Knocked-Out Teeth

Entire tooth Knocked out (Avulsion):

Teeth that are completely out of their sockets are called avulsed teeth. There are two treatment options:

Re-implant the tooth and try to save it. This has only a 25 to 40 percent chance of success in adults but maybe more predictable in children between ages 6 to 8.

Replace the lost teeth with immediate dental implants. If the tooth is contaminated, fractured, or has been out of its socket for longer that 30 minutes, re-implantation is not recommended. The prognosis for implant replacement is 98 percent or above, and is today’s treatment of choice.

Replantation within 5-10 minutes is critical for success. The tooth must be completely intact. Minutes matter. If the root of the tooth has debris on it, rinse with water. If the root appears clean, grasp the crown between your thumb and first finger with the smooth flat surface forward.

If it is an upper tooth, place the other hand on top of the person’s head to stabilize it then push firmly and hold the tooth in place. When the tooth is seated into its original position, it must be held there by hand or with a wad of wet paper tissue to keep it in place. Do not worry about getting the tooth in ‘correctly’. It can be adjusted by the oral surgeon later during splinting. Bleeding can be controlled by uninterrupted direct pressure for 5 minutes.

If no one is prepared to replant the tooth, if the injured patient is unwilling or unable to cooperate with immediate replantation, or if the damage to the socket and adjacent teeth is substantial, control bleeding with pressure, place the tooth in liquid such as milk or inside of your cheek (be careful not to swallow) to keep it from drying. See the oral surgeon as soon as possible (within 30 minutes).

Transport the patient and tooth to a dentist, preferable your oral surgeon, immediately.

Tooth in socket, but wrong position (Luxation):

• Extruded Tooth- Upper tooth hangs down and/or lower tooth has been pushed up

1. Reposition tooth in socket using firm finger pressure like replantation.
2. Stabilize tooth by gently biting on towel or we paper tissue.
3. Transport immediately to dentist

• Lateral Displacement- Tooth pushed back or pulled forward

1. No treatment at accident scene as tooth is locked in bone
2. Transport immediately to dentist

• Intruded Tooth- Tooth pushed into gum- looks short

1. No treatment at accident scene as tooth is locked in bone
2. Transport immediately to dentist

Broken tooth (Fracture):

If tooth is in pieces, save the broken portion and bring to the dental office iin water or milk

The nerve of the tooth may be exposed causing pain from cold, heat and air passage. Analgesics are recommended.

The patient should see a dentist as soon as possible.

Treatment options for avulsed teeth:

• Reimplantation of tooth: Possible if tooth is clean, the supporting bone is not damaged, and reimplantation is done within 30 minutes. If successful, root canal treatment must follow. Long term follow up is necessary as the tooth may undergo possible resorption process later.
• Immediate implant placement: This is done if the supporting bone is relatively healthy and undamaged from the injury. Dr. Kazemi is also a specialist in dental implants.
• Bone graft: If bone was significantly damaged or lost during injury, immediate implant may not be possible. In this case, bone grafting material may be placed to build up the supporting bone and prepare it for implants once they are healed in four to six months.
• No treatment: In more severe injuries, it may not be possible to place an implant or bone graft. They may be irrigated, cleaned and sutured. Implant placement may be initiated in two to three months.
• Getting a temporary tooth: A transitional or temporary tooth can be made within days of injury to help you return to work or school.