John C. Chao, DDS

Research Associate Professor, University at Buffalo, SUNY
Adjunct Assistant Professor, Ostrow School of Dentistry, USC

(626) 308-9104

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John C. Chao, D.D.S., M.A.G.D
Anxiety Management,
Behavior Science,
Faculty, USC School of Dentistry

What To Do With A Knocked-Out Tooth

Parents commonly know that when a whole tooth that has been avulsed (knocked-out) it can be saved. In an article published in GDA Action, The Journal of the Georgia Dental Association, October 2005, it is important that the tooth be retrieved and taken to the dentist for re-implantation as soon as possible. The following are other steps that should be taken to enhance the chances of success.

The authors stress that the periodontal ligament left on the root not be allowed to dry. The periodontal ligament is a sheath of collagen tissue that connects the root of the tooth to the bone. This collagenous tissue remains for the most part attached to the root of the avulsed tooth. Re-planting the tooth within 15 to 20 minutes can prevent drying of the periodontal ligament.

However, if it is not possible to get to the dentist within this short period of time, then the tooth should be stored in a transport medium that would preserve the vitality of the ligament. The authors recommend "Hank's Balanced Salt Solution, which is available as "Save A Tooth." This fluid preserves and reconstitutes the cells of the periodontal ligament. However if this product is not available, milk is acceptable. Milk has pH (acidity) osmolarity (permeability) similar to vital cells and is bacteria free.

If milk is not available immediately, saliva or tap water can be used. Although not preferred choice, saliva or tap water is better than allowing the root to completely dry out.

In any case take the patient with the tooth as soon as possible to the dentist. Hopefully, the dentist can re-implant the tooth back into the socket in time. Then the implanted tooth should be rigidly stabilized by splinting (gluing) it to other adjacent teeth. This splinting should remain at least 7-10 days, but often much longer. After 1-2 weeks, root canal treatment must be done to reduce the chances of root resorption in the future.

Root resorption is a "foreign body reaction," where the immune system mistakenly destroys or absorbs normal root tissue, as if it were a foreign body. This reaction is often triggered by trauma, but occurs over a long period of time. However, root canal treatment that removed the necrosed or dead tissue will reduce the chances of root resorption. Re-implanted teeth do not have a good prognosis. Parents and patients should be prepared to accept implants or bridgework should the tooth break down in the future.

Be also aware that the re-implanted tooth may turn a dark color because of the change in the tissue inside in tooth. Sometimes these teeth may need cosmetic procedures to make them look normal. Bleaching, veneering, or even crowning the teeth are some of the alternatives.

It is reported that over one million teeth are lost to sports injuries. To prevent dental injuries, consult with your dentist as to whether your child needs a sports guard.


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