What to do when your teeth comes out from the socket? (Avulsion)

Avulsion is defined as the complete displacement of the tooth out of the socket. It means that the teeth has come out from the socket entirely. Losing a tooth can be physically and emotionally demanding as a result it is difficult to fill and replace. As early as 400 BCE, Hippocrates suggested that teeth should be replaced and fixed firmly to adjacent teeth with wire. Modern techniques nowadays focus on reimplanting the tooth as soon as possible, minimizing periodontal damage and preventing infection of the pulp tissue.


 1-16 % of all the traumatic injuries occur in adults.

Sports, fall from height and automobile accidents are most frequent cause.

Trauma to the teeth is not life threatening but when coupled with maxillofacial injuries and fractures, can compromise the airway. Morbidity to the  teeth may be individualized to both kids and adults teeth.

Possible Result of Trauma to Kids Teeth

  • Infection
  • Abscess
  • Loss of space in the dental arch
  • Ankylosis
  • Failure to continue eruption of adults teeth
  • Injury to permanent teeth

Possible Result of Trauma to Adults Teeth

  • Infection
  • Abscess
  • Loss of space in the dental arch
  • Ankylosis
  • Resorption of root structure
  • Abnormal root developement

What To Do When You Have An Avulsed Tooth?

You need to immediately store the tooth in a liquid container.

Storage Media For Avulsed Tooth

  • Hank’s Balanced Solution
  • Milk
  • Saline
  • Saliva
  • Visapan
  • CPP-ACP (Casein phospho-peptides-amorphous calcium phosphate)
  • Coconut water
  • Water

Hank’s Balanced Solution (Save A Tooth)

This pH-preserving fluid is best used with a trauma reducing suspension apparatus. The HBBS is biocompatible with the tooth periodontal ligament cells and can keep these cells viable for 24 hours because of its ideal pH and osmolality. Composition of HBSS is:

  1. Sodium Chloride
  2. Potassium Chloride
  3. Glucose
  4. Calcium Chloride
  5. Magnesium Chloride
  6. Sodium Bicarbonate
  7. Sodium Phosphate

Researches have shown that this fluid can rejuvenate degenerated ligament cells and maintain a success rate of over 90  % if an avulsed tooth is soaked in it for 30 mis prior to replantation.


Milk has shown to maintain vitality of periodontal ligament cells for 3 hours. Milk is relatively bacteria-free with pH and osmolality comptaible to vital cells


Saline is isotonic and sterile and thus can be used as tooth carrier solution.


Saliva keeps the tooth moist. It has advantage that it is a biological fluid. It provides 2 hours of storage for an avulsed tooth. However, it is not ideal because of incompatible osmolality, pH and presence of bacteria.


Visapan has a pH of 7.4 and osmolarity of 320 mosm/L. These properties are advantages for cell growth. It can preserve the viability of fibroblasts for 24 hours.

Coconut Water

Studies have shown that the electrolyte composition of coconut water is similar to intracellular fluid. So it can be also used as storage media for an avulsed tooth because of its ease of availability, economical and sterile nature. It has been shown to be equally effective as HBSS in maintaining the cell viability.


Water is the least desirable transport medium because it results in hypotonic rapid cell lysis.

If the tooth has been out of its socket less than 15 minutes :

Take it by the crown, place it in a tooth preservation solution ( Hank’s Solution) , wash out the socket with the same solution. The dentist will reimplant the tooth firmly and have the you bite down firmly on a piece of gauze to help stabilize the tooth and when possible, will secure it to the adjacent teeth with wire, arch bars or temporary periodontal pack. You will be put on a liquid diet and antibiotics.

If the tooth has been out 15 minutes to 2 hours:

Soak the teeth for 30 minutes to replenish nutrients. Local anesthesia will probably be needed before reimplanting as above.

If the tooth was out over 2 hours, the periodontal ligament is dead and should be removed along with the pulp. The tooth should be soak 30 minutes in 5 % sodium hypochlorite and 5 minutes each in saturated citric acid , 1 % stannous fluoride and 5 % doxycycline before reimplanting. The dead tooth should ankylose into the alveolar bone of the socket like a dental implant.

If your child is between 6-10 years old :

Soak the tooth for 5 minutes in 5% doxycycline to kill the bacteria which could enter the immature apex and form an abscess.

The main aim of the reimplantation is to preserve the maximal number of periodontal ligament cells which have the capacity to regenerate and repair the injured root surface. Most important factor in the success of the reimplanted tooth is the speed with which  the tooth is reimplanted. The sooner an avulsed tooth is replanted , the better the prognosis. So make sure that you visit the dentist as soon as the tooth is avulsed. Do not wait!