What do I do if a tooth gets knocked out?

Injuries always involve a certain level of shock.  The victim will not be thinking clearly.  Throughout treatment calmly talk to the injured person and assure them that help is coming.   

Whenever there is trauma to the body always look for head injuries too.  If any injury causes loss of consciousness, severe bleeding, breathing trouble, extreme pain, threat to a limb, threat to eye sight, or if you are uncertain of the extent or risk of an injury, CONTACT THE EMERGENCY MEDICAL SERVICES (EMS), usually by dialing 9-1-1.   Do not delay in getting medical help!!!

FIRST AID is critical to minimizing permanent tissue damage and disability.  First make certain that it is safe to approach the victim.  If safe, assess the victim for injuries.  Contact EMS 9-1-1 or send someone competent to contact them. DO NOT delay in getting help.  Once you are sure that EMS is activated, begin first aid within the limits of your abilities. 

Education is paramount in preparing for rending first aid.  This post will only focus on tooth trauma.  I highly recommend taking an American Red Cross First Aid class or classes from other similar agencies.  Do not give first aid if you are non certain of your abilities.

First Aid treatment for teeth that have been knocked out:

1. Determine if the tooth is a baby or an adult tooth.  Baby teeth are not re-implanted.   Front baby teeth do not hold space for the adult teeth that will begin to erupt at age six, and the early loss of one of these teeth rarely causes harm to the adult dentition.

2. Handle the adult tooth by the enamel “crown” part and NOT the root.  Touching the root will damage the cells still attached to it and will minimize the chance of successful tooth re-implantation.

3. Look to see if the adult tooth has any sharp edges or if bone is still attached.   If the tooth has a sharp part and not rounded, then the root of the adult tooth is broken and re-implantation is not possible.   This means that the trip to the dentist may be put off until it is convenient.  The only things a dentist can do under such circumstances it to prescribe pain relievers, antibiotics and to place artificial bone in the socket for possible implant placement at a later date by an oral surgeon or a periodontist.

4.  Look for dirt on the tooth and clean the non-fractured adult tooth by having the victim spit on it.   If the tooth is dirty, simply have the patient remove all dirt with their own saliva.

5. Once cleaned of visible dirt, place  the tooth into its socket. Any  tooth must be re-implanted in the socket within 60 minutes if the re-implantation is to have a reasonable chance of working. This may be done at the site of the accident by any adult  or the patient  provided the tooth is fairly clean and provided it slips back into the socket easily with light finger pressure.  If the tooth goes back into its proper position so that the patient may bite down without pushing the tooth out of its normal alignment, then the process has been successful.

6. Contact the dentist.  You still must take the patient to a dentist, but the major emergency has been averted and there is less urgency associated with the emergency once the tooth is back in its position.

If the tooth cannot be replaced in the socket (for any reason), then there are four ways to transport the tooth to the dentist’s office:

1. Have the victim store the tooth in their own mouth in the pouch between the cheek and the top back teeth.  DO NOT SWALLOW THE  TOOTH.  Transport the patient to a dentist ASAP.

This is NOT advisable if the child is under the age of six since the child may swallow the tooth.  If this is the case, proceed to the next two options.

     2. Place the tooth is a cup of clean sterile saline (salt water) as with contact cleaner.

3. Place the tooth in a cup of fresh milk (any fat content).  This has nearly the same advantages as saline.

4.  Place the tooth in a cup of a commercial product that is available for the storage of an avulsed tooth if you, or someone you know happens to have it in their medicine cabinet.  The manufacturer states that the tooth may be re-implanted up to 24 hours after the avulsion if it is kept in this solution.

Once you are at the dentist office be ready to give details about the event.  This will help to provide the dentist with information to better treat the patient.

I hope that you never have to use this information but it will come in handy if you do.

-Philip N. R. Estes, DDS