If a tooth has been knocked out, what you do in the next hour matters more than almost anything else that follows. An adult tooth can often be saved and reimplanted, but the odds fall with every minute it spends out of the mouth. So this is written to be read quickly.
On this page
- What to do right now
- Why minutes matter
- How to store the tooth
- Baby teeth are different
- If the tooth is loose or pushed out of place
- What happens at the practice
- What happens afterwards
- The bottom line
What to do right now
If this is an adult tooth:
- Find the tooth and pick it up by the crown, the chewing part. Never touch the root. The delicate cells on the root surface are what allow the tooth to reattach.
- If it is dirty, rinse it briefly in milk, or in cold running water for no more than ten seconds. Do not scrub it, do not use soap, and do not dry it.
- Put it back in the socket if you can. This is the best possible outcome. Push it gently but firmly into place the right way round, then bite gently on a clean handkerchief or gauze to hold it there.
- If you cannot reimplant it, keep it in milk. A small container of ordinary milk is ideal. Saliva is second best: hold it inside your cheek if the person is old enough not to swallow it.
- Get to a dentist immediately. Ring on the way rather than before you set off.
If there is significant facial injury, bleeding that will not stop, or any loss of consciousness, go to A&E instead. The tooth matters, but not that much.
Why minutes matter
The root surface is covered in living cells called the periodontal ligament, and these are what allow a tooth to reattach to the bone. They begin to die within minutes of drying out.
Reimplantation within the first fifteen minutes gives the best prospects. Within the first hour is still good. After an hour out of the mouth, and dry, the outlook drops sharply.
Two practical consequences follow. Do not spend time looking for a dentist before dealing with the tooth. And never let it dry out, which is why milk matters so much.
How to store the tooth
In order of preference:
- Back in the socket, which is where it belongs and where the cells stay happiest.
- Milk. Ordinary milk from the fridge is close to the right composition to keep the cells alive.
- Saliva, held inside the cheek, or spat into a container with the tooth in it.
- Saline or contact lens solution at a pinch.
Never water. Plain water damages the root cells quickly, which is counter-intuitive but important. And never wrapped in a tissue or left dry in a pocket, which is the commonest mistake of all.
Baby teeth are different
This is the exception that everyone should know: a knocked-out baby tooth should never be put back in.
Reimplanting a baby tooth risks damaging the developing adult tooth in the bone beneath it, which can leave permanent defects in the adult tooth’s enamel or affect how it comes through.
So for a child’s baby tooth: keep them calm, control any bleeding with gentle pressure on clean gauze, and ring the dentist for advice and an appointment. Bring the tooth if you have it, but do not attempt to replace it.
If you are unsure whether it was a baby or adult tooth, keep it in milk and let the dentist decide. Our page on children’s dentistry covers dental injuries in children more broadly.
If the tooth is loose or pushed out of place
Teeth that have been displaced rather than knocked out entirely also need prompt attention.
If a tooth has been pushed out of position, you can try to reposition it gently with light finger pressure, but do not force it. If it is simply loose, leave it alone, avoid biting on it, and stick to soft food until you are seen.
Either way, get seen the same day. Our post on what counts as a dental emergency explains how urgency is judged.
What happens at the practice
The tooth is cleaned and repositioned in the socket if that has not already been done, and your bite is checked. An X-ray confirms the position and checks for any fracture of the tooth or the surrounding bone.
The tooth is then usually splinted to the neighbouring teeth for a period of weeks, so it is held still while the ligament reattaches. You will be given aftercare advice, a soft diet for a while, and a follow-up schedule.
What happens afterwards
A reimplanted tooth almost always needs root canal treatment, usually within a week or two, because the nerve supply is severed when the tooth comes out. Our post on whether root canal treatment hurts may set your mind at rest about that stage.
The tooth is then monitored over months and years, since some reimplanted teeth are lost later even when the initial outcome is good. Where a tooth cannot be saved, our pages on tooth extractions and replacing missing teeth explain the options.
Our page on emergency dental treatment covers what to do in a dental emergency generally, including for visitors to the area. The NHS guidance on urgent dental care is useful too.
The bottom line
Adult tooth: pick it up by the crown, rinse briefly in milk if dirty, put it back in the socket if you can, otherwise keep it in milk, and get to a dentist immediately. Never water, never dry, never scrubbed. Baby tooth: never put it back, and ring for advice.
If this has just happened, stop reading and ring us on 01255 422506. Out of hours, call NHS 111 or go to A&E if there is significant injury.
This article is general information rather than personal dental advice. Every mouth is different, so please speak to your dentist about your own teeth.
