Knocked Out Tooth
Medically reviewed by Dr. Kayla Lebeau, DDS
Do this now. Read the rest afterwards
A knocked-out adult tooth can often be saved, and the odds fall with every minute it is out of the mouth. The cells on the root surface start dying within about 30 minutes in the open air. If you do nothing else, do these three things.
- Pick it up by the crown. The chewing part. Never touch the root. The fibers on the root are what will reattach, and wiping them off destroys them.
- If it is dirty, rinse it briefly in milk or saline for a few seconds. Not tap water, and do not scrub, scrape or use soap.
- Put it back in the socket if you can. Push it gently into place and bite on a clean cloth to hold it. If you cannot, drop it in milk. Or hold it inside your cheek. Never in water.
Then call us and come straight in. Bring the tooth even if it is broken.
- Best chanceReplanted within 30 to 60 minutes
- Store it inMilk, saline, or your own cheek
- Never store inTap water
- Baby toothDo not put it back
Why milk, and why not water
This catches almost everyone out. Tap water seems like the clean, sensible option and it is the single worst choice. Water has no dissolved salts, so by osmosis it floods into the root cells and bursts them. Within a few minutes the cells that would have reattached the tooth are dead.
Milk works because its salt concentration is close to that of your body, so the cells survive in it for several hours. Saline is equally good. Your own saliva is a reasonable third option. Holding the tooth inside your cheek is better than a dry tissue or a plastic bag, as long as there is no risk of swallowing it.
- What we do when you arriveThe tooth is repositioned into the socket if it is not already, checked with an X-ray for correct position and for fractures of the socket wall.
- SplintingThe tooth is bonded to the neighboring teeth with a thin flexible splint for a couple of weeks. Flexible matters, a small amount of movement encourages the ligament to reattach.
- Tetanus and antibioticsChecked and prescribed where appropriate, particularly if the injury happened outdoors.
- Root canal treatmentNearly always needed for a replanted adult tooth, usually started within one to two weeks. The nerve does not survive being severed, and leaving it causes the root to resorb.
- Follow-upReviews over the following months and years to watch for resorption and confirm the ligament has reattached.
Children, baby teeth, and partly displaced teeth
- Never replant a baby tooth. Pushing it back can damage the developing adult tooth in the bone above it. Control the bleeding, keep your child calm, and call us.
- A tooth pushed sideways or into the gum still counts as urgent. Do not try to reposition it yourself. That needs an X-ray first.
- A chipped tooth with pink or red showing in the middle means the nerve is exposed. It needs covering the same day.
- Save any fragments in milk. A broken piece of front tooth can often be bonded back on and looks better than anything we can build.
- Mouth guards prevent most of this. If your child plays contact sport, a custom guard is the cheapest dentistry you will ever buy.
How long do I have?
Ideally under 30 minutes for the best outcome, and it is well worth trying up to about an hour. Even beyond that, bring it in, a tooth replanted late may still serve you for years and preserves the bone in the meantime.
What if it has been dry for hours?
Bring it anyway. The outcome is less predictable and the tooth may eventually be lost, but it can hold the space and the bone while a longer-term plan is made.
Will the tooth definitely survive?
Not always. Replanted teeth can undergo resorption, where the body gradually replaces the root with bone, sometimes over years. Prompt replanting and proper follow-up give the best chance, and we will be straight with you about the outlook.
What if the socket is bleeding a lot?
Bite firmly on a clean cloth or gauze for 15 minutes without lifting it to check. Steady pressure is what stops it.
Should I take painkillers?
Ordinary painkillers as directed on the packet are fine. Do not put aspirin against the gum.
What if it cannot be saved?
Options are an implant, a bridge, or a temporary replacement while you decide. In a child, we wait until growth is complete before placing an implant.
Call now. Do not wait for an appointment slot
- (310) 860-6969Someone here answers.
- Request a visitWe will call to confirm.
- Pick a time onlineChoose your own slot.
How teeth actually get knocked out
Knowing the mechanism matters, because it changes what else we check for.
- Sport. Basketball, baseball and cycling account for far more than contact sports do, mostly because guards are worn less. An elbow does this as often as a ball.
- Falls. The commonest cause in young children and in older adults. In older adults we also ask what caused the fall.
- Car and bike accidents. Often with facial injuries that need checking before the tooth does.
- Biting something hard. Rarely enough on its own. If a tooth came out on food, it was almost certainly already loosened by gum disease, and the other teeth need looking at too.
Tell us how it happened. A tooth lost to a fall and a tooth lost to bone loss are different problems with different plans.
Steps to Take When a Tooth Is Knocked Out
If you cannot face putting it back
Replanting it yourself gives the best odds, but plenty of people cannot do it. There is blood, the socket hurts, and it feels wrong. That is fine. Do not lose the tooth trying to force yourself.
Storage, best to worst:
- Inside your own cheek, held between cheek and gum. Saliva is close to ideal. Not for a young child, who might swallow it.
- Cold milk. The standard advice, and genuinely good. Any fat content works.
- Saline, such as contact lens solution.
- Water. Last resort only. It is better than letting the tooth dry out, and worse than everything above, because it bursts the root cells.
Never wrap it in tissue or a napkin. That dries it out faster than leaving it in open air.
Broken, rather than knocked out
A tooth that has chipped or fractured but is still in place is a different situation, and less time-critical, though still same-day if the break is deep.
- Small chip, no pain. Smooth or bond it. Often one short visit.
- Larger break, sensitive to air or cold. The dentin is exposed. It needs covering to keep bacteria out of the nerve.
- A pink or red dot visible in the break. That is the pulp. Same day, without exception.
- Broken at or below the gum. Sometimes savable with a crown, sometimes not. We take an X-ray before promising either way.
Save any fragment in milk. Front-tooth pieces can occasionally be bonded straight back, and the color match is perfect because it is your own enamel.
Preventing the next one
Most of what we see was preventable by one cheap piece of plastic.
- A custom sport guard for any sport with a ball, a stick, a bike or another body. A fitted guard stays put and is worn because it is comfortable; a boil-and-bite one gets left in the bag.
- Wear it at practice too. A meaningful share of injuries happen at training, where guards get skipped.
- Stop opening things with your teeth. Bottles, packaging, tags. This causes more front-tooth fractures than sport does.
- Treat looseness early. A tooth loosened by gum disease comes out on a sandwich. That is a periodontal problem, and it is treatable before it gets that far.