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You may have heard the joke about the judge who visited his family dentist requesting that the doctor take out "the tooth, the whole tooth and nothing but the tooth" Well, the TRUTH is that dental injuries, such as fractured and knocked-out teeth happen all too commonly, and this quarterly column outlines the steps that I recommend to my patients when accidents do happen.

While I have your attention, I must first clear my conscience and remind everyone of the benefits of an ounce of prevention that is, the benefits of a dental mouth guard. These are worth much more than the pound of cure that I am about to discuss, and are not only intended for football and boxing, but also for any sport where injuries to the mouth and teeth can occur including sports that you may not think of as requiring a mouth guard, such as baseball and softball, basketball, volleyball and soccer.

And while I am at it, this doesn't exclude us adults who trade in our weekday workday attire to transform into weekend warriors in family barbeques and picnics, pick-up games and on various playing fields.

"Dental injuries are far less common due to the effectiveness of mouth guards protecting our players,"Kamiak head football coach Dan Mack said.

When prevention fails though, what arethe steps that are recommended in the event of a tooth avulsion or fracture? In all of the cases described below, it is important to seek dental treatment as soon as possible. Describe the nature of the injury and your dental professional will advise accordingly.

So whatto do in case of acci-dental (pun very much intended) injuries?

For primary (baby) teeth: If avulsed (knocked out): Baby teeth should NOT be reinserted, as the space can be maintained until the adult (permanent tooth) comes in. If a baby tooth is fractured or partially displaced, contact your dentist for the best course of action.

For permanent (adult) teeth: If avulsed: Adult teeth should be re-implanted immediately, if possible.

(1) Locate the tooth and hold the crown (the white part that you normally see) and not the root (the yellowish part), and rinse if contaminated.

(2) Re-implant the tooth in its original position the sooner the better as the critical time to re-implant successfully is within a matter of minutes, according to researchers.

(3) Hold the tooth in place with gentle finger pressure or by biting on a towel and see your dentist immediately.

(4) If the tooth cannot be replaced, place it in milk or saline, or even in saliva from the person's mouth. Last time I checked milk wasn't sponsoring any sporting events, nor was it the preferred beverage of choice for re-hydrating, so the likelihood of having milk around when a tooth is knocked out may be rather slim so as awkward as it may seem, saliva or the patient's own mouth may be the most convenient way to keep the tooth from drying out.

(5) Seek dental treatment immediately. If fractured: See if you can find the piece(s), and contact your dentist as soon as possible (the pieces may be useful for your dentist in creating the most cosmetic repair of your tooth). It is important to contact your dentist even though there may be no associated pain. If partially displaced, contact your dentist for the best course of action.

As you can see, the course of action depends on whether the tooth is baby or adult, and whether or not the tooth, part of the tooth or the 'whole tooth' is involved. The information presented in this article is intended for information only and does not constitute a treatment recommendation.

For more information about dental injuries, contact your primary care dentist.Dr. Peter M. Pellegrini, DDS, MS, P.S. is a certified specialist in Orthodontics and Dentofacial Orthopedics. His practice, Pellegrini Orthodontics, is located at 827 128th St. SW Suite B, Everett. For more information, call (425) 374-8218, email drpellegrini@everettbraces.com or visit: www.everettbraces.com