Hesperian Health Guides

Tooth Injuries

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HealthWiki > Where There Is No Dentist > Chapter 7 Part 1: Problems You Will See Most Often > Tooth Injuries


  1. Broken tooth
    It is possible to save a broken tooth. It depends on where the tooth is broken and whether its nerve is still covered.
    Signs:
    • Pain when breathing air or
      drinking water.
      DENT Ch7 Page 96-1.png
    • Blood from the gums around the tooth.
    • Tooth moves when you touch it.
    Treatment:

    Take out the broken tooth if:

    • its nerve is not covered. If no one can give special root canal treatment, the tooth must come out. Germs from the saliva have already gone inside the tooth and started a small infection.
    • its root is broken. To see if it is broken, push gently against the tooth as you feel the bone around its roots. The tooth’s root probably is broken if the tooth moves but the bone does not. The root probably is not broken if both the tooth and bone move. However, the bone around the roots may be broken.


    You can save a broken tooth if the nerve is still covered and the root is not broken. To do this, use a file on the sharp edges around the break. This makes them smooth so they do not cut the tongue. Later, an experienced dental worker who has the equipment can cover the broken part with a cap or a filling. Until this is possible, tell the person how to protect the tooth:

    • Give the tooth a rest. Use other teeth to eat.
    • Do not drink things that are very hot or cold, and do not eat spicy food.
    • Watch the tooth. See if it changes color (gets darker). Also watch the gums near the root. See if a sore (gum bubble) develops.


    A dark tooth and gum bubble are signs that the tooth is dying. Take it out, unless you can give special nerve treatment.

  2. Tooth knocked out
    When a tooth is knocked out of the mouth, you should ask two questions: (1) Was it a baby tooth? (2) How long ago did it happen?

    Baby tooth. There is no reason to try to put a baby tooth back into the socket. Tell the child to bite on some cotton to stop the bleeding. Then wait for the permanent tooth to replace it. Warn the mother that the permanent tooth may take more time than usual to grow into the mouth.
    DENT Ch7 Page 97-1.png


    Similarly, there is no need for treatment if the baby tooth is pushed up under the gum.

    The tooth may grow back into the right place later, or it may turn dark and die. If you see a darkened tooth or a gum bubble, take out the baby tooth before it hurts the permanent tooth that is growing under it.

    Permanent tooth. A permanent tooth is worth saving. How long ago was it knocked out? If it was less than 12 hours ago, you can put a permanent tooth back into the socket. The sooner you do this the better, so do not wait. If you replace the tooth in the first hour, it has a much better chance of joining with the gum and bone. In order to heal and to join the bone, the tooth must be held firmly.



    a) Wash the tooth gently with saline, milk, or clean water. There should not be any bits of dirt on the root of the tooth.


    Keep the tooth damp with wet cotton gauze.
    DENT Ch7 Page 97-2.png
    Do not scrape away any skin from the root or from the inside of the socket.
    b) If you can not use anesthetic, tell the patient that it will hurt somewhat. Gently push the tooth up into the socket. As you push it up, use a slight turning movement back and forth.


    The biting edge of the loose tooth should be at the same level as the teeth beside it.

    Hold it in place with your fingers for about 5 minutes.
    DENT Ch7 Page 98-1.png
    c) Soften some beeswax and form it into 2 thin rolls. Place 1 roll near the gums on the front side of 5 teeth: the loose tooth and the 2 teeth on each side of it. Press the wax firmly, but carefully, against these teeth.


    Do the same with the second roll of wax on the back side of the same teeth, again near the gums.

    It is good if the wax on the back side is touching the wax on the front side. This helps the wax hold the teeth more firmly. To do this, you can push the wax between the teeth with the end of your cotton tweezers.

    illustration of the above: beeswax on the front and back of 5 teeth.
    Keep the wax in its position for at least 3 weeks.


Tell the person with the injured tooth to return to see you several times. The tooth may die several months or even several years later. If that happens, you must take out the tooth, unless you can do root canal treatment.

If it is possible, take an X-ray of the tooth 6 months later and then again each year. Look at the X-ray picture of the root to be sure an infection is not eating it away. To do this, compare the root with the roots of the teeth beside it.



This page was updated:19 Feb 2018