Dental injuries, especially to the upper central incisors, are extremely common in both young children and in athletes, both adolescent, and adult. Most of the time, the teeth get chipped or cracked and can be repaired by routine dental techniques like fillings or crowns. Unfortunately, if a properly fitted mouthguard is not worn, more severe injuries can occur like bone fracture and tooth avulsion, where the tooth gets knocked out of the mouth completely.
If the avulsed tooth is a baby tooth and not a permanent tooth, usually before the age of 5 or 6, prudent treatment is usually to simply manage the wound and let the tooth fairy have the tooth. Replanting the tooth can cause damage to the adult tooth that is developing below, which has already probably been injured and scarred by the original trauma. Depending on how old the child is when the baby tooth is avulsed, cosmetic scarring of the adult tooth may be expected which would require some cosmetic dentistry for repair in the future. Also, due to the loss of function of the surrounding cells that cause natural resorption and exfoliation of baby teeth, eruption of the adult teeth may be delayed; however, it will occur.
If the avulsed tooth is an adult tooth, the treatment options and outcomes are much more complicated. The time that the tooth is out of the mouth is by far the most important factor in successful replantation. If a tooth is immediately replanted after avulsion within 5 minutes after the injury, the success of replantation is best (50%). Obviously, in most cases, someone other than the dentist will be performing the replantation. Because the cells on the root surface must be alive and are very delicate, the tooth should not be scrubbed or rinsed vigorously; if the tooth falls in the dirt, like on a ball field, the tooth should be rinsed gently with the athlete’s own saliva before replantation. Simply place the tooth back into the socket and stabilize it with gauze or cotton until a dentist can manage the situation. Anesthesia is not an issue because even in an ideal dental setting it takes about 7 minutes to numb the site, which is beyond the critical time. If immediate replantation is absolutely not possible for whatever reason, place the tooth immediately in a biologic storage medium such as saliva (store in the cheek), milk, or an even better medium is a solution called EMT Toothsaver®. Coaches and paramedics often have the EMT Toothsaver®, but it might be wise to purchase one of these containers from your dentist and keep is with you at all athletic events.
Once a tooth is replanted, several events will need to occur. The dentist will need to take several x-rays during the therapy to assess proper positioning and to monitor the tooth at frequent intervals, usually at 2 weeks, 3 months, 6 months, and then annually. Root canal therapy will be necessary and some form of orthodontic splinting for about 2 weeks will be needed. The healing process will then occur to result in one of three outcomes: normal healing, ankylosis, or root resorption.
Ankylosis is the process where the tooth actually gets scarred directly to the bone, which can be a problem for orthodontic development and for future extraction. Root resorption usually occurs as the cells around to the tooth react to the replanted tooth as a foreign body and then try to destroy it. Most likely, this is what will eventually cause the loss of a replanted avulsed tooth. Of course, infection is also possible. All of these are reasons for the dentist to do frequent follow-up x-rays. One other factor that should be considered in this age of implant therapy is that the current literature suggests that implants may not fare as well in the site of a previously replanted and subsequently extracted tooth as they would in other sites, possibly because of the inflammatory processes that have occurred around the replanted tooth.
Therefore, if your child has their tooth knocked out, be sure that you know if it is an adult or baby tooth. If it’s an adult tooth, try to immediately replant it and get to your dentist as soon as possible. Apply ice to the lip to reduce swelling and pressure to control major bleeding. Once at the dentist’s office, cooperation is essential. The dentist will need to be able to take x-rays and provide the necessary care, probably without anesthesia. When unavoidable traumatic injuries occur, tension and fear levels are high; cooperation, support, and teamwork is essential to achieve the best outcome.