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Avulsed (Knocked-Out) Tooth

Clinical Overview


Traumatic injuries to the mouth and face can result in an avulsed, or “knocked-out” tooth. A tooth can be knocked completely or partially out of the socket (alveolus), and can even be pushed (intruded) into the socket. The traumatic forces causing the loss of a tooth or teeth can also result in other oral and facial injuries such as lacerations (a tear or cut) of the lip, mouth, tongue, gum tissues and/or face, as well as fractures to surrounding teeth and/or jaw bone.
Approximately five million teeth are lost by both children and adults each year due to trauma from accidents and sports injuries, making tooth avulsion a common but serious dental injury. Tooth avulsion is a dental emergency requiring immediate attention by a dentist, endodontist or oral surgeon. Some teeth that are knocked out can be replaced (reimplanted) giving the tooth the possibility of being saved, if prompt and proper action is taken. If a severe injury is sustained to the head and face, a life-threatening emergency situation can result causing unconsciousness, seizures, difficulty breathing or respiratory arrest, excessive blood loss, and possible shock. If a traumatic dental or facial injury is believed to be severe or life-threatening, call 911 immediately so that you or the injured person can receive immediate medical care and be transported to a local hospital or trauma center. Types of Tooth Avulsion and Associated Traumatic injuries 1. Concussion: The tooth has been hit but not noticeably loosened or moved. Part of the crown of the tooth may be fractured or broken off. The tooth may be sore to the touch or sore upon chewing. The tooth should be examined by a dentist, who will also take a radiograph (X-ray) of the tooth to determine if any other damage was caused to the tooth, gum tissue or jaw bone. Restorative treatment – such as a crown – will be needed if the tooth was significantly chipped or fractured. A root canal treatment will be necessary if the fracture extends into the pulp (nerve and blood supply) of the tooth. 2. Subluxation: The tooth has been hit and is noticeably loose, and bleeding may be seen around the tooth at the gumline. Part of the crown of the tooth may be fractured or broken off. The tooth root may also be fractured. The tooth is likely to be painful to the touch or when chewing and the tooth may move when chewing. Immediate attention from a dentist is needed to evaluate the injury and possibly stabilize the loose tooth with a splint. Restorative treatment, including the possibility of root canal treatment, will be needed if the crown of the tooth was chipped or fractured. 3. Partial Avulsion – Extruded Tooth: The tooth has been hit and partially knocked out of the socket. The tooth looks like it is longer than the teeth next to it (extruded), or the tooth has been moved out toward the lip or in toward the tongue. The tooth can be significantly loose with significant bleeding from the gumline around the tooth. The fibers (periodontal ligament) that hold the tooth in the socket have been torn and there is a loss of nerve and blood supply to the tooth due to the trauma. The jaw (alveolar) bone around the tooth may be fractured. Immediate attention from a dentist is needed to evaluate and treat the injury, including treatment such as: Placing the tooth back into the socket properly, performing root canal treatment, and stabilizing/splinting the loose tooth. 4. Intruded Tooth: The tooth has been hit and pushed further into the socket. The tooth looks like it is shorter than the teeth next to it. The tooth may not be loose and there may also be bleeding from the gumline around the tooth. The fibers (periodontal ligament) that hold the tooth in the socket have been torn and there likely is a loss of nerve and blood supply to the tooth due to the trauma. The tooth root as well as the jaw (alveolar) bone around the tooth may be fractured. Immediate attention from a dentist is needed to evaluate and treat the injury, including treatment such as: Moving the tooth back into its proper position, performing root canal treatment and stabilizing/splinting the tooth. 5. Complete Avulsion: The tooth has been hit and completely knocked out of the socket. The tooth may fall out onto the ground or floor, or can be swallowed or aspirated (caught in the airway). If the tooth is swallowed, a radiograph may be needed to confirm this. If the tooth is aspirated, this is an emergency requiring immediate medical intervention. If possible, a permanent tooth that is knocked out should be picked up by the crown, rinsed off with water and placed back in the socket by the patient or parent. If this is not possible, the tooth can be placed in milk or water and taken immediately with the patient to the dentist. The bone around the tooth may be fractured and in more traumatic cases, the jaw may be fractured or dislocated. Immediate attention from a dentist is needed to evaluate and treat the injury, including treatment such as: Placing the tooth back into the socket properly, performing root canal treatment and stabilizing/splinting the loose tooth. 6. Alveolar Fracture: When a tooth is partially or completely knocked out of the socket, part of the bone that makes up the socket (the alveolus) may become fractured due to the force of the injury. This type of bone fracture may not be visible on a radiograph (X-ray). Alveolar fractures can result in permanent bone loss around the affected tooth and may require specialized treatment by a periodontist or oral surgeon to replace or rebuild the lost/damaged bone. 7. Jaw Fracture: In cases of significant trauma to the face, one or more teeth can be knocked out and the upper and/or lower jaw can be broken (fractured). In some cases, this amount of trauma can also result in a fracture to one or more vertebrae in the neck. Jaw fractures can produce malocclusion (problems with the upper and lower teeth not coming together properly), inability to open the mouth, pain in front of the ear and significant pain and swelling where the fracture is located. Some jaw fractures can cause numbness of the face and vision problems. Jaw and facial bone fractures are serious injuries that require immediate treatment by an oral and maxillofacial surgeon. If the jaw fracture causes difficulty breathing or uncontrolled bleeding, this is an emergency and possibly life threatening situation – call 911 immediately so the injured person can receive immediate medical care and be transported to a local hospital or trauma center. 8. Jaw Dislocation or Jaw Joint (TMJ) Trauma: In cases of significant trauma to the face where one or more teeth have been knocked out, knocked loose or knocked into the socket, the jaw may become dislocated. A jaw dislocation is caused by trauma to the jaw and the temporomandibular joint (TMJ) – the joints that connect the lower jaw (mandible) to the head. A dislocated jaw is often “locked” open, making it impossible to close the mouth. Jaw dislocations are serious injuries and can become emergencies, because other trauma to the head and neck may be present that the injured person is unaware of. Immediate attention by an oral and maxillofacial surgeon is recommended, so that the full extent of the injury/injuries can be determined and the jaw placed back in its proper position.

Last updated: Aug-29-06

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