Knocked Out Tooth: What to Do When a Tooth Is Damaged or Avulsed

How Do You Know If a Tooth Is Damaged?

Signs of tooth damage include: loose tooth, color change (pink, yellow, gray, or brown), pain when eating, bleeding from gums, swelling around the tooth, sensitivity, or a broken piece of tooth. Any of these symptoms after an accident warrant a dental visit.

You can tell that a tooth has been damaged if you or your child has one or more of the following symptoms after an accident:

• The tooth is looser than the other teeth in the mouth
• The tooth changes color and becomes pink, yellow, gray, or brown
• The tooth hurts and it may be difficult to eat
• There is bleeding from the gum around the tooth
• The gum around the tooth swells up and blisters form
• The tooth feels sensitive or different
• A piece of the tooth has broken off

When and Where Should You Seek Care?

Contact a dentist immediately if a permanent tooth is knocked out or damaged. For a knocked out permanent tooth, time is critical - seek emergency dental care right away. If it's closed, find an emergency dentist. Call emergency services if there's difficulty breathing or severe facial injury.

Contact a dentist if a child has knocked out or damaged a baby tooth.

For permanent teeth

Contact a dentist if you or a child has damaged a permanent tooth and has one or more symptoms described above.

Contact a dentist immediately if you or a child has knocked out a permanent tooth. If the dental office is closed, find an emergency dentist.

Call your local health information line if you want healthcare advice. They can help you assess symptoms or advise where to seek care.

What Can You Do Yourself? Emergency First Aid

For a knocked out permanent tooth: 1) Pick up by the crown only, never the root. 2) Rinse gently if dirty. 3) Try to reinsert it into the socket, or store in milk. 4) See a dentist immediately. For baby teeth: Never reinsert - wrap in tissue and bring to dentist.

It's crucial to store a knocked out tooth correctly.

Knocked out baby tooth

Never put a knocked out baby tooth back in the child's mouth. This can damage the permanent teeth waiting in the jaw beneath the gum line.

You can wrap the knocked out tooth in paper and bring it to the dentist. The tooth does not need to be stored according to the instructions below.

Knocked out permanent tooth - store in mouth or liquid

A dentist needs to examine the teeth as soon as possible if a permanent tooth has been knocked out. It's important to protect the tooth's root on the way to the dentist so it doesn't dry out.

Do one of the following as soon as possible after the accident:

1. Reinsert the tooth into the hole in the tooth row where it was. This is the best place to store it on the way to the dentist. Children can bite on a handkerchief or similar to hold the tooth in place.
2. Place the tooth in a glass of cow's milk if you cannot reinsert it into the hole.
3. Place the tooth in a glass of saline solution if you don't have cow's milk. You can use the kind of solution used for cleaning contact lenses.
4. Place the tooth under the tongue if you don't have cow's milk or saline solution and cannot reinsert it into the hole.

Hold the tooth crown when handling a knocked out tooth

You may need to clean the tooth before reinserting it into the mouth. When doing so, hold the tooth crown - that's the white upper part of the tooth. Avoid touching the tooth root.

Gently rinse the tooth under cold running water for about ten seconds. You can also rinse the tooth in sterile saline solution if you have it.

Then gently press the tooth back into the hole where it was. You can also place it in a glass of cow's milk or saline solution as described above.

Store a broken piece of a permanent tooth in water

If it's a piece of a permanent tooth's crown that has broken off, you should place the piece in a glass of cold water. It should stay there until you see a dentist. This should preferably happen within 24 hours.

How Are Permanent Teeth Treated?

Treatment depends on the injury: broken teeth are rebuilt with composite filling or crown; loose teeth are splinted to neighboring teeth for 2-3 weeks; knocked out teeth are replanted and splinted. Root canal treatment may be needed within 2-3 weeks for mature teeth.

You should always contact a dentist if the damaged or knocked out tooth is a permanent tooth. What treatment is needed depends on the injury.

The faster the tooth is put back in place, the greater the chances that the tooth will heal well.

If a piece of a permanent tooth is knocked out

The dentist usually builds up the damaged tooth with a plastic (composite) filling. Sometimes the dentist glues the loose piece back on.

Eventually, the glued tooth or filling may need to be replaced. The dentist can then make a porcelain veneer or a porcelain crown.

If a larger piece of the tooth has been knocked off, the tooth's inner part may be visible - the part also called the pulp. Then there is a risk of infection in the tooth. The dentist needs to treat the inside of the tooth first, before the tooth is built up with a composite filling.

If a permanent tooth is loose

The tooth can heal on its own if it remains in its original position. It may bleed and hurt. It may also be difficult to eat.

If the tooth has moved a little, the dentist tries to put the tooth back. With a wire and some composite, the dentist attaches the loose tooth to the teeth next to it. After about three weeks, the dentist removes the wire.

It's important that you take care of your teeth carefully during these three weeks. You can read more about how to care for your teeth further down in this text.

If a permanent tooth has been knocked out

The dentist tries to put the tooth back where it was before. Then the dentist attaches it to the teeth sitting next to it with wire and composite. After about three weeks, the dentist removes the wire.

It's important that you take care of your teeth carefully during these three weeks.

A knocked out tooth may need root canal treatment

A knocked out permanent tooth may need root canal treatment after it has been attached because teeth that have finished growing have difficulty healing on their own. The tooth then needs to be root treated within two to three weeks after the accident.

The permanent teeth of children up to about ten years old are still growing. The teeth can then usually heal on their own.

How Are Baby Teeth Treated?

