Knocked-out and broken teeth

Also called Dental trauma, Avulsed tooth, Chipped tooth

An adult tooth knocked out can often be saved if it goes back within the hour. Never do this with a baby tooth.

What it is

Injury to the teeth from a knock, fall, sporting injury or assault.

**A knocked-out adult tooth is a genuine dental emergency with a short window.** Reimplanting it within 30 to 60 minutes gives the best chance of saving it, and the chance falls steeply after that. Most people do not know this, and the tooth is wrapped in tissue and taken to a dentist hours later, by which time it cannot be saved.

The technique matters: hold the tooth by the crown, never the root; if dirty, rinse briefly in milk or saline, never scrub it; and push it back into the socket and bite gently on a cloth. If that is not possible, store it in milk, or in the person's own saliva inside their cheek if they are old enough not to swallow it, and get to a dentist immediately. Never store it in water, which damages the cells on the root.

**A knocked-out baby tooth must never be replaced**, because it can damage the developing adult tooth underneath.

A chipped or broken tooth should be seen promptly; keeping the fragment can allow it to be bonded back on. Exposed pink or bleeding pulp needs same-day care.

Any dental trauma should also prompt a check for head injury and for other injuries, and, where the account does not fit, a safeguarding thought.

Signs you might notice

A tooth completely out of its socket.

A tooth loosened, pushed in, or moved out of position.

A chipped or broken tooth, with or without visible pink or bleeding tissue.

Bleeding from the gum or socket.

Pain, or sensitivity to air and cold.

Later: a tooth darkening in colour, an abscess, or pain on biting, all of which mean the tooth needs assessment even if it looked fine at the time.

Also assess: concussion or head injury, jaw injury, and difficulty closing the mouth normally, which may mean a jaw fracture.

Urgent: uncontrolled bleeding, a suspected jaw fracture, or an injury where the explanation does not fit the injury.

How it can affect day-to-day life

Knowing the milk trick before it happens is the whole of the practical advice, and it belongs in every first aid kit conversation, every sports club and every school. A carton of milk is the best available storage medium and is usually to hand.

Mouthguards prevent a large proportion of sporting dental injuries, and custom-made ones fit and protect far better than boil-and-bite versions.

Teeth that survive replantation often need root canal treatment later, and may discolour or eventually be lost, so follow-up is essential rather than optional.

For children, dental trauma is common and frightening, and reassurance about baby teeth, that they are not replaced and that the adult tooth is usually fine, prevents a lot of distress.

Dental trauma is a recognised presentation of physical abuse and of intimate partner violence, particularly injuries to the mouth and face, and asking about how it happened, in private, is appropriate.

Cost and access shape what actually happens; emergency dental care through NHS 111 is the route where there is no dentist.

Supporting someone well

For an adult tooth: find it, hold it by the crown, rinse briefly in milk if dirty, and put it straight back in the socket. Bite gently on a clean cloth and go to a dentist immediately.

If you cannot replace it, store it in milk. Never in water, and never dry.

Never replace a baby tooth.

Keep any fragment of a broken tooth; it may be bonded back.

Get seen the same day for exposed pink tissue, a loosened tooth, or bleeding that will not stop.

Check for head and jaw injury at the same time.

Use a custom-made mouthguard for contact sport.

Attend follow-up; teeth can die months later and need treatment.

Ask, in private, if the injury does not fit the explanation.

Where to get help

A dentist immediately; NHS 111 can arrange emergency dental care.

A and E for facial or jaw fractures, head injury, or uncontrolled bleeding.

Oral Health Foundation run a dental helpline.