Can a knocked out tooth be reattached?

Management of Knocked Out (Avulsed) Teeth

Yes, a knocked out (avulsed) permanent tooth can be successfully reattached through immediate replantation, with the best chance of survival when replanted within minutes of the injury. 1

Immediate Actions for Avulsed Permanent Teeth

1. Confirm it's a permanent tooth - Primary (baby) teeth should NOT be replanted 1

2. Handle the tooth properly:

   • Hold the tooth by the crown (white part), not the root
   • Briefly rinse the tooth (<10 seconds) under cold running water if dirty
   • Do not scrub, brush, or use chemicals on the tooth 1

3. Immediate replantation:

   • Attempt to replant the tooth back into its socket immediately
   • Have the person bite on a cloth to hold it in position
   • This is the optimal action for tooth survival 1

If Immediate Replantation Is Not Possible

Store the tooth in an appropriate medium (in order of preference):

1. First choice options 1:

   • Hanks Balanced Salt Solution
   • Oral rehydration salt solutions
   • Propolis
   • Rice water
   • Wrap in cling film to prevent dehydration

2. Second choice options 1:

   • Cow's milk
   • Patient's own saliva (spit into a container)

3. Third choice options 1:

   • Probiotic solution
   • Egg white
   • Almond milk

4. NEVER store in tap water - causes osmotic lysis of root fibroblasts 1

Seek Immediate Professional Care

After replantation or proper storage, immediate dental care is critical:

• A dentist will stabilize the tooth with a flexible splint for 1-2 weeks
• Most avulsed teeth will require root canal therapy within 7-10 days 1
• Systemic antibiotics are typically indicated 1

Factors Affecting Survival

The prognosis depends on several factors:

• Time out of socket - survival rate decreases rapidly with increased time 1
• Storage medium - proper storage preserves periodontal ligament cells 1
• Handling technique - avoiding damage to root surface is critical 1
• Maturity of the tooth - immature permanent teeth have better prognosis 2

Long-Term Considerations

• Some root resorption occurs with almost all replantations 2
• Regular follow-up is essential - twice yearly for 3 years, then annually 3
• Late complications are common and require monitoring 3

Common Pitfalls to Avoid

1. Improper handling - touching or scrubbing the root surface damages critical fibroblasts
2. Delayed replantation - every minute counts for tooth survival
3. Improper storage - using water or letting the tooth dry out significantly reduces success
4. Failure to seek immediate professional care - even after successful replantation
5. Not recognizing that primary teeth should not be replanted - this can damage developing permanent teeth

While evidence for specific interventions to improve outcomes after replantation is limited 4, the basic principles of immediate replantation or proper storage followed by prompt professional care offer the best chance for tooth survival and quality of life.