Knocked-Out Tooth: First Aid Done Right
Children are very active and fall often, so dental injuries are common.
A permanent tooth can be completely knocked out of its socket at any age — in traffic accidents, at work, at home or while eating. This accounts for about 0.5–3% of all dental injuries. Putting the tooth back into its socket (replantation) is the preferred treatment, but it is not always possible straight away.
Correct first aid and timely treatment improve the outcome. In some cases replantation is not recommended — for example when the tooth is badly decayed, there is gum disease, the patient cannot cooperate, or there is a serious general condition such as immunodeficiency.
First aid at the scene
A knocked-out permanent tooth is one of the few true emergencies in dentistry. First, make sure it is a permanent tooth — baby teeth should not be put back.
- Stay calm.
- Find the tooth and hold it by the crown (the white part), without touching the root.
- If the tooth is dirty, rinse it briefly under cold running water (no more than 10 seconds), do not scrub it, and put it back in its original place.
- Hold the tooth in place and go to a dentist immediately.
- If you cannot put the tooth back (for example if the person is unconscious), place it in milk or a special storage solution. If the injured person is conscious, the tooth can be kept in the mouth between the cheek and gum — but not in young children, as they may swallow it. Bring the tooth with you to the clinic.
Treating a knocked-out permanent tooth
Many people who lose a tooth in an accident don't pick it up, assuming they will get an artificial one. This mistake costs them their natural tooth: with correct first aid, the tooth can often be put back.
The treatment depends on how developed the root is and on the condition of the periodontal ligament cells — which in turn depends on how the tooth was stored and how long it was out of the mouth. The time the tooth spends dry is especially important: after about 60 minutes of dryness, the periodontal ligament cells are essentially dead.
There are two scenarios:
- Immediate replantation — when the periodontal ligament cells are still alive: the tooth was put back quickly or stored in a suitable medium.
- Delayed replantation — when the ligament cells have most likely died.
Cleaning the socket
The dentist rinses, cleans and assesses the socket. If conditions are favourable, the tooth is placed back in its correct anatomical position and the bite is checked so the tooth is not under pressure when the teeth close together.
Splinting
The tooth is splinted to the neighbouring teeth as soon as possible, usually for 10–14 days. An X-ray may be taken first to confirm the tooth is correctly positioned. The dentist then checks and adjusts any points that interfere with jaw movement.
What the patient should know
- Do not chew with the replanted tooth for one week; eat soft, easy-to-swallow food for about 2 weeks.
- Do not test whether the tooth is loose with your fingers.
- Light exercise is fine, but avoid contact sports.
- Brush with a soft toothbrush after every meal and rinse your mouth twice a day.
- Attend all follow-up visits exactly as scheduled by your dentist.