Facial injuries often involve the hard and soft tissues of the mouth. Sometimes an entire tooth is completely knocked out/ dislodged from its socket, due to accidents, sports or injuries .These avulsed teeth are considered a dental emergency and require immediate treatment. Avulsed permanent teeth may be replanted i.e. returned to the socket. Deciduous / milk teeth are not replanted due to the risk of damaging the developing permanent tooth germ underneath. Dental avulsion is a real dental emergency in which prompt management (within 20-40 minutes of injury) affects the prognosis of the tooth.

You can first treat your knocked- out tooth by re-inserting your tooth yourself. When a tooth is picked up, it should always be grasped by the enamel of the crown and not the delicate root portion. Replant the tooth immediately after gentle washing, if practical. If the tooth cannot be immediately replaced in it’s socket, first wash the tooth gently under clean water, store/preserve the tooth in the best possible medium available, till you reach the emergency room or dental office. You can store / preserve the tooth in either milk, saline or saliva (in the buccal vestibule of the mouth).  Water is the least desirable medium to store the tooth. Avulsed teeth treated within the first 30 minutes have the best chances of success.

At the dental office after suitable anaesthesia , X-rays are taken to check for any debris in the socket and the condition of the adjacent teeth and bone structure. Socket is cleaned of the debris. Emergency root canal treatment is initiated only if required at this point, otherwise to be done at a later date. The avulsed tooth is gently placed back in the socket.  Soft tissue lacerations if any are sutured. A semi – rigid splint is given to stabilize the tooth usually for 7-10 days. Patient is put on analgesics and antibiotics. Also, an update of tetanus immunisation is required if by chance the mouth was contaminated with soil.

A second visit at the dental office is scheduled in maybe 7-10 days to access whether a root canal treatment is required and completed if necessary. A permanent restoration is given immediately after root canal treatment. Recall visits after every 3 weeks for the first 6 months are needed to examine for any evidence of pathosis.

Prognosis of avulsed teeth:

In some cases, the following conditions may occur:

• Ankylosis: is when your replanted tooth fuses to the underlying bone.
• Apical periodontitis: inflammation of tissue surrounding your re-planted tooth.
• Inflammatory root resorption: A breakdown of your tooth’s root structure.

Replanted teeth need regular dental check-ups but can last for years with proper care. Good dental hygiene and regular check-ups can extend the life of your tooth.

Avulsion of teeth due to trauma during contact sports like basketball, football & hockey can be avoided by wearing a mouthguard which will protect your teeth. Spreading awareness of dental avulsion is significantly important where the incidence of dental avulsion in school aged children is quite high. Many teeth are knocked out during school activities or sporting events. It is important for anyone who is related or working or witnessing sports that they be educated on this subject matter thereby minimizing injuries that could do further harm to the victim.

Dr. Siena Pacheco-BDS