Avulsed Tooth

What is an avulsed tooth?

An avulsed tooth occurs when a tooth is completely dislodged from its socket. Avulsed teeth are dental emergencies and require immediate treatment.

To save your tooth, try reinserting your tooth right away. Teeth treated within 30 minutes to one hour have the best chance of success.

If you can’t see a healthcare provider immediately, keep your tooth in milk or saline solution until you can see a provider. Your health provider will usually use reimplantation to attempt to reattach the knocked out tooth.

Who might get an avulsed tooth?

More than 5 million people in the United States have their teeth knocked out every year. Most dental trauma occurs in kids ages 7 to 11. Dental injuries occur twice as often in males than in females.

What causes tooth avulsion?

Knocking a tooth out of your mouth requires a significant amount of force. The most common causes of avulsed teeth are:

• Falls.
• Bicycle accidents.
• Sports injuries.
• Traffic accidents.
• Assaults.

Sports injuries can knock out a tooth. Sports injuries that can cause tooth avulsion include:

• Football.
• Hockey.
• Lacrosse.
• Martial arts.
• Rugby.
• Skating.

What are the symptoms of an avulsed tooth?

An avulsed tooth is a tooth that has been completely knocked out of your mouth. When your tooth is avulsed, no parts of it remains in your mouth. Symptoms of an avulsed tooth may include:

• A gap in your mouth where your tooth used to be.
• Mouth pain.

Losing your tooth may cause bleeding. If so, place a clean handkerchief or small washcloth over the socket and bite down. Avoid aspirin, which can worsen bleeding. If you’re in pain, ask your healthcare provider about what pain relieving medications are most appropriate for you. Please consult your healthcare provider for any head trauma, particularly if you experience dizziness or nausea. They can rule out any other injuries.

Can I treat an avulsed tooth myself?

An avulsed tooth requires immediate treatment to save the tooth. See your dentist as soon as possible afterward for further avulsed tooth treatment. Call your dentist or the nearest dentist to find out how to get emergency care. You should first treat the avulsed tooth yourself at the scene of the accident. You can follow these steps:

1. Pick up your tooth by the crown (white chewing surface). Don't touch the root (the part that usually holds your tooth to the bone below your gumline).
2. Rinse your tooth with water or milk to remove any dirt. Avoid using soap, and do not scrub or dry the tooth.
3. Gently place your tooth back into the socket, root first. Hold your tooth by the crown and avoid touching the root.
4. Bite on a napkin, gauze or handkerchief to anchor your tooth in place.
5. Visit a dentist immediately.

Only reattach permanent teeth that have been knocked out. Don't try to reimplant baby teeth, as this may cause injury to developing permanent teeth. In both cases, seek dental help as soon as you can. If you can’t reinsert your tooth into the socket, keep the tooth moist until you can see a dentist. Avoid putting your tooth in water if possible. Water can harm the root surface cells. You can put your tooth in:

• A glass of milk.
• A salt solution specifically for preserving avulsed teeth, often found in first aid kids.
• Your cheek, where saliva keeps it wet.
• In saline solution.

What should I do if I can’t find my tooth?

You may have swallowed or aspirated (breathed in) your tooth. See your provider immediately for a chest X-ray to make sure your tooth hasn’t gone into your lungs. Swallowed teeth are usually harmless.

What should I do if I only find part of my tooth?

Never try to only put part of your tooth back into the socket. See a dentist as soon as you can. They may take a dental X-ray to look for root damage before treating your tooth.

How do healthcare providers treat an avulsed tooth?

Most often, you’ll see a dentist if you have a tooth knocked out. How your dentist treats an avulsed tooth depends on whether you could reinsert the tooth yourself or keep it moist. If you put your tooth back into the socket before seeing your dentist, the dentist will:

1. Make sure you have positioned your tooth correctly.
2. Splint your implanted tooth to the surrounding teeth for seven to 10 days. If the bone around your tooth has also fractured, your provider may leave the splint for at least six weeks.
3. Evaluate the pulp condition and schedule a root canal if necessary (removal of the soft center of your tooth) within two weeks.

If you stored your tooth in a moist liquid, your dentist will:

1. Gently rinse your tooth if needed, usually with saline.
2. Give local anesthesia (numbing medication).
3. Reinsert your tooth.
4. Splint your implanted tooth.
5. Schedule a root canal.

Your dentist may prescribe an antibiotic for a few days. They will also make sure your tetanus shot is up to date. You may be at risk for tetanus if your tooth was exposed to dirt. If you couldn’t store your tooth in a moist liquid, your dentist may still reimplant it. For the best chance of success, they can usually only reinsert a tooth within an hour of loss. If your tooth dries out too much, the periodontal ligament (the joint that attaches the root of your tooth to your bone) may die. If this happens, the tooth may be lost and you may want to replace it with something like a partial denture, bridge or dental implant at a later date.

How do I take care of myself after tooth reimplantation?

To help protect your tooth after reinsertion, you should:

• Avoid foods that are too cold or too hot.
• Brush gently with a soft toothbrush after each meal.
• Consume only soft food and liquids for two weeks.
• Rinse with an antibacterial chlorhexidine mouthwash two times a day for two weeks.
• Take nonsteroidal anti-inflammatory drugs (NSAIDs) as needed for pain relief.

You’ll also need to visit your dentist for regular checkups of your reattached tooth. You should avoid contact sports until your provider gives you the go-ahead.

Can I prevent tooth avulsion?

You may prevent a knocked-out tooth by wearing a mouthguard if you play sports. Mouthguards protect your teeth from trauma, especially during contact sports like football and hockey.

What is the outlook for people with an avulsed tooth?

Prompt treatment of a tooth avulsion can save your original tooth. Good dental hygiene and regular checkups can help extend the life of your tooth.

Your tooth may still serve you for many years, but providers can’t predict how long your reinserted tooth may last. Many complications can affect tooth reimplantation, including:

• Ankylosis occurs when your tooth fuses to the bone and starts sinking into the gum tissue.
• Apical periodontitis is inflammation of the tissue surrounding your teeth.
• Inflammatory root resorption is a breakdown of your tooth’s root structure. This can cause your tooth to loosen.
• Pulp canal obliteration (PCO) involves hard tissue deposits along the walls of the root canal. PCO is usually painless but can lead to pulp necrosis.
• Pulp necrosis results when the pulp (tissue in the center of your teeth) dies. Pulp necrosis may lead to complete removal of the tooth or root canal.

When should I see my healthcare provider about a reimplanted tooth?

You should see your provider about a reimplanted tooth if you experience:

• Bleeding.
• Continued tooth pain.
• Swelling.
• Tooth discoloration.

A note from Cleveland Clinic

An avulsed tooth happens when you lose your tooth due to accidents or injuries. You can first treat a knocked out tooth yourself by reinserting your tooth. Otherwise, you should preserve your tooth in milk, salt solution, saliva or saline until you can get to your dentist. Reimplanted teeth need regular dental checkups but can last for years with proper care.