A knocked-out or injured tooth can be worrying, but staying calm and acting quickly makes a real difference to whether the tooth can be saved. This guide explains what to do in the first few minutes, and how an injured tooth is treated afterwards. If a permanent (adult) tooth has been knocked out, time really matters - read the first section and get seen as soon as you can.
A knocked-out permanent tooth has the best chance of being saved when the tooth goes back into the socket quickly. If you feel able to, follow these steps, and get to a dentist straight away:
Do not try to put a knocked-out baby tooth back in, as this can damage the developing adult tooth underneath. Keep the area clean, use a cold compress if there is swelling, and see a dentist so they can check everything is as it should be.
Don’t force the tooth back into place. Avoid wobbling the tooth, keep to soft foods, and see a dentist urgently. In many cases the tooth can be gently repositioned under local anaesthetic and splinted to the neighbouring teeth for a short time while the injury heals.
Save any broken piece if you can, and keep the piece moist in milk or saliva - a fragment can sometimes be bonded back on. See a dentist promptly. A small chip may simply be smoothed or repaired, while a larger break that reaches the nerve needs more urgent attention to protect the tooth.
Once you are seen, the tooth is assessed and X-rays, or sometimes a 3D CBCT scan, are taken to check the tooth and the surrounding bone. Depending on the injury, the tooth may be repositioned and splinted, and the nerve is monitored over the following weeks and months. Sometimes the nerve inside an injured tooth later loses its blood supply, and root canal treatment is then needed to keep the tooth. That possibility is why follow-up matters, even if the tooth feels fine at first.
Injured teeth often need careful monitoring, and the decision about whether and when a tooth needs root canal treatment can be finely balanced. As an endodontic clinician I manage dental trauma using the dental operating microscope and CBCT imaging, following current British Endodontic Society and international trauma guidance, to give an injured tooth the best possible chance of being kept.
Two front teeth that lost their nerve supply after an injury years earlier, re-treated when symptoms persisted.
Two upper front teeth root filled after a cycling injury, comfortable for fifteen years before symptoms appeared.
Colleagues managing an acute injury may find the British Endodontic Society guide to traumatic dental injuries of permanent teeth a useful reference: the BES trauma guide. I am always glad to receive trauma referrals and to see patients quickly.