A knocked-out tooth, medically termed an avulsed tooth, is a dental emergency where quick, appropriate action determines whether the tooth can be saved. This injury requires immediate attention because the viability of the periodontal ligament (PDL) cells attached to the root rapidly decreases outside the mouth. First aid aims to preserve these cells and maximize the tooth’s chance of successful replantation by a professional. Acting calmly and correctly in the moments following the trauma is the most important factor in the outcome.
Immediate First Steps
The first action should be to locate the dislodged tooth and manage the bleeding from the empty socket. Gently press clean gauze or a cloth over the injured area to control the bleeding, and apply a cold compress to the cheek outside the mouth to minimize swelling and pain. Find the tooth quickly, handling it only by the crown (the chewing surface). The root surface cells are sensitive and must be protected from damage.
If the tooth is visibly dirty, it requires a gentle rinse, but scrubbing must be avoided. Use either cold milk or a sterile saline solution for this delicate cleaning process. Do not use tap water, as its chemical composition is not compatible with the root cells and can cause them to swell and burst. After rinsing, keep the tooth moist at all times and immediately prepare to seek professional dental care.
Distinguishing Between Tooth Types
Before taking the next steps, determine if the avulsed tooth is a primary (baby) tooth or a permanent adult tooth, as the protocol for each is different. Permanent teeth typically have a full, solid, and significantly longer root structure. In contrast, a primary tooth will often have a shorter, more tapered root that may appear partially dissolved or frayed. This root resorption is a natural process that occurs as the permanent tooth pushes up beneath it.
If the lost tooth is identified as a primary tooth, it should not be reinserted into the socket. Attempting to replant a primary tooth can damage the developing permanent tooth bud underneath the gum line. Contact a dentist for a professional assessment of the injury and the empty socket. If the tooth has a long, solid root, it is a permanent tooth and must be saved.
How to Store a Permanent Tooth
Storage is vital for preserving the permanent tooth during transport, ideally for less than 60 minutes. The best action, if the patient is conscious and cooperative, is to gently reinsert the tooth back into its socket immediately after rinsing it. If successful, the tooth should be held in place by gently biting down on gauze or a cloth while traveling to the dentist.
If immediate reinsertion is not possible, the tooth must be kept in a specific moist environment to prevent the root from drying out. The most recommended transport media include:
- Commercial tooth preservation kits like Hank’s Balanced Salt Solution (HBSS), which is considered the gold standard.
- Cold milk, which has an appropriate pH and osmolarity to keep the cells alive for a short time.
- A sterile saline solution, which is an acceptable alternative for transport.
Emergency Dental Treatment and Follow-Up
Once the tooth is secured, contact a dental professional or emergency room immediately, as the first 30 minutes offer the highest chance of successful replantation. Upon arrival, the dental team will assess the tooth and the socket, often using X-rays to check for any associated bone damage. If the tooth is viable, the dentist will gently clean the socket and the tooth with saline before carefully repositioning it.
Following replantation, the tooth is stabilized by attaching it to the neighboring teeth with a flexible splint, usually kept in place for one to two weeks. The dental professional may prescribe antibiotics to prevent infection and may also recommend a tetanus booster depending on the nature of the injury. For the short term, a soft diet and careful oral hygiene are necessary to allow the periodontal ligament to heal. Most avulsed permanent teeth will require a root canal procedure within a couple of weeks after replantation to manage the severed blood and nerve supply and prevent future complications.