Dental Trauma — Knocked Out, Broken, and Loose Teeth
Dental injuries need fast action. This leaflet explains what to do if a tooth is knocked out, broken, or loosened — including the critical steps that can save a tooth.
A permanent tooth that has been completely knocked out (avulsed) can often be saved if you act quickly. Every minute matters.
Find the tooth — pick it up by the crown only (the white part you normally see). Never touch the root.
If the root is dirty, rinse it very briefly (no more than 10 seconds) under cold running water or in milk. Do not scrub, scrape, or use soap or disinfectant.
Try to push the tooth back into the socket — use gentle finger pressure. Once in place, bite down on a clean cloth or handkerchief to hold it there.
If you cannot replant it, place the tooth immediately in one of these (in order of preference):
Cold milk — the best widely available storage medium (can preserve root cells for several hours)
Saline (salt water) — if available
The patient's own saliva — place the tooth in the mouth between the cheek and gum (not suitable for young children due to swallowing risk, or for anyone who is not fully alert)
Do NOT store the tooth in tap water — water damages the root surface cells and significantly reduces the chance of successful reimplantation.
Do NOT wrap it in tissue or cloth — this dries the root out.
See a dentist immediately — the best chance of saving the tooth is within 20 minutes. Success is still possible within 60 minutes. After this, the chance of long-term survival decreases significantly.
Baby teeth — do NOT reimplant
If a baby (primary) tooth is knocked out, do not attempt to put it back in.
Reimplanting a baby tooth risks damaging the permanent tooth developing underneath. The permanent tooth could be displaced, discoloured, or fail to develop normally.
What to do instead:
Control any bleeding by having your child bite gently on a clean cloth
Apply a cold compress to the outside of the face to reduce swelling
Contact your dentist — they will want to check the area and monitor the permanent tooth as it develops
Keep the knocked-out tooth if you can find it, so the dentist can confirm the whole tooth came out. If you cannot find the tooth, tell your dentist — they may need an X-ray to confirm it has come out rather than been pushed up into the gum
Broken or chipped teeth
Tooth fractures range from minor chips to serious breaks that expose the nerve. The type of break determines the urgency and treatment needed.
Enamel chip (minor) — a small piece of the outer layer has broken off. The tooth may feel rough or sharp but is not painful. Your dentist can smooth or repair it with composite bonding. This is not urgent but should be seen within a few days to prevent the sharp edge cutting your tongue or lip.
Enamel and dentine fracture — a larger break that exposes the yellow layer (dentine) underneath the enamel. The tooth may be sensitive to air, cold, or touch. See your dentist within 24 hours. While waiting, you can cover the exposed surface with dental wax (available from pharmacies) and take ibuprofen or paracetamol for pain. Avoid ibuprofen if you have asthma, cardiovascular disease, stomach problems, kidney issues, take blood-thinning medications, or are pregnant.
Fracture with nerve exposure — the break is deep enough to expose the nerve (pulp). You may see a pink or red spot and the tooth will be very painful. See your dentist urgently (same day). This tooth needs either a pulp cap, root canal treatment, or extraction depending on the severity.
If you find the broken fragment, keep it in milk or saline and bring it to your appointment — your dentist may be able to bond it back on.
Loose or displaced teeth
A blow to the face can loosen, push in, or move a tooth without knocking it out completely. These injuries are called luxation injuries.
Slightly loose tooth (tender to bite on) — eat soft foods, avoid biting on that tooth, and see your dentist within a few days. This often recovers on its own.
Noticeably loose or pushed sideways — see your dentist as soon as possible (same day if possible). The tooth may need to be repositioned and splinted (bonded to neighbouring teeth with a wire) for several weeks to allow healing.
Pushed up into the gum (intruded) — the tooth appears shorter or has disappeared into the gum. See your dentist urgently. In children, the tooth may re-erupt on its own. In adults, it may need to be repositioned.
Pushed partially out of the socket (extruded) — the tooth appears longer than its neighbours. See your dentist urgently. The tooth can usually be gently pushed back into place and splinted.
After any injury to a tooth, your dentist will monitor the nerve over the following months. Even teeth that appear to recover well initially can sometimes develop problems weeks or months later.
Soft tissue injuries
Dental trauma often involves cuts or bruising to the lips, gums, tongue, or cheeks.
Bleeding cuts — apply firm pressure with a clean cloth for 10–15 minutes. Most minor oral cuts stop bleeding with sustained pressure.
Lip lacerations — if the cut is deep, goes through the lip border (the line between the red lip and surrounding skin), or does not stop bleeding, go to A&E — it may need stitching.
Torn frenum — the thin strip of tissue connecting the lip to the gum can tear on impact. This usually heals on its own but may bleed noticeably.
Important: Always check inside the lip for embedded tooth fragments if a tooth has broken. Your dentist may take an X-ray of the lip to check.
When to go to A&E
Go to your nearest A&E or call 999 if you have:
Difficulty breathing or swallowing after a facial injury
A suspected broken jaw — signs include inability to open or close the mouth, numbness of the lower lip, teeth not meeting together properly, or visible deformity
Uncontrollable bleeding that does not stop with 15 minutes of firm pressure
A head injury with loss of consciousness, confusion, vomiting, or drowsiness
Swelling that is spreading rapidly to the neck or throat
Clear fluid leaking from the nose or ears
For dental injuries without the above signs — such as a knocked-out, broken, or loose tooth — contact your dentist or call NHS 111 for an emergency dental appointment. Do not go to A&E for injuries a dentist can treat — they do not have dental instruments or expertise.
After treatment — what to expect
If a tooth has been reimplanted or splinted, your dentist will give you specific instructions. In general:
Eat soft foods for at least 2 weeks
Avoid biting directly on the injured tooth
Keep your mouth clean — use a chlorhexidine mouthwash if recommended
Avoid contact sports until your dentist advises it is safe
Attend all follow-up appointments — your dentist will monitor the nerve and root over weeks and months. Complications (such as the nerve dying or the root being resorbed) can develop later, even if the tooth initially feels fine
You may need root canal treatment at a later date — your dentist will explain if this becomes necessary
Preventing dental injuries
Many dental injuries are preventable:
Wear a mouthguard for contact sports (rugby, boxing, hockey, martial arts, football, cricket, basketball). A custom-made mouthguard from your dentist provides the best fit and protection — significantly better than boil-and-bite or stock mouthguards.
Children's mouthguards need replacing annually as the jaw grows and teeth change. Adult mouthguards should be replaced every 1–2 years.
Use appropriate safety equipment for activities such as cycling, skateboarding, and horse riding.
Do not use teeth to open bottles, tear packaging, or hold objects.
This leaflet is for general information only and does not replace professional dental advice. Your dentist will discuss your individual circumstances and any risks and treatment specific to you. Treatment outcomes vary between patients depending on individual circumstances.
When to Seek Urgent Help
If a permanent tooth is knocked out, time is critical. Pick it up by the crown (the white part), never touch the root. If dirty, rinse briefly under cold running water (10 seconds). If possible, push it gently back into the socket and bite on a clean cloth to hold it in place. If you cannot replant it, place it in cold milk immediately. See a dentist within 60 minutes — ideally within 20 minutes. Do NOT reimplant a baby tooth.