I think most athletes understand the initial treatment of musculoskeletal sports injuries. RICE – rest, ice, compression, elevation – has been ingrained in the minds of athletes of all sports, and it is essential for initial management of knee, shoulder, and ankle injuries in the first 24-48 hours. On the other hand, I doubt that many people know what to do if you have a tooth knocked out. I discussed the situation with J. Mark Barry, DDS, MBA.

Soccer player after losing a tooth

What should an athlete do if he has a tooth knocked out? Are there any steps he can do to help save the tooth?

“If the tooth is completely avulsed, meaning that it’s completely out of socket, the simplest thing is to put it in your cheek,” says Dr. Barry. “The saliva helps to keep the tooth moist. The next best options would be to put the tooth in a cup of milk or a cup of saline. Regardless, he should seek treatment immediately, because if the tooth is completely avulsed, it can possibly be reimplanted, but that has to be done in the first few hours.”

Most high school, college, and recreational sports take place after hours – at nights and on weekends. Who should an athlete call if he has a tooth knocked out? Should he go to the ER?

“It depends. If the athlete has a personal dentist, he should call that dentist’s office. Even if it’s after normal business hours, that dentist’s office will have an answering service that will connect him with an oral surgeon on call for that dentist. That oral surgeon can then direct the patient to the appropriate facility. If he does not have his own dentist, then he should go to the local emergency department. The ER will then call the oral surgeon on call for that hospital.”

What will the oral surgeon likely do?

“Hopefully, the oral surgeon will be able to reimplant the tooth with a splint. Later an Endodontist will need to fill the tooth with calcium hydroxide paste to prevent resorption. Ultimately the patient will need a root canal.”

What if the tooth is loose but not knocked out completely? Or if part of the tooth is fractured?

“First, keep it in place. Don’t take it out. Access the dentist / oral surgeon the same way as I mentioned before. If it is subluxed and not completely out, the surgeon will set it back in place and splint it. The treatment of a fracture depends on the type of fracture. A fracture that does not involve the nerve can usually be treated by a general dentist. If the nerve is involved, the patient will need a root canal and a crown.