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Knocked Out Tooth

A multitude of teeth are knocked out every year in the United States. The main causes in the permanent dentition are fights and sports injuries. Researchers have developed methods of saving most of these teeth. These knocked out teeth can often be re-implanted under favorable conditions. If the tooth can be replanted within minutes after the accident, there is a greater chance the tooth will be retained for life.

After the accident, the tooth should be located and picked up by the crown or enamel portion and NOT the root. If the tooth is dirty or contaminated, it should gently be rinsed with milk or water. Do not store the tooth in water.

It should be noted that if a primary (baby) tooth is knocked out, it should NOT be replanted as it could damage the permanent tooth bud in formation. Parents should NOT try to place the baby tooth back into the socket, and should immediately seek the advice and treatment of their dentist.

Modern research has developed a common thread in the success rate of the treatment of avulsed teeth. That common premise is the rate at which the teeth are reimplanted. Recent studies have shown that critical time to be in the range of five minutes to an hour. The American Association of Endodontists (2004) recommends reimplanting the fully formed tooth (closed apex) if it has been in a storage medium of milk, saline or saliva tooth even up to 60 minutes or less of extra-oral dry time (tooth out of bony socket).

Dr. Martin Trope, highly respected researcher from the University of North Carolina, recommends reimplanting the fully formed tooth within 15-20 minutes if possible. He states the single most important factor is the speed of reimplantation and the use of a proper storage medium when the avulsed tooth is out of the mouth. Recommendations are milk and HBSS when available.

Dr. David Kenny, highly respected researcher from Toronto, Canada, recommends reimplanting the fully formed tooth within 5 minutes. Regeneration of normal PDL (periodontal ligament), the essential element for success, is not expected beyond 5 minutes of extra alveolar dry storage (time the tooth is out of the natural bone socket). He further states that avulsed teeth fall into 2 categories, less than 5 minutes extra alveolar dry storage and greater than 5minutes extra alveolar dry storage. The prognosis for long term success is poor if the tooth is reimplanted after 5 minutes. This now suggests that it is of extreme importance to educate parents, caregivers, coaches, and athletic trainers on the proper first aid in the event of a traumatic avulsion injury. The tooth now must be immediately reimplanted, within 5 minutes, most likely at the site of the injury. By the time the injured person gets to the dental office (30 – 60 minutes post injury) it will be too late. The drying of cells on root surface drastically reduces success and immediate reimplantation is superior to dry storage. If one can’t reimplant immediately, use milk in packed ice. Do not store the tooth in water as water storage damages root surface cells.

It is advised that if the accident victim shows any signs of head injury, unconsciousness, nausea, or persistent headaches, they should be first evaluated for their head injury by proper medical personnel. Once a head injury is ruled out, they may precede to the dentist for treatment of the avulsed (knocked out) tooth. A tooth or teeth should not be immediately reimplanted at the site of injury if the injured person is unconscious for fear of aspiration.

Therefore the treatment of choice is immediate reimplantation, after rinsing the tooth if necessary, and immediate transfer to a trauma dentist for proper splinting and evaluation. If one cannot reimplant the tooth, then store the tooth in milk or HBSS when in route to the dentist.