The mere mention of the dentist is enough to make most of us squeamish, so the thought of dealing with a dental emergency alone during a disaster scenario is truly terrifying. We've previously written about dealing with toothaches and cavities when no dentist is available. Today, we'll tackle another dental problem that is likely to be common during natural disasters and other survival scenarios: dental avulsion.

Dental avulsion is the complete displacement of a tooth from its socket due to trauma — in layman's terms, a knocked-out tooth. This may occur due to a variety of injuries which may occur during a disaster: taking a punch to the mouth, crashing a car, or simply stumbling and falling while running for cover.

If a tooth is knocked out, most people know to save the tooth and bring it to a dentist (assuming that's a possibility). However, holding the tooth in the palm of your hand or even wrapping it in a clean cloth is a bad idea. In fact, it may make saving the tooth impossible. This is because the periodontal ligament (PDL) fibers that attach the tooth root to the bone are extremely fragile, and are normally protected by the gums. These PDL cells will die if they're crushed, dried out, or cut off from blood flow for too long.

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So, what should be done to save a knocked-out tooth in an emergency? Here's a guide based on tips from the American Association of Endodontists, Colgate, and the Columbia University College of Dental Medicine:

• ACT IMMEDIATELY. If you want to save the tooth, treatment within 60 minutes of the accident is strongly recommended.
• The tooth should be touched only by the hard crown portion, not by the fragile root.
• Rinse the tooth carefully with sterile saline solution or milk to remove any dirt or debris. Saliva is another acceptable alternative. Regular tap water is not recommended since it will eventually damage the PDL fibers.
• If possible, gently re-implant the clean tooth into its socket. Be sure to insert it in the correct orientation and at the correct angle. In most cases, it should slip in easily.
• Gently bite down to hold the tooth in place. Use your fingers or a clean cloth to hold the tooth in its socket if necessary.
• If immediate re-implantation is impossible, keep the tooth moist with one of the liquids listed above. Don't allow it to dry out under any circumstances.
• See a dentist ASAP if one is available. The dentist will splint the tooth with a wire to hold it in place. If all goes according to plan, the tooth should re-attach to the bone in three to four weeks.
• A root canal will eventually be necessary due to damage to the nerves and blood vessels. Antibiotics may also be prescribed.

Written by Patrick McCarthy