Tooth damage or loss from fighting:

What to do before arriving at the dentist

by Dr. Jason Armstrong (Ph.D.) & Dr. Matthew Gentner (Endodontist)

The below is a sub-section taken from the book:

Karate technique selection & Street Fighting Statistics & Medical Outcomes

Tooth damage is a very real possibility in fighting scenarios of dojo training. The question arises: what is the best practice first-aid before arriving at a dentist? As standard practice anytime a student is doing partner drills or fighting in the dojo they should be wearing a mouthguard (custom form fitted upper tooth guards provided by dentists are suggested as a minimum practice, rather than the off the shelf ―boil in water‖ mouthguards which provide poor tight moulding around individual teeth and therefore do not give the best impact force dissipation). Furthermore, bi-maxillary mouthgaurds by far offer the best protection for not only the teeth but jaw damage. This is because bi-maxillary mouthgaurds cover and connect both the upper and lower teeth and brace the jaw (Chapman, 1985; Jagger 1995). They also potentially buffer, or prevent loss of consciousness following significant blows (see Sections A16, A17 & A23). Even with a standard policy of mouthguards in all partner training, instructors should know what the first lines of action are should a tooth be broken, displaced, or knocked out.

The approach to care varies, depending on whether the tooth is a ―baby tooth‖ (primary tooth) or adult tooth (permanent tooth). All patients with mouth damage should see a dentist and/or doctor, but effective on the spot actions (first aid/primary care) can improve the outcome.

For a young child with damage to a non-permanent tooth, the first line objectives are to relieve pain and prevent possible damage to the developing tooth germ (the source of what will become the adult tooth). The damage associated with the loss of a primary tooth can affect the development of the permanent tooth – and most commonly it may cause discoloration and/or defects in the enamel. For young children the situation can be complicated with emotions and anxiety from both the child and parents. Cleaning of the wound is best done with normal saline (from a sterile resource kept in the Dojo‘s first aid kit). In the case where bleeding does not quickly cease, pressure for up to 5 minutes will usually address the issue (e.g. pressure with a moistened gauze bandage square).

If a child‘s primary tooth is knocked out, one should not be tempted to re-insert the tooth as it may well damage the developing tooth germ (which will become the adult tooth). Other risks are involved with attempting to re-insert a young child‘s tooth including swallowing, aspiration (inhaling the tooth) and inflammation. It can also lead to ankylosis (fusion of tooth to bone) that can then prevent normal eruption of the underlying permanent tooth.

For older children or adults with damage to a permanent tooth - a completely knocked-out ―adult tooth‖ is best re-inserted (re-implanted) as soon as possible – the first 15-20 minutes leaves some hope for a good outcome, 2 hours or more leaves a very small chance of saving the tooth (Primed GP, 2007). Before re-inserting the tooth it should be washed with a stream of saline while being held by the crown – do not handle the tooth by the roots. If there is a delay for whatever reason, the tooth should be kept in medical grade saline, milk or saliva. The martial artist who has received the damage (and has not decided to gently re-insert themselves) can store the tooth in their cheek, under their tongue, or even in a container with their spit until medical/dental assistance is available (milk is the favored choice of the endodontist contributing to this text).

If a tooth is being re-inserted it should not be rubbed, or touched as this can potentially damage the periodontal ligament fibers/roots which are involved in a successful re-implantation. Dentists will typically have other measures post re-insertion to better the outcome which may include splints or medications (such as antibiotics).

For broken teeth (fractures), dental assistance should be sought. Saving any tooth fragments is worthwhile (as they may be reattached) and they should be stored in medical grade saline, milk or saliva. If bleeding does not quickly cease, pressure should be applied on transit to dental treatment (pressure with a moistened gauze bandage square either applied, or created by biting down).

A good resource for up to date dental trauma information is the IADT website (

The above is a sub-section taken from the book: Karate technique selection & Street Fighting Statistics & Medical Outcomes