So it only feels right to document what happened last Sunday, Father's Day, June 16th 2019.
We were having a lovely afternoon in the park. The sun had come out after a morning of rain and we had met up with some JIA friends for a play. After a couple of hours we saw Miss T heading towards us with blood dripping from her mouth. Armed with tissues we thought it was a cut lip but she was incredibly distressed saying her adult tooth had been knocked out when she fell.
The other kids set to work searching in the woodchip and mud for the tooth whilst we comforted Miss T and called 999 for advice on what to do. Knocking an adult tooth out IS a medical emergency.
The tooth was promptly found by the kids and it was covered in debris. We rinsed it in a cup of water and asked 999 what to do with it as I had heard that you should try to re-insert a knocked out adult tooth.
They said NOT to try to reinsert it and to head to A&E. Please read on for what you SHOULD DO as it seems we were given a catalogue of incorrect advice. I told them I had put the tooth in water- they said it needs to go in milk. There was no access to any milk. So I asked whether it is better to keep it in water or nothing. They said nothing. (The dentist later cringed at this when I told her).
Things went from bad to worse at A&E. Upon arrival (we were now about 30 minutes post-injury and I was conscious that there is a limited time frame to re-insert the tooth) I asked for milk explaining why we needed it. They said there was none.
I told them that is ridiculous and that SOMEWHERE in the hospital there would be some milk. They pointed me towards a drinks trolley in another room so I got the tooth into some milk. They then proceeded to slowly register Miss T with no sense of urgency. Upon going through to the children's A&E section we were told to take a seat and wait. The time now was nearing 45 minutes post injury. I pointed out that we only had a limited time to re-insert the tooth and they said that it wasn't something they would do in A&E anyhow.
At this point, I took matters into my own hands and re-inserted the tooth myself. Miss T did find it distressing but she realised it was something we had to do because no-one else there was going to do it. They said that her screams were disturbing the other patients and could we move to a cubicle. By that point I had pushed the tooth in as best as I could although Miss T could feel it slipping down.
We were advised that there was nothing they could do at A&E and that we needed to phone the emergency dental line...That didn't open until 6pm.
We called our own dentist and tried their emergency number - They could get to the dental practice by 7pm but there was a call out fee and together with the treatment fee of splinting the tooth it cost £500 - they said they were happy to do that but to try the emergency dental line again at 6pm. We tried the emergency line again as by this point it was 6pm - no luck getting through - on hold for 10 minutes. So we contacted our own dentist again and said we would like them to treat Miss T.
They reinserted the tooth properly as I hadn't quite managed to with all the blood in the area and cleaned up her mouth as best they could. It needed a couple of stitches in the gum too. She was given antibiotics and advised to check that her tetanus was up to date.
She's on soft mushy food for a month and needs to rinse with warm salt water and clean gently but well around that tooth brushing downwards around the gum.
She was sent to Kings Hospital yesterday so that they could look at what needs to be done from here on in although she does have a couple more follow ups with our own dental practice - our dentist was amazing!
Kings need to see her 14 days after the original trauma to have the splint removed. We need to watch for signs of infection/pus in which case they would need to remove the nerve / root canal treatment. But there is a tiny chance that the tooth will be able to reattach sufficiently to get nutrients etc to it.
In the longer term it will need replacing with an implant as the way the jaw repairs is to fuse bone to the tooth which means the tooth won't grow like the others and won't be responsive to orthodontic treatment. High risk of infraocclusion. They gave us some corsodyl gel to use 3 times a day at different times to brushing to help keep germs away.
Incredibly Miss T seems to be taking things in her stride despite the distress of the original trauma where she was devastated to have lost an adult tooth.
We are having to be really careful with all activities (mustn't risk it being bumped or knocked again) so no PE, no playtimes outdoors at school etc and she's drinking with a straw. But generally is doing really well!
So what SHOULD have been done:
From what I have found out since from speaking to the dental experts - they say "Pick, lick and stick":
- Pick the tooth up holding only the crown not the root
- Lick it clean or VERY GENTLY rinse in water to remove any obvious debris
- Stick the tooth back in being careful to put it in the right way (ONLY for ADULT TEETH do not try to re-insert baby-teeth).
If you are able to form a kind of brace using thick foil like milk bottle lid thickness of foil then do so to help hold it in using the surrounding teeth.
Get EMERGENCY dental treatment for it to be splinted properly.
In theory all the dentists we have spoken to have said that A&E departments SHOULD know what to do. But in our case they didn't know what to do and refused to help.
So if it was to ever happen again (we pray it won't!) - I would follow the "pick, lick and stick" advice. It also seems crucial to keep the tooth moist if you are unable to re-insert it immediately - so ideally milk but failing that saliva or saline.
Since the trauma I've come across a few other web articles which seem to give sensible advice which corresponds with what we've been told by the dentists who knew what they were doing:
* Please note that we are not providing medical advice, but what we have experienced and what we did. This is to maintain a record for our purposes. If you experience the same situation, seek urgent medical advice.
Toothbrush photo from Unsplash - Credit: Photo by Alex on Unsplash
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