Traumatic Tooth Injuries

The front teeth, especially the upper incisors are the most prone to getting accidentally damaged because of their prominent position in the mouth. This can occur in accidents, fights, playing sports, or just horsing around. Where the tooth is chipped or broken, you should seek dental treatment as soon as possible, particularly if the tooth is loose or if the soft tissue (known as the dental pulp) is exposed, making the tooth very sensitive to cold water or air.

Sometimes the tooth could just be loosened, be out of position or even knocked out of the jaw. If the front tooth is knocked out of the jaw, treatment will depend on whether it is a milk (baby) tooth or the permanent adult tooth. The permanent front tooth can be saved by replacing it into position (replantation). However, time is the essence for success of this procedure. Therefore, prior knowledge on managing the situation will mean valuable time saved during an emergency. This can make all the difference between success and failure of tooth replantation.

Loose Tooth But In Position

Milk Tooth

No treatment required. To monitor tooth for pain or abscesses which may develop should the tooth not recover from the trauma.

Permanent tooth

See your dentist to stabilise the tooth with a flexible splint which will be left on for 2 weeks.

Tooth Out Of Position

Milk Tooth

See your dentist to reposition the tooth and place a splint to stabilize the tooth for 1-2 weeks. If pushed further into the jaw (intruded), so that the tooth looks shorter, then it will be left to emerge again on its own. However, if the injury is severe or the tooth about to shed to make way for the permanent tooth, then it is likely to be extracted.

Permanent tooth

See your dentist to reposition the tooth and place a splint to stabilize the tooth for 2-4 weeks. If intruded, so that the tooth looks shorter, then it will be left to emerge again on its own in newly emerged teeth. A mature tooth that is intruded may have to be repositioned and also require root canal treatment within 3 weeks, as the trauma disrupts the blood supply to the tooth.

Tooth Knocked Out

Milk Teeth

If the baby front tooth is knocked out, it should not be replaced into the jaw as this could damage the developing adult front tooth underneath. Just make the child bite a clean handkerchief or something similar, to stop the bleeding. See your dentists as soon as possible to assess if there is any other damage.

Permanent Teeth

  1. Find the tooth that was knocked out. If the tooth is allowed to dry out for longer than 15 minutes, the success of replantation reduces drastically!
  2. Pick the tooth by holding onto its crown, and try not to touch the root surface, so as not to damage further the tissues on the root surface required for the tooth to reattach itself.
  3. Inspect—if dirty, rinse off dirt. In order of preference, use either cold milk, undiluted coconut water, physiologic saline solution (for cleaning contact lenses, also often available in emergency first-aid kits), or lastly water.
  4. Re-insert the tooth into the socket from where it came from, and wiggle it to its original position, preferably within 5 minutes of coming out.
  5. If unable to do this for any reason, store the tooth (in order of preference) immersed either in:
    • Tissue culture medium — Viaspan, Hanks balanced salt solution (but who has this handy in an emergency!)
    • Coconut water, undiluted (handy if you are close to a drink store!)
    • Milk UHT or fresh (but not condensed or evaporated milk!)
    • Physiologic saline
    • Saliva — place into the cheek of the mouth to prevent the tooth from drying out.
    • Water
  6. Seek professional dental help immediately to replant the tooth. However, it is best if the tooth can be replanted almost immediately.
  7. See your dentist who will stabilise the reinserted tooth with a flexible splint for 1 week. Antibiotics and a tetanus injection will also be prescribed. Root canal treatment will be required for mature teeth within 2 weeks as the ruptured blood supply is unable to reconnect.
Knocked out tooth
Pick tooth by the crown without touching the root.
Clean debris with milk
Wash off dirt with either milk, physiologic saline or water (in order of preference).
Reinsert tooth that was knocked out
Reinsert into the correct position within 5 mins. of being knocked out.