When a pupil knocks out a permanent tooth, someone needs to know what to do with it while parents are contacted. Those first actions can affect whether the tooth can be retained.
Losing a permanent front tooth can mean years of treatment as a child grows. However, simple instructions and prompt action may give that tooth a better chance of being retained.
As a general dentist, I want schools to understand how much that initial response matters. In an emergency situation staff may face competing demands on their attention, including a bleeding and/or frightened child. Clear instructions, familiar equipment and a reliable route to dental advice can help them act promptly.
Before the parents arrive
While preparing this article, I contacted a number of schools about their response to dental injuries. Among those that replied, the usual approach described was an initial assessment by a first aider or medical staff, followed by contacting parents to arrange further care.
One school also mentioned an established relationship with a local dental practice. These informal enquiries focused on who would respond, with some emails suggesting first-aid involvement and contacting parents as examples.
The issue I would encourage headteachers to examine is what happens between the accident and the pupil leaving school. Parents may be travelling, difficult to reach or unsure where to obtain treatment. Staff need to know which actions should begin while those calls take place.
If a knocked-out permanent tooth is left dry until collection, its chances of successful treatment can deteriorate during that wait.
Does your first aid training cover dental injuries?
A first-aid certificate alone does not tell a headteacher whether someone has been taught how to manage dental injuries. In separate conversations with trainers, I heard differing accounts of how much attention the subject receives across courses.
Ask your training provider specifically whether their course covers a knocked-out permanent tooth. Staff should understand the distinction between permanent and baby teeth, when immediate replacement is appropriate and how to protect a tooth that cannot be replaced.
Details on what to do in a dental emergency should be easily available in school, including:
- where staff can find full first guidance
- which materials they can access
- how they can contact urgent dental services.
Make sure adults supervising playgrounds, sports fixtures and trips have access to this information too.
Make the immediate response clear
NHS public guidance advises trying to put a knocked-out permanent tooth back into its socket and seeing a dentist as soon as possible. If it is not possible to replace it immediately it should be kept in milk or the pupil’s saliva in a container.
A baby tooth must never be put back, because this could damage the permanent tooth developing underneath.
Give staff clear, clinically reviewed instructions that they can follow at the scene. Keep these alongside the materials needed to act, so staff can find both quickly.
For a knocked-out permanent tooth, the essential steps are:
- Hold the crown: pick it up by the white part normally visible above the gum. Avoid touching the root.
- Rinse gently if dirty: use milk, saline or the pupil’s saliva.
- Try immediate replacement where safe; the pupil must be conscious and cooperative. If the tooth goes back easily, ask the pupil to bite gently on a clean cloth to hold it in place.
- Keep the tooth moist if replacement is not possible: place it in milk or the pupil’s saliva in a container.
- Obtain urgent dental care: this remains necessary even if the tooth has been replaced.
If staff are unsure whether it is a permanent tooth, obtain urgent dental advice and keep it moist while seeking help. Serious accompanying injuries take priority under the school’s usual emergency procedures.
For a broken tooth, keep any recovered fragments in milk or saliva and send them with the pupil. A dentist may be able to reattach them.
Four steps to a robust dental emergency policy
- Ask your first-aid lead to check that instructions are accessible, materials are available and the route to dental advice is clear.
- Keep dental-trauma instructions and supplies together where staff can reach them quickly. Check that the instructions reflect current clinical guidance, such as the International Association of Dental Traumatology (IADT) guidelines, and that staff can access the materials during sports activities and trips.
- Record how to obtain urgent dental care. A local practice may be willing to help schools clarify their response, but confirm what it can offer before relying on that relationship. In England, NHS advice is to call 111 if there is no dentist or an emergency appointment cannot be obtained. Schools elsewhere should confirm their local route.
- At the next first-aid review, run through a playground incident with staff. Locate the instructions and supplies, check the dental contact number and agree who does what. Include an occasion when the usual first aider is absent. Resolve any uncertainty there, with time to discuss it, before a pupil needs the answer.
Dr Yousuf Ibrahim is a general dentist with interests in restorative dentistry and endodontics. He is the founder of ToothRevive, which produces dental-trauma kits containing instructions and basic supplies for use before professional dental care.
