The Knocked Out (Avulsed) Tooth

The Knocked Out (Avulsed) Tooth

Knocking out a tooth, otherwise known as avulsion, can be a scary thing! Avulsion accounts for 0.3-5% of all dental injuries. This is one of the most serious dental injuries and many studies have shown that the first few minutes following the accident are key.

Timing is everything!

In most situations involving permanent teeth, the best treatment is replanting the tooth, and the sooner, the better! Immediately replanting the tooth at the site of the injury is the best treatment. If the tooth that has been knocked out is a baby tooth, leave this tooth for the tooth fairy—baby teeth should not be replanted as it can cause damage to the developing adult tooth.

In cases where replantation cannot be done, the following guidelines can help ensure the best prognosis for the tooth in question.

• Make sure the patient is calm!
• The tooth should be handled ONLY by the crown (the whiter, chewing surface). Try not to touch the root.
• If there is dirt or debris on the tooth, wash it gently under cold water for a maximum of 10 seconds. Avoid soap, chemicals, and do not scrub the tooth! Once clean, attempt to replant the tooth. Once in place, hold it there with your fingers or by biting gently on it.
• If you cannot put the tooth back in place, make sure to keep it moist. If the patient is conscious, the tooth can be held in the patient’s mouth, near the cheek. Alternatively, the tooth can be placed in milk, saline, or emergency tooth preservation solution (Hanks balanced storage medium). We do not want to store the tooth in water! The delicate cells on the surface of the root cannot tolerate being stored in water for long periods of time.
• See a local dentist or root canal specialist within 30 minutes.

Once you arrive at your dentist, treatment depends on where the tooth is (replanted or in storage solution) and how long ago the injury occurred. In most cases, the tooth will require a root canal after emergency care is rendered. Any lacerations will be sutured, a splint will be placed on the tooth, and antibiotics will be given. You may be referred to your physician to evaluate the need for a tetanus booster. At home, you will be given a special mouth rinse to use and a soft diet will be recommended for at least 2 weeks.

As with other types of dental trauma, follow-up is key! Your dentist will want to evaluate the tooth regularly to confirm that healing is progressing normally. If you have any questions about knocked out teeth, we are here to help!