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Emergency Tooth Loss >>>>>>

Knocked-Out Tooth (Avulsed Tooth)

Dentists refer to a knocked-out tooth as an "avulsed" tooth. This is one of the most serious dental emergencies, but the damage isn't necessarily permanent. If you act quickly, there's a good chance the tooth can be saved.

What You Can Do

When a tooth has been knocked out, the nerves, blood vessels and supporting tissues are damaged, too. The nerves and blood vessels can't be repaired, but if your dentist can put the tooth back in place within an hour after it was knocked out, there's a good chance that the supporting tissues will reattach and hold the tooth in place.
It's essential to get to a dentist right away. In the meantime, here's what you should do:
Pick the tooth up by the upper portion (the crown). Avoid touching the root end.
If the tooth is dirty, rinse it under running water for a few seconds. Don't scrub it because the tooth can be damaged easily. When the tooth is clean, tuck it between the cheek and gum or, preferably, place it back into its own socket. Make sure it's facing the right way. The tooth has a better chance of surviving if it's kept in its natural environment. Another option is to put the tooth in a container of milk, or spit into a cup and place the tooth in the cup with the saliva. The most important thing is to keep the tooth moist. Use a cup of water if nothing else is available. You can also purchase a kit at some pharmacies. The kit contains a solution similar to natural saliva.

Remember, if you act quickly and get to your dentist as soon as possible, there's a good chance the tooth can be saved.


What our Emergency Dentist Will Do

Putting the tooth back in place is a simple procedure. Your dentist will use water to flush debris from the tooth socket. Then he or she will slip the tooth back into place. The tooth may be splinted to adjacent teeth with plastic resin and orthodontic wire. This keeps the tooth stable so it can heal and reattach.

The tooth does not always reattach in the right way. If it doesn't reattach properly, the tooth may eventually fuse to the jawbone. If this happens, the root of the tooth can erode or be reabsorbed into the body. This occurs slowly. Your dentist will monitor this condition and may suggest further treatment such as a root canal.

The nerves and blood vessels that were severed when the tooth was knocked out often don't heal. If this happens, the tooth may begin to darken. This is usually a sign that you will probably need to have root canal treatment. If you do not get treatment, the tooth will weaken and be more likely to break and crack. If this happens, you are more likely to develop an abscess, which is an infection. Sometimes, you will not know that you have an infection, but if you see something near the damaged tooth that looks like a pimple that comes and goes, you should see your dentist.

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Steps to Save a Knocked-Out Tooth

Act quickly and a knocked-out tooth may be able to be reimplanted in the jaw.
Plants that are pulled up by the roots may survive if they're put back into soil right away. The same is true of teeth. They may seem bony and lifeless, but teeth are alive and can often be saved as long as you act quickly.
The blood vessels and nerves in knocked-out teeth (also called "avulsed" teeth) are usually damaged beyond repair. But microscopic ligaments in the jaw may reattach to the root of the tooth once it's put back into place.
"After a tooth is avulsed, time is of the essence and the quicker you get it back in the mouth, the better," says Donald Sadowsky, D.D.S., M.P.H., Ph.D., professor of dentistry at Columbia University School of Dental and Oral Surgery in New York.
The odds of saving a tooth are highest in young children, but adult teeth can be saved as well. Even if the tooth reattaches, however, you most likely will need root canal treatment to clean out the damaged nerve.
How the tooth is handled right after the accident will largely determine whether it can be saved. To improve the chances of the tooth being saved, Dr. Sadowsky suggests doing the following:

Handle the tooth carefully. Avoid touching the root of the tooth (the part of the tooth that was embedded in the gum) because it can be damaged easily.
If the tooth is dirty, hold it by the upper part (the crown) and rinse it off with milk until most of the dirt is washed away. If you don't have any milk available, then it is best to leave the tooth alone. Wiping it off with a handkerchief or shirttail may cause additional damage.

It is important to keep the tooth moist. If possible, drop it into a glass of milk. If no milk is available, then place the tooth in the mouth between the cheek and gum.
A young child who has had a tooth knocked out may not be able to safely "store" the tooth in his or her mouth without swallowing it, so don't give the tooth to a young child for safe-keeping in his or her mouth. Place the tooth in milk or have the child spit into a container and place the tooth in the cup with the saliva. The most important thing is to keep the tooth moist. Use a cup of water if nothing else is available.

Get to a dentist as quickly as possible. If getting to a dentist immediately after a tooth has been knocked out is impossible, then you may want to try slipping the tooth back into its socket. In many cases, it will slip right in. Make sure it's facing the right way. Don't try to force it into the socket. If it doesn't go back into place easily and without pressure, then it's better just to hold it between the cheek and gum or to keep it in milk, saliva or water.

Even if the odds of success seem poor, Dr. Sadowsky recommends that you try to save the tooth. "I can remember seeing a youngster who appeared in the office with a knocked-out tooth after a three-hour trip from summer camp," Dr. Sadowsky recalls. "I reimplanted the tooth, hoping for the best. The front tooth remained in place for five years until she reached her late teens, at which time a permanent solution was feasible."

The Next Step

It usually takes about two weeks for ligaments in the jaw to firmly reattach to the tooth. Because soft tissues inside the tooth probably are damaged, you'll most likely need a root canal at some point, which will prevent the tooth from darkening or becoming infected.

 

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