Frequently Asked Questions

What is the difference between an avulsed tooth and a chipped tooth?

An avulsed or knocked-out tooth is totally removed from its socket, root and all. A chipped tooth is a broken tooth where some of the tooth remains in the socket while the remainder is broken off. Save-A-Tooth^® System can provide successful re-implantation of avulsed teeth, but what about chipped teeth?

Preliminary indications are that Save-A-Tooth^® System will help maintain the color of the chip (prevent browning of the chip) and prevent the tooth chip from becoming brittle thus enhancing the possibility of the tooth chip being re-attached with good aesthetic results. However, further clinical work is needed to support this claim. Therefore, we do not at this point make the claim that Save-A-Tooth System can save chipped teeth. Can an avulsed tooth be pushed back into the socket and within what time frame?

Yes, an avulsed tooth can be replaced into its socket immediately, in fact, if done within 30 minutes of avulsion this is the best treatment. However, immediate re-implantation is often not possible for a variety of reasons. A patient is usually scared, panicked, and possibly not cooperating. The patient may suffer from more serious injuries that need immediate medical attention. The first aid provider at the scene may not have the confidence or the ability to re-plant the tooth. Also, the first aid provider may be unsure of his/her capabilities/liabilities in situations of dental trauma. Finally, given that there is blood involved with this injury, many people are unwilling and/or afraid to become involved. How quickly does an avulsed tooth begin to die and why?

When a tooth is knocked out, the ligament that holds the tooth in its socket (called the periodontal ligament or PDL) is torn in half. The PDL cells that remain on the tooth root begin to die within 5 minutes of avulsion. After 30 minutes, success following re-implantation diminishes rapidly. These PDL cells die quickly because they are cut off from their blood supply and are removed from their normal physiological state. If a tooth cannot be re-implanted immediately (within 15-30 minutes), what is the key to long-term re-implant success?

The key to success in re-implanting avulsed teeth is maintaining the viability of the PDL cells. To achieve this the tooth must be stored in an environment that keeps the tooth from drying and that is physiologically compatible with the cells, eg. Proper pH, osmolality, nutrients, etc. The PDL cells must also be protected from crushing. The Save-A-Tooth System provides these conditions for proper storage and protection of the avulsed tooth. Studies show that the Save-A-Tooth^® System helps keep a tooth alive for up to 24 hours. With Save-A-Tooth^® System up to 90% of knocked-out teeth that were placed in the system within 1-2 hours of being knocked out were successfully re-implanted. How many teeth are knocked out annually in the U.S.?

It is estimated that 5 million teeth are knocked out annually in the U.S. Additionally many more teeth are chipped and broken. What are the leading causes for teeth being knocked out?

Here are some statistics from a study (Harrington, et.al., Dentofacial Trauma in Children, J. of Dentistry for Children, Sept. /Oct., 1988): Falls were the leading cause of dental injury. Intentional injury (fights) was one of the five leading causes of dental injury. Other causes of dental injuries were being struck by an object, bicycle incidents, and motor vehicle accidents. Sixty-two percent of the injuries occurred in the home. What roles do an endodontist, a periodontist, and a pedodontist have in situations of avulsed teeth?

In most cases an avulsed tooth will need root canal surgery performed one week after re-implantation. This surgery is performed by an endodontist. A periodontist is not usually involved, and specializes in treatment of gum disease. A pedodontist specializes in dentistry for children. Any dentist can perform the actual re-implantation of an avulsed tooth, but usually the procedure is performed by a general dentist, pedodontist, or in some cases by an oral surgeon. What is the lifetime cost of dental work if an avulsed tooth is not successfully re-implanted?

The lifetime cost of replacing a knocked-out tooth can be as high as $30,000. The reason for this is the cost of bridges that must be maintained and replaced every year up to the age of 18 years and every 10 to 15 years thereafter. Additional cost may involve the periodontal work around the bridges. What types of storage mediums are currently being used to store avulsed teeth?

No scientific system existed prior to the development of the Save-A-Tooth^® System. Teeth are currently being stored and transported in: tissue paper (or simply dry), tap water, saliva, saline, milk, Save-A-Tooth System. Save-A-Tooth System is the most favorable medium and provides an ideal transport vehicle as well. Its use can significantly improve the chances of re-implantation success. Save-A-Tooth^® System helps keep a tooth alive and protected for up to 24 hours until a dentist can re-implant the tooth. The other storage media listed above are not ideal and can be damaging to the tooth. How does each of these storage media compare and what time limitations do they have?

