A Knocked Out Tooth: the First Thirty Minutes

If an adult tooth has just been knocked out, the clock matters more than anything else you will read here. Pick the tooth up by the crown, the part you chew with, put it straight back into the socket if you can, and get to a dentist immediately. If you cannot put it back, store it in milk and take it with you.

Within about thirty minutes gives the best chance of the tooth surviving. After that the odds fall steadily, though a tooth kept in milk is still worth bringing hours later. Never store it in plain water, and never scrub the root.

Do these things in the next few minutes

Speed beats getting every step perfect. Work through this quickly and do not stop to research a better container.

• Find the tooth and pick it up by the crown, never by the pointed root
• If it is dirty, rinse it for a few seconds in milk or saline, not by scrubbing
• Put it back into the socket the right way round and bite gently on a clean cloth
• If you cannot reinsert it, drop it into cold milk right away
• Get to a dentist now, calling on the way so they are ready for you

The root is alive, which is why you must not clean it

The surface of the root is covered in a thin layer of living cells that attach the tooth to the bone. Those cells are the entire reason a knocked out tooth can be put back at all. They die from drying out, from being wiped, and from being put in the wrong liquid.

So hold the tooth by the crown only. Do not rub the root with a cloth or your fingers, do not use soap, alcohol, disinfectant or toothpaste, and do not dry it off. If it is visibly dirty, hold the crown and rinse it briefly, for about ten seconds, in milk or saline. Cold running water for a few seconds is a last resort if there is nothing else.

If the tooth was dropped on the ground, pick it up the same way and rinse it the same way. A brief rinse is not the problem. Scrubbing is.

The socket is the best storage there is

Nothing preserves a tooth as well as its own socket, so reinserting it is the first choice whenever it is possible. Line it up the way it sat, the flat front surface facing forward, and press it in gently and firmly until it is level with the neighboring teeth. It will not always seat the whole way, and that is acceptable.

Hold it in place by biting gently on a clean cloth, a handkerchief or gauze, and keep biting until you are seen. Rinsing the socket first is not necessary. If a clot has already formed and the tooth will not seat, do not force it: put the tooth in milk instead and go.

An adult can usually do this for themselves. Do not attempt it if the person is drowsy, confused, or cannot cooperate, and never with a young child who could swallow or inhale the tooth.

If you cannot put it back, milk is the answer

Cold milk is the storage medium to reach for, and almost every home, gas station and school has it. Its salt and sugar balance is close enough to the body's own that root cells survive in it for hours rather than minutes. Whole or low fat both work.

Saline, the kind sold for contact lenses or wound rinsing, works too, and a tooth preservation solution from a pharmacy or a sports first aid kit is better still if one is at hand. Holding the tooth inside the cheek against the gum uses your own saliva and is better than nothing for a calm adult, though not for a child.

Plain water is the worst common option. It has none of the dissolved salts the cells need, so it makes them swell and burst, which is the opposite of preserving them. Wrapping the tooth in tissue, a paper towel or ice is equally damaging, since all of them dry it out or freeze it.

• Best: back in the socket, held in place by biting on a cloth
• Good: cold milk, saline, or a tooth preservation solution
• Only if nothing else: inside an adult's cheek, against the gum
• Never: plain water, tissue, a dry container, or ice

Thirty minutes is the target, and going late still beats not going

Replanting within thirty minutes gives the tooth its best chance, and the outlook worsens with every additional half hour the root spends outside the mouth and out of a suitable liquid. That is why the guidance is to move first and sort out details on the way.

Call ahead so the practice can clear a slot and have a splint ready. Most will fit in a knocked out tooth immediately during working hours. If your own dentist is closed and you need somewhere fast, our directory searches every dental practice in the United States by town or ZIP code and shows the closest first, free and with no account. Say on the phone that it is an avulsed adult tooth and how long ago it happened.

Arriving three hours later with the tooth in milk is still worth doing. The dentist decides what is possible, and that decision is theirs to make with the tooth in front of them.

Baby teeth, and the injuries that need an emergency room first

A knocked out baby tooth is never put back. Reinserting it risks damaging the developing adult tooth in the bone above it. Take your child to be seen the same day anyway, so the socket can be checked and the missing tooth accounted for, but do not attempt to replace it and do not store it in milk.

Go to an emergency room rather than a dental practice if there was any loss of consciousness, vomiting or confusion after the blow, if the jaw does not close properly, if bleeding will not stop after twenty minutes of firm pressure, or if there are cuts needing stitches. Go too if the tooth cannot be found after a facial injury, since it can be embedded in a lip or inhaled.

Once the tooth is back in place, expect it to be splinted to the neighboring teeth for a week or two, a soft diet, and a follow up. Most replanted teeth need root canal treatment afterwards, which is normal rather than a sign something went wrong. Ask about cost then: the root canal that follows often falls between seven hundred and one thousand five hundred dollars, varying by city, by practice and by the tooth.

Frequently asked

This is general information to help you ask better questions, not a diagnosis. Anything happening in your own mouth needs a dentist who can look at it.