Of everything covered on our emergency dentistry page, this is the one where minutes genuinely change the outcome. Most dental problems can wait until morning. A knocked-out adult tooth cannot.
It usually happens at football, at the skate park, or off the back of a trip on an uneven footpath. The advice below is worth reading before you need it, because nobody reads carefully with a tooth in their hand.
For an adult tooth, in order
1. Find it, and pick it up by the crown. The crown is the white part you normally see. The root is the tapered part that was in the gum. The root surface is covered in living cells that allow the tooth to reattach to the bone, and they are fragile. Fingers on the crown only.
2. Do not scrub it. If it is dirty, rinse it briefly, for a couple of seconds, in milk or saline. No soap, no toothbrush, no scraping, no tap water. Scrubbing removes the very cells you need.
3. Put it back in the socket if you can. This is the best possible storage. Line it up the right way round, matching the neighbouring teeth, and press it gently into place. Then bite softly on a clean cloth or a folded tissue to hold it there. It will feel wrong. That is fine.
4. If you cannot reseat it, use milk. Ordinary milk from the fridge. It has roughly the right balance of salts and sugars to keep those root cells alive, far better than water. Saline works. So does the person’s own saliva, held inside their cheek, though only for an older child or adult who is definitely not going to swallow it.
5. Ring us and come in. (02) 6672 1980. Say it is a knocked-out tooth and we will get you in as fast as we can manage.
Why tap water is the wrong choice
This catches almost everyone, because rinsing something dirty under the tap is the obvious move.
Tap water has a very different salt concentration to the fluid inside cells. Water floods into those root surface cells and destroys them within minutes. A tooth rinsed thoroughly under a running tap can be functionally unsalvageable even if it looks spotless.
If milk is not available and the tooth is dirty, a very brief rinse in water is better than reseating a mouthful of gravel. Brief is the operative word.
The timing, honestly
The first 30 minutes matter most. After about an hour of being dry, the outlook drops away sharply.
The word doing the work there is dry. A tooth sitting on a bench for an hour is in a much worse position than a tooth that has been in milk for the same hour. Storage medium buys time. If it has been longer than an hour, still bring it in. The chance is lower, not zero, and that is our call to make rather than yours at the side of a football field.
Baby teeth: do the opposite
This is the part that surprises parents, and it is the reason this article exists rather than a simple checklist.
Never put a knocked-out baby tooth back in the socket.
Underneath every baby tooth sits the adult tooth, still forming. Pushing a baby tooth back into that socket can damage the developing adult tooth, and that damage shows up years later as a discoloured, malformed or misplaced permanent tooth. The short-term cosmetic gain is not worth it.
What to do instead: keep your child calm, sit them upright, and press a clean damp cloth gently over the socket for ten minutes or so to settle the bleeding. Cold water or an ice block afterwards helps. Then ring us so we can check that the socket is clean, that no fragments have been left behind, and that the adult tooth underneath has not been disturbed.
If you are not sure whether the tooth was a baby tooth or an adult one, bring it in and let us look. As a rough guide, adult front teeth generally arrive between six and eight years of age, and the root of a baby tooth is usually short, hollow or partly dissolved, whereas an adult tooth has a long solid root.
What happens when you get here
We check that the tooth is the only injury, because a knock hard enough to remove a tooth can also fracture the socket or the jaw, and can loosen the teeth either side.
If the tooth is out and reseatable, we clean the socket carefully, place the tooth back, and splint it to the neighbouring teeth with a thin wire and composite so it can stabilise. That splint typically stays for a couple of weeks. If you already reseated it yourself, we will check the position and splint from there.
A replanted tooth almost always needs root canal treatment afterwards. The blood supply to the nerve is severed when the tooth comes out and does not reliably re-establish, so the nerve dies. Root canal treatment before that becomes a problem is a normal, planned part of saving a replanted tooth, not a sign that anything went wrong.
You will need follow-up appointments to check the tooth is holding. There is no guarantee it takes, and we will be straight with you about how it looks rather than leaving you guessing.
Worth doing before it happens
If someone in the house plays contact sport, a custom-fitted mouthguard is the single most effective thing you can do. A fitted guard from an impression of the teeth protects considerably better than a boil-and-bite version from a sports shop, mostly because it stays put and people actually wear it. Rugby league, union, AFL, hockey and skateboarding account for most of the knocked-out front teeth we see across the Tweed Valley.
Keep milk in the fridge and know where the nearest one is at the ground. That sounds trivial. It is the difference between a tooth that survives and one that does not.
If it happens
Ring (02) 6672 1980. We are open Monday to Friday, 8:00am to 5:00pm, at Level 1, Tweed Arcade, 2 Queen Street in Murwillumbah, and we see people from Uki, Pottsville, Kingscliff and across the border.
If it happens outside our hours and the tooth is out of the mouth, put it in milk, and go to a hospital emergency department if there is also a facial injury, a suspected broken jaw, or bleeding you cannot control.
Frequently asked questions
Can a knocked-out tooth be put back in? +
An adult tooth often can, and the sooner it goes back the better the outlook. Handle it by the crown, not the root, and reseat it in the socket if you are able. A baby tooth should never be put back, because it can damage the adult tooth developing above it.
What should I store a knocked-out tooth in? +
Milk is the best thing most people have to hand. Saline or the person's own saliva also work. Do not use tap water, because it damages the delicate cells on the root surface that the tooth needs in order to reattach.
How long do I have to save a knocked-out tooth? +
The first 30 minutes matter most, and the outlook falls away steadily after about an hour of dry time. Storing the tooth in milk buys you considerably more time than leaving it dry, so a tooth that has been in milk for two hours is still worth bringing in.
Should I clean the tooth before putting it back? +
Only if it is visibly dirty, and then only a brief rinse in milk or saline. Never scrub it, use soap, or scrape the root. Those root surface cells are exactly what determines whether the tooth reattaches.
What if I cannot get the tooth back in the socket? +
Do not force it. Put it in milk and come straight in. Trying repeatedly can damage both the tooth and the socket.