A dislodged, or luxated, tooth is one that has been partially pushed into or out of its socket, or sideways, during an injury. If this has happened to you, see your dentist or endodontist as soon as possible to stabilize the tooth.
Root canal treatment is usually needed for permanent teeth that have been dislodged and should be started a few days following the injury. Medication may be placed inside the tooth as part of the root canal treatment. For those patients, an endodontist or dentist will monitor the healing carefully and intervene immediately if any unfavorable changes appear. Therefore, multiple follow-up appointments are likely to be needed.
Avulsed Teeth or Knocked-Out-Teeth
With proper emergency action, a tooth that has been knocked out of its socket can be successfully replanted and last for years. If this has happened to you, see an endodontist or nearest available dentist as soon as possible. Time is of the essence!
Steps to saving a knocked-out tooth:
1. Pick up the tooth by the crown (the chewing surface) NOT the root. Locate the tooth immediately; do not leave it at the site of the accident. The tooth should be handled carefully. Touch only the crown to minimize injury to the root.
2. If dirty, gently rinse the tooth with water.
- Do not use soap or chemicals.
- Do not scrub the tooth.
- Do not dry the tooth.
- Do not wrap the tooth in a tissue or cloth.
3. Reposition the tooth in the socket immediately, if possible. The sooner the tooth is replaced, the greater the likelihood it will survive. To reinsert, carefully push the tooth into the socket with your fingers, or position above the socket and close your mouth slowly. Hold the tooth in place with your fingers or by gently biting down on it.
4. Keep the tooth moist at all times. The tooth must not be left outside the mouth to dry. If it cannot be replaced in the socket, put it in one of the following:
- Emergency tooth preservation kit (such as Save-a-Tooth®)
- Mouth (next to cheek)
- Regular tap water is not recommended for long-term storage because the root surface cells do not tolerate water for long periods of time.
5. See an endodontist or nearest available dentist within 30 minutes of the injury or as soon as possible .
Bring the tooth with you to your emergency appointment ideally, within 30 minutes. However, it is possible to save a tooth even if it has been outside the mouth for an hour or more.
Immature tooth injury in children
When an immature tooth is affected by caries or trauma and the pulp tissue has been compromised, root-end closure procedures are required when the apex has not fully formed. Those two procedures are:
This procedure encourages the root to continue development as the pulp is healed. The exposed pulpal tissue is covered with a medicament called MTA, or Mineral Trioxide Aggregate. This will allow for the exposed tissue to heal against the MTA, keeping the pulpal tissues vital and encouraging further maturation and growth of the tooth. This proccess will enable the tip of the root (apex) to continue to close as the child gets older. In turn, the walls of the root canal will thicken, and the tooth will become stronger. If the pulp heals, no additional treatment will be necessary. The more mature the root becomes, the better the chance for the survival of the tooth.
In this case, the unhealthy pulp is removed. The endodontist will place MTA into the apical portion of the root to stimulate hard tissue to form near the root tip (approximately 4-5 mm’s of MTA condensed carefully into the apical portion of the root). The coronal portion of the canal space is then acid-etched, and a bonded composite or glass ionomer is condensed into the canal to re-enforce the root and provide more sturctural integrity. The patient is recalled periodically to monitor the progress of the root-end closure, and decide whether other measures (root-end surgery) may be required