Emergency
A knocked-out tooth: what to do in the first thirty minutes
The outcome is decided by people who are not dentists, in the first half hour, usually at a playground or a roadside. This is the page to have read before you need it.
Most dental problems can wait until morning. This one cannot. A permanent tooth that has been knocked completely out of its socket has a real chance of being saved and reattaching, and that chance is largely determined before anyone reaches a clinic.
Why the first thirty minutes matter so much
Clinging to the root surface of a knocked-out tooth is a layer of living periodontal ligament cells. Those cells are what will reattach the tooth to the bone. They are the entire mechanism of a successful replantation.
They are also fragile. Left dry in open air, most of them become non-viable after around thirty minutes, and damage continues past that point. Once the ligament cells are dead, the body tends to treat the root as foreign material and resorb it, replacing it with bone over subsequent years. The tooth may be retained for a while, but the long-term outlook is much poorer.
This is why handling matters more than speed to the clinic, and why the two common instincts, rinsing it clean under the tap and wrapping it in tissue, are the two worst things you can do.
What to do, in order
- Find the tooth. Stay calm and check that the person is otherwise alright first.
- Hold it by the crown, which is the white part that is normally visible in the mouth. Do not touch the root. Every contact with the root surface destroys ligament cells.
- If it is visibly dirty, rinse it very briefly, about ten seconds, in milk, saline or the injured person's own saliva. Cold running water only if you have nothing else. Do not scrub it, do not use soap or disinfectant, and do not let it dry.
- Put it back in the socket if you reasonably can. Line it up the same way round as the neighbouring teeth and push it gently but firmly into place. Then have the person bite softly on a clean handkerchief or gauze to hold it there. Replanting immediately gives by far the best outcome.
- If you cannot replant it, put it in milk. Plain cold milk is an excellent storage medium because its osmolality and pH suit the cells. Saline works. So does the person's own saliva, and an adult old enough not to swallow it can hold the tooth inside their cheek.
- Go to a dentist straight away, and take the tooth with you even if it looks damaged. Ring ahead so the clinic is ready.
What not to do
- Do not store or transport the tooth in plain water. Water is hypotonic, meaning the cells absorb it, swell and burst. It is worse than milk by a wide margin.
- Do not scrub the root, scrape it, or wipe it dry with a cloth or tissue. You are removing exactly the tissue the treatment depends on.
- Do not carry it dry in a pocket or wrapped in paper.
- Do not use antiseptic, alcohol or soap on it.
- Do not replant a baby tooth. This one matters: forcing a primary tooth back in can damage the developing permanent tooth sitting in the bone above it. Baby teeth are not replanted. Take the child to a dentist, but leave the tooth out.
If it has already been hours
Bring the tooth anyway. The outlook is poorer once the ligament cells are gone, but replantation is still often attempted, particularly in a young person, because keeping the tooth in place preserves the bone and buys years before a permanent solution is needed. That is a decision worth having a dentist make rather than making it by throwing the tooth away.
Other dental emergencies, briefly
A chipped or broken tooth
Find the fragment and keep it in milk. Modern bonding can often reattach the patient's own piece of tooth with a better result than any filling material. Rinse the mouth with warm water and use a cold compress on the outside of the cheek for swelling.
A tooth pushed out of position but still attached
Do not force it. You can try to reposition it very gently with light finger pressure, but if it resists, leave it and get seen the same day. It will need splinting.
Severe toothache with facial swelling
Swelling means the infection has spread beyond the tooth, and it is the symptom that turns a toothache into an urgent problem. Swelling that is spreading toward the eye or under the jaw, difficulty swallowing, difficulty opening the mouth, or fever all need same-day attention. Painkillers manage the symptom while the cause continues.
When it is a hospital, not a dentist
Go to an emergency department rather than a dental clinic if there was loss of consciousness, confusion or vomiting after a head injury, if bleeding will not stop after fifteen minutes of firm pressure, if the jaw appears broken or the bite has suddenly changed after trauma, or if there is any difficulty breathing or swallowing. Dental injuries frequently come with head injuries, and the head injury is assessed first.
Common questions
Milk or water for a knocked-out tooth?
Milk, without question. Water causes the ligament cells on the root to swell and burst because it is hypotonic. Milk, saline or the person's own saliva all preserve the cells far better. Water is a last resort only for a brief rinse if nothing else exists.
Should I put a baby tooth back in?
No. Replanting a primary tooth risks damaging the permanent tooth developing in the bone above it. Take the child to be seen, but do not replace the tooth.
How long do I have?
Replant immediately if you can. Ligament cells on a dry root are largely non-viable after about thirty minutes, so the practical target is to have the tooth either back in the socket or into milk within minutes, then reach a dentist as fast as possible.
Will the tooth need a root canal afterwards?
A fully formed adult tooth almost always will, because the nerve supply is severed when the tooth comes out. This is done shortly after replantation, once the tooth is stabilised. Teeth in children with incompletely formed roots are sometimes monitored instead, as the nerve can occasionally re-establish.
Is a knocked-out tooth an emergency at night?
Yes. It is one of the few genuine dental emergencies where delay directly costs you the tooth. Ekdantay takes emergency calls around the clock.
References
This article is general information about dental health and is not a diagnosis or a substitute for an examination. Symptoms that look alike can have very different causes. If something in your own mouth is worrying you, book a visit or call us on +91 95878 15285.
Have a question about your own teeth?
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