Knocked-Out or Injured Tooth

First aid for a knocked-out, loosened or broken tooth, in short steps. Call us at (305) 568-8899 on the way.

A permanent tooth knocked out

Every minute counts: a tooth put back within minutes has the best chance of reattaching.

1. 1
   Step 1 of 5 Hold it by the crown

   The part you normally see. Do not touch the root.

2. 2
   Step 2 of 5 Do not scrub, wipe or soak it

   If it is dirty, clean it gently with saliva, or rinse it for a few seconds under cold running water.

3. 3
   Step 3 of 5 Put it back in the socket right away

   Facing the right way, pressed gently home, then held in place with your fingers. Done at once, by the patient or a parent, this gives the tooth its best chance.

4. 4
   Step 4 of 5 If you cannot, keep it moist

   In a small cup of milk or saliva, in Hank's Balanced Salt Solution (tooth-saving kits at many sports fields and schools), or inside the cheek of a patient old enough not to swallow it. Never dry, never in water.

5. 5
   Step 5 of 5 Come straight in

   To us or the nearest emergency dentist. Call on the way: (305) 568-8899.

Never put a baby tooth back. It can damage the adult tooth forming underneath. Keep the tooth and bring the child in to check for other injuries.

Why the root matters: the soft film on it holds the living cells that let the tooth reattach, and they begin to die within minutes once the tooth dries out or sits in water. These steps follow the International Association of Dental Traumatology’s guidelines, which the American Academy of Pediatric Dentistry also endorses.

A tooth loosened or pushed out of place

• Do not wiggle it or pull on it.
• If it has been pushed out of line and moves easily, guide it gently back with light finger pressure. Do not force it.
• Hold it in place with your fingers and come in the same day.
• A tooth pushed up into the gum, or sideways into the bone, needs the same prompt visit. Do not try to move it.

At the visit the tooth is checked, repositioned if needed and usually splinted to its neighbors with a thin wire and bonding for a few weeks while the ligament that holds it heals.

A broken or chipped tooth

• Rinse your mouth gently with warm water.
• Keep any piece you find, moist in milk; sometimes it can be bonded back on.
• Cover a sharp edge with sugar-free gum or dental wax if it cuts your tongue or lip.
• A small chip with no pain: within a day or two.
• The pink or bleeding center of the tooth showing, or pain with air or cold: the same day. The nerve is exposed, and the sooner it is covered the better its chances.

Cuts to the lip, tongue or cheek

• Press firmly with clean gauze or a cloth for ten minutes. Most cuts stop.
• A cut that gapes, keeps bleeding or goes through the lip needs stitches, usually at an emergency room or urgent care.
• Check the cut for pieces of tooth; a chip can end up inside the lip.

What we do at the visit

We first make sure nothing more serious has been missed, then find every injured tooth, not only the obvious one; a blow often loosens or cracks the neighbors too. X-rays, and sometimes a 3D scan, show root fractures and the bone. Then:

• A replanted or loosened tooth is positioned and splinted, and the bite is checked so nothing hits it.
• A chipped tooth is rebuilt with composite bonding, matched to the tooth, often the same day; a large fracture may need a crown once things have settled.
• An exposed nerve is covered and protected. Some teeth keep their nerve; others will need a root canal, either now or later.
• A tooth that cannot be saved, split or fractured through the root, is removed with the replacement planned at once. For an adult’s front tooth that often means an implant placed at the time of extraction, with particular care for the shape of the gum, so the final result looks like the tooth you lost. In children and teens, whose jaws are still growing, an implant waits until growth is complete, and a temporary replacement holds the space until then. A temporary tooth covers the gap in the meantime.

The months afterward

• An injured tooth is not finished when the splint comes off: the nerve can die weeks or months later.
• Signs: the tooth turns slightly gray, aches, or a small bump appears on the gum.
• We see injured teeth again at intervals, with cold tests and X-rays, and treat a dying nerve when it shows.
• Keep the follow-up visits even if the tooth feels fine.
• If the injury happened playing a sport, ask about a custom mouthguard.

Frequently asked questions

My tooth was knocked out. What do I do right now?

Pick it up by the crown, never by the root, and do not scrub, wipe or soak the root: the soft film on it holds the cells that let the tooth reattach. If it is dirty, clean it gently with saliva, or rinse it for a few seconds under cold running water. Put it back in the socket right away if you can and hold it in place with your fingers. If you cannot, keep it moist in milk, in a little saliva in a cup, in Hank's Balanced Salt Solution or inside the cheek, never dry and never in water, and get to a dentist straight away. Never put a baby tooth back.

The tooth is loose or pushed out of position. Should I move it?

If it has been pushed out of line, gently guide it back toward its normal position with light finger pressure if it moves easily, hold it there with your fingers and come straight in. Do not force it. A loose tooth is splinted to its neighbors for a few weeks to let the ligament heal.

It only chipped. Do I need to come in today?

A chip with no pain, no exposed nerve and no looseness can wait until the next day or two. Keep the fragment. Pain, bleeding from the center of the tooth, a tooth that has moved or any bite that feels different means the same day.

Will the tooth survive?

A knocked-out tooth put back within minutes has the best chance, and the chance falls with every minute it spends out of the mouth, faster if it dries. Loosened and displaced teeth usually recover. Any injured tooth can lose its nerve in the weeks or months afterward, which is why follow-up visits and a root canal if needed are part of the plan.

When is a dental injury an emergency room visit?

If there was a blow to the head with loss of consciousness, confusion or vomiting; if the jaw may be broken or will not close properly; if bleeding will not stop; or if there are other injuries. Medical care first, then us.

Sources

Professional guidelines and peer-reviewed reviews this page draws on.

1. Fouad AF, Abbott PV, Tsilingaridis G, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dental Traumatology. 2020;36(4):331-342. DOI
2. Day PF, Flores MT, O'Connell AC, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Dental Traumatology. 2020;36(4):343-359. DOI
3. American Academy of Pediatric Dentistry. Endorsement of the International Association of Dental Traumatology guidelines on avulsion of permanent teeth. AAPD