Knocked-Out Tooth: First Aid in 5 Minutes

The 30-minute window

If a permanent tooth is knocked out (avulsed), the chance of successful reimplantation drops rapidly with time:

• Within 15 minutes: 90%+ success if handled correctly
• 15–30 minutes: 70–80% success
• 30–60 minutes: 40–60% success
• Over 60 minutes: poor prognosis

Step-by-step

Step 1 — Find the tooth

Locate it immediately. Handle only by the crown (the white visible part). Never touch the root with bare fingers — the delicate periodontal ligament cells must stay alive.

Step 2 — Clean briefly if dirty

If the tooth has debris on it, rinse briefly (10 seconds) with:

• Milk (best option)
• Saline
• Saliva

Don't use water — water kills the ligament cells. Don't scrub the root. Don't use soap, disinfectant, or alcohol.

Step 3 — Reimplant if possible

If you feel comfortable:

1. Make sure the tooth is oriented correctly (notches up, flat edge down)
2. Gently push it back into the socket
3. Hold in place by biting gently on a piece of gauze or cloth
4. Go to the dentist immediately

Step 4 — If you can't reimplant

Store the tooth in:

• Milk (best widely-available option)
• Saline (if you have it)
• Saliva (hold between cheek and gum)
• Specialised cell-preserving solution (Save-A-Tooth if available)

Don't store dry. Dry cells die within 30 minutes. Don't store in water. Destroys cells quickly.

Step 5 — Get to a dentist

• Call ahead so they're ready
• Bring the tooth even if reimplanted (to check orientation)
• Bring any other broken pieces

What happens at the dentist

1. Assess the socket and clean debris
2. Reposition the tooth if still out
3. Splint the tooth to adjacent teeth for 1–2 weeks
4. Root canal may be needed within 7–14 days
5. Follow-up x-rays at 1 month, 3 months, 1 year

Baby teeth — don't reimplant

Knocked-out baby teeth are not reimplanted — risk of damage to the permanent tooth forming underneath. See a dentist promptly to check the adult tooth below.

Permanent tooth root fragments only

If only a root fragment remains in the socket with the crown broken off — different situation. Don't try to remove the fragment yourself; see a dentist for surgical management.

After reimplantation

• Soft diet for 2 weeks
• No biting directly on the affected tooth
• Gentle brushing, avoid the splint
• Warm salt water rinses several times daily
• Follow-up x-rays at scheduled intervals
• Watch for darkening (possible pulp death requiring root canal)

Long-term outcomes

Even with optimal handling, 10–30% of reimplanted teeth develop complications — root resorption, ankylosis, or pulp death. Most are manageable; some require eventual extraction and implant. The effort is still worth it — a reimplanted tooth can function for decades.

Prevention

• Mouthguards for contact sports (custom-fitted preferred)
• Seat belts in cars
• Child-proof your home for toddlers

References

• International Association of Dental Traumatology — Avulsion guidelines
• American Association of Endodontists