What to do when a tooth breaks or is knocked out

Dental injuries are most common in children, in sport and in accidents at home. The right first aid often decides whether the tooth can be saved.

First assess the person's general condition

If after a blow to the head there is loss of consciousness, vomiting, severe headache, dizziness or bleeding that does not stop, go to an emergency department first. The tooth comes after these.

If a tooth is broken

1. Find the broken pieceKeep it in milk, saline or saliva. In suitable cases it can be bonded back onto the tooth.
2. Rinse the mouth with lukewarm waterIf there is bleeding, press gently with a clean piece of gauze.
3. Apply cold against swellingOn the outside of the lip or cheek.
4. See a dentist the same dayEven if the break looks small it may be close to the nerve, or there may be a crack in the root.

Treatment depends on the size of the break

• Small enamel fractures: Smoothing and polishing, or a composite filling.
• Fractures reaching the dentine: Bonding the piece back on, or repair with composite.
• Fractures that expose the nerve: Treatment aimed at preserving the nerve, or root canal treatment, followed by a filling or crown.
• Root fractures: Splinting the tooth or extracting it, depending on where the fracture is.

If a permanent tooth is knocked out completely

This is one of the true emergencies of dentistry. The sooner the tooth is put back, the better its chance of survival; the first half hour is very valuable.

1. Hold the tooth by the crownDo not touch the root; the living cells on the root surface are needed for the tooth to reattach.
2. If it is dirty, rinse it brieflyFor a few seconds under running water or milk. Do not scrub or wipe it, and do not use soap or disinfectant.
3. Put it back in if you canSeat the tooth gently in its socket and hold it in place by biting on a clean cloth.
4. If you cannot, keep it moistCold milk is the most readily available suitable medium. In conscious adults the tooth can also be carried between the cheek and the gum. Do not let it dry out, do not wrap it in tissue and do not leave it in water for long.
5. See a dentist immediatelyThe tooth is put back in place and splinted to the neighbouring teeth for a while.

If a tooth has moved but not come out

Do not try to correct a tooth that has been pushed in, pulled out or shifted sideways yourself. See a dentist the same day; the tooth is brought back to its correct position and splinted.

Cracked tooth

Not every crack is caused by a blow. Clenching, biting something hard and large fillings can also crack a tooth. Sharp pain on biting or on releasing the bite, and sensitivity to cold, are the typical signs. If the tooth is covered with a crown before the crack progresses, it can usually be saved.

Follow-up after an injury

A tooth that has taken a blow may seem fine at the time but lose its vitality weeks or months later. If the tooth darkens, a pimple-like bump appears on the gum or there is pain, come for a check-up. X-ray follow-up is carried out at the intervals your dentist recommends.

Prevention

• Wear a mouthguard for contact sports, cycling and skateboarding. Guards made by a dentist from an impression give the best fit.
• Do not use your teeth to open bottles or tear packets.
• Do not bite very hard things such as ice, boiled sweets and seeds in their shells.
• Front teeth that stick out are more exposed to injury; orthodontic treatment reduces this risk.

Frequently asked questions

This article is for general information and is not a substitute for diagnosis or treatment. If you have a complaint, please see your dentist.