If a permanent tooth is knocked out, pick it up by the crown, rinse it briefly if dirty, put it back in the socket or keep it moist in milk or saliva, and see a dentist right away, ideally within 30 minutes. Speed and gentle handling give the best chance of saving it. A knocked-out baby tooth should not be put back.
Key Takeaways
- A knocked-out permanent tooth is a dental emergency: the American Association of Endodontists advises acting within about 30 minutes.
- Hold the tooth by the crown only, never the root, and do not scrub it, wrap it in tissue or let it dry out.
- If you cannot put the tooth back, keep it in cold milk, in the person's saliva or in a tooth-preservation kit; do not store it in tap water.
- Do not replant a baby tooth; bring the child to a dentist so the mouth and the permanent tooth underneath can be checked.
- Call 911 or go to the emergency department first if there is a head injury, loss of consciousness, trouble breathing or bleeding that will not stop.
What is a knocked-out tooth?
A knocked-out tooth, called an avulsed tooth by dentists, is a tooth that has come completely out of its socket, root and all. It usually happens from a fall, a sports hit, a car crash or a blow to the face.
A knocked-out tooth is different from a broken tooth. When a tooth breaks, part of it stays in the mouth. When a tooth is knocked out, the whole tooth is outside the mouth, and the living cells on its root begin to die as they dry. Those cells are what help the tooth reattach, which is why the clock matters so much.
A knocked-out permanent tooth can sometimes be saved if it goes back into the socket quickly. According to the American Association of Endodontists, success is still possible after 30 minutes, but the chances fall the longer the tooth is out and dry. No home step can guarantee the tooth will reattach, but good first aid gives it the best chance.
What to do in the first 30 minutes
Work through these steps calmly. Most can be done in a minute or two.
- Check the person first. Make sure they are breathing normally, awake and not bleeding heavily. If not, call 911 before anything else.
- Find the tooth. Look on the ground, in clothing and in the mouth. If you cannot find it, the tooth may have been swallowed or inhaled, and the person still needs to be seen.
- Pick it up by the crown. The crown is the white chewing part you normally see. Do not touch the root.
- Rinse only if dirty. Rinse the tooth for a few seconds with milk, saline or cool water. Do not scrub it, use soap, or wipe it with a cloth or tissue.
- Try to put it back. If it is a permanent tooth and the person can cooperate, push it gently back into the socket the right way round, matching the neighbouring teeth.
- Hold it in place. Have the person bite gently on clean gauze, a clean cloth or a handkerchief to keep the tooth still.
- If it will not go back, keep it moist. Use one of the storage options below. Never let it dry.
- Call the dental office and go now. Tell them a tooth has been knocked out so they can prepare.
These steps are first aid, not treatment. Even when a tooth goes back in easily at the scene, a dentist still needs to check its position, stabilize it and plan follow-up.
When not to replant
Do not try to put the tooth back if:
- it is a baby tooth;
- the person is unconscious, confused, very young or unable to hold still;
- there is a serious facial or jaw injury;
- the tooth is badly broken or you cannot tell which way it goes.
In these cases, keep the tooth moist and get help. Forcing a tooth into the wrong place can harm the socket or the tooth developing beneath it.
How to store a knocked-out tooth
The cells on the root surface survive best in a liquid that is close to the body's own fluids. The table compares the common options.
| Storage option | How well it works | Notes |
|---|---|---|
| Back in the socket | Best | Hold in place by biting on gauze; see a dentist right away |
| Tooth-preservation kit | Very good | Kits such as a balanced salt solution are made for this; follow the package directions |
| Cold milk | Good | Easy to find at home, school or an arena canteen; cover the tooth fully |
| Saliva | Good for a short time | Spit into a clean cup and put the tooth in it; an adult may hold it in the cheek |
| Saline (salt water for contact lenses or wounds) | Acceptable | Use if milk is not available |
| Tap water | Poor | Avoid for anything more than a quick rinse; root cells do not tolerate it |
| Dry (tissue, pocket, hand) | Worst | Drying quickly damages the root |
The American Association of Endodontists advises against tap water because root-surface cells cannot handle it for long. The same source lists milk, the mouth and emergency preservation kits as acceptable ways to keep the tooth moist.
