Dental trauma emergencies

When a tooth gets bumped out of position, immediate treatment is required to ensure its long-term health.  

Right away:
–  Do your best to push the tooth back into the proper position.
–  If the tooth has been knocked out completely, hold it by the white enamel end (not the yellow root end), rinse it gently with water only, (do not wipe it or scrub it).  Rinse the tooth socket with water, and place the tooth back in the socket, as close to the proper position as possible.
–  If the tooth has been knocked out completely and you can’t get it back in the socket, store the tooth in:
1) Hank’s Balanced Salt Solution or Save-A-Tooth (available at pharmacies),
2) cool milk,
3) 0.9% saline water (available at pharmacies), or
4) saliva.  Have the person whose tooth was knocked out hold it inside their cheek.
All these solutions have the purpose of keeping the cells of the tooth alive until it can be placed back in the socket.
–  Call your dentist immediately.   If the tooth is repositioned and stabilized in one hour or less, it has a much better chance of healing well and staying alive.  If it takes longer than an hour, then it runs the risk of the body rejecting it as if it’s an extracted tooth.  

When a tooth has been knocked out of place there are three areas that might be injured: the nerve inside the tooth, the ligament that secures the tooth root to the tooth socket, or the bone surrounding the tooth.  Immediately repositioning the tooth gives the ligament the best chance at survival.  If the ligament dies, the tooth may become fused to the bone, or the tooth may fall out completely.  If the nerve is injured the tooth may need a root canal within a few days after the injury or even years later.  

Baby teeth do not heal well if stabilized because they do not have enough root.  If a baby tooth gets bumped, contact your dentist with any questions about what is best for your child.

Treatment for a dental injury to permanent teeth includes repositioning the tooth, stabilizing it, prescription medication, and evaluating the health of the nerve.  The patient shown below was hit with an elbow while playing a pick-up game of football.  He was not wearing a helmet or mouthguard. He had one tooth completely knocked out that no one could find.  Another tooth was pushed slightly out of the socket (red line on x-ray), while the bone around a third tooth was broken (yellow line on x-ray).  He arrived at the dental office eight minutes after his injury.  Once the area was numbed, the teeth and broken bone were repositioned.  A wire was bonded to the teeth to secure them in place while they healed.  He was prescribed an antibiotic and pain medication.  After two weeks the wire was removed.  The nerves had died in these two teeth, so both teeth had root canal therapy.  His missing tooth was later replaced with an implant and crown.  If he hadn’t received immediate treatment he would have lost three teeth instead of one.

The injury

The wire splint stabilizes the teeth

The wire is removed after two weeks

Root canal therapy was done on two teeth. The socket and broken bone are healing.