What to do when a tooth breaks or is knocked out: emergency steps

Types of fracture and urgency

• Enamel crack / small corner chip: No or mild pain; not urgent but see a dentist within a few days. If a sharp edge is cutting the tongue, it can be covered temporarily with dental wax or sugar-free gum.
• Fracture reaching the dentine: Hot-cold sensitivity; restoration within 1–2 days.
• Fracture reaching the nerve: A pink/red spot on the fracture surface, bleeding, severe pain. Same-day treatment; early intervention improves the chance of the tooth staying alive.
• Displacement / intrusion / partial extrusion: Same day; the tooth is repositioned and splinted to the neighbouring teeth.
• Complete avulsion: Minutes count — see below.
• Root fracture: Not visible from outside; pain on biting and mobility. Diagnosed on X-ray, splinted.

The first 30 minutes after a permanent tooth is knocked out

1. Hold the tooth by the crown (the white part); don't touch or scrub the root.
2. If dirty, rinse for a few seconds in milk or saline; don't use tap water for long, and never soap or alcohol.
3. If possible, put the tooth straight back into its socket the right way round and hold it in place by biting gently on a clean cloth or tissue. This is the step that gives the best result.
4. If you cannot reimplant it, transport the tooth in milk, or failing that in the patient's saliva (holding it in the cheek is not advised for children because of the risk of swallowing) or in saline. Don't let it dry out; water is a poor medium.
5. Reach a dentist within 30–60 minutes. Phone the clinic ahead.

The dentist reimplants the tooth, splints it flexibly for 2 weeks, asks about tetanus status and gives antibiotics if needed. Reimplanted teeth usually need root canal treatment within 1–2 weeks; follow-up X-rays continue for months.

The difference for primary teeth

A knocked-out primary tooth is not reimplanted; it could damage the permanent tooth bud beneath. An examination is still needed: is a fragment left, are the neighbouring teeth affected, does the space for the permanent tooth need holding. Displaced or intruded primary teeth also need a dental assessment. More: Paediatric dentistry.

What about the broken fragment?

Keep the fragment in milk or water and bring it; if suitable, the dentist can bond it back, which gives the most natural result. Without the fragment the shape is rebuilt with composite; for large losses a veneer or crown is planned. See Fillings and restorative treatment.

For pain and swelling

• An external cold compress (20 minutes on, 20 off)
• A painkiller after consulting the dentist; avoid aspirin (increases bleeding)
• Soft foods; don't chew on that side
• Press a clean cloth on any lip or tongue cut; for bleeding that does not stop in 10 minutes, the emergency department

If there was a blow to the head

With loss of consciousness, vomiting, dizziness, drowsiness or memory loss, the emergency department comes first; dental treatment is planned afterwards.

Prevention

A custom mouthguard for contact sports, giving up biting pens, nails or ice, not opening packets with the teeth. Decayed or heavily filled teeth are more prone to fracture; a timely crown is protective.