Do you know what to do when a child’s permanent tooth is knocked out?

“It is possible to save a tooth if you act quickly,” says LaToya Wilson, DMD, dentist with St. Louis Children’s Hospital Healthy Kids Express. “There is only a 30- to 60-minute window of opportunity before it is too late. The main goal is to keep the tooth in an environment that is as similar as possible to the human body. The tooth should stay in this environment from the time it is knocked out to the time you arrive at a dentist’s office for emergency care.”

Dr. Wilson offers five tips that can help increase the chances of saving a tooth:

1. Locate the tooth immediately. Do not pick it up by the root. Pick it up by the crown—the chewing surface—and handle with care.

2. If the tooth is dirty, gently rinse in water.

  • Do NOT use soap or chemicals
  • Do NOT scrub the tooth. Scrubbing will remove cells and fibers that nurture the tooth and are very important for a dentist to be able to reattach the tooth.
  • Do NOT dry the tooth
  • Do NOT wrap it in a tissue or cloth

3. If possible, place the tooth in the tooth socket immediately. The sooner the tooth is replaced, the greater the chances it will survive. To reinsert, carefully push the tooth into the socket with your fingers, or place the tooth above the socket and ask the child to close his or her mouth slowly. The child can hold the tooth in place or gently bite down on it.

4. Keep the tooth moist. If the jaw or tooth socket is injured, you may not be able to reinsert the tooth. In these cases, you must keep the tooth moist. Dr. Wilson cautions against using regular tap water or bottled water because they can harm the surface cells on the tooth’s root.

“We don’t want anything on those delicate cells and fibers of the tooth except moisture that mimics the mouth’s natural environment as closely as possible.”

Dr. Wilson recommends the following, in order of preference:

  • An emergency tooth preservation solution such as Hank’s Balanced Salt Solution. This can be purchased at most drug stores. Dr. Wilson suggests adding an emergency tooth preservation solution to your family first-aid kit.
  • Milk in a cup. The milk does not need to cover the tooth completely but should cover it enough to keep the tooth from drying out.
  • Your child’s own saliva. Ask him to spit into a cup—just enough to keep the tooth moist—and place the tooth gently in the saliva.

5. See the dentist as soon as possible, preferably within 30 minutes.

In addition to these five steps, Dr. Wilson urges parents and caregivers to remain as calm as possible.

“I am a mother of three boys, and I know it’s easier said than done,” she says. “However, we all know how children mirror our moods and reactions. You’ll have a better chance of protecting and preserving the tooth if you remain calm.”  

She also reminds parents that prevention is the best protection.

“Never underestimate the power of a fitted mouth guard and helmet,” she says. “When participating in sports or bike riding and skateboarding, they’re the best tools for protecting your child’s beautiful smile.”


Expert Advice