Advice to parents and team coaches used to be fairly straightforward
and easy to remember. First, find the tooth and keep it moist while
transporting the injured child to the dental office. Distilled
water, contact lens solutions and milk were considered acceptable
liquids for the purpose. Second, the predominant treatment
philosophy following an accident involving tooth loss called for
replacing the tooth immediately or within 30 to 60 minutes if
possible.

But after years of study, researchers have found that the long-term
clinical rate of replanted avulsed teeth has been low, ranging from
4 to 50 percent. For this reason, attention is now being focused on
keeping the soft tissue around the root healthy rather than on the
speed of tooth replacement.

The best outcome in the case of a tooth being knocked out can be
expected when the tooth is replaced within a few minutes of the
traumatic event. According to Endodontics: Colleagues for
Excellence, if teeth can be replaced within 15 minutes of being
knocked out, the periodontal ligament (soft tissue surrounding root
of tooth) will be restored within a few weeks in a very high percent
of teeth. However, the pulp cannot be expected to survive; therefore
root canal therapy is an important part of successful treatment. The
sole exception to performing root canal treatment of teeth that have
been replanted is in the case of a very immature tooth, where
revascularization of the pulp is possible and desired. Ideally, root
canal treatment should be performed on a tooth during the second
week after replantation. Calcium hydroxide placed for up to 1 month
prior to filling the root canal will aid in disinfection of the root
canal system, and stabilization of the tooth with a functional,
nonrigid splint for 2 to 3 weeks will help re-establish the
periodontal ligaments.

If the avulsed (knocked out) tooth has been left dry for more than 1
hour, chances for restoration of the periodontal ligament are very
poor. However, replantation of such a tooth may be worthwhile
because the patient may benefit from several years of use.

Parents and coaches can take preventative measures to protect the
children from facial injuries when playing sports. Approved mouth
guards are the first step. But somehow, accidents will happen.

Consequently, you should purchase the commercially available
balanced salt solution (HBSS or ETPS) from the local drug stores and
have one or two of the kits available at every game and practice
session. Because a team will use only one or two of the kits in a
season, the cost should not be prohibitive. Simply having one of
these balanced salt solution kits available will provide a
significant head start when dealing with an avulsed tooth. If
commercially prepared balanced salt solutions kits are not available
in your area, consider informing the various sports leagues, local
schools and pharmacies that there is a market for these kits, and
their promotion should be encouraged.

(Sources: Endodontics: Colleagues for Excellence, Spring 2006, and
American Journal of Orthodontics and Dentofacial Orthopedics)