Injured teeth

A knocked-out adult tooth

1. Pick it up by the crown, the part you chew with. Do not touch the root.
2. If it is dirty, rinse it briefly with water. Do not scrub or brush it.
3. If you can, put it back in the socket and bite gently on a cloth to hold it.
4. If not, keep it moist in milk, or in the cheek of an adult who will not swallow it.
5. Call your dentist or us right away. The sooner the tooth is back in place, the better its chance.

A tooth can often be saved if it stays moist and is replanted quickly. How long it was out of the mouth, and how it was kept, affect the treatment we recommend. Depending on how far the root had developed, root canal treatment may be started afterward.

A tooth pushed in, out or sideways

Do not force it. Your dentist or endodontist will reposition the tooth and splint it to its neighbors while it settles.

• Pushed into the socket. Root canal treatment is usually started within a few weeks of the injury. A medication such as calcium hydroxide is placed inside the tooth first, and the permanent root canal filling follows later.
• Pushed partly out. If the pulp stays healthy, no other treatment is needed. If it becomes damaged or infected, root canal treatment is required. Left untreated, a dislodged tooth can lead to infection of the tooth, its root or the tissue around it, make the area hard to keep clean, and end in the loss of the tooth.

A chipped or broken tooth

Save any pieces. Small chips are usually repaired by your dentist. If the break reaches the pulp, root canal treatment or, in young patients, a treatment that keeps the pulp alive may be needed.

Children’s teeth

In children and teens whose roots are still growing, an injured tooth may need one of two procedures to improve its chances.

Apexogenesis keeps the living pulp going so the root can continue to develop. The exposed pulp is covered with a medication that encourages healing, the root tip keeps closing as the child grows, and the walls of the root canal thicken. If the pulp heals, no further treatment is needed, and the more mature the root becomes, the better the chance of keeping the tooth.

Apexification is for a tooth whose pulp has died before the root finished forming. The unhealthy pulp is removed and a medication is placed in the root to help a hard tissue barrier form near the tip, so a root canal filling can be sealed against it. Because the root walls will not develop further, the tooth stays more prone to fracture, and a proper restoration from your dentist is important.

Where it is possible, we try to keep the pulp alive or regrow it so the root can finish developing. See regenerative endodontics.

Follow-up after an injury

An injured tooth can change for weeks, months or even years afterward. One of the things follow-up visits look for is resorption, where the tooth slowly loses its own root structure, often without any pain.

More information

The Dental Trauma Guide, published by Copenhagen University Hospital with the International Association of Dental Traumatology, has clear guidance on every kind of tooth injury, for both baby teeth and adult teeth.

The International Association of Dental Traumatology also offers ToothSOS, a free phone app with step-by-step guidance on what to do right after a tooth injury.