Losing a tooth can be an alarming experience, but knowing how to react immediately is crucial. Immediate action can often save the tooth. This guide provides clear steps for adult teeth, their care, what to expect at the dentist, and the distinct approach for baby teeth.
Immediate Actions for an Adult Tooth
When an adult tooth comes out, locate it quickly, as time is a significant factor for successful re-implantation. Handle the tooth only by its crown to avoid damaging the delicate root surface. If dirty, gently rinse it with water or milk without scrubbing or drying, as vigorous cleaning can remove the periodontal ligament fibers that aid in reattachment.
Following the rinse, if possible and safe, try to reinsert the tooth gently back into its socket in the correct orientation. The tooth should slide in without force; if there is resistance, do not push it. Once reinserted, bite down gently on gauze, a clean cloth, or a damp tea bag to hold it in place and control any bleeding. Contact a dentist or emergency dental clinic immediately, as urgent professional stabilization is necessary even if the tooth is successfully reinserted.
Caring for the Tooth Until You See a Dentist
If reinserting the tooth into its socket is not possible, keeping it moist is important to preserve the cells on the root surface. The ideal storage medium for an avulsed tooth is Hank’s Balanced Salt Solution (HBSS). However, HBSS is not commonly available outside of dental or medical settings. Milk is considered the next best option for storage due to its nearly isotonic nature and relative freedom from bacteria, and it improves the viability of periodontal ligament fibroblasts compared to water or saliva.
If milk is not available, the tooth can be stored in the patient’s own saliva, either in a container or by placing it inside the mouth between the cheek and gums. Plain water should be avoided for long-term storage as it can damage the root cells. Transport the tooth to a dentist as quickly as possible, ideally within 30 minutes to an hour, as chances of successful re-implantation decrease with increased time outside the socket.
Understanding What Happens at the Dentist
Upon arrival at the dental office, the dentist will first assess the tooth and the socket for any additional damage, such as a fractured jawbone. If the tooth has been out of the socket for less than 20 minutes, immediate re-implantation is often attempted after gently rinsing the tooth with saline and clearing any blood clots from the socket. For teeth out of the socket between 20 minutes and 2 hours, the tooth may be soaked in HBSS for about 30 minutes to rehydrate the periodontal ligament cells before re-implantation; milk can be used if HBSS is unavailable.
Once re-implanted, the tooth is typically stabilized using a temporary splint, often made of soft wire and composite materials, which attaches the avulsed tooth to adjacent healthy teeth. This splint helps immobilize the tooth and promotes the reattachment of the periodontal ligament to the bone, usually remaining in place for about 7 to 10 days. While successful re-implantation is the primary goal, most re-implanted adult teeth, especially those out of the socket for more than 30 minutes, will eventually require a root canal because the nerves and blood vessels cannot be repaired. If re-implantation is not possible or unsuccessful, alternative tooth replacement options include dental implants, which involve a titanium post surgically placed into the jawbone, or dental bridges that use crowns on adjacent teeth to support a false tooth. Removable partial or full dentures are also available options for replacing missing teeth.
Differences for a Baby Tooth
The protocol for a knocked-out baby tooth differs from that of an adult tooth. Generally, baby teeth are not re-implanted. Re-implantation of a baby tooth could potentially damage the developing permanent tooth underneath. Therefore, if a baby tooth falls out, do not attempt to put it back into the socket.
Instead, the immediate focus should be on comforting the child and managing any bleeding. Gently wipe the area with a soft gauze or a clean cloth, and if the child is able, have them rinse their mouth with warm water. Some minor bleeding is normal. If there is discomfort or swelling, a child-appropriate topical anesthetic or anti-inflammatory medication can be used.
Contacting a dentist is still recommended for a knocked-out baby tooth, especially if it was due to an injury, to ensure no other damage occurred and to monitor the eruption of the permanent tooth. The dentist can assess the gum area and potentially take X-rays to check for any impact on the developing adult tooth. In some cases, if a baby tooth is lost prematurely due to injury, a space maintainer or a false tooth might be recommended to prevent other teeth from shifting and to preserve space for the permanent tooth.