What to do if a child's tooth is knocked out

Would you know what to do if your child's tooth was suddenly knocked out?

Of course, you would see a dentist as soon as possible, but did you know that immediately giving the right emergency treatment yourself can greatly increase the chance of the tooth being saved?

Adult front teeth can be completely knocked out during contact sports or a blow to the head or mouth. This is more common in children between the ages of 7 to 10 years, as the bones of their jaws are more elastic then in older children and adults.

If a tooth is knocked out, time is of the essence and the first 30 minutes are critical. 

The following advice applies only to adult (permanent teeth). It is not advisable to re-implant baby teeth as this can damage the developing adult tooth. If a baby tooth is knocked out, you should control any bleeding and see your dentist, taking the tooth with you.

What can I do immediately?

• Stay clam and find the tooth if possible.
• It is important to hold the tooth by the crown and not the root to avoid touching and damaging the sensitive fibres on the root surface.
• If there is no fracture to the root, the tooth can be re-implanted.

The sooner the tooth is replaced into the tooth socket the better its chances of survival. If you are able to do this, it is better than waiting to get to your dentist.

• If the tooth appears dirty, you can rinse it with cool drinking water, do not use any disinfecting agent and do not touch or dry the root surface.

• Still holding the tooth by the crown, push the root into the tooth socket until it appears level (as far as possible) with the adjacent teeth.

• Either hold the tooth in place, or get the child to bite down on a clean handkerchief.

• See your dentist as soon as possible.

If you are unable to re-implant the tooth it is important that it is stored correctly to protect the sensitive periodontal ligament fibres on the root surface from drying out, before the tooth can be re-implanted.

• The child's own saliva is best for storing the tooth. The tooth can be keep in the cheek, but if there is a danger of the child swallowing or or choking on the tooth then they should spit enough saliva into a small cup to cover the entire tooth and keep the tooth in it until going to see the dentist.
• Milk or saline can be used to store the tooth for short periods of time. Plain water is not recommended as it damages the fibres on the root surface.
• Get to a dentist as soon as possible. Out of office hours, call the emergency number and explained what has happened.  

What can the dentist do?

• The dentist can re-implant the tooth, if not already done, and check for any other injuries.
• The tooth will need splinting to hold it in place while healing takes place.
• A child who has had a tooth re-implanted will need antibiotics and a tetanus booster.
• Regular follow-up with x-rays will be required.

What are the chances of saving the tooth?

• The less time the tooth is out of the mouth, the better chance of success. 
• Teeth which are re-implanted within 30 minutes have a greater chance of survival.
• Storing the tooth correctly, before re-implantation, also increases the chance of success.
• Most teeth which have been re-implanted, will require root canal treatment sooner or later. 
• In younger children (under 10 years), where the tooth root is not yet fully formed, there is more potential for healing and regeneration of the nerve and blood supply, especially if they are re-implanted quickly, but they will still need regular monitoring.
• Resorption of the root surface can occur after re-implantation. This will be more extensive if there has been significant damage to the root surface fibres. In severe cases the root may be gradually replaced by bone, eventually leading to the loss of the tooth.
• Even in less than ideal situations, it is often worth attempting to re-implant the tooth. Although the tooth may not survive for a long time, it can be useful to maintain the space while the child is growing, until they are mature enough for other treatment such as a implant or bridge. 

What can be done to prevent a tooth being knocked out?

If your child plays contact sports, they should wear a sports mouth guard to protect their teeth. Ask your dentist about this.