Having a tooth knocked out is a traumatic experience. It also presents you with an urgent situation. By knowing what to do if this happens to you, you will give yourself a much better outcome. This article will explain what you should do in the event you have a tooth knocked out.
It is important to clarify what “knocked out” means, as you might have various pictures in your head that do not technically fit into this category. In dentistry, we use the word avulsed to describe a tooth that has been completely knocked out of the socket. An avulsed tooth is intact, containing the entire root and crown (visible portion) of the tooth. We would not use the term avulsed to describe a tooth that is broken and only partially knocked out.
When someone suffers an injury to the face that breaks the tooth off at the gumline, this leaves the root of the tooth inside the jawbone and does not count as being “knocked out”.
You can determine whether your tooth has avulsed or broken at the gumline by looking at both the injury site and the tooth. In an avulsion, the injury site will look like a deep hole filled with blood. If the tooth has broken, you will likely see the hole filled with a yellow hard substance (the tooth’s root).
When evaluating the tooth itself (or the piece that has been knocked out), you must determine if the entire root is present. A complete root will have a rounded end without any sharp or jagged edges. It will be longer than the tooth itself. If you see a very blunt, sheared off or sharp edge, the tooth is probably broken.
The treatment for avulsed teeth is very different from the treatment for broken teeth. Broken teeth typically have a hopeless long-term prognosis. Only if the break is in the outermost portion of the tooth are these teeth easy to “fix”. When the fracture occurs along the root of the tooth, it is unlikely to be successful with any treatment.
An avulsed tooth, though, requires immediate intervention and can have a good long-term prognosis when caught quickly enough!
If you or a loved one suffer an injury in which a tooth is knocked out completely, it is essential that you act as quickly as possible! The success rate of treatment goes down the longer you wait to see your dentist. Ideally, you should see the dentist within thirty minutes to an hour.
The most important thing you must do as soon as you rule out any other more pressing injuries (uncontrollable bleeding, head wounds, etc . . .), you must find the tooth. When we have the tooth in its entirety, we can re-implant it into the socket. If not, the treatment takes a completely different route.
The root of each tooth is covered in tiny ligament fibers that attach to the surrounding jawbone. These fibers are very important. They must stay moistened and undamaged. This means you should NOT attempt to scrub or clean the tooth in any way. We know, it sounds gross. You may find the tooth in the dirt and want to clean it off. Don’t do it! Leave any cleaning to the dentist.
If the tooth is very dirty, you will want to place it in a small container (cup or baggie) filled with saliva or milk. You can use your own spit, and you only need enough to cover the tooth. Again, do NOT scrub or wipe the tooth off.
If the root is relatively clean, you can hold it inside your mouth. We know that sounds gross, but the mouth is the perfect environment for a tooth . . .
This is the point at which having a great relationship with your dentist comes in handy. Call the dental office. If it is after hours, they likely have an on-call dentist or emergency number you can contact for urgent care. This counts as urgent!
Tell the doctor that your tooth has been knocked out and you are on your way to the office. He or she will meet you there.
After the dentist treats you, placing the clean tooth back into the socket and stabilizing it for healing, your job is to follow his or her instructions as closely as possible. These will include gentle mouth rinsing and modifications to your brushing and flossing routines. You will likely be restricted to soft food for the first few days. You should not use this tooth to bite into anything.
The dentist will most likely use a wire bonded to multiple teeth to hold this re-implanted tooth in its place, allowing the bone and ligaments to reattach to the root.
When a tooth is knocked fully out of the socket, the nerve inside the tooth is torn away from its nerve and blood supply in the jawbone. In most cases, the nerve inside the tooth will then die. After reimplantation, the chance of the nerve reconnecting and healing is extremely low. This means that after the root attaches to the surrounding bone and stabilizes, you will probably need a root canal. The root canal removes the damaged and dead nerve tissue from the inside of the tooth and seals it with a biocompatible filling material.
In addition to nerve death, another potential consequence of a reimplanted tooth is fusion with the surrounding jawbone. This sounds like a good thing, but it can lead to problems in the bite or with any future orthodontic treatment. This is important to consider if the patient suffering the avulsion is a child. It could become impossible to move that tooth in the future.
And of course, there is always the possibility that the reimplantation fails. A failure occurs when the tooth does not reattach to the surrounding jawbone and never achieves stability. Your dentist monitors the attachment with x-rays and clinical evaluation of the tooth over time. If a failure occurs, your dentist will discuss your treatment options to replace the failing tooth.
Call your nearest Premier Dental of Ohio location today to schedule an emergency dental consultation with one of our wonderful dentists. We are ready for all emergency situations and will be happy to care for you and your loved ones.
