Broken or knocked out tooth

Definition

The dentist's term for a knocked out tooth is "avulsed."

Alternative Names

Teeth - broken; Tooth - knocked out

Considerations

A permanent tooth that is knocked out can sometimes be reimplanted. In most cases, only permanent, adult teeth are reimplanted into the mouth. Baby teeth are usually left out. 

Immediately contact your dentist when a tooth is broken or knocked out. If you can find the tooth after the accident or injury, bring it with you when you seek medical help.

Causes

Tooth accidents are commonly caused by:

• Accidental falls
• Sports-related trauma
• Fighting
• Car accidents
• Biting on hard food

First Aid

Save any tooth that has been knocked out for possible reimplantation. Bring it to your dentist as soon as possible. The longer you wait, the less chance there is for successful reimplantation. Handle the tooth only by the crown (chewing edge).

Use one of the following options to transport the tooth:

1. Try to replace the tooth in the socket, to the level of adjacent teeth. Bite down gently on gauze or a wet tea bag to help keep it in place. The surrounding teeth can be used as anchors. Care must be taken not to swallow the tooth.
2. If the tooth cannot be replaced in the socket, place it in a container and cover with a small amount of whole milk or saliva. The tooth can also be carried between lower lip and lower gum or under the tongue.
3. A tooth-saving storage device (Save-a-Tooth, EMT Tooth Saver) may be available at your dentist's office. Such a kit contains a travel case and fluid solution. Consider buying one for your home first aid kit.

1. Apply a cold compress to the mouth and gums for pain.
2. Apply direct pressure, using gauze, to control bleeding.
3. Get dental help immediately. The sooner dental attention is received, the better the chances are for successful reimplantation.

Teeth that have been badly fractured may expose nerve tissue inside the tooth. In this case, immediate attention is needed to avoid infection, abscess, and pain.

Simple chips or fractures may be tended to on a non-emergency basis, but should still be fixed to avoid sharp edges that can cut the lips or tongue, and for cosmetic reasons.

Do Not

1. DO NOT handle the roots of the tooth. Handle only the chewing edge -- the crown portion of the tooth.
2. DO NOT scrape the root of the tooth to remove dirt.
3. DO NOT brush or clean the tooth with alcohol or peroxide.

Call immediately for emergency medical assistance if

See a dentist immediately if:

• A permanent tooth has been knocked out.
• A tooth has been partially fractured and pain and swelling results.

In the case of simple tooth fractures, a non-emergency dental appointment can be made.

After a major accident, if you are not able to bring your upper and lower teeth together, the jaw may be broken. This requires immediate attention. You may call a dentist, but also seek help at a hospital.

Prevention

• Wear a mouth guard when playing any contact sport.
• Avoid fights.
• Avoid hard foods, such as bones, stale bread, and tough bagels.
• Always wear a seatbelt.

References

Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine. 4th ed. Philadelphia, Pa: Saunders; 2004.

Marx JA, Hockberger RS, Walls RM, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002.