Knocked-out or chipped tooth: a parent's first-aid guide

First, check for serious injuries

Mouth injuries bleed a lot, which can make them look worse than they are. Take a breath, get down to your child's level, and look at the whole child before you look at the teeth.

Call 911 or go to the nearest emergency room right away if your child:

• Hit their head and has a headache, is vomiting, seems confused or very sleepy, or isn't acting like themselves
• Passed out, even briefly
• Is bleeding heavily, and firm pressure doesn't slow it down
• Has trouble breathing or swallowing, or swelling that spreads toward the eye
• May have broken their jaw, or can't open or close their mouth normally
• Is coughing hard or breathing noisily after losing a tooth you can't find

If none of these apply, comfort your child, help them rinse gently with water, and press clean gauze or a cloth on any bleeding spot. Then work out which tooth was hurt and how, using the sections below.

Is it a baby tooth or an adult tooth?

This is the key question, because baby teeth and adult teeth are handled in opposite ways. A knocked-out adult tooth has its best chance if it goes back in or is stored properly right away. A baby tooth should never be put back.

Your child's age is the best clue:

• Under about age 6: the tooth is very likely a baby tooth. Most children have all 20 baby teeth by about age 3, and they usually don't start losing them until around age 6.
• About ages 6 to 12: it could be either. Children lose baby teeth and gain adult teeth throughout these years, often starting with the front teeth.
• Older than about 12: it's most likely an adult tooth.

For kids in the in-between years, a few other clues help. Did a baby tooth already fall out of that spot and a new tooth grow in? Then it's an adult tooth. New adult front teeth are also larger than baby teeth and often have a slightly bumpy, ridged biting edge. Our baby teething timeline shows when teeth usually come in.

Knocked-out adult tooth: what to do

A knocked-out permanent tooth is a true dental emergency. The living cells on the root can be damaged quickly once the tooth is out and drying, so every minute counts.

1. Find the tooth

   Look carefully around where your child fell. If you can't find it, it may have been pushed up into the gum or swallowed, so your child still needs to be seen.

2. Hold it by the crown

   Pick it up by the crown, the smooth white part you see when your child smiles. Avoid touching the root, the longer part that sat inside the gum.

3. Rinse briefly, only if it's dirty

   Swish it in cold milk or hold it under cold running water for a moment. Don't scrub it, don't use soap, and don't wipe it dry or wrap it in a tissue.

4. Put it back, if you're able

   If you've been shown how and your child is calm enough, gently push the tooth back into its socket with the front facing forward. Have your child bite softly on clean gauze or a cloth to hold it in place.

5. If not, keep it wet

   Place the tooth in a small container of cold milk, or in your child's saliva by having them spit into a cup. Don't store it in plain water, and never let it dry out.

6. Get to a dentist right away

   Call your dentist on the way. Ideally your child should be seen within 30–60 minutes. If the office is closed, go to the nearest emergency room and bring the tooth.

What the dentist will do

The dentist will check the tooth and socket, take X-rays, and often place a thin, flexible splint that holds the tooth steady while it heals. They may also ask about your child's tetanus shots if the tooth landed in dirt. Our page on pediatric dental emergencies explains what happens when you arrive at our office.

Not every replanted tooth lasts for life. Results depend on how long the tooth was out, how it was stored, and how far the root had developed, so acting quickly gives your child the best chance.

Knocked-out baby tooth: what to do

Don't put a baby tooth back in. That's the biggest difference between baby and adult tooth injuries.

The adult tooth that will eventually replace it is growing very close to the baby tooth's root. Pushing a baby tooth back into the socket can injure that developing adult tooth, so dentists don't recommend it. Here's what to do instead:

• Have your child bite gently on clean gauze or a damp cloth to slow the bleeding.
• Hold a cold compress against the outside of the lip to ease swelling.
• If you find the tooth, bring it so the dentist can check that nothing is left in the gum.
• Call your dentist the same day. If you can't find the tooth at all, call right away, because it may have been pushed up into the gum.

Losing a front baby tooth early is upsetting, but it's often more about appearance than health. Your dentist will let you know if anything needs watching while your child waits for the adult tooth. To see why dentists care so much about these small teeth, read why baby teeth matter.

