Intended for healthcare professionals

Practice 10-Minute Consultation

Tooth avulsion

BMJ 2016; 353 doi: (Published 25 April 2016) Cite this as: BMJ 2016;353:i1394

This article has a correction. Please see:

  1. Isabelle Moran, dental core trainee year 21,
  2. Martin James, dental core trainee year 21,
  3. William Cook, emergency medicine senior house officer2,
  4. Michael Perry, oral and maxillofacial surgery consultant1
  1. 1Oral and Maxillofacial Surgery, Northwick Park Hospital, London HA1 3UJ, UK
  2. 2Emergency Medicine, Northwick Park Hospital
  1. Correspondence to: I Moran isabellemoran{at}
  • Accepted 24 February 2016

What you need to know

  • Re-implantation within an hour of the injury improves outcomes

  • Milk is an ideal storage medium

A 7 year old boy has tripped in the playground and knocked his front tooth out. He attends the emergency department with his mother, who has the tooth in her hand. He is stable and has no other injuries of concern.

What you should cover

Permanent dental problems can be avoided by taking a simple dental history and doing a basic examination. The main question is whether re-implantation of the tooth is appropriate. Was this a primary (baby) tooth or a permanent (adult) tooth? At 6-8 years of age, the primary central incisors have usually fallen out and the larger, permanent incisors have erupted (fig 1). The associated with avulsion injury of a primary tooth, such as disturbances in eruption and appearance of the developing permanent teeth, can be increased if a primary tooth is re-implanted.1 This is not advised, and monitoring of permanent tooth eruption is essential following injury.2 3

Fig 1 Diagram highlighting difference in size between primary and permanent incisors. The primary central incisor is approximately 16 mm in length, two thirds the size of its permanent successor


  • Establish whether the adult with the …

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