Dry storage, tap water, saliva, saline, and milk are not as effective as the Save-A-Tooth^® System and they have more restrictive time limitations for storage. Dry Storage and Tap Water - These storage methods are the most damaging to the PDL cells of an avulsed tooth. Dry storage causes immediate cell death and soaking in tap water is equally as destructive because water is ionically incompatible with the PDL cells. Work by Andreason (Atlas of Replantation and Transplantation of Teeth, 1991) has shown that after 5 minutes of dry storage PDL healing is less than 30%. A number of authors have recommended that water not be used as a storage media for avulsed teeth. Saline/Saliva - These media have also been found to be very damaging to the PDL cells. The osmolality of saliva causes cell swelling and membrane damage after 1-2 hours of storage. The damaged cells are more easily penetrated by bacteria in the saliva and at risk of becoming infected. Saline is able to preserve PDL cells for a short period of time (2-3 hours), however, for long term storage, it is not able to maintain cells. Andreason (same reference as above) has shown that after 20 minutes of storage in saliva (in the mouth) or saline, PDL healing is less than 20%. Milk - Milk is a suitable media for storing an avulsed tooth for 3-6 hours but certain important problems exist: it must be fresh and kept cold, and even though it has the ability to maintain cell membrane integrity, it does not have the ability to replenish depleted cell metabolites like the Save-A-Tooth System does. It has been shown that the PDL cells mitotic ability (cell division) diminishes dramatically after storage in milk for more than an hour (Krasner, et.al., JADA, 1992). In addition, fresh, cold milk is not always available at the scene of the accident. Once in milk it is difficult to se the tooth and when it comes time to remove it, the PDL cells may be crushed and further damaged during retrieval. Save-A-Tooth^® System - As stated earlier, this is the most favorable storage system. It is pH balanced cell culture fluid that is biocompatible with the PDL cells and helps keep the cells viable for up to 24 hours. The media contains ingredients which help nourish and rejuvenate the degenerated PDL cells. One researcher (Matsson et.al., Pediatric Dentistry, 1982) found that even teeth that were dry-stored for 60 minutes or more before being placed in the Save-A-Tooth^® System solution benefited significantly from the soaking before being re-implanted. Based on his findings he recommended that knocked-out teeth which have been kept dry for 15 minutes or longer should be conditioned in the Save-A-Tooth^® System solution for about 30 minutes prior to re-implantation. Importantly, clinical research shows that teeth placed in Save-A-Tooth System within one hour of avulsion can be successfully re-implanted in 90% of cases (Krasner, et.al., JADA, 1992). What is in the solution which makes up the Save-A-Tooth^® System and why is it better than the other storage mediums?

The medium in the Save-A-Tooth System is a pH balanced cell culture fluid that is the type used in genetic engineering to grow cells in the laboratory, a form of Hanks Balanced Salt Solution. Tests indicate that the PDL cells stored in Save-A-Tooth^® System maintain their viability longer and that depleted cells can be rejuvenated if the tooth is soaked in the Save-A-Tooth^® System maintain their viability longer and that depleted cells can be rejuvenated if the tooth is soaked in the Save-A-Tooth System for 30 minutes or more. Where could the Save-A-Tooth^® System be stored for future use?

The Save-A-Tooth^® System could be stored manufacturing locations, factories, and many other facilities where accidents occur in the workplace. Save-A-Tooth^® is also stored in the medicine chest at home and in many other places such as a car, boat, first aid kit or summer home. EMS units could have it on their ambulances and schools could also stock the product. Hospitals might stock it in the emergency room and operating room. Summer camps, sports facilities, ice-skating and roller-skating rinks are other locales likely to use the Save-a-Tooth^® System. How long has the Save-A-Tooth^® System been on the market?

The Save-A-Tooth^® System has been on the market since 1988. It was introduced as The Emergency Tooth Preserving System and was sold primarily to dentists and schools. Who developed/invented the Save-A-Tooth^® System?

The Save-A-Tooth System was invented in 1987 by Dr. Paul Krasner, DDS. Paul is an endodontist with a private practice as well as a professor at Temple University Dental School. What clinical data can we use to support the Save-A-Tooth^® System success claims?

There are many articles that have been published that support the Save-A-Tooth^® System claims. These article can be provided upon request. What is the purpose of the plastic basket and net and the padded cover?

The purpose of the basket and padded cover are essential to the success of the Save-A-Tooth^® System and what differentiates it from using another type of storage. When an avulsed tooth is transported to the dentist, the ligaments can be crushed if they are placed in a container without any protective mechanism. The basket and net keep the tooth in the solution and prevent the ligaments from banging against the sides of the container and being crushed. Both of these product features reduce the incidence of crushing the periodontal ligament cells. Can the Save-A-Tooth^® System container be used to hold multiple teeth?

Yes, up to eight teeth from the same person only. The Save-A-Tooth should not be reused. Have any states, or schools mandated the use of Save-A-Tooth System for use in first aid kits, sporting events, day care centers?

Yes, in the State of Ohio Save-A-Tooth^® is mandated the Department of Job and Family Services (ODJFS). The Redwoods Group Insurance Company has also endorsed Save-A-Tooth^®, highly recommending Save-A-Tooth to the YMCAs that they insure. Additionally, several hundred schools, many professional sports teams, the Olympics, and many EMS units use Save-A-Tooth^®. What is the shelf life of the Save-A-Tooth^® System?

Two years. What is the cost of Save-A-Tooth^®?

It is presently being sold retail $14.25 plus shipping and handling bringing the cost of one unit to $21.25. What are the case configurations that are available?

One case has 24 units. However, Save-A-Tooth^® can be purchased in any desired amounts. If you have any more questions or comments, please call 888-788-6684 or e-mail SaveATooth@comcast.net