A note about holding a tooth in the mouth: an adult or teenager can carry the tooth inside the cheek, but young children should not, because they may swallow or inhale it. Use a cup of milk or the child's saliva instead.
Bring any broken pieces of tooth in the same container. The dentist will decide whether they can be used.
Knocked-out baby tooth versus permanent tooth
Baby teeth (primary teeth) and permanent teeth are treated differently after they are knocked out.
Do not put a knocked-out baby tooth back. Guidance from the American Academy of Pediatric Dentistry and the International Association of Dental Traumatology advises against replanting primary teeth. Pushing a baby tooth back into the socket can damage the permanent tooth growing underneath, and a young child may inhale or swallow it.
If a baby tooth is knocked out:
- press clean gauze gently on the gum to stop bleeding;
- find the tooth so you know it was not swallowed or inhaled, but keep it out of the mouth;
- call the dental office so the child can be checked soon;
- watch for signs of a head injury, such as sleepiness, vomiting or confusion.
A knocked-out baby tooth is still a reason to see a dentist. The dentist will look for other injuries, check that no pieces are left behind and plan how to watch the permanent tooth as it comes in.
How to tell which kind of tooth it is
Children usually start losing front baby teeth around age six, and the permanent front teeth grow in over the next few years. Children in this stage have both kinds at once, so it can be hard to tell. Permanent front teeth are larger and often have a slightly ridged edge when new.
If you are unsure, do not replant it. Keep the tooth moist in milk and call the dental office right away. The team can help you decide over the phone.
In Nova Scotia, the provincial Children's Oral Health Program covers some basic dental services for children aged 14 and younger with a valid health card, including fillings and necessary extractions. Ask the office how your child's visit will be billed.
When to call 911 instead of the dental office
A knocked-out tooth on its own is a dental emergency (see what counts as a dental emergency for other urgent problems). It becomes a medical emergency when other injuries or warning signs are present.
Call 911 or go to the Emergency Department at the Colchester East Hants Health Centre first if there is:
- difficulty breathing, or noisy breathing after the injury;
- a tooth or piece of tooth that may have been inhaled, especially a child who is coughing or choking;
- bleeding from the mouth or face that does not stop with firm pressure;
- any loss of consciousness, confusion, repeated vomiting or a bad headache;
- a suspected broken jaw, the mouth will not close properly, or major cuts to the face;
- swelling that is making it hard to swallow.
Medical safety always comes first. While the person is being cared for, someone else can put the tooth in milk. Once the person is stable, the hospital team may not replant the tooth, so arrange dental follow-up as soon as you can.
Never delay airway or bleeding care to search for a tooth.
What happens at the dental office
When you arrive, the dentist will look at the tooth, the socket, the neighbouring teeth, the lips and the gums. Digital X-rays are often used to check the root, the bone and nearby teeth that may also have been hit.
If replanting is possible, the dentist may:
- gently clean the socket and the tooth;
- place the tooth back in the correct position, or adjust a tooth you already put back;
- attach it to the neighbouring teeth with a flexible splint for a period of time while it heals;
- stitch any cuts to the gums or lips.
In some cases, especially in adults, the tooth may later need root canal treatment. The need depends on the age of the patient, how developed the root is and how long the tooth was out of the mouth. The dentist will explain what to watch for.
If a knocked-out tooth cannot be saved, or does not heal well over time, your dentist can discuss replacement options such as a bridge, a removable denture or a dental implant once the area has healed. For growing children, the timing of any replacement is planned around development.
Recovery, follow-up and protecting teeth later
Follow-up is part of the treatment, not an extra. A replanted tooth may look fine for weeks and then show problems such as colour change, tenderness or root changes on an X-ray. Regular checks allow the dentist to catch these early.
While the tooth heals:
- eat soft foods and avoid biting into hard food with the front teeth;
- brush gently around the splint with a soft brush;
- use any rinse your dentist recommends;
- take pain relief only as the label directs and as it suits your health;
- avoid contact sports until your dentist says it is safe.
