Tooth Came Out: Emergency First Aid Steps and What to Do Next

When a tooth came out unexpectedly due to injury, accident, or trauma, knowing what to do in those first critical minutes can mean the difference between saving and losing your tooth permanently. Whether it happened during sports, an accident, or from biting something hard, quick and proper action is essential. This comprehensive guide will walk you through every step you need to take when a tooth came out to maximize the chances of successful replantation.

Understanding Tooth Avulsion: When a Tooth Came Out

Tooth avulsion is the dental term for when a tooth came out completely from its socket. This is considered one of the most serious dental emergencies, particularly for permanent teeth. The key to successful treatment lies in how quickly and properly you respond to the situation. Every minute counts when a tooth came out, as the cells on the root surface begin to die rapidly when exposed to air.

Permanent teeth can often be saved if handled correctly and replanted quickly, typically within 30 minutes to an hour. However, baby teeth that came out are never replanted, as doing so could damage the developing permanent tooth underneath.

Immediate Steps When Your Tooth Came Out

Stay Calm and Act Quickly

The first thing to do when a tooth came out is to remain calm. Panic can lead to mistakes that reduce the chances of saving your tooth. Take a deep breath and focus on the following immediate actions:

• Locate the tooth immediately and pick it up carefully
• Note the time the tooth came out
• Control any bleeding by applying gentle pressure with clean gauze
• Call your dentist or seek emergency dental care right away

How to Handle the Tooth Properly

The way you handle your tooth after it came out is crucial for survival. Follow these critical guidelines:

Hold by the crown only: Always pick up the tooth by the white part (crown) that you normally see in your mouth. Never touch the root surface, as this contains delicate cells necessary for reattachment.

Inspect carefully: Look at both the crown and root to check if any pieces appear to be missing or if the tooth is cracked. This information will be important for your dentist to know.

Do not scrub or rub: Even if the tooth has dirt, blood, or debris on it, never scrub, rub, or scrape the tooth. This damages the root surface cells that help the tooth reattach to your jawbone.

Avoid wrapping in tissue: Do not wrap your tooth in tissue, paper towels, or cloth, as these materials can stick to and damage the root surface.

Cleaning Your Tooth When It Came Out

If your tooth came out and has visible dirt or debris, gentle cleaning is acceptable, but you must do it correctly:

• Use only cow’s milk or your own saliva to rinse the tooth briefly (10-15 seconds maximum)
• Never use tap water or hold the tooth under running water, as tap water can kill the root surface cells
• Do not use soap, alcohol, or any other cleaning agents
• Simply swish the tooth gently in the liquid to remove visible contaminants

Replanting Your Tooth: The Best Option

The ideal situation when a tooth came out is to replant it yourself before reaching the dentist. This gives the tooth the best chance of survival:

Steps for Self-Replantation

1. Rinse your mouth: Gently rinse with water to clean the socket area
2. Position the tooth correctly: Look at the tooth to ensure you know which direction it should face
3. Gently insert the tooth: Place the tooth back into the socket slowly and carefully
4. Apply gentle pressure: If the tooth doesn’t seat all the way, bite down gently on clean gauze or a damp paper towel
5. Hold it in place: Keep the tooth in position by gently biting down until you reach your dentist

Do not force the tooth into place if it won’t go in easily. You could cause additional damage to the tooth or socket.

Storage Solutions When You Cannot Replant

If you cannot put the tooth back into the socket after it came out, proper storage is the next best option. The tooth must be kept moist at all times:

Best Storage Options (In Order of Preference)

1. Tooth preservation solution: Products specifically designed for knocked-out teeth are available over-the-counter at many pharmacies. Look for American Dental Association (ADA) approved products like Save-A-Tooth or EMT Tooth Saver.

2. Cold cow’s milk: Place the tooth in a small container filled with cold whole milk. Milk has the right balance of proteins and sugars to keep root cells alive.

3. Your own saliva: Spit into a clean container and place the tooth in your saliva. You can also hold the tooth between your cheek and gums if you’re old enough to do so safely without swallowing it.

What NOT to Use for Storage

• Tap water (damages root cells)
• Ice or very cold liquids (can harm the tooth)
• Dry storage like plastic bags or containers
• Mouthwash or alcohol-based solutions

Getting Emergency Dental Care

After a tooth came out, seeking professional dental care immediately is non-negotiable. Here’s what you need to know:

Time is Critical

The success rate for replanting a tooth decreases significantly after 30-60 minutes. Every minute that passes reduces the likelihood of successful reattachment. Aim to see a dentist within 30 minutes of when your tooth came out.

