Dental Injuries - Knocked-Out Teeth

Have you or your child ever had a tooth knocked out? How was it treated?

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What are first aid tips for knocked out teeth?

The upper front permanent teeth are the most common teeth to be completely knocked out ("avulsed"). Primary (baby) teeth that are knocked out from injury are usually not reimplanted into the mouth since they will be replaced naturally by permanent teeth later.

In the event of having a permanent tooth knocked out, care should be taken to handle the tooth only by its crown (chewing surface) and not by its root, gently rinsed in clean water or milk and placed back (reimplanted) into the socket from where it came. This can be done by the patient or parent and then checked by the dentist. If the parent or patient is unsure about reimplanting the tooth, then the tooth should be stored in milk or an emergency tooth preservation solution and brought to the dentist as soon as possible. Alternatively, in older children and adults who are calm, the tooth may be held within the cheeks inside of the mouth while traveling to the dental office. Unfortunately, water is not considered a good storage medium for a tooth for long periods of time. The most important variable affecting the success of reimplantation is the amount of time that the tooth is out of its socket. Teeth reimplanted within one hour of the accident frequently reattach to their teeth sockets.

After reimplanting the tooth into its original socket, the dentist can then splint this tooth to adjacent teeth for two to eight weeks. Splinting helps to stabilize the tooth while the bone and tissue around it heals. During the splinting period, the patient should eat soft foods, avoid biting on the splinted teeth, and brush all the other teeth diligently to keep the mouth as clean as possible.

In adults, the reimplanted tooth should have a root canal procedure within seven to 10 days. Reimplanted permanent teeth in children (where the tooth root has not yet completely formed) may not need a root canal procedure. These teeth should be observed for at least five years for signs and symptoms such as pain, discoloration, gum abscess, or abscess visible on a dental X-ray, which could indicate a dying pulp.

In most patients who have had tooth reimplantation, over-the-counter medications like acetaminophen (Tylenol) or ibuprofen (Advil) are sufficient for pain relief. Since the splinted teeth cannot be brushed normally and the splint usually collects extra dental plaque and food debris, chlorhexidine gluconate (Peridex) mouth rinse may be prescribed to prevent and control gum inflammation (gingivitis). Oral antibiotics and a tetanus toxoid injection are considered for patients with accompanying significant soft-tissue cuts (lacerations).

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