A fall from a cycle, a cricket ball to the face, a slip on a wet monsoon floor, and suddenly there is a whole tooth in your hand. If you are reading this with the tooth in front of you, here is the answer first. An adult tooth that has been knocked out (avulsed) can very often be saved, but only if it goes back into the socket quickly. The first 30 minutes decide almost everything.
Pick the tooth up by the white crown, never the root. If it is clean, push it gently back into the socket now and hold it there. If it is dirty, rinse it for a few seconds in milk or clean water and then put it back. If you cannot put it back, drop it into a cup of milk and get to a dentist within the hour.
This guide explains why each step matters, what to do for a child’s milk tooth (which is different), and what the dentist will do when you arrive.
What should you do the moment a tooth is knocked out?
Tooth avulsion first aid is simple, but it has to be done fast. The steps below follow the International Association of Dental Traumatology (IADT) guidelines used by dentists worldwide (Fouad et al., 2020).
- Find the tooth; check the ground, the clothing and the mouth
- Pick it up by the crown (the white part you normally see), not the root
- Do not scrub, brush or wipe the root, and do not wrap it in tissue or cloth
- If the root looks dirty, rinse it for no more than 10 seconds under milk or cold running water, or in the person’s own saliva
- Put the tooth straight back into its socket, the right way round, using gentle finger pressure; compare with the tooth next to it
- Have the person bite gently on a folded handkerchief or clean cloth to hold it in place
- Go to a dentist at once, ideally within 30 minutes
- If you cannot replant it, store it in milk and go straight to the dentist
Putting the tooth back yourself is the single most useful thing you can do. It feels alarming, but the socket is the right storage place, and the IADT encourages parents, teachers and coaches to do this on the spot.
If there is heavy bleeding, a suspected broken jaw, loss of consciousness or vomiting, the hospital emergency department comes first. Bring the tooth in milk and see the dentist afterwards. Our dental emergency page lists which injuries need a hospital and which need a dentist.
Why do the first 30 minutes matter so much?
The root of a tooth is covered by a thin living layer of cells called the periodontal ligament (the fibres that tie the tooth to the bone). When a tooth is replanted, these cells reattach and the tooth heals back into the jaw. When they die, the body slowly eats the root away and the tooth is lost within a few years.
Those cells start dying as soon as they dry out. Research summarised in the IADT guidelines shows that a tooth replanted within 15 minutes has the highest chance of healing normally, and that after 60 minutes of dry time nearly all the ligament cells are dead (Fouad et al., 2020). Milk keeps the cells alive for several hours because its salt balance is close to body fluid. Water makes the cells swell and burst, which is why a tooth should never be stored in water.
A large study of replanted teeth found that teeth put back within minutes had far better long-term survival than those replanted after an hour of dry storage (Andreasen et al., 1995). Speed and moisture are the two things that decide whether the tooth can be saved.
It is still worth trying if time has passed. A tooth kept in milk for two hours has a reasonable chance. A tooth that was dry for two hours has a lower chance but can still be replanted to hold the space and keep the bone for a few years. Results vary from person to person; our dentists assess this for you at the consultation.
What if the knocked-out tooth is a milk tooth?
This is the one big exception. A milk tooth that has been knocked out should not be put back. The IADT is clear on this: replanting a milk tooth risks damaging the adult tooth developing in the bone right above it, and the milk tooth would fall out on its own anyway (Day et al., 2020).
Toddlers knock out front milk teeth often, usually between one and three years of age. It looks dramatic because the gum bleeds a lot, but it heals fast.
What to do for a child’s milk tooth
- Comfort the child and press a clean cloth on the gum for five to ten minutes to stop the bleeding
- Find the tooth, so you know it is not lodged in the lip, the nose or the airway
- Do not try to put it back
- Give soft cool food and a child paracetamol dose if the child is sore
- See a dentist the same day to check the socket, the neighbouring teeth and the gum, and to make sure no fragment is left behind
- Keep the tooth so the dentist can confirm it came out whole
The dentist will usually take a small RVG digital X-ray to check the adult tooth bud and rule out a fragment in the gum. The gap stays until the adult tooth arrives, around age six or seven for a front tooth. Occasionally the adult tooth comes in with a small mark from the injury, but this is not common. If you are not sure whether it is a milk tooth or an adult one, treat it as adult and store it in milk; the dentist can tell in seconds.
If a tooth has just been knocked out, put it back or in milk and call Apollo Dental Vadavalli on +91 88705 04111 while you are on the way; injured teeth are seen the same day.
What should you never do with a knocked-out tooth?
The mistakes below are the ones we see most often, and each one lowers the chance of saving the tooth.
- Do not hold the tooth by the root or touch the root with your fingers more than necessary
- Do not scrub the root with a brush, soap, salt, turmeric or antiseptic; you will strip off the living cells
- Do not store the tooth in plain water, ice or a dry tissue
- Do not wait until morning; keep the tooth in milk and get to a dentist as soon as one is open
- Do not give aspirin for the pain, as it increases bleeding; paracetamol is the safer choice
- Do not put a milk tooth back into a child’s mouth
- Do not assume the tooth is lost just because an hour has passed; let the dentist decide
A common Indian question is whether coconut water will do. It keeps cells alive better than water, but milk is more reliable and easier to find. If there is no milk, the person’s own saliva (spat into a small cup) or coconut water are acceptable stand-ins. Milk, saliva, then anything moist that is not plain water.
