Facial Trauma
After a mouth or face injury, check first for emergencies: difficulty breathing, heavy bleeding, a head injury, or a jaw that will not open or close properly all need the emergency department right away. For a knocked-out adult tooth, time matters most: pick it up by the crown, rinse it briefly, and put it back in the socket if you can, or store it in milk, and see a dentist immediately. A possible broken jaw causes pain, swelling, and a bite that suddenly feels wrong, and needs same-day medical assessment.
Key takeaways
- Call 911 or go to the emergency department for breathing problems, uncontrolled bleeding, loss of consciousness, or a suspected jaw fracture.
- A knocked-out permanent tooth has the best chance of survival if it is replanted within minutes.
- Never scrub a knocked-out tooth or hold it by the root.
- Do not put a knocked-out baby tooth back in.
- Wear a mouthguard for contact sports to prevent most dental injuries.
Step 1: Check For Emergencies
Go to the nearest emergency department, or call 911, if there is:
- Difficulty breathing or swallowing
- Bleeding that will not stop with firm pressure
- Loss of consciousness, confusion, vomiting, or other signs of a head injury
- A jaw that cannot open or close, or a bite that has suddenly changed
- Deep cuts to the face, lips, or tongue
- Changes in vision, or numbness of the cheek, lips, or chin
In Waterloo Region, emergency care is available at hospital emergency departments, including Grand River Hospital and St. Mary's General Hospital in Kitchener.
A Knocked-Out Adult Tooth: What To Do
Follow these steps, based on International Association of Dental Traumatology guidelines:
- Stay calm and find the tooth. Pick it up by the crown (the white part), not the root.
- Rinse briefly under cold running water for no more than about 10 seconds if it is dirty. Do not scrub it or wrap it in tissue.
- Replant it if you can. Gently push it back into the socket the right way round and bite on a clean cloth or gauze to hold it.
- If you cannot replant it, store it in milk, saline, or the patient's own saliva (for example, in a cup of saliva). Do not store it in water.
- Get to a dentist immediately, ideally within 30 to 60 minutes. The sooner the tooth is treated, the better its chance of survival.
The International Association of Dental Traumatology notes that applying its guidelines "can maximize the probability of favorable outcomes." — Fouad et al., Dental Traumatology, 2020
A Knocked-Out Baby Tooth
Do not try to put a baby tooth back in, because it can damage the adult tooth developing underneath. Control bleeding with gentle pressure and see your dentist promptly to check for other injuries.
Broken Or Chipped Tooth
- Rinse the mouth with warm water and save any pieces of the tooth.
- Use a cold compress on the face to reduce swelling.
- See your dentist as soon as possible. If the tooth is very painful or you can see pink or red in the centre, the nerve may be exposed and needs urgent care.
Signs Of A Broken Jaw
| Sign | Why it matters |
|---|---|
| Your bite feels different or teeth do not meet properly | A fracture may have shifted the jaw |
| Pain when opening, closing, or chewing | Common with fractures of the jaw or joint |
| Swelling or bruising along the jaw or under the chin | Suggests bone or soft tissue injury |
| Numbness of the lower lip or chin | The nerve inside the jaw may be affected |
| Bleeding from the mouth or around loose teeth | Fractures often extend through the tooth-bearing bone |
| Difficulty opening the mouth | May indicate a fracture near the jaw joint |
If you suspect a broken jaw, support the jaw gently with a hand or bandage, avoid eating, and go to the emergency department. Imaging such as X-rays or a CT scan is needed for diagnosis.
How Are Facial And Jaw Fractures Treated?
Facial fractures are usually treated in hospital. Depending on the injury, treatment may include:
- Realigning and stabilizing the jaw with small plates and screws
- Wiring or elastics to hold the teeth together while the bone heals
- Repairing cuts inside the mouth and on the face
- Splinting loose or displaced teeth
Oral and maxillofacial surgeons are trained in the diagnosis and treatment of injuries to the teeth, jaws, and face as part of their hospital-based residency. Dr. Kevin J. McCann has served as Division Head of Oral and Maxillofacial Surgery at St. Mary's General and Grand River Hospitals.
After A Dental Injury: Long-Term Care
Even when a tooth looks fine after an injury, the nerve inside may be damaged and show problems weeks or months later. Keep follow-up appointments with your dentist. If a tooth cannot be saved, options include dental implants once healing is complete, often with bone grafting if the injury damaged the bone.
Preventing Mouth And Face Injuries
- Wear a properly fitted mouthguard for hockey, football, basketball, soccer, martial arts, and other contact sports.
- Wear a helmet and face shield where appropriate.
- Use seatbelts and proper car seats.
- Childproof stairs and sharp furniture edges for young children.
Oral Surgery Care In Waterloo
Our office at 96 Union Street East in Waterloo treats patients from Waterloo, Kitchener, Cambridge, Guelph, and Stratford. For injuries that are not emergencies, such as a tooth that needs to be removed after trauma, a follow-up after hospital treatment, or implant planning, call +1 (519)-743-7811 or ask your dentist to send a referral. For emergencies, go to the nearest emergency department. Learn more about what an oral and maxillofacial surgeon does.
Sources
- Fouad AF, Abbott PV, Tsilingaridis G, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dental Traumatology, 2020.
- Day PF, Flores MT, O'Connell AC, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Dental Traumatology, 2020.
FAQ
How Long Do You Have To Save A Knocked-Out Tooth?
The best results come when the tooth is replanted within minutes. If you cannot replant it, keep it in milk or saliva and see a dentist within 30 to 60 minutes.
Should I Go To The Dentist Or The Emergency Room After A Facial Injury?
Go to the emergency department for breathing problems, heavy bleeding, head injury, a suspected broken jaw, or deep facial cuts. For a knocked-out or broken tooth without other injuries, see a dentist immediately.
Can A Broken Jaw Heal On Its Own?
Some minor, non-displaced fractures are managed without surgery, but every suspected jaw fracture needs assessment and imaging. Untreated fractures can heal in the wrong position and affect your bite.
How Long Does A Broken Jaw Take To Heal?
Jaw fractures commonly take about six weeks to heal enough for normal function, with a modified diet during that time. Your treating surgeon will give you a specific timeline.
Can A Knocked-Out Tooth Be Saved If It Was Dry?
The longer a tooth is dry, the lower its chance of survival. It is still worth bringing it to a dentist immediately, stored in milk or saliva, so they can assess it.
This article is general patient education and does not replace an examination, diagnosis, or the written instructions from your own surgeon or dentist. If you have heavy bleeding, trouble breathing or swallowing, or rapidly spreading swelling, call the office or go to the nearest emergency department.