A soccer ball to the face, a fall off a scooter, an elbow during a pickup game. When a knocked-out tooth lands in someone's hand, most people panic and wrap it in a napkin. That's the one thing you shouldn't do. A permanent tooth that's been knocked out can often be saved, but the cells on its root start dying as soon as they dry out, so the next hour decides a lot. Here's what we tell parents and patients who call us in that moment.
Step 1: Find the tooth and pick it up by the crown
Pick the tooth up by the white part you normally see when you smile (the crown). Don't touch the root. The thin layer of tissue on the root is what lets the tooth reattach, and fingers, tissues and scrubbing all damage it.
Step 2: Rinse it only if it is dirty
If the tooth fell on the ground, rinse it briefly in milk or with a gentle stream of cool water for a few seconds. Don't scrub it, don't use soap and don't wrap it in a tissue or paper towel.
Step 3: Try to put it back in the socket
For an adult or older child who is calm and alert, the best place for the tooth is back where it came from. Hold it by the crown, make sure it faces the right way, and push it gently into the socket. Then bite softly on a clean cloth to hold it in place on the way to the dentist.
Don't do this with a baby tooth. Baby teeth aren't put back, because doing so can damage the adult tooth developing underneath.
Step 4: If you can't put it back, keep it wet
If the tooth won't go back in, or the person is too young or too upset, keep the tooth moist. In order of preference:
- A cup of cold milk
- An emergency tooth-saving solution, if you have one in a first aid kit
- Inside the cheek of an adult who won't swallow it
- Saliva in a small container
Plain tap water is a last resort, because cells on the root swell and break down in it over time. Never let the tooth dry out.
Step 5: Call a dentist right away
Try to be in a dentist's chair within the hour. Call ahead so the team knows you're coming and can be ready. At NOHO Dental Group in North Hollywood, call (747) 339-7016 and tell us a tooth has been knocked out. Our dental emergency page explains how we handle urgent visits.
Go to an emergency room instead if there is a head injury, loss of consciousness, heavy bleeding that won't stop with pressure, or a possible broken jaw.
What the dentist will do
If the tooth is back in its socket, the dentist checks its position, takes an X-ray and usually attaches it to the neighboring teeth with a thin, flexible splint for a couple of weeks while it heals. If you bring the tooth in milk, it is cleaned gently and replanted first.
Because the nerve inside a knocked-out adult tooth often doesn't survive, many of these teeth need a root canal a week or two later. Your dentist will tell you the timing. Follow-up visits over the next months make sure the tooth is healing and the root isn't being reabsorbed.
If the tooth can't be saved
Sometimes a tooth has been out too long, or the root or bone is too damaged. That doesn't mean living with a gap. Once the area heals, options include a dental implant, a bridge or a partial denture. For children and teens whose jaws are still growing, the dentist may suggest a temporary solution until growth is complete.
Chipped or pushed-in teeth
Not every injury knocks a tooth out. A tooth that is chipped, loose, pushed back or pushed up into the gum also needs to be seen the same day. Save any broken pieces in milk, rinse your mouth with warm water and use a cold compress on the outside of the face for swelling.
Preventing it next time
Most knocked-out teeth happen during sports, falls and accidents. A mouthguard is the simplest protection for basketball, soccer, skating, martial arts and anything with contact. A custom guard made from a model of your teeth fits better and stays in place more reliably than a boil-and-bite version, which makes people more likely to actually wear it.
If you only remember five things
- Pick the tooth up by the crown, never the root.
- Rinse briefly in milk or water only if dirty.
- Put it back in the socket if you can, and bite on a cloth.
- Otherwise keep it in milk or saliva.
- See a dentist within the hour.
It's worth saving this page or screenshotting the list for your kid's sports bag. And if an injury already happened and you're not sure what to do, get in touch and we'll walk you through it.
