How to save a knocked out tooth

Over 5 million teeth are knocked out in adults and children every single year.  With attention to detail and proper dental care these teeth can potentially be reimplanted and last many years.  The most important component in preserving these teeth is time, how fast can you get that tooth back in the mouth is critical in saving a tooth.

So how much time do you have?  In an ideal scenario 5 minutes.  It’s possible to replant a tooth after 60 minutes but the overall success rate is greatly diminished.  Really every minute does count so the first 5 minutes is more successful than the next five minutes and so on. So let’s say you’re on the soccer field and somebody crosses the ball and you see it fling and hit your mid fielder right in the face and a big pearly white tooth floats out of his or her mouth.  There’s blood, tears and after the initial panic the next logical thing you think of is what are we going to do with this tooth?!?

Your first instinct might be to go rinse the tooth with tap water and clean it off, best to go with your first instinct.  If you’re comfortable doing it then rinse it under cold water or bottled water for no longer than 10 seconds.  If the person who lost the tooth can do it even better.  Remember not to scrape the tooth, this is very important.  All the proteins and tiny teeth ligaments are integral in giving the tooth a chance to enter back into a stable homeostasis with the body. 

Sustained pressure is required to push the tooth back into the socket since clotting will have already begun.  The tooth needs to be held in place for 5 minutes and don’t worry if the position is not ideal.  A dentist can always fine tune the position.

If no one at the scene is comfortable replanting the tooth, or if the injured person is unwilling or unable to co-operate, it is possible to store the tooth for delivery to a dentist.  Storing in water is a big no–no.  The human body thrives in an alkaline environment and because of that if the tooth is placed in water the cells on the surface of the tooth will literally explode because water will diffuse inside the cell membranes.  It is best if someone has some Hank Balanced Saline Solution (HBSS) which can be found in some pharmacies to place the tooth into.  In the likely event no one has HBSS the next best solution is to have the person whose tooth it is to hold it in their mouth, a great alkaline environment.  The last option would be to place the tooth in cold milk.  With these three methods the periodontal ligament cells (the tooth’s shock absorber cells) have a chance to survive outside the mouth.

So we know time is really important in successfully reimplanting a tooth. There are two other factors which are also of great importance:

• Nerve health - Within a few days the pulp will slowly start to disintegrate inside the tooth.  The resulting infection can be painful and will slowly destroy the surrounding bone so it’s important to perform a root canal as soon as it’s possible to remove the diseased nerve tissue and seal off the internal portion of the tooth.
• Age - The jawbone and roots of teeth are all at different levels of maturity throughout the lifetime of the individual and this can impact both success and the type of treatment a dentist may deliver.

So why, as mentioned, once you pass that 5 minute threshold does the ability to survive outside the body become less and less favourable?  Slowly the body will start to see the reimplanted tooth as a foreign body invader.  The more the body doesn’t like the tooth the more likely it will release host factors that can cause the root to resorb resulting in eventual tooth loss. Sometimes it will ankylose the tooth to the bone. Meaning it will cause bone to mineralize around the tooth essentially killing the periodontal cells and fuse bone directly to the tooth surface.

Studies have shown that teeth implanted in pre-adolescents typically have shorter survival times than young adults because of the impact of mature roots on completed growth. Primary teeth that have been knocked out are managed differently and should never be reimplanted because they can damage the permanent tooth designated to replace them.  The risk to a normal eruption pattern is extremely high when attempting to reimplant a baby tooth.  Take a look at the X-ray below and you’ll see why this is the case.  See how the primary tooth intimately sits on the permanent tooth.  

A permanent tooth is surrounded by a delicate sheath which helps protect it until it erupts. This sheath has the potential to be damaged with reimplantation resulting in a malformed permanent crown.

One of the final things a dentist will do after reimplanting a tooth is to splint the reimplanted tooth in place for a period of at least 3 weeks. Buttressing the weaker tooth to the stronger teeth will help to keep the tooth stable while bone forms around the tooth.

Over 80% of people say they would not feel comfortable reimplanting a tooth but hopefully this information helps you realize that you might be the difference between saving someone tooth or them losing it forever!