Knocked-out tooth not always a loss


Having a tooth knocked out (avulsed) is one of the most physically and emotionally traumatic accidents that can occur in dentistry.

The first few minutes after the tooth is lost are the most critical to saving it.

If the tooth can be reimplanted within a few minutes the likelihood of preserving it goes up dramatically. After an hour the long term success is virtually gone.

While there are many steps in the process of preserving the tooth after a dentist is involved there are a few critical steps necessary to be performed by the patient or helper or guardian prior to seeing the dentist.

Teeth are held in the jaw bone by a ligament called the periodontal ligament. The crucial aspect of dental first aid in a case where the tooth is removed from the bone is maintaining the presence and vitality of the ligament.

Maintaining the presence of ligament cells basically means the tooth should not be "scrubbed" or scraped.

It should be gently rinsed in cool water and any gross debris removed but it should not be scraped or scrubbed. Neither should any harsh cleaning chemicals be used on it; particularly stay away from bleach and detergents.

The process of cleaning the tooth should be done very quickly and should not take more than ten or fifteen seconds. We do not want the cells present to be exposed to straight water for very long as it too will kill the cells that are present.

Once the tooth is "cleaned" we need to preserve the vitality of the ligament cells that are present. There are a number of ways that will preserve the vitality.

The best is to insert the tooth back into its socket. Usually the area is "shockey" and there is really little pain but the co-operation of the patient is obviously necessary. Aligning the tooth is of little consequence as it will be ultimately positioned by a dentist and we are only trying to keep the cells alive at this point.

The next best "medium" to keep the tooth in is saliva. If the patient is conscious, co-operative and able, placing the tooth in the fold between the cheek or lips and gums works nicely.

The minerals and salt content of the saliva is close enough to the fluids of the socket (blood) to keep the ligament cells alive for quite awhile.

The next alternative is to use a saline solution if it is available. The most likely source is contact lens solution. Not the cleaning solution. Obviously if normal saline is available for whatever reason, it will work as well.

Finally, milk may be used as a way to preserve the cellular integrity of the remaining ligament.

By keeping the tooth moist in one of these ways the length of time that the tooth can remain viable prior to getting the help of a dentist will be prolonged.

It should be remembered that plain water is not a good alternative to the other mediums we have discussed. Storing the tooth in plain water for any extended period of time will kill the remaining ligament cells which we are trying to preserve.

Water is "hypotonic" and will cause the ligament cells to swell until they burst thus killing them. This process is called hypotonic lysis.

In the event the tooth is not recovered immediately it should still be brought to the dentist with the patient.

While the long term viability of the tooth is dramatically compromised, placing the tooth back in the boney socket may help preserve the bone around the tooth.

The tooth will probably ankylos (grow directly to the bone with no intervening ligament) and ultimately the roots will resorb (dissolve) however the bone usually remains and is good for implant placement and to maintain aesthetics.

The process of ankylosis and resorption usually takes several years and while there are several potential long term outcomes decisions can be made as time progresses.

So if a tooth is knocked out, recover it as soon as possible. Store it in a suitable medium and get to the dentist immediately.

If the tooth is not recovered in a short period of time (a half-hour) the likelihood of long term preservation of the tooth is reduced, however, an attempt to reimplant the tooth should still be made in the hope of preserving the bone in the area.

Dr. Dan Laizure practices dentistry at Walla Walla Dental Care, 2014 S. Howard St. More information about the practice can be found at


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