The Tooth Was Back in Its Socket Within Half an Hour

Quick answer: If a permanent tooth is knocked out, put it back in the socket immediately — that is the single most important thing anyone can do, and a parent can do it. If you cannot, keep it in milk and get to a dentist within the hour. Do not scrub it, and never store it dry.

The call

Friday afternoon at the park in Sheinfeld. Yonatan, 10, came off a swing and landed face first. His mother phoned us at 4:12pm; the accident was at 4:05.

What she did in those seven minutes is why this story has a good ending.

What we found

Before he arrived — because the crucial part happened at the park — she had followed instructions given over the phone in under a minute:

• Found the tooth. It was on the tarmac.
• Picked it up by the crown, the white part, not the root.
• Rinsed it for about ten seconds under running water from a bottle, without scrubbing.
• Put it straight back into the socket, the right way round, and pushed it gently into place.
• Had him bite on a folded tissue to hold it, and drove straight to us.

He was in the chair at 4:31. The tooth had been out of the mouth for roughly four minutes and back in place for twenty-two by the time we saw him.

On examination: upper left central incisor replanted, in reasonable position. Slight over-eruption, which we corrected. The lip was cut but did not need suturing. The neighbouring tooth was slightly loose. X-rays showed no root fracture and no jaw fracture.

Why speed matters comes down to one thing: the periodontal ligament cells on the root surface. Those cells are what allow the tooth to reattach. They begin dying within about fifteen minutes in a dry environment. Replanted within five minutes, most survive. After sixty minutes dry, essentially none do, and the tooth is likely to be resorbed and lost over the following years.

Milk keeps them alive for several hours because its osmolality and pH suit the cells. Water does not — it is hypotonic and bursts the cells. Saliva is better than water and worse than milk. A dry tissue is the worst option of all.

What we did

Repositioned the tooth precisely, checking the bite, then bonded a flexible splint across it and the two teeth on each side. Flexible, not rigid, and for two weeks — a rigid splint or a long splinting time promotes root resorption.

Antibiotics, a tetanus check (his was current), a soft diet and chlorhexidine rinses.

Root canal at day ten. This surprises parents, but it is standard for a mature tooth with a closed root apex: the nerve does not survive an avulsion, and leaving it to become infected causes rapid inflammatory root resorption. Treating it before that starts is what saves the tooth. Calcium hydroxide dressing first, permanent filling later.

The outcome

Splint off at two weeks. Root canal completed at three months. At the two-year review the tooth is firm, the colour matches, and there is no sign of resorption on x-ray. He has been told to expect lifelong monitoring, because resorption can appear late.

What to do if this happens to you

1. Find the tooth. Hold it by the crown, never the root.
2. If it is dirty, rinse it in milk or saline for ten seconds. Do not scrub, do not use soap, do not dry it.
3. Put it back in the socket immediately and have the person bite on a tissue to hold it. This is the best possible action.
4. If you cannot replant it, put it in milk. Not water. Not a dry tissue. Milk is in most fridges and most makolets.
5. Get to a dentist within the hour, phoning on the way so they are ready.
6. Baby teeth are different — do not replant them. Replanting a baby tooth can damage the adult tooth developing above it.

Tooth knocked out in Beit Shemesh or RBS? Put it back in and call Ramat Beit Shemesh Urgent Dental Care immediately: 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh.

Based on real cases treated at the clinic. Names have been changed.