Emergency Steps for a Knocked-Out Tooth

A knocked-out tooth (dental avulsion) is one of the most frightening dental emergencies. It happens in an instant—a collision on the rugby field, a fall from a bike, or a simple trip at home. The result is blood, shock, and a gap in your smile.

However, here is the good news: **A knocked-out tooth can often be saved if you act quickly.**

Time is the enemy. The cells on the root of the tooth begin to die the moment they dry out. You have a critical window of about **30 to 60 minutes** to get the tooth back in the socket or into a protective solution. At Dental Implants London, we have successfully replanted many teeth, but the patient's actions in the first few minutes determined the outcome.

The Golden Rule: Handle with Care

The most important rule is: **Do NOT touch the root.**

The root (the yellowish part that was under the gum) is covered in delicate periodontal ligament cells. These cells are essential for re-attachment. If you scrub them, dry them, or touch them with your fingers, they will die, and the re-implanted tooth will eventually fail (resorb) even if it looks okay initially.

• **Pick it up by the crown:** This is the white part you normally see in the mouth.
• **Do NOT wash with soap or alcohol:** Chemicals kill the root cells.
• **Rinse briefly:** If the tooth is dirty (e.g., fell in mud), rinse it gently with milk or saline. If neither is available, use water for max 10 seconds. Do not scrub.

Step 1: Try to Replant Immediately

The best place for a tooth is in its own socket. If the injured person is conscious and cooperative:

• Hold the tooth by the crown.
• Check the orientation (make sure it's facing the right way forward).
• Gently push it back into the hole in the gum.
• Bite down gently on a handkerchief or gauze to hold it in place.
• Go to the dentist immediately.

**Warning:** Do NOT do this for baby teeth. Replanting a baby tooth can damage the developing adult tooth underneath.

Step 2: If You Can't Put It Back In

If the gum is too swollen, or you are too squeamish to push it back in, you must keep the tooth moist in a physiological medium. **Do not wrap it in tissue** and put it in your pocket. It will dry out and die.

Best Storage Mediums (In Order):

• **1. Hank's Balanced Salt Solution:** (Found in some first aid kits, rare).
• **2. Cold Milk:** The proteins and pH of milk are perfect for keeping root cells alive for a few hours.
• **3. Saliva:** Place the tooth inside your cheek (be careful not to swallow it).
• **4. Water:** Only as a last resort. Water is hypotonic and will cause the cells to swell and burst within minutes.

Step 3: Get to the Dentist NOW

This is a true emergency. Call Dental Implants London immediately at 020 7183 3573. Tell the receptionist 'I have a knocked-out tooth.' We will clear a chair for you.

Expert Review

Dr. Yasha Y Shirazi

Principal Dentist and Clinical Director | GDC: 195843

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What We Will Do

When you arrive, we will:

• Numb the area so you are comfortable.
• Gently flush the socket to remove debris/clots.
• Replant the tooth into the correct position.
• Splint the tooth: We bond a flexible wire to the loose tooth and its neighbors to hold it steady for 2 weeks.
• Prescribe antibiotics to prevent infection.

The Long-Term Outlook

Even with perfect emergency care, a knocked-out tooth has suffered a major biological insult. The nerve inside will likely die and require a root canal treatment within 1-2 weeks.

In some cases, the body may slowly dissolve the root over years (resorption). If this happens, the tooth will eventually be lost. However, saving the tooth for even 5-10 years preserves the bone volume, making a future dental implant procedure much easier and more aesthetic.

What If The Tooth Cannot Be Saved?

If the tooth was out of the mouth for too long (>60 mins dry), replantation may not work. In this scenario, we focus on managing the gap.

For adults, an **Immediate Dental Implant** is often the best solution. We can sometimes place the implant into the socket on the same day or perform a 'socket preservation' graft to keep the bone ready for an implant later.

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