Emergency Care for Knocked Out Tooth

My 13-year-old son dove for a basketball and knocked his upper front tooth out. The coaches quickly put the tooth on ice and covered it with a damp towel. Within five minutes, I put the tooth back into the socket. We were at our dentist's office within 10 minutes after the tooth came out. What are the odds that the tooth will be saved? Please tell others the importance of replacing the tooth in the socket as quickly as possible.


When a permanent tooth is lost or knocked out (avulsed), it is important to replant it as quickly as possible. This gives the tooth the best chance for survival. There are several reasons why individuals may not replace the tooth in the socket. Simple fear may be one reason. If multiple teeth are lost, one might be confused about which tooth belongs in which socket. The accident victim may be hysterical or uncooperative, or even unconscious. In these cases, it is not prudent to replant the tooth because the victim could choke on it.

If it is not possible to replant the tooth at the scene of the accident, proper handling of the tooth is important. If the dentist replants the tooth within 30 minutes, the tooth has the best chance of survival. The root of the tooth should not be touched. The tooth should not be wrapped in tissues, handkerchiefs, or gauze. If the tooth is transported in a plastic or glass container, it should have a tight lid so the tooth and storage liquid are not spilled. Under no circumstances should the tooth be kept dry or stored in water. Milk is one of the best storage mediums. One of the best ways to transport the tooth is in the Save-A-Tooth system (from Smart Practice) or the Emergency Tooth Rescue System (a trademark of Biological Rescue Products). One of the best transport liquids is called Hank's Balanced Salt Solution, which is a medical research fluid and contains several ingredients such as sodium chloride, glucose, sodium bicarbonate, and potassium chloride. It's a good idea for coaches to have these solutions available in the event that a tooth is knocked out during competition.

Once the tooth is replanted, it should be splinted. The patient should then return to the dentist within a week to 10 days for an exam and possible removal of the splint. Two of the most common complications of replantation of avulsed teeth are pulpal necrosis and root resorption. Treatment for these would involve performing root canal therapy. For several weeks after the accident, the tooth or teeth should be monitored clinically and radiographically. If signs and/or symptoms of pulpal necrosis or resorption are evident, root canal therapy should begin. Some practioners may automatically begin root canal therapy within one to two weeks after the accident to minimize the chance of further cell damage. This may be the prudent course of treatment if the apex of the root was fully formed prior to implantation.

Prognosis is variable. We may not be able to judge the success of reimplantation for many years. If root resorption continues after root canal therapy, the tooth will most likely be lost. Then, a fixed bridge, a removable partial denture, or an implant will need to replace the missing tooth.

The best treatment is prevention! I strongly encourage all parents and coaches to educate student athletes about the benefits of wearing mouthguards during contact sports like basketball, football, boxing, and wrestling. A mouthguard can prevent loss of tooth structure, loss of teeth, and concussions. While I commend everyone's quick efforts to save your son's tooth, I hope efforts have been made now to obtain mouthguards to prevent future accidents. I also hope all goes well with your son.

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