An avulsed tooth is one that has been completely knocked out of its socket, typically due to sudden impact or trauma. This injury is a true dental emergency, and immediate action is required to save the tooth. The primary goal is to preserve the living cells on the tooth’s root surface, which are necessary for successful reattachment in the jawbone. Acting swiftly and knowing the proper preservation technique significantly improves the chances of the tooth being successfully replanted by a dental professional.
Immediate Care for an Avulsed Tooth
The first step after an avulsion is to locate the tooth and handle it with care. Only pick up the tooth by the crown (the white chewing surface), and never touch the root. The root surface holds delicate periodontal ligament (PDL) cells, and touching them can cause irreparable damage that prevents reattachment. If the tooth is dirty, gently rinse it with water or saline for a few seconds to remove debris, but never scrub it or use soap.
If the injured person is calm and cooperative, the most effective action is to attempt immediate reinsertion into the socket. Gently position the tooth back into the hole, ensuring it faces the correct way. If it slides easily into place, have the person hold it there by biting down softly on a clean cloth or gauze. Do not force the tooth if it does not go in easily, as this can cause further damage to the socket.
The Science Behind Milk as a Storage Medium
When immediate replantation is not possible, the tooth must be kept moist in a suitable storage medium, and milk is widely recommended. This preference is due to the need to maintain the viability of the periodontal ligament (PDL) cells that cling to the tooth root. These cells are essential for the tooth to reattach to the bone after it is replanted.
Milk, particularly whole milk, is a superior temporary storage solution compared to water because of its chemical properties. It has a relatively neutral pH (typically between 6.5 and 7.2) and its osmolarity is close to that of the body’s cells. This nearly isotonic environment prevents the PDL cells from rapidly swelling and bursting, which would happen in hypotonic tap water. Milk also contains nutrients that help keep the cells alive until professional treatment can be provided.
Commercial tooth preservation kits are the best storage medium, followed by Hank’s Balanced Salt Solution, but these are rarely available during an emergency. If milk is not accessible, alternatives include a saline solution or placing the tooth inside the patient’s mouth, tucked between the cheek and gums, where saliva can keep it moist. Storing the tooth in tap water is the least preferred option, as it can cause rapid cell death within minutes.
The Critical Timeline and Professional Treatment
Time is the most significant factor in determining the outcome for an avulsed tooth; the first hour is often referred to as the “golden hour.” The chances of successful re-implantation are highest if the tooth is placed back into the socket within 30 to 60 minutes of the injury. After 60 minutes of dry time, the PDL cells begin to die, and the success rate decreases sharply.
Upon reaching the dentist, they will first assess the tooth and the socket, often taking X-rays to check for additional injury. If the tooth has not been replanted, the dentist will gently clean the area and place the tooth back into the socket. The re-implanted tooth is then stabilized using a flexible splint—a thin wire bonded to adjacent teeth—which holds it in place for one to two weeks while the PDL heals. Because the nerve and blood vessels are severed during avulsion, a root canal procedure is often necessary to prevent infection and is typically performed within a week or two after stabilization.
When Not to Replant: Primary Teeth
It is important to distinguish between a permanent tooth and a primary (“baby”) tooth. The steps for preservation and re-implantation discussed here are strictly for permanent teeth. An avulsed primary tooth should not be replanted under any circumstances, even if it has been stored correctly in milk.
Re-implanting a primary tooth carries a risk of damaging the underlying developing permanent tooth germ. This damage can result in defects to the permanent tooth’s enamel or root structure. If a primary tooth is knocked out, seek a dental visit to confirm no fragments remain in the socket and to check for other injuries. No attempt should be made to save the tooth.