Chipped or broken tooth

A chip can be as small as a rough corner or as large as half the tooth. Either way, the first steps are the same:

1. Find any broken pieces and keep them in a small container of milk or water. Dentists can sometimes bond a piece back onto the tooth.
2. Have your child rinse with warm water to clean the area.
3. Hold a cold compress against the face near the injured tooth to keep swelling down.
4. Call your dentist. Most chips should be seen the same day or soon after.

Signs a broken tooth needs care right away

Call immediately if you see a pink or red dot in the center of the broken surface, if the tooth is bleeding from inside, or if your child is in a lot of pain. These can mean the nerve inside the tooth is exposed, and quick treatment can help protect it.

How chipped teeth are repaired

Small chips may just need smoothing. Larger breaks are often rebuilt with material shaped to match the tooth, much like a tooth-colored filling. If the nerve was affected, a baby tooth may need pulp therapy. Even a small chip is worth a check, since cracks can run deeper than you can see.

Tooth pushed in, pushed out, or loosened

A hard hit can move a tooth without knocking it out. It might look longer or shorter than its neighbors, sit at an angle, or wiggle.

• Pushed up into the gum. The tooth looks shorter, or seems to have disappeared. Call your dentist right away. A baby tooth sometimes comes back down on its own over time, but only a dentist can tell whether waiting is safe.
• Pushed out or sideways. The tooth looks longer or out of line, and your child may not be able to bite normally. Don't force it back. Use a cold compress and call right away, because a moved adult tooth does best when it's repositioned quickly.
• Loose but in place. Offer soft foods, help your child brush gently around the tooth, and call your dentist the same day.

What to watch for in the weeks after

Some problems show up later. Call your dentist if you notice:

• The tooth turning gray, darker, or yellowish
• A small bump like a pimple on the gum near the tooth
• New swelling, pain, or sensitivity to hot or cold
• The tooth getting looser instead of firmer

Bitten lip, tongue, or cheek

Cuts inside the mouth tend to bleed a lot, but they also tend to heal well. To care for one:

• Rinse gently with cool water so you can see where the bleeding is coming from.
• Press a clean piece of gauze or cloth firmly on the cut and hold steady pressure.
• Use a cold compress on the outside of the lip or cheek. For toddlers, an ice pop can soothe and numb the area at the same time.
• Offer soft, cool foods while it heals, and skip salty or spicy ones.

Go to the ER or urgent care if the bleeding doesn't stop with firm pressure, or if the cut is deep, gaping, or crosses the edge of the lip onto the skin, since it may need stitches. Check the nearby teeth too, because the same fall may have chipped or loosened one.

Build a dental first-aid kit

Injuries rarely happen at a convenient moment. A small kit in your car, diaper bag, or sports bag means you're ready wherever you are. Print this list or save it to your phone.

What to pack

• A small container with a tight lid, for carrying a tooth or broken pieces
• A small carton of milk, or a note on the lid reminding you to find cold milk fast
• Clean gauze pads for bleeding
• An instant cold pack
• A clean washcloth or handkerchief
• Our number, (916) 770-4567, and a reminder to call 911 for serious injuries
• A printed copy of the knocked-out tooth steps above

Make sure babysitters, grandparents, and coaches know where the kit is and what to do. A knocked-out adult tooth can't wait until you get home.

Preventing dental injuries

Many dental injuries happen during ordinary play, like a slip on wet tile or a collision on the field. You can't prevent every one, but you can lower the odds.

Babies and toddlers

• Use gates at the top and bottom of stairs, and pad sharp furniture corners.
• Anchor bookcases and dressers to the wall so climbers can't pull them over.
• Don't let little ones walk or run with a toothbrush, cup, or toy in their mouth.
• Buckle your child into a car seat that fits their age and size on every ride.

Older kids and teens

• Use a mouthguard for contact sports and other activities with a risk of falls or hits to the face, as the American Dental Association recommends.
• Wear a helmet for biking, skating, and scooters, and use the right booster or seat belt on every trip.
• Keep pool decks a walking zone, and supervise trampoline time.
• Ask about upper front teeth that stick out, since they're more likely to be hit in a fall. An early orthodontic evaluation can check the bite.

Frequently asked questions