Dental Trauma (Tooth Injuries): First Aid and Treatment

What to do right now

Knocked-out adult (permanent) tooth

1. Find the tooth. Pick it up by the crown (the white chewing part). Do not touch the root.
2. If dirty, rinse briefly (about 10 seconds) under cold running water or with milk. Do not scrub it or wrap it in tissue.
3. Put it back in the socket right away if you can, the correct way around. Bite gently on a clean cloth to hold it in place.
4. If you cannot replant it, keep it moist: in a glass of cold milk, saline or the person's own saliva (for example inside the cheek of an adult who will not swallow it). Do not store it in water.
5. See a dentist or go to the ER immediately. The best outcomes happen when the tooth is replanted within 30 to 60 minutes.

Knocked-out baby tooth

Do not put it back, as this can damage the adult tooth developing underneath. Control bleeding with gentle pressure and see a dentist soon.

Broken or chipped tooth

• Rinse the mouth with warm water.
• Save any pieces in milk or water and bring them to the dentist. They can sometimes be bonded back.
• Apply a cold compress to the face to reduce swelling.
• Take acetaminophen (paracetamol) or ibuprofen at the label dose for pain.

Loose or displaced tooth

• Do not wiggle the tooth.
• If it is pushed out of position, gently push it back with light finger pressure only if it moves easily, then see a dentist right away.

Bleeding from the mouth

Press a clean, damp gauze or cloth firmly on the bleeding area for 10 to 15 minutes.

Types of dental injuries

Injuries to the gums, lips, tongue and jaw bone often occur at the same time, including a broken jaw. A cracked tooth without a visible break can cause pain on biting.

Causes and who is at risk

• Falls, especially in toddlers learning to walk and older adults
• Contact sports and cycling, skateboarding and playground accidents
• Fights and assaults
• Car crashes
• Biting hard objects
• Children with protruding front teeth, and people with seizures

Diagnosis

A dentist examines the teeth, gums and bite, tests how loose and sensitive the teeth are, and takes X-rays to look for root fractures, displacement and damage to the bone or developing teeth. A head injury or concussion should be ruled out first in anyone with a significant blow to the face.

Treatment

• Chips and fractures: smoothing, tooth-colored bonding, reattaching the fragment, or a crown. Exposed nerves may need a partial or full root canal treatment.
• Loose and displaced teeth: repositioning and a flexible splint attached to neighboring teeth, usually for 2 to 4 weeks.
• Replanted teeth: a splint for about 2 weeks, antibiotics in some cases, and usually root canal treatment within 1 to 2 weeks for fully developed adult teeth.
• Teeth pushed into the gum: in children, may be allowed to re-erupt; in adults, repositioned with orthodontic or surgical methods.
• Soft tissue injuries: cleaning and stitches.
• Tetanus: a booster may be needed if the wound is contaminated and your vaccination is not up to date.

Care at home after treatment

• Eat soft foods for 1 to 2 weeks.
• Brush gently with a soft toothbrush and use a chlorhexidine mouthwash if advised.
• Avoid contact sports until the dentist approves.
• For children, avoid pacifiers and thumb-sucking where possible while healing.

Complications

• Death of the tooth nerve, causing gray discoloration, abscess or infection (see dental abscess)
• Root resorption, where the body gradually dissolves the root
• Ankylosis, where the tooth fuses to the bone
• Damage to developing adult teeth after injuries to baby teeth
• Loss of the tooth

Follow-up X-rays at intervals over months to years help spot these problems early.

Prevention

• Wear a custom-fitted mouthguard for contact sports, martial arts, skateboarding and similar activities.
• Wear seatbelts and use proper child car seats.
• Childproof homes for toddlers.
• Avoid chewing ice, pens and hard candy.

Frequently asked questions

What should I do if a tooth gets knocked out?

For an adult tooth, pick it up by the crown, rinse briefly if dirty, and put it back in the socket right away. If you cannot, keep it in milk or saliva, not water, and see a dentist within 30 to 60 minutes. Never put a baby tooth back.

Can a knocked-out tooth be saved?

Often, yes, if it is a permanent tooth that is replanted quickly. The cells on the root start dying within about 15 to 60 minutes if the tooth is kept dry. Storing the tooth in milk or saliva and getting to a dentist fast gives the best chance of saving it.

Is a chipped tooth an emergency?

A small chip without pain is not an emergency, but see a dentist within a few days to smooth or repair it. A large break, severe pain, bleeding from the tooth or a visible pink spot (exposed nerve) needs same-day dental care.

Why is my tooth turning gray after an injury?

A gray or dark tooth after trauma usually means bleeding inside the tooth or damage to the nerve. Sometimes the color improves, but it can signal that the nerve has died, which may lead to infection. See a dentist for X-rays and tests.

Will a loose tooth tighten after an injury?

Mildly loose teeth often firm up within 1 to 2 weeks with a soft diet. Very loose or displaced teeth need a dentist to reposition and splint them. Avoid wiggling the tooth and see a dentist promptly to check the root and surrounding bone.