Avulsed tooth (knocked out but intact)

Our expectation—that someone who has read the following instructions will be present when this occurs. More likely when spectating at a children’s basketball, soccer, baseball or other types of team sport where headgear isn’t usually worn.

  1. Take charge/find the tooth/ instruct all others to stay away.
  2. Carefully pick the tooth up by grasping only the crown—enamel. Beware, saliva will make the crown slippery. Hold the tooth vertically—root up, crown down.
  3. Carefully inspect all root surfaces to verify no soil is attached.
  4. If soil is visible, rinse off with bottled water. Saliva from the child, saline, distilled water or skim milk are better choices but access is time-consuming. Total time out of the socket is inversely proportional to overall success. The small tags of connective tissue seen on the root surface will survive if tooth out of socket time is very short.
  5. Push the root firmly into the socket, without regard to proper rotation. The child will be in the early stages of shock and will not suffer significant pain during replantation.
  6. Parent, guardian or possibly the child must stabilize the tooth en-route to their dental office.
  7. The dentist should verify rotation without removing the tooth and then fabricate a stabilization system, as well as checking the condition of surrounding bone and gum tissue.
  8. After initial healing has taken place, endodontic tmt (root canal) will be needed. In case the tooth is mandibular (lower arch) the root is narrow from side to side and long from front to back, therefore requires more attention (can only fit 2 ways) when replanting.