In our lifetime we will have a total of 52 teeth. Twenty of these are what we call primary or “baby” teeth, which appear around the ages of 6 months to 1 year, and will be fully developed by age 3. We have these teeth until the ages of 6-7, when primary teeth begin to fall out and permanent teeth come in. By the time we have reached our early 20’s, the full set of 32 teeth should be well established.
It is estimated that over 3 million teeth are knocked out (avulsed) every year. As you can see from this statistic, the likelihood that your son or daughter will experience an injury to this area is quite high. Sports that have the highest incidences of tooth avulsion are basketball and baseball, mostly due to the poor facial protection of these sports. Other sports with high rates include hockey, rugby, and soccer, and seem to effect kids around the ages of 8-12 the most.
Again, we only get one set of permanent teeth. Taking the proper steps to ensure we do not lose these after avulsion occurs is crucial!
So, what do I do when the tooth comes out?
- Never re-implant a primary tooth. Doing so can disrupt the bud of the permanent tooth behind it.
- Keep the athlete calm. Many times the shock of the accident or seeing the tooth can cause the athlete to panic.
- Always pick a tooth up by the crown (chewing side), never the root. Doing so can damage the nerve.
- Attempt to rinse with water, milk, saliva, or saline (if the tooth is dirty)–again never touch the root.
- Re-implantation of the tooth by a dentist. This is considered to be the most important factor in determining successful outcomes for tooth avulsions. Re-implantation involves putting the tooth back in the socket, if possible. Dentists also agree that 30 seconds to 5 minutes is the optimal time for this to occur. The longer this takes, the higher the risk of cell death. Once the tooth is implanted, get to the dentist ASAP for further evaluation.
- Do not re-implant the tooth into its socket if it is dirty. This helps to prevent infection.
- Control bleeding. Avulsions are usually accompanied with facial or mouth trauma that may also have severe bleeding. Use light pressure and cold compresses to stop before re-implanting the tooth. Do not disrupt clot if formed in socket.
- Get to the dentist ASAP.
What do I do if I can’t re-implant the tooth?
- Store it in their cheek.
- Store it in milk, Hanks Balanced Salt Solution (Save a tooth Kit), saline or the last resort is water.
- Go to the dentist ASAP for re-implantation and evaluation.
Additional things to consider
- Sometimes, athletes may be unconscious or have a concussion.
- Attempt to save the tooth in one of the above-mentioned means of transport, and get to hospital. Rule out any type of severe concussion or head injury before worrying about the tooth.
- Do not place avulsed tooth in unconscious athlete for fear of aspiration or choking.
How do I prevent this from happening?
Unfortunately, this type of injury is very hard to prevent in any sport. The most important factor in limiting the incidence of this is proper facial protection and use of an approved mouth guard. It is highly advised, especially in sports that do not have facial protection (basketball, rugby, baseball, softball, wrestling, soccer), to use mouth guards at all times. Additionally, proper dental screenings can help identify at risk individuals for avulsions who may have poor dental habits, gum disease, orthodontics or loose teeth.
Taking these steps, along with the ones mentioned above, can greatly increase the chances you have a nice smile your whole life, even if you sustain a tooth avulsion at some point.
Written by: Matt Brewer, MS ATC/R, Certified Athletic Trainer, Sports Medicine for Young Athletes, Orthopedics Institute, Children’s Hospital Colorado. To find out more about tooth loss prevention, read our archived injury prevention posts, or schedule an appointment at 720-777-6600. We are happy to consult with parents or referring providers before a patient is seen at Children’s Colorado.