Tooth Avulsion (Knocked-out Tooth)

Trauma to the face and mouth from sports or other accidents can cause teeth to fracture, loosen or be knocked completely out of its socket (avulsion). An avulsed tooth can often be saved if it is replanted back into the socket immediately or soon after the injury.

Avulsion of upper left primary central incisors

Avulsion is one of the most serious dental injuries and the outcome for an avulsed permanent tooth is dependent on the actions taken at the place of accident.

If a tooth is avulsed, make sure it is a permanent tooth before replanting it. (You should not replant a baby tooth!)

1. Remain calm, act quickly and don't delay. Remember, time is critical.
2. Find the tooth and pick it up by the crown (the white part), avoid touching the root.
3. If the tooth is clean, place it back immediately into the socket.
   
   Replantation of lower left incisors after avulsion
4. If the tooth is dirty, rinse it briefly in cold running water (maximum 10 secs) before placing it back into the socket.
5. Do not scrape or rub the root surface.
6. Apply finger pressure to keep tooth in place.
7. Seek immediate dental treatment.

Note: If you are unable to replant the tooth, keep the tooth moist in a container of plain cold milk and see a dentist immediately. Do not store in water.

If milk is not available, place the tooth in your mouth between the cheeks and the gums.

The most critical factor is time. Teeth that have been replanted within 30 minutes have a better chance of surviving.

If you participate in contact sports, consider wearing a customised mouth guard or a splint to protect your teeth.

• The dentist will perform an examination and relevant investigations.
• The avulsed tooth will be replanted.
• If the tooth has already been replanted, the dentist will check that it is in the correct position.
• The tooth will be splinted to help it reattach. Replanted permanent teeth will be splinted up to 2 – 4 weeks depending on the severity of the injury.
• Antibiotics and possibly a tetanus booster, if indicated, will be prescribed.
• The dentist will inform you of follow-up treatment that may be needed.

Splinting of upper teeth

Splinting of lower teeth

Post-Trauma Care

There are a few things that can help to optimize healing of the replanted tooth in the first few weeks. These include:

• Avoiding participation in contact sports.
• Soft diet for up to 2 weeks. You may resume normal function thereafter.
• Brushing your teeth with a soft toothbrush after each meal.
• Using a chlorhexidine mouth rinse twice a day for up to 2 weeks.

Replanted teeth should be monitored by your dentist in regular intervals. Root canal treatment will be required in teeth that are fully formed or when the tooth develops pulp necrosis.

Sequelae

When a tooth is avulsed, there is damage to the pulp within the tooth, and the periodontal ligament which surrounds the tooth.

Pulpal death (necrosis) usually occurs after an avulsion injury to a fully formed permanent tooth. Root canal treatment will then be necessary to remove the infected pulp tissue. In a tooth that is incompletely formed, pulpal healing may occur if the conditions are optimal.

During avulsion, the tooth is "separated" from the socket due to the tearing of the periodontal ligament. There may be damage to the root surface due to the crushing or scraping of the tooth against the socket. This results in inflammation of the root surface which may result in ankylosis or root resorption of the tooth. Severe root resorption that cannot be resolved may result in the eventual loss of the tooth. Hence, a replanted tooth should be monitored by your dentist at regular intervals so as to monitor the condition of the tooth and to advise on future treatment options if necessary.

Ankylosis of tooth

​What Should You Avoid:

Do not:

• Let the tooth dry out or wrap it in tissue paper.
• Store the tooth in water or any hot liquid.
• Store the tooth in your pocket.
• Delay seeking treatment.​

Tooth stored incorrectly in tissue paper