Tooth Avulsion

Dear Lisa,

My son got his front tooth knocked out playing soccer. Luckily my dentist was open and I brought him directly there. His tooth was saved, but now I realize, I wouldn’t know what to do if my dentist wasn’t open. I have three other children and I would like to be prepared if this happens again. What is the right way to handle a tooth that is knocked out?

“Knocked out tooth in N.J.”

Dear “Knocked out tooth”,

A tooth avulsion is the total displacement of a tooth from the dental socket. “In the United States, the prevalence of avulsions is 16% in permanent teeth and as high as 13% in primary teeth.” (1) It is very smart of you to ask about the proper handling of a knocked out tooth, because a tooth can be saved if handled correctly.

A tooth avulsion is considered a dental emergency and should be replanted within 30-60 minutes in order to decrease your chances of losing the tooth. Time is of the essence; therefore if your dentist’s office is closed you may want to contact him through the emergency line. Most dentists will come to the office for an emergency or offer a covering dentist who will. Your other option is to contact your pediatrician for a referral to a different dentist if yours is not available. In the case where a dentist cannot be reached a visit to your local emergency room may be necessary.

When handling the tooth, avoid contact with the root and only hold the tooth by the crown. Under no circumstances should you scrub the root because scouring is harmful to the fragile tooth root (1). You can place the tooth back in the socket and have the child bite down on gauze while transporting the child to your dentist or local emergency room. This is asuming that your child is mature enough to follow directions and sit still, otherwise the tooth may become dislodged and become a choking hazard. If the tooth is filled with debris, or it is not feasible to put the tooth back in the socket, then it is a good idea to transport the tooth in milk.

The important thing to remember is, only permanent teeth should be replanted. Primary teeth should not be replanted because the developing tooth bud in the gum may be injured in the process. (2) If for some reason the tooth is missing, shake out all of your child's clothing and check the area well. If you cannot locate the tooth, I would recommentd an evaluation by a healthcare practitioner to make sure your child did not aspirate the tooth and to check to see if the tooth became embedded in the cheek or inner lip.

(1)Triola, M. How to deal with dental emergencies. The Clinical Advisor. 2005;Dec 36-42.
(2)Halpern, J., Bernardo, L. Emergency treatment for dental injuries. Int J Trauma Nurs. 2002;8:15-17.

Lisa Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

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