Losing a tooth is one of the most serious emergencies that can happen to your teeth. Whether it was knocked out in sport, you fell over or got hit, it can be scary to lose a permanent tooth that has come out completely. However knowing exactly what to do in the first few minutes can make all the difference.

The best chance of successfully re-implanting your tooth is within 30-60 minutes. This guide outlines exactly what to do in an emergency, how to keep the root cells safe, what not to do and what to expect whilst seeing an emergency dentist.

1. Stay Calm and React Fast

Time is the key to saving your tooth.

Golden 30 Minutes

  • In the first 30 minutes of your tooth being knocked out it has the best chance of surviving permanently.

After 60 Minutes

  • After 60 minutes the success rate drops dramatically but emergency dentists can still attempt to re-implant your tooth using specific techniques.

Permanent Teeth

  • Make sure your knocked out tooth is a permanent adult tooth. Baby teeth should never be re-implanted as this can cause damage to the adult tooth underneath.

2. Hold only by the Crown

Handling your injured tooth correctly will help save the living fibers on the root.

Hold only by the Crown

  • Always hold your tooth by the white part. Never touch, push or hold the root.

Periodontal Ligament

  • There are lots of sensitive periodontal ligament (PDL) cells on the root of your tooth. These are needed to help re-implant your tooth to your jaw. By touching the root you will crush these sensitive cells.

Don’t Scrub

  • Never scrub the root of your tooth. It is very important not to use brushes or anything to scrape away the tissue stuck to the tooth. This will remove the cells completely.

3. Rinse your Tooth

If your knocked out tooth landed in any dirt, concrete or messy surfaces you need to gently clean it.

Rinse with Milk/Saline

  • Gently rinse your tooth in a small bowl of cold fresh milk or sterile saline to remove any dirt.

Rinse with Water (Last Resort)

  • If you don’t have any milk/saline you can gently rinse with cold tap water. But only for a maximum of 10 seconds.

Don’t Use Soap or Anti-Bacterial

  • Don’t use any soaps, alcohol, hydrogen peroxide, washing up or hot water. This will cause the root cells to die straight away.

Don’t Wipe

  • Don’t wrap your tooth in any dry tissue, paper towel or cloth. This will cause the cells to die within minutes.

4. Try Re-Implant

If your conscious, calm and can co-operate the best way to try and save your tooth is to re-implant it. This will give the tooth the best chance of surviving.

Correct Orientation

  • Make sure the tooth is facing the right way. The white crown should face outwards and the root should go in.

Gently Re-Implant

  • Gently slide your tooth back into the gap. Don’t force it if there is a lot of resistance.

Bite Down Gently

  • Once fitted gently bite down on a clean piece of gauze, damp tea bag or paper towel.

5. Choose a Suitable Liquid

If your tooth cannot be re-implanted immediately (due to it hurting too much, swelling or fear of swallowing the tooth) you need to place the tooth in a suitable liquid to keep the root cells alive.

Cold Milk

  • Cold milk is the best option as it contains the correct chemical balance, proteins and sugars. This will help keep the cells alive for several hours.

Save-a-Tooth

  • Special emergency dental kits contain Hank’s Balanced Salt Solution. This will keep your root cells alive for up to 24 hours. If you play contact sports make sure to keep a kit in your first aid kit.

Inside Cheek

  • If you don’t have any milk you can place the tooth inside the patients mouth. Place between the lower cheek and gums. The patients saliva will keep the root moist. Don’t use this method on young children as they may swallow the tooth.

Don’t Use Tap Water

  • Never submerge your knocked out tooth in a cup of tap water. This will cause the root cells to swell and burst due to the hypo-tonic shock.

6. See an Emergency Dentist

Once your tooth is stored or re-implanted head straight to your nearest emergency dental clinic .

Call Ahead

  • Whilst traveling to your clinic call ahead to let them know you’re coming. This way they can get everything ready for you.

Stop Bleeding

  • Apply firm pressure with sterile gauze or clean cloth to stop any bleeding.

Ice Pack

  • Apply an ice pack wrapped in a cloth to the outside of the lip/cheek to help reduce swelling and pain.

7. Treatment & Splinting

On arriving at your emergency clinic your dentist will carry out some immediate treatment.

Digital X-Rays

  • Digital x-rays will be taken to see if there is any damage to the jawbone, root or bone fragments in the socket.

Cleaning & Re-Implant

  • Your dentist will numb the area gently and clean out the socket. They will then carefully re-implant your tooth.

Splinting

  • The knocked out tooth will be secured with a thin flexible wire and composite resin next to the healthy teeth. This will keep the tooth secure for 2-4 weeks whilst the bone and ligaments heal.

Root Canal

  • As the main nerve supply has been severed a root canal will generally be required within 2 weeks. This will stop the root from reabsorb and causing an infection.

Key Points to Remember

  • Find your tooth immediately. Make sure you only hold it by the white crown.
  • Is it a permanent (adult) or baby (primary) tooth? Never re-implant baby teeth.
  • If dirty gently rinse with cold milk/saline for a few seconds. Don’t scrub or use any chemicals.
  • If possible gently slide the tooth back into the socket. Bite down gently on gauze.
  • Place in cold milk/saline or inside the cheek.
  • Don’t place in tap water.
  • Apply direct pressure to stop any bleeding with clean gauze.
  • Apply an ice pack to the outside of the cheek to reduce swelling.
  • See an emergency dentist within 30-60 minutes.
  • Take any antibiotics, tetanus top-ups and attend your pulp therapy appointment.

FAQs

Can I put my baby tooth back in?

No, you should never re-implant your baby tooth. This can cause damage to the adult tooth growing underneath. Contact your pediatric dentist to check the socket and make sure it is healing cleanly.

What if my tooth has broken?

If your tooth has broken collect all the pieces and place in cold milk. Take to your emergency dentist. Whilst broken roots can be hard to re-implant large pieces of crown can be saved. Your dentist can bond the pieces back together using composite.

How long will my tooth be splinted for?

Generally your tooth will be splinted for 2-4 weeks. How long depends on how badly the bone and ligaments were damaged. Long periods of splinting are generally avoided to allow your ligaments to naturally re-attach.

Will I always need a root canal?

Yes, fully formed adult teeth will have the blood and nerve supply cut off to the tip of the root. Within 7-14 days of re-implanting your tooth a root canal will be carried out. This will remove the dead nerve tissue. This will prevent the root from re-absorbing and causing an abscess and infection.

Knowing what to do if you knock out your tooth can help you react quickly. By keeping the root safe, keeping it moist in milk/saliva, not scrubbing and seeing an emergency dentist within 30-60 minutes you have the best chance of your tooth recovering fully. Remember these points to help keep your smile safe.