Guide to Avulsed Teeth

An avulsed tooth is the medical term for a tooth that has been knocked out. Obviously, there are lots of reasons why a tooth can be knocked out and accidents can happen just as easily to both children and adults. But how many of us know exactly what actions to take if one of our teeth does get knocked out? Or even worse, if one of our children loses a tooth? What is the best course of action to follow to ensure the best possible treatment and the best possible outcome?

In this article, we will explain exactly what you need to if you have a tooth knocked out or if one of your children has a tooth knocked out. As an aside, it is worth remembering that a knocked out tooth is usually caused by a fairly severe blow to the head. So if the accident happens to you, don’t forget that you may well be disorientated, bleeding or concussed. It is therefore worth making sure that other family members or sporting colleagues know what needs to be done if emergency dental treatment is required.

Avoiding confusion

Let’s get the terminology right from the outset. An avulsed tooth is a tooth that has been knocked clean out of its setting, so that it is either completely detached or perhaps hanging just by the nerve. It should not be confused with a tooth that has been dislodged but not completely knocked out. The blow to the head will probably feel the same! However, the treatment required for each type of injury is slightly different. There is a full guide to partially-dislodged teeth elsewhere on this site.

It is also important to note that this guide is specifically for adult teeth, rather than a child’s milk teeth. Milk teeth are usually knocked out more easily as they are not as permanent as adult teeth. If your child does knock out a milk tooth, do not try to push the tooth back into its socket. This may damage the adult tooth which is trying to come through underneath and the adult teeth are far more important than the milk teeth in the longer term. The most appropriate action is to use wad of tissue paper to stem any bleeding and some junior painkillers to take away the pain. Then, you just have to leave the rest to the tooth fairy! A one pound coin under the pillow can have incredible recuperative powers!

Replacing an avulsed tooth

The good news is that knocked out teeth can be replanted if you get emergency dental treatment quickly enough. In many cases, the bad news is that losing a tooth never seems to happen outside your friendly local dental practice! Teeth are usually lost on sports fields or in accidents that leave people disorientated and needing hospital treatment. The dental treatment can sometimes be less of a priority.

However, there are some basic steps that you can take to ensure that you give your avulsed tooth the best possible chance of being saved.

The first question is: is the tooth still in one piece? If the tooth has shattered or fragmented, it will probably be difficult to replace. However, most dentists will recommend that you try to keep the shards if at all possible. At the very least, the broken pieces of tooth will help your dentist match your tooth colour when they are creating an implant to fill the gap.

But let’s assume your tooth has been knocked out cleanly and it remains in one piece. What should you do then? Well, this is when the race against time starts. Ideally, you need to get emergency dental treatment within the hour! It isn’t going to be easy, but how soon you reach the dentist can make the difference between whether or not your tooth can be saved.

Before you get to the dentist, you also need to make sure that you are looking after your avulsed tooth correctly. First of all, when you pick it up, you should never touch the root. Always hold the tooth by the crown so that the root does not become damaged or infected. If your tooth is still attached to the nerve (if it is ‘hanging by a thread’), then it can be tempting to pull it out. But you should resist that temptation. The fact that the tooth is still connected to the nerve means that it is a good candidate for being replanted.

Secondly, how exactly do you transport an avulsed tooth? It doesn’t seem right to just put it in your pocket and jump on the bus, does it? The ideal situation is to push the tooth back into the socket it has just been knocked out of. This ensures that the tooth remains in the right sort of environment. Of course, it is not going to stay there. So while you travel to the dentist, you need to put a piece of gauze or cotton wool over the avulsed tooth and bite down on it to keep it in place.

Sometimes, it is difficult to put the avulsed tooth back into its original socket. It could be because there is additional swelling to the face or damage to the gums. In these instances, you can transport the tooth in a cup of milk. This will help to keep the tooth as healthy as possible. Alternatively, if you cannot replace the tooth directly into the socket, perhaps you can hold it carefully in your cheek. This means that the tooth is still bathed in saliva as it would be naturally if it had not been knocked out of your mouth.

The most important thing is not to try to scrub the tooth or to clean it with antiseptic. This will damage the tooth.

How do I stop my gum from bleeding?

When you have a tooth knocked out, it is normal to expect the socket to bleed. It may even bleed more than you expect it to, but there is no need to panic. Each tooth has a healthy blood supply. Normally, placed a wad of cotton wool onto the socket and biting down will stem the bleeding. Hopefully, then the tooth can be placed in its socket and you can head for the dentist!

What dental treatment can I expect?

If you have followed the above steps and acted quickly enough when your tooth has been knocked out, your tooth may naturally reimplant itself. It depends largely on how much damage the roots have sustained. The roots of your teeth are very delicate and very sensitive. Provided your have avoided scrubbing the roots or trying to wash them, there is a chance your tooth may take root naturally again, once you push it back into the socket.

It is, of course, still vitally important that you visit your dentist immediately. The first action your dentist will take will be to produce x-rays of your tooth to check whether it has naturally re-established itself into the socket.

If your dentist believes that there is a good chance the tooth remains healthy and that it can re-establish itself, they may attach a splint to help encourage the process and to keep the tooth in the right position while the gums around it strengthen. A splint holds the avulsed tooth to the teeth next to it, thereby ensuring that it does not reattach itself crookedly. It can feel a bit awkward and uncomfortable to wear, but it is worth it if it can help to save your tooth.

What if the tooth does not reimplant?

Unfortunately, there is always a chance that you may have lost the tooth for good. If this is the case, what are the options for treatment that your dentist can offer you in the future?

Dentists advise against leaving a gap in your teeth if you have lost a tooth. This is not simply because it is visually less appealing (although this is important for many patients, especially if you have lost a front tooth). It is also because a missing tooth can negatively affect the balance of your bite.

Therefore, most dentists will recommend that you have a false tooth fitted. There are now a number of options that patients have, each of which suit different people and different pockets. You can have a removable denture, which has the benefits of being easy to clean and cheaper to buy. Alternatively, you can have a fixed denture, which attached to the teeth on either side (assuming, of course, that those teeth have a sound structure to support a denture).

A more and more common choice for patients who lose a tooth is a dental implant. Implants can match the colour of your existing teeth and are permanently attached to your jawbone via a metal rod. Once they are fitted, the feel just like your other teeth – and unlike dentures, they do not affect the type of foods you can and cannot eat.

Can a replanted tooth become infected in the future?

Of course, it is only to be expected that, for a period of time, a replanted tooth will be more vulnerable to infection than your other teeth. It will need time for the roots to take hold and for the gums to heal over properly.

During this time, it is vital that you consult your dentist regularly so that they can evaluate how your tooth is progressing. They will demonstrate how to gently clean your tooth to stop plaque from building up.

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