Dental Trauma: Broken and Knocked-Out Teeth

Dental trauma means a tooth being broken, loosened or knocked completely out of its socket by a fall, a blow, a sports injury or a road accident. It is most common in childhood and adolescence: in toddlers learning to walk, in the playground, on bicycles and in contact sports. The upper front teeth are the ones most often affected.

With dental trauma, the outcome is often decided before any dentist is involved, by the adult who is there when the accident happens. So this page first explains what to do in the first hour, and then what happens at the clinic.

What should you check first when the accident happens?

The child first, then the tooth. Loss of consciousness, vomiting, a severe headache, dizziness, or blood or fluid coming from the nose or ears are signs of a head injury; in that case go straight to an emergency department, and the tooth can wait. If there is coughing or shortness of breath after the accident and a broken piece of tooth cannot be found, consider that it may have been inhaled into the airway, and seek emergency care. If there is a deep cut in the lip or bleeding that will not stop, press on it with a clean cloth and set off; stitches may be needed. If the wound or the tooth came into contact with soil, ask your family doctor whether your child's tetanus vaccinations are up to date.

A permanent tooth has been knocked out: what do you do in the first 60 minutes?

Whether a permanent tooth knocked completely out of its socket can be saved depends on the cells on the root surface staying alive. Once these cells dry out, they die quickly. Stay calm and do the following:

1. Find the tooth and hold it by the crown, the white part you normally see in the mouth. Do not touch the root.
2. If it is dirty, hold it under cold running water for ten seconds at most. Do not brush or scrub it, and do not use soap or alcohol.
3. Put it back in if you can. If your child is calm, push the tooth back into its socket the right way round and have them bite on a clean handkerchief or gauze to hold it in place.
4. If you cannot put it back, put it in milk. If there is no milk, use saline or your child's own saliva spat into a small container. Do not wrap it in a tissue or let it dry out.
5. See a dentist immediately. If you are in İzmir, call our clinic on the way so we can be ready for you; if you are not, go to the nearest dentist or emergency service. Once the tooth has been out of the mouth and dry for more than 60 minutes, the chance of success drops sharply: the sooner, the better.

At the clinic we put the tooth back in place, or check that you have replanted it correctly, and then splint it to the neighbouring teeth with a fine wire and composite, usually for two weeks.

Why is a knocked-out baby tooth not put back?

The bud of the permanent tooth develops just behind the root of a baby tooth. Pushing a knocked-out baby tooth back into its socket can damage that bud and carries a risk of infection. That is why baby teeth are not put back. Even so, have your child examined the same day, by the nearest dentist if you are not in İzmir: we check whether any piece of root has been left behind, look at injuries to the lip and gum, and confirm whether the tooth has really come out or has been pushed up into the gum. Early loss of a baby front tooth does not usually lead to significant space loss; if needed for appearance or speech, a space maintainer can be discussed.

What is done for a broken or loosened tooth?

If you can find the broken piece, bring it in a glass of water or milk; in suitable cases it can be bonded back on.

What does a change in colour mean, and why is follow-up needed?

The effects of trauma sometimes appear only weeks later, because the blood vessels supplying the nerve of the tooth may have been damaged at the moment of the accident. That is why we do check-ups with X-rays in the first weeks, then at around 3 months, 6 months and 1 year; with some injuries, follow-up continues for several years. Do not wait for the next check-up if you notice:

• the tooth turning grey or darker;
• a pimple-like bump or swelling on the gum;
• pain that does not go away, or the tooth becoming loose again.

A change in colour does not always mean the nerve has died. Especially in baby teeth, a grey colour can fade over time; sometimes the inside of the tooth calcifies and the tooth turns yellowish, which usually only needs monitoring. A permanent tooth showing signs of infection needs root canal treatment. In a tooth with a fully formed root that has been put back in place, root canal treatment is usually started within the first two weeks; in young teeth whose roots are still developing, we decide while monitoring whether the nerve may recover. After injuries to baby teeth, we also keep watch until the permanent tooth underneath comes through, to see whether its enamel has any staining or defect in shape.

What if a teenager loses a permanent front tooth, and how can accidents be prevented?

For a permanent front tooth that cannot be saved, the long-term solution is usually a dental implant. But implants are not placed until jaw growth is complete, because unlike natural teeth an implant does not move with growth. Until then the gap is held with a temporary denture or a bonded bridge.

The most effective protection is wearing a mouthguard for contact sports; custom mouthguards made from an impression fit better than ready-made ones and interfere less with speech. Children whose upper front teeth stick out noticeably are at higher risk of breaking them, and an orthodontic assessment is useful from this point of view too.