What to Do Immediately When a Tooth Is Knocked Out
If a permanent tooth has been knocked out, act fast. The steps you take in the first few minutes directly affect whether the tooth can be saved. Do not panic. Follow these steps in order.
Step-by-Step Emergency Actions
- Find the tooth. Pick it up by the crown only. The crown is the white, visible part of the tooth. Do not touch the root (the pointed end that sits in the gum).
- If the tooth is dirty, rinse it gently under cold running water for no more than 10 seconds. Do not scrub, scrape, or use soap, alcohol, or peroxide. The root has fragile cells that must stay alive for the tooth to survive.
- Try to reinsert the tooth into the socket. Hold it by the crown, gently push it in with your fingers, and bite down on a clean cloth to hold it in place.
- If you cannot reinsert it, place the tooth in a container of cold milk. Milk has the right pH and nutrients to keep the root cells alive for up to an hour. Saline solution works too. As a last resort, hold the tooth between your cheek and gum.
- Do not store the tooth in water. Water damages the root cells within minutes.
- Get to a dentist or endodontist as fast as possible. Call ahead so they are ready when you arrive.
Why Every Minute Counts
The cells on the root surface of a knocked-out tooth begin to die as soon as the tooth leaves the socket. These cells, called periodontal ligament cells, are what allow the bone to reattach to the tooth. If they dry out or are damaged, the body may reject the tooth over time.
Reimplantation within 30 minutes gives the best chance of long-term success. After 60 minutes outside the mouth, the prognosis drops significantly. A tooth stored in milk can maintain viable root cells for up to one hour, which is why milk storage is so important when immediate reimplantation is not possible.
What the Dentist or Endodontist Does for a Knocked-Out Tooth
Once you reach the dental office or emergency room, the dentist will assess the tooth and the socket. If you have already reinserted the tooth, they will check the position and take X-rays. If the tooth is still outside the mouth, they will clean the socket gently and reimplant it.
Splinting the Tooth
After reimplantation, the dentist will bond a flexible wire splint across the knocked-out tooth and the neighboring teeth. This splint holds the tooth stable while the periodontal ligament heals. The splint typically stays in place for 2 weeks, though teeth with more damage may need splinting for up to 4 weeks.
During the splinting period, eat soft foods and avoid biting directly on the injured tooth. Your dentist may prescribe antibiotics and recommend a chlorhexidine mouth rinse to prevent infection.
Root Canal Treatment After Reimplantation
In most cases, a knocked-out permanent tooth will need root canal treatment. The blood supply to the pulp (the nerve and tissue inside the tooth) is severed when the tooth is avulsed. Without blood supply, the pulp tissue dies and can become infected.
An endodontist will typically begin root canal treatment 7 to 14 days after reimplantation. During this procedure, the endodontist removes the dead pulp tissue, cleans the inside of the tooth, and fills the root canals to prevent infection. This step is critical for long-term tooth survival. Learn more about what endodontists do on our endodontics specialty page.
Prognosis: How Time Outside the Mouth Affects Outcomes
The single biggest factor in whether a knocked-out tooth survives long-term is how long it was outside the mouth and how the root was handled during that time.
Expected Outcomes by Time Elapsed
Even when prognosis is poor, reimplanting the tooth is often worthwhile. It preserves the bone in the jaw, maintains space for a future implant, and can function for years before requiring replacement.
- Under 30 minutes, kept moist: Best prognosis. The periodontal ligament cells are likely still alive. With proper splinting and root canal treatment, the tooth may last for many years.
- 30 to 60 minutes, stored in milk or saline: Good prognosis, but some root cell damage is expected. Healing may take longer, and some root resorption may occur over time.
- Over 60 minutes or stored dry: The periodontal ligament cells are likely no longer viable. The tooth can still be reimplanted, but the body will gradually replace the root with bone (a process called replacement resorption or ankylosis). The tooth may function for several years but will eventually need to be replaced with an implant or bridge.
Knocked-Out Teeth in Children vs. Adults
The approach to a knocked-out tooth depends on whether it is a baby tooth or a permanent tooth. This distinction matters because the treatment is completely different.
Baby Teeth (Primary Teeth)
Baby teeth that are knocked out should not be reimplanted. Pushing a baby tooth back into the socket can damage the developing permanent tooth underneath. Instead, see a pediatric dentist for evaluation. They will check for injuries to the gums and underlying bone and monitor the area as the permanent tooth develops.
If your child has knocked out a baby tooth, control any bleeding with gentle pressure from a clean cloth. Apply a cold compress to the outside of the mouth to reduce swelling. Contact a pediatric dentist within 24 hours.
Permanent Teeth in Children and Teens
Knocked-out permanent teeth in children and teens actually have a better prognosis than in adults. The developing roots have more blood supply and healing capacity. In some cases, young patients with open (still-developing) root tips may not need a root canal because the pulp can regenerate.
An endodontist will monitor the tooth closely to determine whether the pulp recovers or whether root canal treatment is needed. Regular follow-up visits are essential for at least 5 years after the injury.
Cost of Treating a Knocked-Out Tooth
The total cost of treating an avulsed tooth includes the emergency visit, splinting, root canal, and the final crown. Costs vary by location, provider, and case complexity.
An emergency reimplantation and splinting visit typically costs $200 to $600. Root canal treatment ranges from $700 to $1,500 depending on the tooth. A crown to restore the tooth afterward adds another $800 to $1,500. If the tooth cannot be saved and needs to be replaced with a dental implant, the cost is significantly higher.
Most dental insurance plans cover emergency treatment and root canals, though coverage varies. If the injury is from an accident, homeowner's insurance or the at-fault party's liability coverage may apply. Ask the dental office about payment plans if cost is a concern.
When to See an Endodontist for a Knocked-Out Tooth
Any knocked-out permanent tooth needs professional care as soon as possible. A general dentist can handle the initial reimplantation and splinting. However, the root canal treatment that follows is often best performed by an endodontist, especially for teeth with complex root anatomy or developing roots in children.
If the injury involves multiple teeth, damage to the jawbone, or teeth that have been pushed into the gum (intruded), the case may also involve an oral surgeon. Your dentist will coordinate referrals based on the specific injuries.
Find an Endodontist Near You
If you or a family member has a knocked-out tooth, time is critical. Find a verified endodontist in your area through the My Specialty Dentist directory and call ahead so they can prepare for your arrival.
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