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
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). See
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. See reference .
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. See reference .
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