I have a friend who managed to "file" a small semi-circle in his front tooth at home. How did this happen? Let's just say it's not a good idea to use your teeth to tighten the strings on your steel-stringed guitar. Zzzzzzip!
The little chips and bumps aren't usually an emergency situation, but a whole tooth being knocked out (avulsed), is different. Time is crucial, and knowing what to do can mean the difference between saving the tooth or permanently losing it.
Like all sensible but boring health messages, this is another case where prevention really is best. If you're playing sport or undertaking an activity where a hit to the face is possible, then wear a custom-made mouthguard. Some accidents just happen though, so what should you do? If the victim is under the age of 14, consider that it may be a baby tooth. Baby teeth are smaller, rounder, and whiter than permanent teeth. If a baby tooth is knocked out, it should never be replanted. Pushing the tooth back into the socket can damage the permanent tooth which is developing underneath.
Once you're sure it's a permanent tooth that's been completely knocked out, root and all, then it might be saveable. The first thing to do is find the tooth, then pick it up without touching the root. Only handle the crown of the tooth, (the whiter part). The root, (the yellower part), is covered in living cells which help attach the tooth to your jaw bone. These cells are easily damaged, so if the tooth is handled incorrectly it might not be able to reattach itself once put back in place.
Give the tooth a QUICK rinse under clean running water or a splash of plain milk. No more than 10 seconds, just enough to rinse any dirt off. You don't want to damage those precious cells. If possible, put the tooth back into its socket in the mouth. This is the safest place for it. Bite down on something soft to hold it in place, a clean handkerchief works well. If there's aluminium foil handy, you can fashion a sort of mouthguard out of it to hold the tooth in.
If you can't easily get the tooth back in place, it needs to be stored in something to stop the cells on the root from drying out and dying. Plain water is no good, it doesn't contain any nutrients to keep the cells alive and can cause them to swell and microscopically explode. The best thing is a specially made solution, called "Hanks balanced storage medium". If you're somewhere close to an amazing first aid kit, there's a chance you'll be able to get your hands on some Hanks. More often than not though you'll have to make do with something else:
- Balanced saline, (medical saline, contact lens solution)
- Plain milk
- The patient's own saliva. Yep, get them to spit into a container.
- The patient's own mouth. If they are old enough to know not to swallow the tooth, it can be kept on the inside of their cheek next to their back teeth.
Regardless of whether it's a baby or a permanent tooth, GET TO A DENTIST. Go now! Quickly! An avulsed adult tooth has a much better chance of surviving if it is replanted within 60 minutes. The dentist needs to make sure there are no stray fragments of tooth around, manage any soft tissue injuries, check the other teeth for damage, and provide treatment for any permanent teeth that have been knocked out. An avulsed permanent tooth will need to be professionally splinted in place, and will likely need to have root canal therapy and antibiotics given to prevent complications that could end in the loss of the tooth.
Like any first aid, I hope you never have to use what you've learnt in this article. Should you be first on the scene of a tooth avulsion though, you can be the expert and give that tooth its best chance of survival.