A permanent tooth that has been knocked out can often be replanted if it is handled correctly and reaches a dentist fast. The first 30 minutes decide the outcome.
A permanent tooth that has been completely knocked out can often be put back if it is handled correctly and reaches a dentist quickly. What decides the outcome is whether the ligament cells on the root surface stay alive, and those cells die fast in dry air. That is why the first thirty minutes matter more than anything done later.
Step by step
- Stay calm and find the tooth. Press a clean gauze or tissue on the socket if it is bleeding.
- Hold the tooth only by the crown, the white part you normally see. Never touch the root.
- If it is dirty, rinse it for a few seconds in cold milk or water. Do not scrub, brush or use soap.
- If you can, put the tooth back into its socket the right way round and press gently.
- If it will not go back, store it in a suitable liquid and travel to a dental clinic immediately.
What to store it in
The socket itself is the best storage medium. If that is not possible, cold milk comes next: it is close to sterile and its concentration keeps root cells from swelling and bursting. Saliva works too, and the tooth can be held inside the cheek, though not in small children because of the risk of swallowing. Sterile saline is also acceptable.
- Do not use tap water: its low salt content kills root cells quickly.
- Do not wrap the tooth in a dry tissue or put it in a pocket.
- Do not put it on ice or in a freezer.
- Do not scrape tissue off the root; that tissue is what heals.
- Do not disinfect it with alcohol or hydrogen peroxide.
Why time matters so much
In a suitable liquid the root surface cells survive for hours. In dry air most of them stop functioning within about half an hour. Once they are gone the tooth may still be replanted, but instead of a healthy ligament forming, the root tends to fuse with bone or slowly resorb. Waiting until the next morning changes the outcome directly.
What happens at the clinic
The dentist checks for jaw fractures and injuries to neighbouring teeth, repositions the tooth and splints it to the adjacent teeth for a few weeks. Tetanus status is reviewed. In fully formed teeth root canal treatment is usually started within a few days to two weeks, because the blood supply was severed when the tooth came out. Follow-up X-rays through the first year are part of the treatment, not an optional extra.
Baby teeth are different
A knocked-out baby tooth is not replanted, because doing so can damage the developing permanent tooth underneath. The child still needs to be examined so the socket, bone and neighbouring teeth can be checked.
This is an injury measured in minutes. Keep the tooth moist and set off straight away; earlier care after a knocked-out tooth injury greatly improves the chance of keeping it. Our Muratpaşa 24/7 dental clinic is open every day and every hour.