Where to Go

• Your regular dentist: Call your dentist’s office first, as they know your dental history
• Emergency dental clinic: Many areas have dental offices that handle emergency walk-ins
• Hospital emergency room: If no dental care is available, go to the ER. They can provide initial treatment and help preserve the tooth until you can see a dentist

What to Tell the Dental Professional

When you arrive for treatment after your tooth came out, provide these important details:

• When the tooth came out (exact time if possible)
• How the injury occurred
• How you handled and stored the tooth
• Whether any pieces of the tooth appear to be missing
• Any other injuries to your mouth, face, or head
• Your tetanus vaccination status

What to Expect During Treatment

When you see a dentist after your tooth came out, they will take several steps:

Examination: The dentist will examine your mouth, the tooth socket, and the tooth itself to assess damage and determine if replantation is possible.

Cleaning: If necessary, the dentist will clean the tooth and socket area more thoroughly using proper solutions.

Repositioning: The dentist will carefully place the tooth back into the socket, ensuring proper alignment.

Stabilization: A splint (usually a flexible wire) will be attached to the replanted tooth and neighboring teeth to hold it in place during healing, typically for 1-2 weeks.

Follow-up care: Your dentist may recommend pain management strategies and will schedule follow-up visits to monitor healing. Always consult with your dentist before taking any medications for pain relief.

Special Considerations

Baby Teeth vs. Permanent Teeth

When a baby tooth came out due to injury, it should never be replanted. Replanting primary teeth can damage the permanent tooth developing underneath. However, you should still see a dentist to ensure no fragments remain and that the permanent tooth isn’t damaged.

Partially Knocked-Out Teeth

If your tooth came out partially but is still attached, this is called a luxated tooth. Do not try to remove it or push it back into place yourself. Keep it as stable as possible and see a dentist immediately.

Fractured Roots

Sometimes when a tooth came out, part of the root may remain in the socket. You might see a sharp or shiny surface where the root broke. In these cases, replantation is still possible but less likely to succeed long-term. Your dentist will need to remove the remaining root fragment first.

Post-Replantation Care and Recovery

If your tooth was successfully replanted after it came out, proper aftercare is essential:

Immediate Recovery (First 24-48 Hours)

• Eat only soft foods to avoid putting pressure on the replanted tooth
• Maintain excellent oral hygiene, but be gentle around the injured area
• Avoid touching the tooth with your tongue or fingers
• Use any prescribed mouth rinses as directed by your dentist
• Apply ice packs to the outside of your face to reduce swelling

Long-Term Care

• Attend all follow-up appointments with your dentist
• Watch for signs of infection such as increased pain, swelling, or fever
• Be prepared for the possibility of root canal treatment, which is often needed for replanted teeth
• Understand that the tooth may eventually require additional treatment or extraction despite initial success

Potential Complications

Even with proper treatment after a tooth came out, complications can occur:

Root resorption: The body may gradually break down and absorb the root of the replanted tooth over time.

Ankylosis: The tooth may fuse directly to the bone, preventing normal movement and potentially causing problems with jaw development in younger patients.

Infection: Bacteria can enter the damaged tissues, requiring antibiotic treatment. Consult with your dentist about any prescribed medications.

Color changes: The tooth may darken over time, indicating the nerve inside has died.

Prevention: Protecting Your Teeth

While accidents happen, you can reduce the risk of having a tooth come out:

• Wear mouthguards: Use properly fitted mouthguards during contact sports and high-risk activities
• Avoid hard foods: Be cautious with hard candies, ice, popcorn kernels, and other foods that can cause dental injuries
• Childproof your home: Reduce fall risks for young children by securing furniture and using safety gates
• Use seatbelts: Always wear seatbelts in vehicles to prevent facial injuries during accidents
• Address dental problems: Decay and gum disease weaken teeth, making them more susceptible to being knocked out
• Regular dental checkups: Maintain regular visits to your dentist to keep your teeth and gums healthy

When Replantation Isn’t Possible

Unfortunately, not every tooth that came out can be saved. If replantation fails or isn’t possible, several replacement options exist:

Dental implants: A titanium post is surgically placed in the jawbone to serve as an artificial root, topped with a crown.

Dental bridges: Artificial teeth anchored to neighboring teeth can fill the gap.

Partial dentures: Removable appliances can replace one or more missing teeth.

Your dentist can discuss these options with you and recommend the best solution for your specific situation.

Conclusion

When a tooth came out, swift and proper action is essential. Remember these key points: handle the tooth by the crown only, keep it moist, try to replant it yourself if possible, and seek emergency dental care immediately. The first hour after your tooth came out is the most critical for successful replantation. By following the guidelines in this article, you give your tooth the best possible chance of survival. Always remember that even with perfect care, a tooth that came out may not survive long-term, but taking immediate action significantly improves the odds. Keep your dentist’s emergency contact information readily available, and if you participate in high-risk activities, consider keeping a tooth preservation kit on hand. Your quick thinking and proper actions in those first crucial minutes can make all the difference in saving your smile.

Sources:

• Mayo Clinic – Tooth Loss First Aid
• American Dental Association – Dental Emergencies
• American Academy of Pediatric Dentistry – Dental Trauma
• National Center for Biotechnology Information – Tooth Avulsion
• MedlinePlus – Dental Emergencies