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Seven steps to do when your tooth gets knocked out

As a general rule, the sooner a tooth can get back into its socket inside the mouth, the better chance it has to survive long-term.

1. When a tooth gets knocked out, it is important to pick it up while only touching the crown of the tooth (the crown is the part of the tooth that is normally visible inside your mouth.)  If you can’t find the tooth try as hard as you can to find it.  Although aspiration rarely occurs, it is possible that the tooth could’ve been inadvertently breathed in by the accident victim.

2. Next, rinse off the tooth very gently with tap water, saliva (spit), or saline solution. It is important not to scrub the root of the tooth (the root is the part of the tooth that is normally hidden below the gums in your mouth and is more yellow than the crown.) Many people think it is important to scrub the tooth to get all of the germs off. However, if you scrub the tooth, you could scrub away the periodontal ligament or the cementum, which both help to hold the tooth in the socket. By scrubbing them away, you will reduce the chances of the tooth permanently re-attaching itself inside the mouth. Soap and chemicals such as bleach will damage the cells that are left on the tooth which could make successful re-implantation impossible.

3. Try to put the tooth gently back in its socket and steadily hold it there. Sometimes, people may not know exactly how to put the tooth back in or there may be doubts about how to put it back in. Other times, the person who had the tooth knocked out isn’t cooperative enough to allow the tooth to be re-implanted. In this case, go to step #4.

Before putting the tooth back in the mouth, make sure that you are dealing with a permanent tooth, you could end up damaging the developing permanent tooth if you try to re-implant a baby tooth back on top of it. If you’re not sure, it is best to not try to re-implant the tooth, simply go to step #4 below.

You also want to make sure that you have the whole tooth. If it fractured somewhere along the root, you might want to wait to have the dentist look at it first to see if the tooth can be saved. In this case, go to step #4 below.

4. If you can’t put the tooth back in for any reason, you need to put the tooth into an appropriate solution to keep it healthy. The goal is to keep the tooth moist. There are a variety of solutions that will work to store the tooth, however some are better than others.

The absolute best place to store a tooth is in a Save A Tooth Emergency Tooth Preserving System balanced salt solution. A good way to get a balanced salt solution is by purchasing the Save-A-Tooth Emergency Tooth Preserving System. Many schools and athletic facilities have the Save-A-Tooth or a similar system readily available in the event of an accident. You can learn more about tooth avulsion at this page.

The next best place to store the tooth is in milk because it is fairly biologically compatible with teeth and doesn’t contain too many bacteria. Milk has been proven to keep the periodontal ligament cells healthy in studies such as this one by Dr. Martin Trope.

You should avoid storing the tooth in pure water as this will cause the periodontal ligament cells to die. Another place to avoid storing the tooth is in your mouth since it contains a lot of bacteria, lacks the optimum electrolyte balance, and has an incompatible pH (acidity) for the periodontal ligament cells.

You should never dry the tooth off or store it in a towel or tissue since the cells on the root of the tooth need to remain wet in order to stay alive.

5. Go to the dentist for emergency dental care. The dentist will be able to help you determine if the tooth is in good enough condition to return to full function. If the tooth looks good, then the dentist will take some x-rays to determine if optimum healing will be able to occur. The dentist will then be able to splint (attach) the tooth to the teeth next to it so it can be immobilized and have proper support for healing to take place.If the tooth has been out of the mouth for more than 20 minutes, then the dentist will need to soak the tooth in a balanced salt solution for about a half hour and then put it in an antibiotic before re-implanting it. The salt solution helps to keep the periodontal ligament cells alive and reduces the chance of them dying and your tooth attaching directly to bone (a condition known as ankylosis, which has a variety of problems associated with it — I’ll get into that in a future article.)

6. Take antibiotics and get a tetanus booster shot if you haven’t had one in the past five to ten years. Because it would be impossible to sterilize the tooth before re-implanting it without killing the cells in the tooth, you will probably end up introducing a small amount of bacteria into your body. To be on the safe side, your dentist will probably prescribe you 7-10 days’ worth of antibiotics. Also, if you haven’t had a tetanus booster shot in the past five to ten years, you should go to your doctor to get one.

7. Hope for the best and return to your dentist often. If the tooth is young, the pulp may heal. If the tooth is a few years old and is fully formed, the pulp will probably not survive. In these cases, the tooth can still be successfully re-implanted, but it will need to have a root canal treatment performed where the dead pulp tissue is removed and replaced with a compatible material. Also, the tooth may get eaten away a little bit by the cells around the periodontal ligament.