A complete displacement of a tooth from its socket, known as an avulsed tooth, constitutes a dental emergency. This injury typically results from severe trauma, such as a sports accident or a fall, and requires immediate, correct action to maximize the chances of saving the tooth. The long-term outcome is highly dependent on how quickly and carefully the injury and the tooth itself are handled. Acting fast to preserve the delicate root surface is crucial, as the viability of the tooth decreases rapidly the longer it remains outside the mouth.
Immediate First Aid for the Avulsed Tooth
If you find the tooth, handle it only by the crown, which is the white chewing surface, and avoid touching the root portion. The root is covered by a fragile layer of cells called the periodontal ligament (PDL), and damaging these cells reduces the likelihood of successful reattachment. If the tooth is visibly dirty, gently rinse it with cold water, milk, or sterile saline for no more than ten seconds; never scrub it or use chemicals.
The most effective action is to reinsert the tooth immediately back into its socket, provided the injured person is conscious and cooperative. Gently push the tooth into the socket and have the person bite down lightly on a clean cloth or gauze to stabilize it during transport. This immediate replantation minimizes the “dry time” damaging to the PDL cells.
If immediate reinsertion is not possible, the tooth must be kept moist in a suitable medium to preserve the root cells. Acceptable storage liquids include:
- Cold cow’s milk.
- Sterile saline solution.
- A commercial tooth preservation kit.
- The patient’s saliva (stored inside the mouth, tucked between the cheek and gums, for older, conscious persons).
This first-aid advice applies only to permanent teeth; baby teeth should generally not be replanted.
Managing Pain and Bleeding
While dealing with the tooth, you must also address any bleeding from the empty socket. Apply firm, consistent pressure to the site using a piece of clean gauze, a clean cloth, or a moistened black tea bag. The tannic acid in the tea bag helps promote blood clot formation and staunch the flow. Maintain the pressure for at least 15 to 30 minutes.
For discomfort, an over-the-counter pain reliever like acetaminophen or ibuprofen can be taken. Avoid aspirin, as it can thin the blood and potentially increase bleeding at the trauma site. Swelling is common after a traumatic injury, and this can be reduced by applying a cold compress or ice pack to the outside of the face, directly over the injury area.
The cold compress should be applied for 15 minutes on and 15 minutes off, helping to constrict the blood vessels and limit inflammation. A gentle rinse with a saltwater solution can be used after the initial 24 hours to keep the area clean. However, excessive rinsing or spitting immediately after the injury should be avoided, as it may dislodge the forming blood clot.
Seeking Professional Treatment and Restoration Options
A dental professional must be seen immediately, ideally within 30 to 60 minutes of the injury, as the success rate for replantation drops significantly after this window. Upon arrival, the dentist will assess the tooth and the socket, often taking X-rays to check for additional damage. If the tooth was not replanted, the dentist will clean the socket and the tooth, and then carefully reinsert it.
After replantation, the tooth is stabilized by attaching it to the neighboring teeth using a flexible splint, which is typically kept in place for two to four weeks. The patient will need follow-up care, which may include a root canal procedure to prevent infection, especially if the tooth was out of the mouth for an extended period. This procedure removes the damaged nerve and blood vessels inside the tooth.
If the tooth cannot be saved or if replantation is unsuccessful, there are several options for long-term restoration. The dentist may recommend a dental implant, which is a prosthetic root placed surgically into the jawbone, offering a permanent and stable replacement. Other common alternatives include a fixed bridge, which uses the adjacent teeth as anchors to support a replacement tooth, or a removable partial denture.