How to Manage a Knocked-Out Tooth

Have you ever had your tooth knocked out?  

If you answered yes, you are not alone and probably know what to do.  But if you have not, you will be someone’s hero in knowing how to manage a knocked out tooth.  

Chances are high if you work in an urgent care or you have kids of your own that you will encounter this sometime in your career.  Truth is, more than 5 million teeth are knocked out each year in children and adults due to injury or accidents. The good news is that with proper emergency dental care, a tooth can be saved and reimplanted successfully.

I am writing this blog because a CRNA colleague of mine encountered this with her child.  She took her child to an urgent care and the provider did not know how to manage this urgent situation.  It is an urgent situation that needs to be addressed within 30 minutes as the roots could die.

Here are some tips from the American Association of Endodontists (those are the dentists that specialize in management of tooth pain and performing root canals) should you encounter a patient (or family member) that had their tooth knocked out.

  1. Pick up the tooth by the chewing surface (the crown), not by the root.  Gather any tooth fragment(s). There will be a lot of bleeding associated with this but it is not one that could not be controlled.  Put pressure on the socket with a gauze or tissue and rinse out your mouth after the bleeding is controlled.
  2. If the tooth is dirty, use ONLY water to rinse off the dirt.  Do not apply soap or chemicals to clean the tooth. Do not scrub or dry it.  Do not wrap the tooth in tissue or cloth, as you may damage the root.
  3. If you can, reposition the tooth back in the socket immediately by gently pushing it up with your finger.  Handle it by the crown and gently bite down on it. This does not apply to baby teeth as placing them back into the socket may damage the underlying adult tooth.
  4. Keep the tooth moist at all times. This could be accomplished by placing it in its socket and have it moistened by your saliva.  Other options would be to soak it in milk or place it in your mouth next to your buccal region. If you have a tooth preservation kit (such as Save-a-Tooth, which is a balanced salt solution), that will work also.   Do NOT soak it in tap water – the root surface will swell up and burst. Milk is a good medium as it contains protein to keep a constant acid-base ratio, sugar to keep cells growing, and is anti-bacterial. 
  5. See a dentist or an endodontist within 30 minutes of the accident (most ideal).  Most likely, a root canal is a necessity treatment to preserve the knocked out tooth.

Tooth Saving Products:

  • Save-a-Tooth Approx. $25, can be purchased from Walmart or Amazon
  • Hanks Balanced Salt Solution Approx $15, order online

Do you have any good tooth removal or replacement stories to share?

Source:  

  1. Knocked out tooth.  From aae.org. (2019)

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