You’re putting up the Christmas tree after Thanksgiving (hopefully) and, while carefully placing ornaments, you turn around to be greeted by your kid swinging a branch. You look down to reveal your front tooth in your hand and you’ve quickly realized what has happened – you just lost your tooth! Quick – let’s review what to do.

Don’t Panic

Your tooth may be okay. Look at the tooth to reveal if it’s whole or if parts have fractured off – try and keep all of the pieces if so. If you find that the tooth is dirty (if you are on a baseball field, for instance) your first instance may be to wash it off. If you’ve made it this far – this is important – so pay attention! Do NOT rinse the tooth off excessively. Just like the bones in your body, your teeth are attached to the bone in your jaw with ligaments. If you wash off the tooth aggressively, the fibers that still remain on your tooth will not have a chance to re-attach to the bone. If the tooth has large debris, a gentle wash with milk, saline, or saliva will suffice. The next step? Stick that tooth back in there, baby! Pick the tooth up by the crown, NOT the root, and attempt to place it back in the socket. Grab something to bite on such as a rolled-up kleenex or piece of cotton and place moderate pressure on the tooth. We are attempting reimplantation, and it may save your tooth!

What Is Reimplantation?

Reimplantation is a procedure that dentists and oral surgeons utilize in order to save a tooth or even move a tooth to another site (wisdom teeth may be reimplanted in spaces where other molars are lacking). It’s important to understand that this technique is ONLY for permanent teeth, and shouldn’t be bothered with primary/ baby teeth as it may damage the permanent tooth beneath it. Reimplantation isn’t perfect and depends on several factors. These factors include – ‘the extra-alveolar time until reimplantation, storage medium, handling, and periodontal ligament condition of the avulsed tooth as well as the patient’s general health¹.’ With that being said, let’s focus on the studies provided by the International Association of Dental Traumatology.

The International What?

A recent study has shown that the chances of a long-term survival of an avulsed tooth (a tooth that has come out) has a higher chance of long-term survival by following the International Association of Dental Traumatology Guidelines². We’ve already discussed the basics of what to do, but let’s outline them.

1. Remain calm
2. Pick the tooth up by the crown, not the root
   1. If the tooth is dirty, rinse with milk, saline, or your own saliva (gently)
3. Place the tooth immediately back in the jaw
4. Once in its position, bite on gauze, a handkerchief, or a napkin and hold it in place
5. Go see your dentist³

If you’re unsure if the tooth is whole and do not want to replace the tooth, your best option is to store the tooth in a medium that is available to you. The best medium is the one you have available. If you have it nearby, though, milk is greater than saliva, and saliva is greater than saline. A study found that teeth stored in milk decreased the rate of loss of avulsed teeth by greater than 50%⁴. Although saline is the worst out of the choices, leaving the tooth air-dry is detrimental to the prognosis of the tooth. In fact, after a tooth has dried out for 30 minutes, most of the ligament cells surrounding the tooth have died.

So What Next?

Treatment of an avulsed tooth after it has been re-implanted (or lack thereof) varies depending on the type of tooth and the conditions it has withstood. Your dentist should know the following steps after an accident has occurred. With that being said, let’s review some of the possibilities:

• You may require a flexible splint to hold the tooth in
• You may require a root canal two weeks after the trauma occurred (this depends on age)
• Systemic antibiotics may be administered
• You may be given an antibiotic rinse such as chlorhexidine
• You may have a follow-up appointment routinely to observe the teeth

To Summarize:

• A tooth that has fallen out hasn’t lost all hope!
• If a tooth is clean and has fallen out, stick it back in (if not soak it in milk)
• Follow up with your dentist and call their emergency line as soon as possible
• You may need a root canal after the tooth has stabilized

References:

¹Gonçalves, P., Ionta, F. Q., Rios, D., Oliveira, D., Couto-Filho, C., & Honório, H. M. (2018). Reimplantation of an avulsed mature permanent tooth after 6 days: a 1-year follow-up. General dentistry, 66(4), 71–75.

²Wang G, Wang C, Qin M. A retrospective study of survival of 197 replanted permanent teeth in children.

³Fouad AF, Abbott PV, Tsilingaridis G, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol 2020;36(4):331-342. https://doi.org/10.1111/edt.12573. 

⁴Coste, S. C., Silva, E., Santos, L., Barbato Ferreira, D. A., Côrtes, M., Colosimo, E. A., & Bastos, J. V. (2020). Survival of Replanted Permanent Teeth after Traumatic Avulsion. Journal of endodontics, 46(3), 370–375. https://doi.org/10.1016/j.joen.2019.11.013

Liability Statement:

The medical advice given in this blog should only be utilized by a medical professional who has received a medical degree. I am not responsible for the medical advice given in this blog and each case should be reviewed extensively with sources outside my blog. This blog is for education purposes only and is not meant as a substitute for an academic institution.