Loose Or Knocked Out Permanent Teeth

Loose Or Knocked Out Permanent Teeth

What To Do If A Permanent Tooth gets Knocked Out


If you get a tooth knocked out, or “Avulsed,” don’t panic.  With the right actions on your part, you can play a crucial role in saving your tooth.


Act Quickly


When a tooth gets knocked out, the nerves, root, blood supply and supporting tissue around the tooth are damaged.  Even though it may be difficult to repair the nerves and blood vessels, the bone may be able to reattach to the root of the tooth if it is put back into place properly and quickly.  Studies show that teeth begin to die within 15 minutes of being knocked out of their socket.  Experience has shown that on average, there is about a 30-60 minute window in which there is the best chance of saving an avulsed tooth.

That is why it is absolutely essential to act quickly and get to your dentist, or if necessary to an emergency room as soon as possible.  


Clean The Tooth Properly


As soon as the injury occurs, locate the knocked out tooth.  The key is to only touch the tooth by the crown (the part of the tooth you are accustomed to seeing in the mouth).  Never touch the root of the tooth that was under the gum.  Touching the root will compromise the tooth further and cause further damage to the living cells on the root and a lower rate of success.

If the tooth is dirty, hold it by the crown and gently rinse it with cold tap water.  

  • Do Not scrub the tooth
  • Do Not clean the tooth with soap, alcohol, mouthwash or any other chemical
  • Do Not wrap the tooth in tissue, cloth or plastic
  • Do Not allow the tooth to dry; In order to save the tooth and place it back in the mouth, it must stay moist! 

Reposition the tooth if possible


The best thing to do is try to put the tooth back into the socket as quickly as possible, as long as the tooth is intact and not cracked or broken.  Without touching the root, gently push the tooth back into place.  Make sure the tooth is facing the right direction before you reinsert it.  Hold the tooth in place by biting down gently or with your fingers until you arrive at the dentist or emergency room. Some people might find it more comfortable to bite down on a wet tea bag or wet gauze.

The tooth must stay damp at all times to remain alive. If you cannot reposition the tooth in the socket, there are a few other options.  Transport the tooth in the following liquids in order of preference:

  • Hanks Balanced Sal Solution (Save-A-Tooth).  Sometimes found in first aid kits or pharmacies.  If available, the tooth may be safely kept in this solution for up to 24 hours.

  • Milk – Preferably cold and low fat.  Tooth may be kept in milk up to 3 hours.

  • Cold Gatorade or Cold Contact Lens Solution.  Tooth may be kept in these solutions up to 1 hour.

  • Cold tap water or inside your mouth.  This is the last resort – living cells on the root may completed die within an hour.

Whether you were able to place the tooth yourself in the socket, or found an appropriate transport solution, at this point you must call a dentist immediately to arrange for care.  If unable to find a dentist right away, or if it is after normal business hours, immediately proceed to a hospital emergency room.


What To Expect Next?


The first thing your dentist will do is clean or flush out the socket to remove debris and assess the injury. X-rays and possibly other imaging such as CT scans will be utilized to make sure you have no other dental or facial injuries.  The standard of care in this situation will be to gently reposition the tooth in the socket and splint the tooth to the surrounding teeth with soft wire and composite bonding.  You will remain with this splint for a period of several weeks in hopes that the tooth will reattach inside the socket to the surrounding bone.  Routine follow up appointment will be scheduled to track your healing and the progress of your case.

It is important to note that the vast majority of cases that undergo successful re-implantion of an avulsed tooth will experience some degree of darkening of the tooth involved and will require root canal therapy in addition to a crown to preserve the structural integrity as well as the aesthetics of the tooth.  Individual timelines vary based on the unique circumstances of each individual.  


What If A Baby Tooth Gets Knocked Out


If a child had a baby tooth knocked out, it is essential to visit the dentist to make sure the socket and bones are healthy, and there is no debris left in the gums.  Generally speaking, we do not recommend trying to replant the baby tooth back into position because of the risk of infection as well as to prevent potential damage to the adult tooth that will grow in later.  Appropriate arrangements will be made instead based on each situation and circumstances of the child.  


Prevention Is The Best Strategy


There are many causes for teeth getting knocked out, but sports injuries are among the most common causes for avulsed teeth. Wearing a mouthguard during sports is one of the easiest ways to prevent teeth from getting knocked out. An athlete is 60 times more likely to experience a severe dental injury if they are not wearing a mouthguard, according to the American Dental Association.

Whether you choose a custom made mouthguard or a “boil-and-bite” guard, it will add significant protection and should be worn during all contact sports.


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