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Dental Injuries
Teeth Knocked Out
The upper front permanent teeth are the most common teeth to be completely knocked out. Children with forward-protruding front teeth that have not had orthodontic treatment to bring them into alignment are at increased risk. Knocked out baby or primary teeth are usually not reimplanted in the mouth, since they will be naturally replaced by permanent teeth later. However, knocked out permanent teeth should be retrieved, kept moist, and placed back into their sockets (reimplanted) as soon as possible. The most important variable affecting the success of reimplantation is the amount of time that the tooth is out of its socket. Teeth reimplanted within one hour of the accident frequently reattach to their teeth sockets.
The knocked out tooth is rinsed in clean water or milk, and placed back (reimplanted) into the socket from which it came. This can be done by the patient or parent and then checked by the dentist. Care should be taken to handle the tooth only by its crown and not by its root. If the parent or patient is unsure about reimplanting the tooth, then the tooth should be stored in milk (if available) or in water and brought to the dentist as soon as possible. Alternatively, in older children and adults who are calm, the tooth may be held within the cheeks inside of the mouth while traveling to the dental office.
After reimplanting the tooth into its original socket, the dentist can then splint this tooth to adjacent teeth for 2-8 weeks. Splinting helps to stabilize it while the bone around it heals. During the splinting period, the patient eats soft foods, avoids biting on the splinted teeth, and brushes all the other teeth diligently to keep the mouth as clean as possible.
In adults, the reimplanted tooth should have a root canal procedure within 1-4 weeks. On the other hand, reimplanted permanent teeth in children (where the tooth root has not yet completely formed) may not need a root canal procedure. These teeth are observed for at least five years for symptoms of dying pulp, such as pain, discoloration, gum abscesses, or abscesses seen on an x-ray.
In most patients who have had tooth reimplantation, over-the- counter medications like acetaminophen (TYLENOL) or ibuprofen (ADVIL) are sufficient for pain relief. Chlorhexidine (PERIDEX) mouth rinse may be prescribed to prevent and control gum inflammation (gingivitis), since the splinted teeth cannot be brushed normally and the splint usually collects extra dental plaque and food debris. Oral antibiotics and tetanus toxoid injections are considered for patients with accompanying significant soft tissue cuts (lacerations).
TEETH DISPLACED
Instead of being completely knocked out of the mouth, a tooth can be displaced. A displaced tooth may be pulled out and appear elongated, or be pushed in and appear shorter. A displaced tooth can also be pushed forward, backward, sideways, or rotated. While not an emergency, the sooner the dentist can splint or realign the tooth with orthodontic brackets and wires, the easier it can be brought back into proper alignment. Trauma significant enough to cause tooth displacement can also lead to pulp injury. Therefore, a displaced tooth should be evaluated periodically for several months to determine if a root canal procedure or tooth extraction is needed.
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