My child knocked out a permanent tooth — what should I do right now?

This is a real emergency — read this fast

If a permanent tooth (not a baby tooth) has been completely knocked out of your child’s mouth, time is the single biggest factor in whether the tooth can be saved. The first 30 minutes matter most. After 60 minutes, success rates drop sharply.

Baby teeth that get knocked out are not replanted — replanting a baby tooth can damage the developing permanent tooth underneath. If a baby tooth is knocked out, you still need to call us, but it’s not the same time-critical emergency.

Step-by-step in the first 5 minutes

1. Find the tooth

Look in the area of the injury. Often the tooth is on the ground, in clothing, or in your child’s mouth. Even if the crown looks broken, find the whole tooth.

2. Pick it up by the white part only

The crown is the white enamel part you can see when teeth are in the mouth. The root is the yellowish part that was buried in the gum. Always handle the crown — never the root. The root has tiny living cells (called periodontal ligament cells) that are critical for re-attachment. Touching the root crushes them.

3. If it’s dirty, rinse briefly

If there’s visible dirt, rinse the tooth with cold milk or sterile saline (contact lens solution works) for no more than 10 seconds. Do not use water. Do not scrub. Do not soap. Do not let the tooth sit out and dry.

4. Try to put it back in the socket

If your child is calm enough and the socket is clean, you can try to gently push the tooth back into place — crown up, root down, in the same orientation. Have your child bite gently on a clean cloth or gauze to hold it. This is the best storage option there is.

If you can’t reimplant it (your child is panicking, the tooth won’t go back, or you’re unsure), proceed to step 5.

5. Store the tooth correctly

In order of preference:

1. In the cheek pouch — only if your child is old enough not to swallow it (probably age 12+).
2. In a cup of cold milk — milk is close to the tooth’s natural environment and keeps the cells alive for several hours.
3. In Hank’s Balanced Salt Solution — sold over the counter as “Save-A-Tooth.” Some sports first-aid kits carry it.
4. In sterile saline — okay, but worse than milk.
5. In the parent’s saliva (a clean container with the parent’s spit) — works but worse than milk.

Do not store the tooth in water. Water actually kills the cells faster than saliva or milk because of osmotic pressure differences.

6. Get to a dentist or ER within 30 minutes

Call our office on the way. If we’re closed, call the on-call line on our voicemail or go directly to the nearest emergency room.

What we’ll do at the appointment

If you arrive within an hour, we’ll:

1. Numb the area thoroughly.
2. Gently rinse the socket with saline to remove debris.
3. Re-implant the tooth in its original position.
4. Splint it to the neighboring teeth with a soft wire and dental composite for 1–2 weeks.
5. Take an x-ray to confirm position.
6. Prescribe an antibiotic and possibly a tetanus check.
7. Schedule a follow-up to check pulp vitality (whether the nerve survived) — sometimes this takes weeks to know.

A successfully replanted tooth can last a lifetime. Even when the nerve doesn’t survive, root canal treatment after the tooth is stable can preserve it.

What about a tooth that’s only chipped or pushed in?

A tooth that’s broken but still in the mouth, or a tooth that’s been pushed into the socket or to the side, is also urgent — but slightly less time-critical than a fully knocked-out tooth. Call us and come in the same day. Save any broken pieces of the tooth in milk and bring them with you.

Prevention

The biggest risk factor for knocked-out teeth in kids is contact sports without a mouthguard. We can fit a custom mouthguard at your next visit — they’re more comfortable than the boil-and-bite type and dramatically reduce the risk of dental injury during sports. Highly recommended for football, basketball, soccer, hockey, lacrosse, wrestling, and martial arts.