A tooth may chip (fracture), be knocked loose or completely knocked out. A blow to the upper or lower jaw is the usual mechanism by which the teeth can be damaged. A fractured tooth exposes the nerve within to the environment, rendering the tooth very sensitive to cold, and thereby requiring the athlete to keep his/her mouth closed.

Signs & Symptoms

• Obvious cracking, splitting or chipping of the tooth.
• Sensitivity of the tooth to cold.
• Pain.
• Crooked or obvious missing tooth!

On-Site Management

Stop Bleeding. Have the athlete sit with their head forward, allowing the blood to drain from the mouth. Apply pressure with sterile gauze to any areas of the mouth that may be bleeding.

Protect. In the case of a chipped tooth, the injured site should be protected from the air by wrapping it in wet gauze. A small amount of calcium hydroxide, or "Dycol", can be applied to the exposed area to reduce the pain.

Replace Tooth. If a tooth has been completely knocked out, immediately replace the tooth back into the tooth socket, provided that the tooth is clean and replacement is easily accomplished. Do not attempt to wipe the tooth clean as this may destroy an important membrane surrounding the tooth and will delay treatment. Rinse the tooth with only water or saline solution. If it is not possible to replace the tooth, have the athlete hold it under their tongue (somewhat dangerous as the athlete may inadvertently swallow the tooth) or wrap it in a saline-soaked gauze pad. Alternatively, the tooth could be placed in a container of saline solution.

Referral. Referral to a dentist is mandatory. Immediate referral is mandatory if the tooth is completely knocked out. There is only a small window of opportunity (approximately 30 minutes) to save an injured tooth.

Prevention

• Athletes in contact sports should be required to wear mouth guards and/or face guards.

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