Knocked-out permanent tooth

A permanent tooth that has been knocked completely out should be returned to its socket as soon as possible, ideally within about thirty minutes. If you are able to reposition it yourself, do so at once and then call. The longer the root surface remains dry, the lower the chance that the tooth will reattach.

  1. Handle the tooth by the crown only

    The crown is the part normally visible above the gum. The root surface is covered in living cells that must survive for the tooth to reattach, and handling or scrubbing the root damages them.

  2. Rinse it briefly, and only if it is dirty

    Use milk, saline or the patient's own saliva, for no more than ten seconds. Do not scrub the tooth, do not use soap, do not dry it, and do not wrap it in a tissue. Tap water is a poor storage medium, so do not leave the tooth sitting in water.

  3. Return it to the socket without delay

    The socket is the best place for the tooth. Line the tooth up with the neighboring teeth, press gently but firmly into place, and have the patient bite on a clean cloth or gauze to hold it there.

  4. If it cannot be replanted, keep it moist

    Cold milk is the most widely available suitable option, and a tooth preservation solution is better if one is available. Saliva also works, including holding the tooth inside the cheek for an older child or an adult who will not swallow it. Water, unlike milk or saline, damages the cells on the root surface.

  5. See a dentist immediately

    Call (559) 683-4694 on the way so that we know you are coming. Bring the tooth even if it is broken or you are not sure it can be saved.

What to do for other common emergencies

These are common dental emergencies. In each case, call the office. The steps below cover the time between the injury and your appointment.

Broken or chipped tooth
Save any pieces you can find and bring them with you. Rinse your mouth with warm water. A cold compress on the outside of the face helps limit swelling. If the broken edge is sharp, covering it with orthodontic wax or sugar-free chewing gum can keep it from cutting your tongue or cheek.
Toothache that will not settle
Rinse with warm salt water and floss gently on either side of the tooth in case food is trapped there. A cold compress on the outside of the face can help, and heat is best avoided because it can make an infection worse. If you want to take something for the pain, ask your pharmacist or physician what is safe for you, and do not hold a tablet against the gum, which can burn the tissue.
Lost filling or crown
Keep the crown or the filling if you still have it and bring it with you. Do not attempt to put a crown back on the tooth yourself, because a loose crown can come off again and be swallowed or inhaled. Avoid chewing on that side, and be careful with hot and cold foods, because the exposed tooth is likely to be sensitive. Call the office.
Swelling in the face or gum
Facial swelling can mean an infection has spread beyond the tooth and needs prompt attention. Call the office the same day. If the swelling is growing quickly, involves your eye or your neck, or is accompanied by fever or trouble swallowing, go to an emergency department rather than waiting.
Something stuck between teeth
Try dental floss first, easing it gently through the contact. If floss does not work, stop there. Do not use a pin, a knife, a needle or any other metal object, which can damage the gum and push the object deeper. Call the office instead.
Bitten lip, cheek or tongue
Clean the area gently, apply firm pressure with clean gauze or cloth for ten to fifteen minutes, and use a cold compress. Mouth wounds bleed heavily and often look more serious than they are. If the bleeding has not slowed after twenty minutes of steady pressure, seek urgent care.
Broken jaw or suspected fracture
Do not try to reposition the jaw. Support it with a bandage or a folded towel wrapped over the top of the head to keep it still, apply cold to the outside of the face, and go to an emergency department.
Orthodontic wire poking the cheek
Cover the end with orthodontic wax or a small piece of cotton. If a wire is embedded in the tissue, do not pull it out. Call for an appointment and leave the wire in place until then.

What happens when you arrive

The first priority is to make you comfortable and to identify the source of the problem, which is not always where the pain is felt. Referred pain is common with teeth. An upper tooth can feel like a lower one, a sinus problem can feel like a toothache, and a cracked tooth can cause significant pain without any visible sign.

Expect a focused examination of the area, an x-ray of the tooth and the surrounding bone, and tests to determine whether the nerve inside the tooth is healthy, inflamed or dying. That answer shapes everything that follows. A tooth with a reversibly inflamed nerve may only need the source of the irritation addressed. A tooth with an infected or dying nerve usually needs either root canal treatment or extraction.

We will explain what we found, what the options are, and what happens if nothing is done. If you have questions about cost, ask while treatment is being discussed. The usual goal of an emergency visit is to relieve pain and stabilize the situation, with the definitive repair planned for a later visit once the tooth is comfortable.

How to lower the chances of a dental emergency

Some emergencies result from accidents that nothing prevents. Others begin as small problems that are easier to treat while they are still small.

  • Wear a mouthguard for sport. A custom-fitted guard protects better than a boil-and-bite one, and it tends to be comfortable enough to be worn consistently.
  • Treat a cracked tooth before it splits. A crack found early can often be crowned. Once a crack extends below the bone, the tooth usually cannot be saved.
  • Do not use your teeth as tools. Opening packaging, cutting thread, holding nails and cracking shells are all common causes of fractured teeth.
  • Take care with hard foods. Ice, unpopped popcorn kernels, hard candy and olive pits can break teeth that were otherwise sound, especially teeth with large older fillings.
  • Keep your recall appointments. A problem found at a routine examination is usually smaller, less expensive and less painful to treat than the same problem found in an emergency.
  • Address grinding. If you clench or grind at night, your teeth are under load for hours at a time. A night guard helps protect against fractured cusps and failed restorations.

Common questions about dental emergencies

How soon can I be seen?

Call (559) 683-4694 as early in the day as you can, describe what has happened, and ask about timing when you call. Office hours are on the contact page. If a permanent tooth has been knocked out, follow the first-aid steps above while you travel to the office.

What do I do if it happens on a Friday or over the weekend?

Follow the first-aid steps above, which matter most in the first hour, and call the office when it opens. Office hours are on the contact page. If the problem involves spreading swelling, fever, difficulty breathing or swallowing, or bleeding you cannot control, do not wait. Go to an urgent care center or an emergency department.

Can a knocked-out tooth really be saved?

Often, yes, if it is a permanent tooth and it is handled correctly and quickly. The main factor is how long the root surface stays dry. Returning the tooth to the socket within a few minutes gives the best result. Storing it in milk and reaching a dentist within the hour gives a good one. A tooth that has been dry for hours usually cannot be replanted.

Is a toothache always an infection?

No. Sensitivity to cold that disappears within a second or two is usually not an infection. Pain that lingers after the cold is gone, pain that wakes you at night, pain on biting, or pain accompanied by swelling points to something more serious. Only an examination and an x-ray can determine which applies.

Should I go to the emergency room for a toothache?

A hospital is the right place for airway problems, spreading infection, trauma involving the head, or bleeding you cannot control, and it can help with pain and infection in the meantime. Hospitals are generally not set up to treat the tooth itself, so once you are stable the tooth still needs a dentist.

My tooth was knocked loose but it is still in place. What should I do?

Disturb it as little as possible. Do not wiggle it or test it, stay on soft foods, and call the office so that it can be examined soon. A tooth that has been pushed out of position or loosened often settles once it has been assessed, and sometimes it needs to be splinted to the neighboring teeth while it heals.