Dear Dr. Mady: My 12 year old son had a fellow hockey player that got hit by a puck in their game the other night. The puck went right under his clear face shield and knocked his upper front tooth clean out of his mouth. His parents rushed him to their dentist and said they were going to try and have his tooth put back in. It did not look like a whole tooth. Is it possible for a tooth that has been knocked out to be put back in place and stay there and if so how should the situation be handled? Elise in Kitchener

Dear Elise, What you are describing is one of the worst accidents that can happen in sports. Unlike a bone that can heal from a fracture, a lost tooth will not grow back. The accidental loss of a permanent tooth is not easy to treat and treatment sometimes does not succeed even when proper technique is performed.
            In the event of an avulsed or knocked out tooth, the first thing to determine as a parent is whether or not the tooth is a primary or permanent tooth. If it is a baby tooth, then there is no need to attempt to reimplant it. The loss of a primary front tooth rarely effects the formation of the permanent tooth that will replace it at the age of approximately six.
            If the root of an adult tooth is fractured during trauma, then the chances of reimplanting the tooth are hopeless. Any attempt to restore it will lead to failure. However if a tooth is completely avulsed in one piece, it can be replanted within 60 minutes of the trauma and have a chance at survival. In fact this can be done when the accident occurs by the victim or someone else as long as the root is clean and if it goes back into the socket with little pressure and without incident. The test to see if the initial emergency treatment is successful is to have the person in question bite down without interference and without pushing the replaced tooth out of alignment.
            If the tooth is dirty, have the patient clean it if possible with their own saliva. Also have them suck hard on the tooth and this will dislodge any clot formation in the socket to enable easier re-placement on the tooth. Once the tooth is put back, the patient still needs to see a dentist as soon as possible for splinting to hold the tooth in the proper position until reattachment occurs naturally.
            Some situations are not so simple and the tooth sometimes can not be placed back in the mouth. In a situation such as this, the patient must get to a dentist and have the reimplantation done in less than 60 minutes. The most important thing in this case is the storage and transportation of the tooth. One method is to have the person clean the tooth with their own saliva and place it in between their upper back teeth and their cheek until they get help from a dentist. Another way is to clean it and store it in saline solution. It can be made by mixing 1 ½ teaspoons of salt with 4 cups of water, preferably cleaner bottled water. The third way of transporting is to place the tooth in milk temporarily until professional dental help can be accessed.
            There are products available specifically for this kind of accident that can be kept in your medicine cabinet but I am not an authority on the specific products or their shelf life. The key is that time is of the essence. If a tooth is knocked out and can’t be placed back, then store it properly and get to a dentist within and hour. A dentist will splint or affix it to the adjacent teeth with some sort of flexible splint that will help improve the success of the entire procedure. You just have to stay away from the tooth for a couple of weeks.

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This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5


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