How do you, as a non-medical person, handle “Knocked Out Teeth?”
Knocked out teeth are technically called avulsed teeth, which simply means that trauma caused total avulsion of the tooth. This happens primarily in the front (anterior) on the upper (maxillary) arch of an adult. It most certainly can happen on the lower (mandibular) arch. It can happen to adults and sub-teenagers and the emergency treatment may be different for each group.
The tooth, usually upper (maxillary) and front (anterior) may be totally knocked out (avulsed), pushed directly inward (intruded), pushed inward toward the palate or tongue (palato-or linguo- verted), pushed side-ways (partially luxated), or even broken off through the pulp and nerves. All must be treated….and immediately! The sooner the better and the more chances for success!
The success rate of replantation is based entirely upon the time between avulsion and replantation. Again, it must be remembered and emphasized…the sooner, the better!
Knowing the above, how does the patient or the lay person deal with a knocked-out tooth? Your immediate goal is to get the tooth replanted as soon as possible. And that may mean that the patient does it for himself, or, knowing that time is a critical issue, the dentist will do it. Do not scrape or clean the root of the tooth. You may gently rinse off any dirt with clean water. Hold the tooth only by the clinical crown, the part that shows in the mouth, and not by the root. Push the tooth firmly back into the original socket. A lot of blood may be pushed to the side but it is important to get the tooth all the way back into its original position, and then stabilize it by biting down on some type of cloth.
There is a membrane made of fibers on the tooth which normally attaches the root to the bone, similar to a “hammock.” This is what you are trying to protect when you replant the tooth. All these fibers have been torn and stretched from the trauma causing the avulsion. If the tooth can be replaced within five minutes, it is said that the success rate can be as high as 98 %. It is also said that if the tooth can be replanted within 60 minutes there is a reasonable chance of success. If the tooth is replanted within 24 hours, more than likely, the membrane will not survive and the tooth will osseointegrate and become one with the bone. The tooth can be kept for many years but this also creates a dilemma. Usually, years later, it may begin resorbing and possibly be lost. Then an implant should possibly be considered at this time. The implant will maintain the bone. It is recommended that a zirconia or porcelain post be placed in the implant so that restoration with a full porcelain crown will be more aesthetically pleasing.
If for some reason it cannot be replanted immediately, keep the tooth moist by holding the tooth inside the mouth by the cheek, or placing in a container of cold milk. See your dentist immediately and call ahead of time so he will be ready for the procedure. These are the “do’s”.
The “don’t’s” are do not leave the tooth at the place of the accident. Bring it with you. Don’t scrub the tooth or dry the tooth. Don’t touch the root of the tooth where the microscopic fibers are. Don’t use any cleanser of any type to remove dirt…use only water, but gently and quickly. Don’t wrap the tooth in gauze or a cloth. Don’t store the tooth in city water for any length of time due to chemicals…you may gently rinse the tooth, however, but only to remove excessive dirt.
Why do you not replant a child’s baby (deciduous) tooth? Normally, a deciduous tooth exfoliates when the permanent tooth erupts. If a baby tooth is replanted and osseointegrates (becomes one with the bone) , the normal exfoliation process will not occur and the permanent tooth will not erupt. Therefore, one should never replant a baby (deciduous) tooth.
The perfect scenario for replantation of a permanent tooth is for the periodontal ligament to survive the avulsion and replantation leaving you with a normal tooth that will probably only need root canal (endodontic) therapy in the near future. It is imperative that no chemical cleanser be used on the root of the tooth and that scraping not be done. The tissue attached to the root should be maintained and not manipulated. If a lot of dirt is present, wash it off with cold milk, or only very briefly with cold water if no milk is available. The chemicals in city water will kill the tissue if utilized for too long. Do not wipe the root off with anything, especially fabric. Do not dry the tooth as this significantly reduces the success rate. If the tooth cannot be immediately replanted, place it in a container of cold milk and transport the patient to a dentist as soon as possible.
The dentist will anesthetise the area and immediately replant the tooth, and then bond it into place creating stability. Usually antibiotics are prescribed along with an NSAID (Non-Steroidal Anti-Inflammatory Drug) such as Aleve, Motrin, Ibuprofen, Tylenol or Aspirin. If the tooth is palatally-verted, linguo-verted, partially luxated, or intruded, the dentist will do the same. The goal is to move the tooth back into the proper position and then stabilize it by bonding. If the surrounding tissue is significantly lacerated, the dentist may recommend a tetanus injection. Usually a root canal is required on adult patients some 8-10 days later. This may or may not be necessary on teenagers.
If the tooth has been avulsed for a considerable length of time, the dentist may recommend an implant, or maybe a fixed porcelain bridge, or adding the tooth to an existing partial denture. It must be remembered that either the replanted tooth or an implant itself, maintains the existing bone; whereas, a partial denture or fixed bridge does not. Also remember that if a tooth is not replanted within the first hour, eventually there will probably be external root resorption and this gives credence to the placement of an implant.
The main causes of avulsed teeth are fights, falls, playground equipment, swimming pools, auto accidents, athletics. If there is any sign of head injury, preference should be given to that over the avulsed tooth.
A properly fitted mouth guard can easily preclude avulsions in athletics. In addition, always wear safety belts, avoid fights, and do not dive into the shallow end of a pool.
Life Member of American Dental Association, Emeritus Fellow of Academy of General Dentistry, American Association of Implant Dentist.