Most baby tooth injuries heal without problems. However, a dentist should examine the child to check for damage to developing permanent teeth. Loose baby teeth usually aren't treated unless they interfere with biting. Knocked out baby teeth are never reinserted.

Most injuries to baby teeth heal without problems. But sometimes the permanent teeth inside the jaw under the gum line are damaged. Therefore, it's important that a dentist examines the child's teeth and jaw if the child has damaged or knocked out baby teeth.

If the child has knocked off a piece of a baby tooth

If the child has knocked off a piece of a baby tooth, the dentist usually just files down the tooth if needed. The child can get protective composite or fluoride varnish on the tooth if it's very sensitive.

The inside of the tooth may sometimes be visible if the child knocks off a larger piece of the baby tooth. This is where nerves and blood vessels are located, and the child may get pain in the tooth. The dentist then extracts the damaged tooth.

If a baby tooth is loose

The dentist usually doesn't treat a tooth that is loose. But sometimes the tooth may need to be extracted. This can be the case, for example, if the child cannot bite together.

If the child has knocked out a baby tooth

A knocked out baby tooth is never put back, but the dentist examines how it looks in the mouth.

Aftercare: Eating and Caring for the Tooth

Eat soft foods and avoid chewing with the damaged tooth for up to a week. Continue brushing teeth even if it hurts. Rinse with chlorhexidine morning and evening for about 3 weeks if the tooth is splinted. Children should avoid pacifiers and thumb-sucking after tooth replantation.

The tooth may hurt afterward, and it may be difficult to chew. Preferably eat soft, easy-to-chew food and avoid chewing with the damaged tooth. It may hurt for up to a week.

Care for the tooth after the accident

It's important to continue brushing your teeth, even if it hurts.

You can rinse your mouth with chlorhexidine if needed to keep it clean. This often applies if the dentist has used wire to attach a knocked out or loose tooth. Chlorhexidine is a liquid that kills bacteria. You can buy chlorhexidine at a pharmacy.

Rinse your mouth morning and evening for about three weeks, until the wire has been removed. You can also clean just the injured area if it's difficult to rinse your mouth. Then wash the tooth and gum with a cotton swab and chlorhexidine.

Use pain relievers

Pain-relieving medications can help if it hurts. For children, there are medications containing the active ingredient paracetamol, for example.

Children who suck on pacifiers or thumbs

If the child uses a pacifier or usually sucks on their thumb, it's good if the child does it as little as possible after the tooth has been put back in the mouth.

What Complications Can Occur?

A damaged tooth may change color over time: pink indicates internal bleeding, yellow indicates calcification, gray/brown may indicate infection. Pink and yellow colors don't require treatment, but gray or brown teeth should be examined as they may need root canal treatment.

A permanent tooth or a baby tooth that has been damaged can change color over time and become pink, yellow, brown, or gray. What color the tooth gets depends on what happens:

• A pink tooth means there has been bleeding inside the tooth.
• A yellow tooth means calcifications have formed inside the tooth.
• A brown or gray tooth may mean there has been an infection in the tooth.

The tooth doesn't need treatment if it has had bleeding inside or if calcifications form. The bleeding goes away on its own and after a few weeks the tooth becomes white again. The calcification, however, doesn't go away, so the yellow color will remain.

An infected tooth can hurt. The tooth may also feel loose and sometimes it looks longer than before. A dentist should always examine the tooth if it has become gray or brown, which can take several years. Sometimes certain gray discolorations can disappear on their own, but a permanent tooth may also need root canal treatment.

Children can get a temporary bridge

A child who has knocked out a tooth can get a dental appliance with a plastic tooth. The plastic tooth replaces the missing tooth until the child has grown older and can get a temporary bridge. In some cases, the plastic tooth may need to be replaced with an implant.

How Can You Prevent Dental Injuries?

Use a mouthguard during contact sports - especially important if you have protruding front teeth. Custom mouthguards are made by dentists using a mold of your teeth. Though it may feel unusual at first, most people adapt quickly.

In certain sports and activities, there is a greater risk of injuring your teeth. Then it's good to use a mouthguard. It's especially important to use a mouthguard if you or the child has protruding front teeth.

In the beginning, the mouthguard may feel unusual, but most people get used to it quickly.

Mouthguards are made at the dentist. You or your child leave an impression of the teeth, so the mouthguard is personal.

The cost of a mouthguard varies between different regions. Contact your dentist to find out what applies to you.

Your Rights in Dental Care

You can seek dental care at any clinic nationwide. Prices vary by clinic - ask for costs in advance. Children and young people receive free dental care through the year they turn 19. Adults receive an annual dental care allowance, with additional high-cost protection available.

You can seek dental care at any dental clinic you want throughout the country. Each dental clinic decides its own prices for the dental care it provides. Ask what an examination or treatment costs. You have the right to know this in advance.

Free for children and young people

Children and young people don't have to pay for dental care. This applies through December 31 of the year you turn 19. This includes almost all examinations and treatments that the dentist or dental hygienist considers you need.

Dental care allowance

You pay for dental care from the year you turn 20. You receive an allowance for dental care every year. How much you get depends on how old you are. This is called the general dental care allowance. Tell them you want to use the allowance when you pay.

High-cost protection

The high-cost protection for dental care works so that during a twelve-month period you pay the full cost of dental care up to a certain amount. If your dental care costs during the period exceed that amount, you receive dental care support from the state.

Guarantees

There are guarantees for most treatments. This means you can have a treatment redone without having to pay again.

Interpretation to your language

You can get help from an interpreter if you don't speak the local language. Let them know you need a language interpreter when you book your appointment. Sometimes you may need to pay for the interpreter.