A completely knocked-out adult permanent tooth (an "avulsion" in clinical terms) is one of the few dental emergencies where the first 60 minutes determine the outcome. The cells on the root surface that allow the tooth to re-attach to the jaw bone start dying within minutes of being out of the socket. By 30 minutes the success rate is dropping. By 60 minutes it has dropped sharply. By two hours, long-term success is rare.
The good news: re-implantation is straightforward in concept. A correctly preserved adult tooth, brought to a dentist within the hour, has an excellent chance of long-term survival. Here is exactly what to do.
Step 1: Pick up the tooth correctly
Pick up the tooth by the crown — the white biting part you see in the mouth. Do NOT touch the root (the yellower, narrower part that was inside the gum). The cells on the root surface are exactly what make re-attachment possible, and they are easily damaged by handling.
If the tooth is dirty (covered in soil, blood, debris), rinse it briefly — under 10 seconds — in milk or saliva. Do not use water. Water is hypotonic relative to the cells on the root surface, which means it draws water into the cells and damages them by osmotic pressure. Milk and saliva have the right osmotic balance.
Step 2: Re-insert the tooth into the socket if you can
If the patient is alert and you can do it without forcing, push the tooth gently back into the socket where it came from. It should slot in with mild pressure. Have the patient bite gently on a clean cloth or gauze to hold it in place during transport.
Re-implantation in the socket is the best preservation method by a wide margin. The natural socket environment maintains the cell viability better than any storage medium.
Step 3: If you cannot re-insert, store correctly
Where re-insertion is not practical (a child too distressed, the patient unconscious or unable to cooperate, the tooth visibly fractured), store the tooth in:
- Cold milk — best practical storage medium. Most households have it.
- The patient's own saliva — store the tooth inside the cheek pouch (NOT for small children who might swallow it).
- Saline solution — if you happen to have contact lens saline, this works too.
Avoid: water, dry tissue, bare hands. All damage the root cells.
Step 4: Get to a dentist within the hour
Submit our matching form marked "knocked-out tooth" or call NHS 111 if you are out of normal hours. Avulsion calls bypass any normal queueing in our matching service — we aim to confirm a Harlow practice within 15 minutes during opening hours.
The dentist will clean the tooth and socket, re-implant if not already in place, splint the tooth to its neighbours for 1–2 weeks, prescribe antibiotics, and check tetanus status. Follow-up appointments monitor whether the tooth is taking root or being rejected.
A different rule for baby teeth
If a child knocks out a baby (deciduous) tooth, do NOT try to re-insert it. Re-implanting a baby tooth risks damaging the developing adult tooth in the bone underneath. The child still needs an emergency dental check — the dentist will examine the socket for retained fragments, check for damage to the adult tooth bud, and manage pain. Bring the tooth so the dentist can confirm it is whole.
This guide is for adult permanent teeth. For children's baby teeth, do not re-insert — see a dentist for assessment but leave the tooth out.
What if the tooth has been out for more than two hours?
Long-term success is rare beyond two hours, but not impossible — especially if the tooth was preserved in milk for some of that time. Bring the tooth in any case. The dentist will assess and either re-implant with realistic expectations or discuss replacement options (implant, bridge, or denture). A late-presented avulsion is still better managed by a dentist than left.
This is a dental matching service, not a medical service
For genuine medical emergencies — uncontrolled bleeding, facial swelling spreading to your eye, throat or neck, difficulty breathing or swallowing, or feeling severely unwell — these are hospital problems and need IV antibiotics, not a dental appointment.