Call the office sooner if you notice swelling, a bump on the gum, fever, increasing pain or the tooth becoming loose again.
Outcomes vary. A replanted tooth may last for many years, may need more treatment later or may still be lost despite good care. Ask your dentist which signs should bring you back early.
Preventing the next one
Many knocked-out teeth happen during sports. Hockey, lacrosse, rugby, basketball, soccer and even skateboarding carry a real risk. A mouthguard is the simplest protection. Our guide to mouthguards and night guards explains the difference between a store-bought guard and a custom one. Keeping a small container and a tooth-preservation kit in a sports bag is also a practical step for coaches and parents.
If a tooth is knocked out in Truro or Colchester County
Speed matters most, so know your route before you need it.
During office hours, call Landmark Dental Care at 902-893-2919 as you head over. The practice is at 125 Queen St in downtown Truro and is open Monday to Friday, 8:30am to 5:00pm. Families in Bible Hill, Millbrook, Brookfield and around Colchester County can usually reach downtown Truro quickly. Tell the team a tooth has been knocked out so they can prepare. Learn more on our emergency dentistry page.
If there is any serious injury, call 911 or go to the Emergency Department at the Colchester East Hants Health Centre, 600 Abenaki Road, Truro, which is open 24 hours. Bring the tooth in milk.
Evenings and weekends, when the dental office is closed and there are no red flags, call 811 to speak with a registered nurse about where to go. Keep the tooth moist, and call the dental office the moment it opens. A tooth that has been out for hours has a lower chance of reattaching, but it is still worth having the mouth examined.
FAQ
Can a knocked out tooth be saved?
A knocked-out permanent tooth can often be saved if it is put back or kept moist and a dentist sees it quickly, ideally within 30 minutes. The chance falls the longer it is out and dry, and no one can guarantee it will reattach.
Should I put a knocked out tooth back in myself?
If it is a permanent tooth, it is clean, and the person is awake and calm, gently putting it back and holding it with gauze is recommended. Do not replant a baby tooth, and do not force a tooth that will not go in easily.
Is milk better than water for a knocked out tooth?
Yes. Milk, saliva and tooth-preservation kits protect the root cells much better than tap water. A quick rinse with water to remove dirt is fine, but do not store the tooth in it.
What if my child knocked out a baby tooth?
Do not put it back. Stop the bleeding with gentle pressure, keep the tooth so you know it was not swallowed, and call the dental office so the child's mouth and future permanent tooth can be checked.
What if I cannot find the tooth?
Still see a dentist promptly, because the socket and nearby teeth need to be checked. If the person is coughing, wheezing or struggling to breathe, the tooth may have been inhaled, so call 911.
Next step
If a permanent tooth has been knocked out and there are no medical warning signs, call for emergency dentistry in Truro at 902-893-2919 right away and bring the tooth stored in milk or saliva to 125 Queen St, Truro. You can also find directions on our contact page. For breathing trouble, uncontrolled bleeding, a possible head injury or major facial trauma, call 911 or go to the Colchester East Hants Health Centre emergency department.
References
- American Association of Endodontists: Knocked Out Teeth
- American Academy of Pediatric Dentistry: Guidelines for the Management of Traumatic Dental Injuries in the Primary Dentition
- International Association of Dental Traumatology / AAPD: Avulsion guidance (PDF)
- HealthyChildren (AAP): First Aid for a Knocked-Out Permanent Tooth
- MouthHealthy (ADA): Dental Emergencies
- Government of Nova Scotia: 811 Health Advice
- Government of Nova Scotia: Children's Oral Health Program
This article provides general educational information and is not a diagnosis or a substitute for care from a dentist or other qualified health professional.
About this guide
This article was written and reviewed by the Landmark Dental Care Team at Landmark Dental Care, 125 Queen St, Truro, NS B2N 2B4. It is general patient education and is not a diagnosis or a substitute for an examination. If you have pain, swelling or a change in your mouth, call us at 902-893-2919 so a dentist can assess you.