Tooth Knocked Out of Socket (Avulsed)
When you understand HOW and WHY things happen, your actions for treatment and prevention are vastly improved.
If you just want to know WHAT ACTIONS TO TAKE, scroll down.
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Accidents happen, especially in kids. Now and then a tooth might get knocked completely out of the head. Dentists call this an avulsed tooth. It’s possible to save these teeth for life IF you understand what to do and you do it timely, and I mean FAST.
- Any sudden impact to a tooth that severes the ligament holding it to the bony socket (fighting, a fall, car or bike accident, etc.)
- Tooth missing from socket
- Chipped teeth around socket
- Temporary numbness associated with the impact
- Pain of varying levels
- State of shock
- This is a true emergency situation where pain relief might be secondary to getting treatment quickly. Treatment timing is critically important for best long-term results.
- Over the counter anti-inflammatory pain medicines, but NOT ASPIRIN. Typically acetaminophen or ibuprofen can be used. These are to be swallowed only and not placed directly on the injury.
- Ice packs on the face if swelling is external. Frozen vegetables like peas or corn make a good pliable ice pack. Wrap in a small thin towel (even a paper towel) before applying directly to skin in order to prevent freezer burn to the skin.
What you do immediately after a tooth is knocked out of its socket will have a strong impact on the lifelong dental needs associated with that tooth. Do your best with the information provided and under the circumstances in which you find yourself.
If the tooth knocked out is a baby tooth, never replant it. Treat other symptoms of the injury only. The following recommendations are …
FOR PERMANENT TEETH ONLY and WITH NO OTHER MAJOR INJURIES SUCH AS BROKEN JAW
When a tooth is knocked out, the ligament that holds the tooth root to the bone has been severed and some of those ligament cells remain attached to the tooth root. The purpose of the recommendations is to keep those cells on the root alive and then get the tooth back into its socket IN THE RIGHT POSITION as quickly as possible. This will maximize the chances of the tooth reattaching.
- Stay calm and keep your child calm. Your injured child may be in shock and will look for cues from you about the seriousness of the matter.
- Assess the child for other injuries FIRST. If knocked out tooth is the only serious injury and the socket is clean from debris such as dirt or bone chips, do the following.
- Pick up the tooth by the part of it you normally see in the mouth covered with enamel. Avoid touching the root of the tooth.
- If there is debris on the root, clean it off WITH SALIVA. NEVER USE WATER. This can be done by having your child spit on the tooth until the debris is gone. If they are in no condition to do that themselves, spit on it yourself until the surface is clean. You can use a clean piece of gauze or soft material very gently, but remember that the point is to keep those ligament cells on the root alive.
- If you can’t clean the root of with saliva, good alternatives are milk (cow’s milk – doesn’t matter which fat content) or saline solution (salt water – half teaspoon salt dissolved in one cup of body temperature warm water). I’ve not seen research on alternative milks (almond, soy, etc.) so be sure to use only cow’s milk. DO NOT RINSE WITH WATER OF ANY TYPE AS IT LEADS TO LIGAMENT CELL DEATH.
- Gently put the tooth back into the socket and try to position it exactly how it was before the injury. Use only gentle force, but persist until it’s repositioned as it was before. NOTE: there is usually temporary numbness from the injury so the sooner you do this, the less your child is likely to feel pain from replanting the tooth.
- Have your child (or someone else if they’re incapable) gently hold the tooth in position. Call your dentist and get your child there a.s.a.p. while remembering to stay calm.
The above is the IDEAL SCENARIO and gives the greatest chance for successful reattachment of the tooth. Below are modifications, depending on your circumstances.
- Follow steps 1 – 5 above.
- If you can’t replant the tooth immediately, don’t let the tooth dry out. Place it in a liquid that has the greatest chance to keep the cells on the root alive. Good options are: saliva, milk, salt water. DO NOT USE NORMAL WATER.
- Call the dentist and get your child there within the hour if possible. Chances of successful replantation and reattachment of the tooth greatly diminish after one hour. Keep calm if you can’t make it within one hour. There are other options available that your dentist may explain to you.
NOTE: Not all dentists are up on the latest research involving trauma to teeth. If they feel inadequate to deal with such situations and refer you to an oral surgeon (believe me, it happens), you don’t have time to find an oral surgeon or someone else. Time is of the essence when teeth are knocked out. For the sake of your child, guide your dentist to review and act on the recommendations at http://www.dentaltraumaguide.org/permanent_avulsion_treatment.aspx