Knocked-out adult tooth: what to do immediately

A knocked-out tooth is also called an avulsed tooth. This guide is for permanent teeth that have come completely out of the socket.

• Permanent teeth usually start to appear from around school age, so a child or teenager can have an adult tooth.
• If you are unsure whether the tooth is baby or permanent, seek urgent dental advice immediately rather than guessing.
• Do not follow permanent-tooth reimplantation steps for a tooth you are confident is a baby tooth.

1. 1Find the tooth if you can do so safely, but do not delay emergency help if it cannot be found.
2. 2Hold the tooth by the crown, not the root.
3. 3If the tooth is dirty, rinse it gently in milk, saline or saliva. Do not scrub it.
4. 4If it is feasible and safe, place the tooth gently back in the socket in the correct orientation without forcing it.
5. 5Bite gently on clean gauze or a clean handkerchief to help hold the tooth in place.
6. 6If the tooth cannot be put back, keep it moist in milk, saliva or saline while you seek emergency dental care.

The root surface is delicate. Keeping it moist and avoiding damage to the root surface are important while arranging emergency dental care.

• Do not touch the root.
• Do not scrape, scrub, brush, disinfect or wrap the root in tissue.
• Do not let the tooth dry out.
• Do not put the tooth in a pocket or dry container.
• Do not force the tooth into the socket if it will not go back easily.

Putting a knocked-out permanent tooth back quickly may improve its chance, but only do this if it is feasible and safe. Do not try it if the person is drowsy, choking, seriously injured, very distressed, or if you are unsure whether the tooth is permanent.

The tooth should go back into the socket in its original position and should not be forced. If it does not go in easily, keep it moist and seek emergency dental care immediately.

If reimplantation is not feasible, keep the tooth moist and get emergency dental help immediately.

• Put the tooth in milk, saliva or saline.
• If using saliva, spit into a clean container and place the tooth in it.
• Avoid storing the tooth in the mouth of a child because of choking risk.
• Do not let the tooth dry out while travelling to dental care.

• Serious injury to the face or jaw.
• Heavy mouth bleeding that will not stop with pressure.
• Head or facial injury with loss of consciousness, vomiting or double vision.
• Breathing difficulty, choking, or concern that the tooth or a fragment has been inhaled.
• The person is not alert enough to safely protect their airway.

If you are unsure whether symptoms need A&E, NHS 111 can advise. NHS 111 can advise the next step but does not guarantee an appointment.

A dentist may check the tooth position, socket, gum, soft tissues, bite and nearby teeth. They may take an X-ray and assess for root, bone or jaw injury.

Depending on assessment, they may reposition the tooth, clean or treat the area, splint the tooth to neighbouring teeth, arrange follow-up, or discuss replacement options if the tooth cannot be kept.

Several factors affect the outlook, including how long the tooth was out, whether it dried, how it was handled, the injury pattern, root development and how quickly dental care is obtained.

Fast action can help, but no online guide can promise that a knocked-out tooth can be kept.

• Do not put a baby tooth back into the socket.
• Do not touch, scrub, scrape or disinfect the root.
• Do not force the tooth back into the socket.
• Do not let the tooth dry out.
• Do not delay emergency dental care because the tooth is missing or cannot be found.
• Do not assume A&E can provide routine dental reimplantation.