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Knocked-Out Or Loose Tooth

Select Your Current Condition:

Intro

Injuries to the mouth may include teeth that are knocked loose, knocked out of position (extruded), knocked or forced into the tooth socket (intruded), or completely knocked out (evulsed). Sometimes lips, gums, tongue or cheeks have cuts (see the following section “Soft Tissue Injuries”). Oral injuries are often painful, and should be treated by a dentist as soon as possible.

You should not delay a visit to our office for needed care. If a permanent tooth is even slightly traumatized, it could result in tooth nerve damage and subsequent need for a root canal.

ALWAYS RULE OUT:
Jaw Fracture (may cause looseness of teeth). Parts of the jaw may move independently.

If You Suspect a Broken Jaw:
Do not move the jaw. Secure the jaw in place by tying a handkerchief, necktie, or towel around the jaw and over the top of the head. If there is swelling, apply cold compresses. Go to your dentist or a hospital emergency room immediately. If you are concerned about a broken jaw, our office is equipped with a panoramic x-ray unit. Dr Landers will read the X-ray and determine if you have a jaw fracture.

 

 
 

#1 Knocked Loose & Still In Position

Rule Out
When evaluating tooth mobility, its important to note that teeth with less bone to support the tooth root will move more. If you have Pre-existing bone loss possibly from a history of Gum Disease, or previous dental infection your teeth may have been loose prior to accident.

TOOTH SLIGHTLY MOBILE (<2mm Movement)

Primary or Permanent Tooth

      • A soft diet and small volume bits are highly recommended. Avoid eating near the tooth and try to avoid touching your tooth or continually trying to test your tooth for movement. If its not hitting when your bite, its best to completely leave it alone. Benefits of leaving it alone: experience less pain and it will begin to heal more quickly. 
      • If your tooth was knocked hard enough to move it out of position. You may notice that your tooth now hits prematurely during normal chewing function. If the later is true, it’s very important that you go to our office as soon as possible. 
      • in all cases, its recommended you come to our office to have your tooth evaluated. Tests Dr. Landers will complete:
        • Evaluate amount of Looseness (tooth Mobility). Determine if a bonded splinting of your teeth together is necessary.
        • Check for Tooth nerve vitality. Trauma can cause tooth nerve necrosis and possible need for a root canal.
        • Take 3D Xray to evaluated for Root or crown (tooth enamel cracks). 

TOOTH GROSSLY MOBILE (>2mm Movement)

Children -Primary (baby) Tooth
Loose teeth in children will generally tighten up over a few weeks or exfoliate. Come to our office (24 hours) for an evaluation.

Adults Permanent (Adult) Tooth

      • Bite gently on gauze to keep tooth in place, and/or prepare soft orthodontic wax molded over several teeth to temporarily stabilize teeth.
      • Soft diet and avoid eating near the tooth.
      • Come to our office (within 24 hours) for tooth to tooth bonding together as a splinting stabilization.

 

 
 

#2 Knocked Out Of Position

Rule Out

      • Pre-existing bone loss from a history of Gum Disease or dental infection (teeth may have been loose prior to accident).
      • Tooth is not knocked inward into the tooth socket (see Intruded).
      1. If the tooth is pushed out of position, it should be repositioned to its normal alignment with very light finger pressure. Do not force the tooth into the socket. Make sure the tooth does not prematurely interfere when the injured person closes into biting contact.
      2. Bite gently on gauze to keep tooth in place, and/or prepare soft orthodontic wax molded over several teeth to temporarily stabilize teeth.
      3. Soft diet and avoid eating near or disturbing the tooth.
      4. It is important that the injured individual be seen by a dentist within 30 minutes for splint stabilization. It’s best to go immediately but no more than 12 hours.

 

 
 

#3 Knocked Inward (into tooth socket)

CLINICAL PRESENTATION

      • History of trauma
      • Crown of tooth is partially or completely embedded in gum tissue.

TREATMENT:
Primary (baby) Tooth

      • Rinse to locate tooth
      • Patient manipulation of tooth not recommended
        (dentist may choose to allow tooth to re-erupt on its own).
      • Soft diet and don’t eat near or disturb the tooth.

Refer immediately (24 hours) to dentist for appropriate x-rays and treatment.

Permanent Tooth

      • Rinse to locate tooth
      • Patient manipulation of tooth not recommended.
      • Soft diet and don’t eat near or disturb the tooth.

Refer immediately (12 hours) to dentist for appropriate x-rays and treatment. Timely dental treatment is essential to prevent ankylosis. 
 

#4 Knocked Completely Out

CLINICAL PRESENTATION

      • Tooth is missing? (rule out complete intrusion of tooth below gingival level)
      • If tooth is available and intact, assess tooth status:
        1. Time elapsed since avulsion (up to 2 hrs. -prognosis is good if proper re-implantation procedures are followed- get to our office or hospital ASAP).
        2. Store the tooth on the tongue or cheek side in the injured person’s mouth* or in a container of milk.
        3. Age of patient:
          <5 yrs. old — do not replant (primary teeth)
          > 5 yrs. old — refer to Eruption Chart to confirm permanent vs. primary.

When a tooth is knocked out you should:

      • Immediately call our office for an appointment.
      • Hold the tooth by the crown, and rinse off the root of the tooth if it’s dirty. Do not scrub it or remove any attached tissue fragments.

Option A – Less Than 2 Hours Travel Time.

Go to our office or the Hospital.
Place the clean tooth in the injured person’s mouth between the cheek and gum*.
*If it is not possible to store the tooth in the mouth of the injured person, (e.g. young child) wrap the tooth in a clean cloth or gauze and immerse in milk.

Option A – More Than 2 Hours Travel Time.

And it’s possible for you to reimplant the tooth.

      1. Hold the tooth by the crown and gently insert and hold the tooth in its socket.
      2. The tooth should be repositioned to its normal alignment with very light finger pressure. Do not force the tooth into the socket. Make sure the tooth does not prematurely interfere when the injured person closes into biting contact.
      3. Bite gently on gauze to keep tooth in place, and/or prepare soft orthodontic wax molded over several teeth to temporarily stabilize teeth.
      4. Don’t eat near or disturb the tooth.
      5. It is important that the injured individual be seen by a dentist as close to 30 minutes as possible for splint stabilization.

Rx:
Please note your last tetanus immunization, you may need a booster.

 

 
 

#5 Children’s Notes & Eruption Chart

Follow all of the previous 1-4 options & recommendations based on Primary (baby teeth). Use the following chart as a guide if you are not sure if your child’s tooth is primary (baby) tooth or secondary permanent adult tooth.

Eruption And Shedding OF PRIMARY –baby Teeth

BLEEDING AFTER BABY TOOTH COMES OUT
Fold and pack a clean gauze or cloth over the bleeding area. Have the child bite on the gauze with pressure for 15 minutes. This may be repeated once; if bleeding persists, see a dentist.

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