Tooth avulsion describes a dental injury where a permanent tooth is entirely knocked out of its socket. This is a dental emergency, and the difference between saving the tooth and losing it is often measured in minutes. The success of replantation—the process of putting the tooth back—is directly linked to the time elapsed and how the tooth is managed immediately after the accident. The delicate cells on the tooth’s root surface begin to die immediately upon drying out, making quick action essential.
Immediate Steps Following Tooth Avulsion
The first actions taken at the scene should focus on the injured person before the tooth. It is important to control any significant bleeding and check for signs of a more severe head injury, such as loss of consciousness or vomiting, which takes priority over dental care. Once the person is stable, locate the avulsed tooth quickly, as time is critical for its survival.
When handling the tooth, only touch the crown, which is the white, chewing surface. Avoid touching the root surface, as this area is covered in specialized periodontal ligament (PDL) cells. Preserving these cells is the most important factor for the tooth to successfully reattach to the jawbone after replantation. Damage to the PDL cells significantly reduces the chances of long-term survival.
Proper Handling and Cleaning Techniques
If the tooth is visibly dirty, a brief and gentle rinse is required, but this should not be mistaken for scrubbing or cleaning with harsh agents. Hold the tooth by the crown and rinse it for no more than 10 seconds under cool, running water, or ideally, a saline solution. The goal is only to remove gross contamination like dirt, not to sterilize the tooth or scrub off any tissue.
Aggressively wiping, scrubbing, or using chemicals like soap or alcohol will destroy the PDL cells. Once the tooth is rinsed, the best outcome is immediate reinsertion into the empty socket. Gently push the tooth back into its original position, ensuring it faces the correct way, and then have the injured person bite down lightly on gauze or cloth to hold it in place. If the tooth does not slip back in easily, do not force it, and proceed to safe storage.
Safe Storage and Transportation Methods
If immediate reinsertion is not possible due to distress or other injuries, the tooth must be kept moist in a suitable medium until professional help is reached. The most preferred storage media are those that maintain the viability of the periodontal ligament cells. Hank’s Balanced Salt Solution (HBSS) is considered the gold standard, as its balanced physiological properties can keep cells alive for extended periods.
Since specialized solutions like HBSS are rarely available outside a dental office, cold milk is the most recommended alternative, as it has a favorable osmolality and pH for cell preservation. Placing the tooth inside the mouth, between the cheek and gums (buccal vestibule), is another viable option, using the person’s own saliva to keep it moist. Storing the tooth in tap water is discouraged because its non-physiological properties can cause the root surface cells to swell and burst.
Professional Care and Primary Tooth Exclusion
Regardless of whether the tooth was successfully replanted at the scene or stored in a transport medium, immediate professional dental care is required. The prognosis for long-term tooth survival diminishes after the first 30 to 60 minutes out of the mouth. A dentist or oral surgeon will assess the extent of the injury, take X-rays, and stabilize the tooth by splinting it to adjacent teeth for a period of about two weeks.
It is necessary to distinguish between a permanent tooth and a primary, or baby, tooth. Primary teeth should never be replanted after avulsion. Attempting to push a primary tooth back into the socket can cause damage to the developing permanent tooth bud located beneath it in the jawbone. Replantation is a treatment reserved only for permanent teeth.