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If a permanent (second) tooth is knocked out (i.e. in an accident or fight) but is intact, it can be saved by the following, immediate procedure. The tooth should not be out of the mouth for longer than 20 to 30 minutes from the time of injury.


  1. Using a sterile glove hold the tooth by its crown and replace it in its original position, preferably immediately (Fig. 12.1); if dirty, put it in milk before replacement or, better still, place it under the tongue and ‘wash’ it in saliva. Alternatively, it can be placed in contact lens saline or the solution in the ‘Dentist in a Box®’ kit ( Note: Do not use water, and do not rub (it removes dentine) or wipe it or touch the root.

  2. Fix the tooth by moulding strong silver foil (e.g. a milk bottle top or cooking foil) over it and the adjacent teeth. Moulding foil can be difficult: an alternative is to suture with a figure-of-eight silk suture to encompass the tooth. It can also be secured to the two adjoining teeth with a strip of tape cut from a disc in the ‘Dentist in a Box®’ kit.

  3. Refer the patient to his or her dentist or dental hospital as soon as possible. Tell the patient to avoid exerting any direct biting force on the tooth.

Note: If a blood clot is present, remove it after a nerve block. Teeth replaced within 20 to 30 minutes have a 90% chance of successful reimplantation.

Fig. 12.1

Replacement of a knocked-out tooth


Loosening is excessive movement of a permanent tooth with no displacement.

Splint the mobile tooth to a neighbouring tooth with the splinting material from the kit (see above). Alternatively, use chewing gum or Blu-Tack. Refer the patient to a dentist.


Rinse the mouth with warm water. Cover the exposed area, which is usually painful, with dental tape. Recover and store the tooth fragment for use by the dentist. If possible, secure the broken fragment with splinting material from the kit. Refer the patient to a dentist.


A temporary measure is to stick a piece of chewed sugarless gum into the filling or use an OTC dental cement. Refer to the dentist ASAP.


Make appointment to visit dentist ASAP.

If area is sensitive, apply a little clove oil. Slip crown back over the tooth after coating the inner surface with OTC dental cement (or from Box kit). Do not use ‘superglue’.

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