How to Assess and Treat a Person with a Tooth Knocked Loose or Completely Out

A tooth that has been knocked loose or completely out is a serious injury and should be addressed immediately by a dentist. However, before the affected person actually makes it to the dentist, several steps will need to be taken to ensure the best outcome. Below is what you should do in the event of a partially or fully removed tooth:

1. Assess for injuries other than those affecting the teeth - The force it takes to knock a tooth loose or free of the jaw can cause significant injuries to the head or spine. Most importantly, this degree of trauma can cause concussions or even worse injuries, such as hematomas or severed spinal cords. A failure to properly assess for these serious injuries can lead to permanent disability or death for the person affected.

That is why a brief assessment should be performed before addressing the tooth itself. Here is what you should look for:

  • Unconsciousness, even if for a few seconds

  • Disorientation and confusion

  • Vomiting

  • Distention of the neck or back

  • Numbness or loss of movement in extremities

Should any signs of concussion or other neurological damage be present, then call an ambulance and keep the individual still until they arrive. The priority at this point is preservation of life and prevention of permanent damage.

2. Preserve the tooth - If the individual affected seems to be in fairly good condition and shows no signs of a neurological or other systemic problem, then you can focus on saving the tooth from permanent loss. There are a couple of things you can attempt, depending on the resources you have available at the moment and whether the tooth is loose or fully out of place.

Re-seat the loosened tooth - If a tooth has been knocked loose but is not fully out of its socket, then you may be able to gently re-seat the tooth. To do so, rinse the mouth gently with clean, cold water, then lightly apply pressure to the top of the tooth and push it back into place. Do not grasp the roots or apply pressure to the tooth at any point.

Soak the tooth in clean water or milk -  Should the tooth be completely free of the socket, then you can place it into a clean container of tap water or cold milk, if available. When handling the tooth, avoid touching the roots and never scrub the tooth with any objects or your fingers, even if it becomes dirty during the accident. In addition, be sure the water used is cold.

3. Address bleeding and the wound inside the mouth - Much of the time, a tooth knocked loose will not generate life-threatening bleeding, but moderate bleeding should be addressed. By the rinsing of the mouth with cold water, the bleeding will slow down in most cases. However, if bleeding is severe and does not seem to slow on its own, apply direct pressure to the wound with a gauze pad or washcloth until a clot forms. Do not remove the pad or washcloth, though, as you may dislodge the clot.

4. Proceed to the dentist's office immediately - Once you have assessed the individual who was injured and have the tooth in hand, then your next step is to proceed immediately to a dental office or emergency center. Whenever possible, call ahead before arriving to alert the staff of the dental facility; this will help them prepare for the patient and be in a position to move quickly.

After arriving at the dental facility, the staff will likely conduct an evaluation of the injury site as well as take custody of the tooth, if fully removed. X-rays are a normal part of the procedure and are useful for checking for broken roots and fractures within the jaw itself. Finally, the dentist will probably attempt reseating the tooth and attach it to neighboring teeth for support. Most teeth, if properly treated, will reattach to the underlying bone and regain their strength.