What to do when a tooth is knocked out...

One to three million teeth are knocked out every year in the United States primarily in your children. The main causes in the permanent dentition are:
  Methods have been developed for saving over 90% of these teeth. Knocked out teeth can often be re-implanted. If the tooth can be replanted within 15-30 minutes after the accident, there is a greater than 90% chance the tooth will be retained for life. However, practical life experience shows us that may be unrealistic.

The critical determining factors for success of replantation are the condition of the alveolar socket (bone) which should be free from periodontal (gum) disease and be reasonably intact, the time the tooth is out of the bone socket, the storage and transport medium used to deliver the tooth to the dentist, and how the tooth is handled between the accident and arrival at the dentist.

After the accident, the tooth should be located and picked up by the crown or enamel portion and NOT the root. If the tooth is dirty or contaminated, it should gently be placed in a transport solution of  Hank's Balanced Salt Solution. If HBSS is not available, the next best alternatives are whole cold milk, saline, or saliva. However it should be noted that milk, saline, and saliva have their limitations.

Saline solution may be damaging if it is allowed to soak in it for more than one or two hours. Saliva may be damaging as the tooth ligament cells may become infected. Cold whole milk is acceptable for short periods of time however it sours quickly, and milk is usually not available at a sporting event. Never transport the tooth to the dentist in tissue or gauze. If none of the above are readily available, use water.

The HBSS is biocompatible with the tooth periodontal ligament cells and can keep these cells viable for 24 hours because of its ideal pH and osmolality. Research has shown that this fluid can rejuvenate degenerated ligament cells and maintain a success rate of over 90% if an avulsed tooth is soaked in it for 30 minutes prior to replantation. This solution does not need refrigeration and is preserved in a break resistant, sterilized container.

It is now obvious that a proper transport medium for tooth avulsion should be part of the first aid kit at schools and most definitely be part of the sports medicine medical kit of the athletic trainers and coaches available at all sporting events. It would be beneficial for parents to keep a container of HBSS in the home medicine cabinet.

Once the dentist receives the tooth preserved in this system he/she may precede to implant the tooth and do the proper splinting procedures with a favorable prognosis.

It should be noted that if a primary (baby) tooth is knocked out, it should NOT be replanted as it could damage the permanent tooth bud in formation. Parents should NOT try to place the baby tooth back into the socket, and should immediately seek the advise and treatment of their dentist.

It is advised that if the accident victim shows any signs of head injury, unconsciousness, nausea, or persistent headaches, they should be first evaluated for their head injury by proper medical personnel. Once a head injury is ruled out, they may precede to the dentist for treatment of the avulsed (knocked out) tooth. This is another reason why a proper storage medium for the tooth is critical.

Therefore the treatment of choice is HBSS followed by whole cold milk. Hanks Balanced Salt Solution can be purchased by the trade name 3M Save-a-Tooth.

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