Knocked-out tooth: what to do in the first hour to save it

An adult tooth that has been knocked out can often be saved, but only if the cells on its root stay alive (proDente). That depends on two things: how you handle the tooth, and how quickly a dentist sees it. Official advice differs between countries on putting the tooth back and on what to store it in, so the table near the end shows each one.

First minutes

1. Press a clean cloth on the bleeding, and look for the tooth straight away.

   

   Mouths bleed a lot, but pressing a cloth handkerchief or sterile dressing on the spot can stop it (Zahntraumazentrum Regensburg, proDente). proDente also suggests cooling the mouth from the outside.

   Search for the tooth, and any broken pieces, at once (proDente). Every minute the tooth spends in a rescue box improves its chances (Zahntraumazentrum Regensburg).

2. Work out whether it's a baby tooth or an adult tooth.

   

   Never put a baby tooth back in: it could damage the adult tooth growing underneath (NHS). Baby teeth are not replanted (MedlinePlus), but your child should still see a dentist.

   If you can't tell whether it's a baby tooth, don't put it back. Keep it in milk and let the dentist decide.

3. Pick the tooth up by the crown, never the root.

   

   Hold it by the white part that normally sticks out of the gum (NHS). Touching the root harms the cells that let the tooth grow back in (proDente, MedlinePlus).

4. Careful: never scrub the tooth, dry it, or clean it with soap, alcohol or peroxide (AAE, MedlinePlus).

   Only if it's dirty, rinse it very briefly.

   

   The NHS says to rinse a dirty tooth gently in milk, saline or saliva. The American Association of Endodontists says plain water, only if dirty.

   German dental sources go further: don't clean or disinfect the tooth at all, just put it straight into a tooth rescue box (Zahntraumazentrum Regensburg, proDente).

Put it back, or keep it wet

1. Put an adult tooth back into its socket, if it slides in easily.

   

   The NHS and the AAE both say to try putting it back in the hole in the gum, guiding it gently with your fingers (AAE). MedlinePlus says to place it so it's level with the other teeth. Don't force it.

   German dental sources don't ask you to put it back yourself: they say to put it in a tooth rescue box and go straight to a dentist (Zahntraumazentrum Regensburg, proDente).

2. Bite gently on a clean cloth to hold it in place.

   

   Bite down gently on a clean cloth to keep the tooth there (NHS), or on gauze (MedlinePlus). You can also hold it in place with your fingers (AAE). Then go to the dentist.

3. If it won't go back, put it in cold milk or a tooth rescue box. No milk? Use saline.

   

   A tooth rescue box keeps the root cells alive for up to 48 hours at room temperature (Zahntraumazentrum Regensburg). The AAE calls it an emergency tooth preservation kit.

   Without one, use milk (NHS, AAE, MedlinePlus). No milk? Use saline. The Zahntraumazentrum Regensburg recommends cold long-life (UHT) milk for no more than 120 minutes, or saline for no more than 30, until you can get a rescue box. proDente also lists wrapping it in cling film as a short stopgap.

4. Careful: never keep a tooth in tap water, wrapped in a tissue, or dry. The root cells die within minutes (Zahntraumazentrum Regensburg, AAE).

   No milk or saline? Keep the tooth in saliva until a dentist can put it back.

   

   An adult or older child can keep the tooth inside their cheek, between the cheek and the gums, so it stays in saliva until a dentist puts it back in the socket (AAE), or between the lower lip and gum (MedlinePlus). Or the person who lost the tooth spits into a clean container and the tooth goes in that (NHS).

   Never let a young child keep a tooth in their mouth: swallowing or breathing it in can be life-threatening (Zahntraumazentrum Regensburg). Use the container instead.

Get to a dentist

1. Go to a dentist straight away.

   

   The AAE says seeing a dentist within 30 minutes gives the best chance of saving the tooth, though it's sometimes possible after an hour or more. The NHS says to ask for an emergency dental appointment, even if you can't find the tooth.

   • UK: your dentist. If you don't have one, or can't get an emergency appointment, call 111 (NHS).
   • Germany: a dentist or dental clinic (proDente). Out of hours, the zahnärztlicher Notdienst run by your region's dental association (KZV); in Berlin, (030) 89004-333 (KZV Berlin).
   • US: a dentist or an endodontist (AAE).

2. Take the tooth and any broken pieces with you.

   

   Bring the tooth (AAE). Broken pieces can often be stuck back on, so collect them too (Zahntraumazentrum Regensburg). Keep pieces in a tooth rescue box so they don't dry out (Zahntraumazentrum Regensburg), or in milk or saline, never in tap water.

3. Get any other mouth injury checked, even if it looks small.

   

   Teeth can also be loosened, pushed out of place or cracked at the root in ways you can't see. See a dentist after any knock to the teeth (Zahntraumazentrum Regensburg, proDente).

   A doctor should also check the person's tetanus protection, as for any wound (Zahntraumazentrum Regensburg).

Afterwards, and next time

1. Go back for every check-up the dentist asks for.

   

   Regular follow-up visits catch problems early (Zahntraumazentrum Regensburg). In Germany, proDente also says to report the accident to your health insurer.

2. Keep a tooth rescue box at home, especially with children.

   

   In Germany, pharmacies sell tooth rescue boxes for about 15 to 20 euros, and they keep for 3 years at room temperature (proDente). Schools, sports clubs and families with children should have one (proDente). Store it somewhere everyone knows (Zahntraumazentrum Regensburg).

3. Wear a mouthguard for contact sports.

   

   A mouthguard made by a dentist for your sport protects best. Ready-made ones protect much less well and fit poorly, so people stop wearing them (proDente).

What each country says

If something isn't right

For pain that starts later, see our guide to toothache until you can see a dentist.