A tetanus booster may be needed if the injury involved soil or a dirty surface; the dentist will advise.
What will the dentist do when you arrive?
The dentist’s job is to get the tooth into the right position, hold it there while the ligament heals, and stop infection starting inside the tooth. Here is the usual sequence for an adult tooth.
- A quick check of the injury, the other teeth, the lips and the jaw, plus an RVG digital X-ray to see the socket and root and to look for fractures
- If the tooth is in milk, the socket is gently rinsed with saline, any clot is flushed out, and the tooth is replanted under local anaesthetic (numbing injection)
- A flexible splint, a thin wire or fibre bonded to the injured tooth and its neighbours, is fitted to hold it still; this stays for about two weeks
- Antibiotics are usually prescribed
- Soft food, no biting on the front teeth, and gentle brushing with a soft brush around the splint for the next two weeks
Because the blood supply to the pulp (the nerve inside the tooth) is torn when a tooth is knocked out, the pulp almost always dies in a fully grown adult tooth. To stop that dead tissue from causing infection and root damage, a root canal treatment is started about 7 to 10 days after replantation, before the splint comes off. In a child or young teenager whose root tip is still open, the dentist may wait and watch, because the pulp sometimes survives and the root can keep growing.
In-house CBCT (a 3D X-ray) is used if a fracture of the socket bone or root is suspected. The first visit takes about 45 to 90 minutes.
Can a knocked-out tooth be saved for good, and what if it cannot?
Can a knocked out tooth be saved? Often, yes, when it is replanted quickly and looked after properly. The tooth can then last many years, though it needs regular checks because a replanted tooth is never quite the same as an uninjured one.
The most common long-term problem is root resorption, where the body slowly dissolves the root. Teeth that were dry for a long time before replantation are more likely to develop it. In a growing child, a replanted tooth can also fuse to the bone (ankylosis) and end up looking shorter than its neighbours. Follow-up X-rays at two weeks, one month, three months, six months and then yearly catch these problems early.
If the tooth cannot be saved, or is lost later, there are good options. In a teenager, a temporary false tooth holds the space until growth is complete. In an adult, a dental implant is the usual replacement once the socket has healed, and a bridge is another option.
If the tooth was badly fractured as well, removal may be the only safe choice. The tooth extraction page explains what that involves. Results vary from person to person; our dentists assess this for you at the consultation.
When should you see a dentist about a knocked-out tooth?
Immediately. Even if you have replanted the tooth yourself and it feels firm, it needs to be checked, X-rayed and splinted the same day. A knocked-out milk tooth also needs a same-day check for fragments and damage to the neighbours.
See a dentist promptly if a tooth was hit but not knocked out and any of these apply.
- The tooth is loose, pushed in, pushed out or moved sideways
- The tooth has broken and the pink or red centre is showing
- The tooth has turned grey or dark in the days after the injury
- There is pain on biting that does not settle within two days
- A lip cut has something hard inside it, which may be a tooth fragment
A tooth that was hit but looks fine can still die weeks later; read the tooth pain guide if an ache starts after an injury.
Apollo Dental Vadavalli is open every day from 10 AM to 8 PM and sees injured teeth the same day; call +91 88705 04111 while you are on the way so the team is ready. Every specialty here has doctors with more than 5 years of experience, and in-house RVG digital X-ray and CBCT mean the injury is fully assessed in one visit. Outside clinic hours, keep the tooth in milk and come in at 10 AM.
Frequently asked questions
Can a knocked-out tooth be put back in?
Yes, if it is an adult tooth. Hold it by the crown, rinse the root briefly in milk or water if dirty, push it gently back into the socket the right way round, and bite on a cloth to hold it. Then see a dentist at once for an X-ray and a splint. Milk teeth are never replanted.
How long can a knocked-out tooth survive outside the mouth?
Dry, the living cells on the root begin to die within minutes and are mostly gone after 60 minutes. In milk, the cells stay alive for several hours. So the tooth should go back into the socket within 30 minutes if possible, or into milk straight away.
What should I store a knocked-out tooth in?
Milk is the first choice. The person’s own saliva, spat into a cup, is the second, and coconut water is an acceptable stand-in. Never use plain water, ice or a dry tissue, all of which kill the root cells. Do not wrap the tooth; it must stay wet until the dentist sees it.
Should I put my child’s knocked-out milk tooth back?
No. Replanting a milk tooth can damage the adult tooth forming in the bone above it, and the milk tooth would fall out on its own later anyway. Stop the bleeding with a clean cloth, keep the tooth, and see a dentist the same day to check for fragments and damage to the neighbouring teeth.
Will a replanted tooth need a root canal?
In a fully grown adult tooth, almost always. The nerve’s blood supply is torn when the tooth comes out, so the pulp dies and a root canal is started 7 to 10 days after replanting to prevent infection. In children with roots still growing, the dentist may wait and watch, because the pulp sometimes recovers.
What if the tooth is lost or cannot be saved?
In a teenager, a temporary false tooth holds the space until growth is finished. In an adult, a dental implant is the usual replacement once the socket has healed, and a bridge is the alternative. A tooth replanted late can still be worth keeping for a few years to preserve the bone.
If a tooth has been knocked out, put it back or in milk and call +91 88705 04111 now; Apollo Dental Vadavalli sees injured teeth the same day, every day, 10 AM to 8 PM.
This article is general information and not a substitute for a dental consultation. Results vary from person to person.