Have you been in an accident and your tooth was knocked out? — Jump ahead to these guidelines about what to do from the point of your accident until you get to a dentist.

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What information is this infographic based on?

A guide for avulsed teeth.

While investigating the subject of first aid protocols for teeth that have been knocked-out, we ran across a StatPearls review on the NCBI Bookshelf that specifically covered this topic: Avulsed Tooth Care.

What we found interesting in the guide.

While reading, we noticed that this source repeatedly emphasized that improper care of the lost tooth for as little as 30 to 60 minutes can significantly affect the survivability of the cells on its root surface — the cells that play a vital role in whether the tooth heals and reattaches properly once it’s reimplanted.

• In some ways, we were amazed that the cells were that hardy — that they could last in a dry state for even 30 minutes.
• More importantly, in regard to the short time window mentioned, we wondered who, especially on a weekend, can get to a dentist within that time frame? Doing so seems an improbable event.

The good news.

Of course, if you know anything about this topic, or if you’ve even just read through our infographic, you know that the good news is that — with essentially no forethought or planning — the viability of these essential cells can be extended. It’s just a simple matter of keeping them moist — with the catch that the proper kind of liquid must be used.

What kind of liquid must an avulsed tooth be stored in?

The idea is that the liquid chosen must be biologically compatible with living cells. More formally, the solution must be isotonic — meaning it has the same salt and water balance that’s found inside cells.

What kind of solutions qualify?

As our infographic reports, finding an appropriate isotonic liquid is easy.

• If not too overwhelming after the shock of an accident, placing the tooth back into its socket provides the proper environment for the cells.
• Placing the lost tooth between your lower lip and gums, or under your tongue, bathes the tooth in saliva, your body’s own isotonic solution.
• If for some reason an external storage solution is preferred, placing the tooth in a cup with saliva or milk are good options.
• If anyone on your sports team has thought ahead, they may have with them an OTC tooth-preservation kit. Some brand names are: Save-A-Tooth® and EMT Tooth Saver®.

Each of these options is quick and easy. And that means you can accomplish them within moments and then be on your way to a dentist for reimplantation immediately!

Remember, the solution you choose must be isotonic!

A really important thing to keep in mind is that placing the tooth in just plain water never makes the right move. Plain water is not isotonic and soaking the cells on your tooth’s root in it will harm them irreparably.

The same probably goes for most anything else you might have been drinking before the accident — like soda, fruit drink, etc… — at least in the sense that saliva is ideal and 100% available, so why take a risk on any unknown.

Guidelines for storing an avulsed tooth until you get to a dentist.

We used our “Avulsed Tooth Care” source cited above and a MedlinePlus Encyclopedia article: Broken or knocked out tooth. to assemble the following more detailed and complete guidelines for storing an avulsed tooth from the time of your accident until your arrival at a dentist’s office or emergency room.

Steps to take for a knocked out tooth.

1. Recover the tooth carefully. Pick it up by the crown (the chewing surface) only — never touch or handle the root. Avoid scraping, wiping, or cleaning the root, and don’t brush it or use alcohol or peroxide on it.
2. Act fast — don’t let it dry out. The tooth’s outlook depends heavily on how quickly it’s kept moist. Air exposure past 30 minutes measurably lowers the odds of success, and past 60 minutes it needs more involved follow-up treatment once replanted.
3. Try to reinsert it into its own socket first, if you can. Position it level with the surrounding teeth and bite down gently on gauze or a wet tea bag to hold it in place. Be careful not to swallow it.
4. If reinserting it isn’t possible, choose a proper isotonic storage method instead — one of the following:
   • Hold it between your lower lip and gum, or under your tongue, so it’s bathed in saliva.
   • Place it in a container with a small amount of cow’s milk or saliva.
   • Use a commercial tooth-preservation kit (such as Save-A-Tooth® or EMT Tooth Saver®) if one is available.
5. Never store it in plain water. Water’s low osmolality can damage the tooth’s root-surface cells rather than protect them.
6. Manage bleeding and pain. Apply direct pressure with gauze to control bleeding, and a cold compress on the outside of the mouth to ease pain.
7. Get to a dentist immediately — don’t wait, even if it means visiting an emergency room. The sooner the tooth is replanted, the better its outlook.
8. Watch for a possible jaw fracture. If you can’t close your upper and lower teeth together normally, this may indicate a broken jaw, which requires immediate medical attention at a dentist’s office or hospital.

What to expect after arriving at your dentist’s office.

• Reimplantation: Your dentist will align the tooth back into its socket and press it firmly into place.
• Splinting: The tooth is stabilized with a flexible splint bonded to the neighboring teeth. This typically stays in place for 2 weeks — or 4 weeks if the tooth was out of the mouth (and dry) for more than an hour.
• Antibiotics: A course of antibiotics (typically doxycycline for 5 days, or amoxicillin if you can’t take doxycycline) is commonly prescribed to help prevent infection.
• Tetanus check: Your dentist may confirm your tetanus immunization is up to date, since the injury involved trauma and possible contamination.
• Aftercare instructions: You may be asked to stick to a soft diet for about 2 weeks, rinse with a chlorhexidine mouth rinse, and brush carefully after meals to help prevent infection.
• Follow-up visits: The splint is typically removed after 2 weeks, at which point your dentist checks the tooth’s stability and tests whether the nerve is still alive. Further check-ups and x-rays continue at 1, 3, and 6 months, and yearly after that, to watch for any signs of the root fusing to the bone or being resorbed.
• Root canal treatment: This is frequently needed at some point, since the nerve inside the tooth doesn’t survive the injury.

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