If this is happening right now, stop reading and go to dental emergencies. The numbered steps live there, on one page, written to be followed in a hurry.
Then telephone us on (614) 555-0142. This article is the explanation behind those steps, for reading afterwards or beforehand.
The only question that matters
Everything else follows from one thing: whether it is a permanent tooth or a baby tooth. The correct action in one case is very nearly the opposite of the correct action in the other, which is why general first-aid advice found online can be actively unhelpful here.
Telling them apart, quickly
Age is the strongest clue. Permanent front teeth usually arrive somewhere between six and eight, so a four-year-old has lost a baby tooth and an eleven-year-old has almost certainly lost a permanent one. The ages either side of that are the ones that catch people out.
The tooth itself is the second clue. Baby teeth are smaller, whiter and rounder, and the root of a knocked-out baby tooth is often short, blunt or barely there, because the body has been quietly dissolving it to make way for the adult tooth underneath. A permanent tooth normally has a long, complete, pointed root.
If you are not sure — and over a crying child in a car park, plenty of people are not — then do not put it back. Put it in cold milk and telephone us. Guessing wrong that way costs a phone call. Guessing wrong the other way can cost the adult tooth.
If it is a permanent tooth
This is genuinely a minutes-matter emergency, and it is one of very few in dentistry. Three things carry almost all of the weight.
1. Time out of the socket
The living cells on the root surface start to die as soon as the tooth leaves the mouth, and the length of time it spends out is the single biggest factor in what can be done. Putting the tooth back at the scene, within a few minutes, is better than anything a dentist can do an hour later. Aim to be seen inside thirty to sixty minutes regardless. Ring on the way rather than after you arrive.
2. How it is handled
Hold the tooth by the crown — the white part that was doing the chewing. Do not touch the root, wipe it, scrub it or disinfect it, and do not let anyone helpfully clean it up: those root cells cannot be replaced once they are rubbed off. If it is visibly dirty, rinse it briefly in cold milk or saline, still holding the crown. Not in plain tap water, which damages the root surface, and never with a cloth.
3. Where it travels
Back in its own socket is the best place, if your child can manage it and you can face it. Line it up the right way round, press it gently home with a finger, and have them bite softly on a clean cloth or folded gauze to hold it in position while you travel. If that is not possible, the tooth travels in cold milk. The child's own saliva or a saline solution will also do. Plain water will not, and dry in a tissue is the worst option of all.
We will not tell you that replanting a tooth saves it, because nobody can honestly promise that. Some replanted teeth settle for decades, some are lost later, and many need root canal treatment along the way. Replanting early gives the tooth its best available chance. That is the whole of the claim.
If it is a baby tooth
A knocked-out baby tooth is never put back in. This is the part that surprises people, because the instinct to put it back is strong and the tooth looks fine sitting in your hand.
The reason is directly above it. The permanent tooth is already forming in the bone a few millimetres away, and pushing a baby tooth back into that socket can damage it — a white or brown mark in the enamel, a misshapen crown, or a tooth that erupts late or out of position years later. That is a baby tooth which was going to be lost anyway set against a permanent one that has to last a lifetime. Not a close call.
What to do instead:
- Sit your child upright and press a clean gauze or flannel firmly on the socket for about ten minutes without lifting it to check.
- A cold compress on the outside of the lip or cheek helps with swelling and, usually, with the shock.
- Soft food, no straws, no hot drinks for the rest of the day.
- Telephone us the same day, and bring the tooth in a pot even though it is not going back.
We still want to see them: to check the whole tooth came out rather than a piece of it, to look at the teeth either side, and to write the injury into the notes so that in six years' time, when the adult tooth appears looking slightly odd, somebody knows why.
If you cannot find the tooth
Look properly, then take it seriously. Three things can have happened, and two of them need checking.
- It may not be out at all. A tooth can be driven up into the gum — intruded — and look convincingly missing. Only an examination, usually with a radiograph, can tell.
- It may have been swallowed. A swallowed tooth usually passes without incident, but tell us and tell your doctor.
- It may have been inhaled. This is uncommon and it is serious. If your child coughed, choked, wheezed or went briefly blue at the moment of the injury, or if the tooth simply cannot be accounted for, they need medical review and probably a chest X-ray today. Go to urgent care or an emergency department; do not wait for a dental appointment.
Check the lip and tongue too: a fragment can lodge inside a split lip, which is easy to miss.
What happens when you get here
We clean and examine the area, take radiographs of the root and the bone, and check the neighbouring teeth. A replanted permanent tooth is usually held with a thin flexible splint for a short period, and we will ask about tetanus cover if the injury happened outdoors. After that it is review appointments, over months and sometimes years, because a tooth that has been out of its socket has to be watched rather than declared fixed. We cannot tell you on day one how it will end, and we will not pretend otherwise.
Once things have calmed down, ask us about a mouthguard. Most of the knocked-out permanent teeth we see arrive from sport and from scooters, and a properly fitted guard is a small thing to arrange at a routine check-up.
Bookmark the emergency page and save our number in your phone now. The evening it matters is not the evening to be hunting for either of them.