates; younger permanent teeth tend to have better prognoses due to their greater healing capacity.
The Replantation Process and Initial Care
At the dental office, the dentist will conduct a thorough examination, assessing the tooth, its socket, and surrounding structures to determine the extent of the injury. The tooth and socket will be gently cleaned to remove any debris. The dentist will then carefully reinsert the tooth into its proper position in the socket.
After replantation, the tooth is typically stabilized using a temporary splint. This splint, often a flexible wire bonded to the injured tooth and adjacent teeth, holds the tooth firmly in place while the supporting tissues heal. The splint is usually kept in place for about two weeks. The dentist may also consider prescribing antibiotics or a tetanus shot, especially if the injury involved contamination. Initial post-replantation instructions usually include maintaining a soft diet and practicing gentle oral hygiene.
Long-Term Outlook After Replantation
After a tooth has been replanted, ongoing monitoring with the dentist is necessary to assess its healing and detect any potential complications. While replantation can save a tooth, the long-term prognosis varies. Common complications include root resorption, where the body’s own cells begin to break down the tooth’s root, and pulp necrosis, which is the death of the nerve inside the tooth.
Root resorption can manifest in different forms, such as inflammatory resorption, which can lead to rapid tooth loss, or replacement resorption (also known as ankylosis), where the tooth fuses directly to the bone. Pulp necrosis often necessitates root canal treatment to remove infected tissue. The overall survival rate for replanted permanent teeth has been reported as approximately 50% after 5.5 years. If replantation is not successful long-term, alternative treatments like dental implants or bridges may be considered to replace the lost tooth.