After handling an emergency for a friend’s child, I realized that a lot of moms did not know how to respond to the all-too-frequent crisis of a child’s tooth being knocked out. This post is written especially for moms, caregivers, coaches, teachers, and anyone else who might encounter just such a situation.

Studies tell us that about 25 percent of all school-age children experience some kind of dental injury, and about 0.6–16 percent of these dental injuries result in knocked-out teeth, or avulsion. This means that, in the United States alone, there are nearly five million schoolchildren each year who knock out a tooth. Since many dental injuries are sports related, the use of protective mouth guards and helmets can help, but, for routine school or home play, most children’s mouths have no protection. 

How Teeth Are Connected to the Bone

A very specialized connective tissue fiber, known as Periodontal Ligament (PDL), attaches a tooth to the bone. PDL acts as a “cushion” between tooth and bone and help a tooth withstand pressure from chewing.

What Happens When a Tooth Gets Knocked Out

When a tooth gets knocked out, the PDL fibers break. The knocked-out tooth will inevitably need a root-canal procedure at some point, but the key to success is the first response, which should be to maintain the vitality of the remaining fibers. Chances of root resorption (breakdown or loss of root structure) and ankylosis (fusion of the tooth to the bone) will decrease if the tooth can be re-implanted in the socket properly and in a timely manner.

First, look at a tooth that was just knocked out, and determine whether the tooth is a primary (baby) tooth or an adult tooth; then follow these instructions:

A Baby Tooth

If the tooth is a baby tooth, do not try to re-insert it into the socket. Doing so risks damaging the adult tooth that is developing under the knocked-out baby tooth, and, since the four front baby teeth do not “hold the space” for adult teeth, there is no need for re-implanting anyway.

A Permanent Tooth

If the tooth Is a permanent tooth, and the root has not been damaged by the injury, it might have a reasonable chance of reattaching if it can be re-implanted in the socket within one hour from the time it was knocked out. You can try to re-insert the tooth in the socket, or you can transport the tooth (and the child) to the dentist as soon as possible.

To re-insert the tooth:

• Taking care not to touch the “root” and handling the tooth only by holding the “crown” part of the tooth, rinse it very gently with cold water to remove dirt, if necessary. Do not scrub or scrape the tooth.
• Look at the shape of the side teeth to determine the correct position of the tooth, and then try to re-insert the tooth in the socket. Hold it in position with light pressure. Then, take the patient to the dentist as soon as possible, so he or she can stabilize the tooth in the correct position with a flexible splint.

Transporting the Tooth

If for any reason you are not able to re-implant the tooth, you need to place the tooth in a safe medium and transport it to the dentist immediately:

• If the patient is healthy and over six years of age, have him place the tooth under his tongue, where the “safe medium” is the child’s own saliva;
• If the child is too young or cannot be trusted to hold the tooth in his mouth safely, place the tooth in a container and cover it with milk (any fat content), and take it to the dentist immediately; or
• When it is available, use “Hanks solution,” which is commercially available as a “Save-a-Tooth” kit.  (This is a pH-balanced cell-preserving solution that has been extensively tested.)

The long-term prognosis for replanted knocked-out teeth is very variable. Fully mature adult teeth, with completely formed roots, have a better chance of survival than immature teeth, and teeth with less time outside the tooth socket have a better chance than those with more time outside the socket.

Of course, we all aspire to sports safety, in order to prevent dental injuries, but, even with our best efforts, accidents occur. Don’t panic, but to be prepared, you need to be informed, and that is the purpose of my giving you this important information.