Losing a tooth due to trauma (avulsion) requires immediate action. The appropriate response depends entirely on the type of tooth lost: a permanent adult tooth or a primary baby tooth. For a permanent tooth, this is a true dental emergency, and the prognosis for saving the tooth is directly linked to how quickly and correctly you act. Careful steps must be taken immediately to preserve the tooth’s viability before seeking professional dental care.
Immediate Response for a Permanent Tooth
The first priority after a permanent tooth is fully knocked out is to manage the injury site and locate the tooth. Apply gentle pressure to the empty socket using a clean piece of gauze, a cloth, or a tea bag to control bleeding. Once the tooth is found, handle it only by the crown (the white chewing surface), and avoid touching the root. The root is covered in delicate periodontal ligament (PDL) cells, which are necessary for the tooth to reattach to the jawbone. Damage to these cells significantly reduces the chance of successful reimplantation.
If the tooth appears clean, the best course of action is to attempt to gently reinsert it back into the socket facing the correct way. If you manage to reinsert it, have the injured person lightly bite down on a piece of gauze or a clean cloth to hold the tooth in place while traveling to a dentist. If immediate reinsertion is not possible, the tooth must be kept moist in a suitable medium.
How to Preserve and Transport the Lost Tooth
Preserving the viability of the periodontal ligament cells is the most important factor for a successful outcome. If the tooth is dirty, rinse it gently with cold water or milk for no more than ten seconds to remove debris. Do not scrub, scrape, or use soap, as this will destroy the PDL cells. The goal is to keep the tooth from drying out, which causes cell death within minutes.
The most effective storage media available in an emergency setting are milk or a specialized dental preservation solution like Hank’s Balanced Salt Solution (HBSS). Milk is widely available and has a compatible pH and osmolarity, making it a good temporary option. Saline solution is also a viable alternative if milk is not accessible. Placing the tooth between the cheek and the gums is a last resort, due to the risk of accidental swallowing. The highest chance of saving the tooth is within 30 minutes to one hour of the avulsion, as the prognosis decreases significantly beyond this time.
Professional Treatment and Follow-up Care
Upon arrival at the dental office or emergency room, a dentist or oral surgeon will assess the tooth and the socket. If the tooth has not been reinserted, they will gently clean the area and the tooth before attempting reimplantation. The tooth will then be stabilized in its socket using a flexible splint, typically a wire or composite material bonded to the adjacent teeth. This splint is usually kept in place for one to two weeks, allowing the periodontal ligament fibers to begin reattaching the tooth to the bone. Following stabilization, most avulsed permanent teeth will require a root canal procedure to prevent infection and inflammatory root resorption, which may be scheduled within a couple of weeks after replantation.
Follow-up care includes monitoring the tooth for signs of infection, such as pain or swelling, and regular dental check-ups to assess the healing process. The long-term prognosis depends on the initial time the tooth was outside the mouth and the condition of the PDL cells upon reimplantation. Early and correct action greatly increases the likelihood of the tooth remaining functional for many years.
When a Primary Tooth is Lost
The loss of a primary, or baby, tooth due to trauma is treated differently than the loss of a permanent tooth. In this scenario, the general recommendation is not to attempt to reinsert the tooth into the socket. Reinserting a primary tooth can potentially cause damage to the developing permanent tooth bud located underneath the gums.
Manage any minor bleeding by having the child rinse their mouth with water or gently bite down on a clean piece of gauze. If the trauma was significant, or if only a portion of the tooth is lost, a dental professional should be consulted. A dentist will examine the area to ensure no fragments remain in the socket and to check for any injury to the permanent tooth underneath. While the loss of a baby tooth is not an emergency requiring preservation, seeking an assessment is important to ensure the child’s oral health is not compromised. Comforting the child and providing a positive distraction, like focusing on the tooth fairy tradition, can help manage the emotional impact of the injury.