Tooth Knocked Out

Question: What do I do if my child's tooth gets knocked out?

Fortunately, having a tooth knocked out is not something everyone is going to experience. When it happens, people tend to panic due to the volume of blood and the rapid onset of symptoms of pain and swelling. With proper attention, many teeth can be successfully replanted and much time and money can be saved.

Common dental injuries include fracture of tooth, fracture of tooth and bone, or avulsion (the entire tooth is knocked out of the mouth). Since it may be difficult for you to tell if a tooth is broken below the gum line or has come out entirely, it is important for you to locate whatever has been knocked out of the mouth if no tooth can be seen in the socket. If the tooth has not been ejected whole, the ejected piece will not be able to be reattached. The best thing to do is to call the dentist right away so the severity of the fracture, and any further damage to the area can be assessed. If the tooth has been ejected whole, time is critical. If the tooth can be properly replanted in 40 minutes or less, long term retention of the tooth in the mouth is very likely. At three hours after avulsion, the chance of successful replantation is virtually zero.

The tooth must be located without delay. Successful replantation is dependent on maintaining the soft tissue covering of the root (dentists call this the periodontal ligament). Care must be taken not to scrape this covering off or dry it out. After finding the tooth, rinse it carefully with water. Replace it in the socket if you can. Baby teeth are usually not replanted due to the close proximity of the developing permanent tooth to the root tip of the baby tooth.

If the tooth cannot be replanted at the time of injury(usually due to the hysterical nature of the victim), a suitable nondrying liquid must be used for storage of the tooth until the dentist can properly replace it into its socket. Water is fine, but milk is better because it is more like body tissue so chemical elements of the soft tisssue covering of the root are not lost. If the injury is confined to the teeth and surrounding tissue, it's best to bypass visiting the emergency room and call the dentist directly so that time can be conserved. The dentist will meet you without delay and the tooth will be replaced in its socket if possible. Follow up treatment will be required since the tooth will have to be positioned into the socket with something to hold it in place for a while after the accident. The surrounding area is also assessed. X-rays are usually required. The tooth is usually held in place in the socket for a number of weeks. During this time, the severed pulp tissue (nerve) of the tooth is removed and a rubber-like material is placed where the nerve used to be. This is a root canal.

Teeth replanted as described have a reasonable chance of retention at least in for a few years. There are often complications later. Sometimes the body acts to remove what it sees as a foreign body (the replanted tooth) from the mouth by replacing it little by little with bone or soft tissue. The dentist calls this process resorption. Additionally, the tooth usually loses the ability to be moved orthodontically. However, as a short or medium term solution, it is often advisable to replant the tooth. You and your dentist will have to talk about whether or not in your individual circumstance it is better to replant the tooth and take your chances or to leave it missing and deal with alternative solutions to the space the missing tooth leaves right away.


This article was written by Dr. Mike Christensen and published in the Daily Miner and News, and Enterprise. Local Kenora News Publicatons (1998-2006)