Tooth Knocked Out

August 25, 2023

By Dr. Stuart Fass

I re-write this article almost every year at this time. Kids are out playing, adults are doing the backyard basketball games, and hopefully everyone is enjoying the summer weather. But accidents will happen and being prepared is critical. Maybe cut out this one and put it on the refrigerator door for emergency reference.

If a permanent tooth is completely knocked out (we call it “Avulsed”) it’s critical to take immediate action. First for kids (and maybe some adults) is to scream. Then collect your wits, be prepared for what seems like a lot of blood, and FIND THE TOOTH! If your aren’t close to home, it’s critical to keep the tooth moist. The best place is right back in the socket it came from. It will be mostly numb from the trauma (sort of like your thumb after a misplaced hammer strike) and might go in cleanly. Don’t wipe it off or touch the root surface, just rinse it in water or even our own saliva if possible. Not up to this procedure? The next best place is under your tongue, just be careful not to swallow it.

Once you get home, you can put the tooth in cold milk. A small rinsed pill bottle or any small container will do. DO NOT wrap it in anything. No gauze, facial tissue, paper towel, etc. Meanwhile, get on the phone to your dental office and let them know what happened. If the tooth is to be re-implanted successfully, it needs to be done within an hour for kids and less for adults. Don’t forget to bring the tooth with you to the office! If it’s longer, your dentist might opt to do a root canal outside the mouth before replacing the tooth. After it’s in proper position, it will be bonded to the adjacent teeth for several weeks and followed for some time to assess healing.

The same advice of getting to the office quickly follows a partial avulsion. That is a tooth that is knocked out of proper position but not out of the mouth completely. These need to be repositioned as quickly as possible to put the bite back in alignment. If left too long, the tooth cannot be moved and you might be looking at a longer orthodontic treatment course or tooth extraction.

What about partial tooth fractures? Well it’s still best to treat these quickly. If you can find the broken pieces, they can sometimes be re-bonded to the tooth as a “Long term temporary” until more definitive treatment, such as a crown, can be done.

A final word about where to go with dental injuries. As you might have read in the Altamont Enterprise some weeks ago, St. Peters Hospital closed their dental clinic in July this year. Dental departments were similarly closed at Ellis Hospital last year and Albany Medical Center some years ago. The only remaining hospital based dental clinic in our area is now at the V.A. Medical center, which is not an available treatment option for most. The hospitals do not routinely have dental staff available for emergency treatment except for more serious facial trauma. Even in those cases, you probably won’t have an avulsed tooth reimplanted. So keep your dentist’s number in your cell phone for these type of emergencies.

This article was published on 08-25-2023 in The Altamont Enterprise.