My Tooth Got Knocked Out. What Do I Do In The Next 60 Minutes?

A tooth gets knocked out in a fraction of a second. What you do in the next 60 minutes may determine whether you keep that tooth for life or lose it permanently.

This is one of the few dental emergencies where public awareness directly changes the clinical outcome. Studies show that fewer than half of people know the correct first steps for a knocked-out tooth,³ yet the science is clear: correct immediate action dramatically improves the chance of successful replantation.

The 60-minute rule: why time is everything

When a permanent tooth is knocked out (avulsed), the periodontal ligament cells on the root surface begin to die immediately. These cells are critical for the tooth to reattach to the bone.¹

According to the International Association of Dental Traumatology (IADT) 2020 guidelines, replantation within 60 minutes of avulsion is the single most important factor for long-term tooth survival.¹ A retrospective study found that of teeth replanted within one hour, 64% remained in the socket at five-year follow-up — this dropped significantly for teeth out of the mouth longer.²

Step by step: what to do right now

Start the clock from the moment the tooth comes out. Every minute matters!!!

1. Stay calm and find the tooth. Pick it up by the crown — the white part you bite with. Do NOT touch the root.

2. Rinse it briefly if visibly dirty. Hold it under cold running water for no more than 10 seconds. Do NOT scrub, dry, or wrap it in tissue.

3. Replant it immediately if possible. Gently push the tooth back into the socket in the correct orientation. Have the person bite down on a clean cloth to hold it in place. This is the best possible outcome.¹

4. If you cannot replant it, store it correctly. See the table below. Do NOT store it dry.

5. Get to a dentist or emergency department immediately. Call ahead if possible. The goal is professional replantation within 60 minutes of the injury.

How to store the tooth while you travel

Storage medium	Time it buys you	Notes
Replant immediately	Best outcome	If the socket is clean, replant at the scene
Full-fat milk	Up to 60 minutes	✓ Best widely available medium
Sterile saline	Up to 60 minutes	✓ Good if milk is unavailable
Saliva (under the tongue)	Up to 30 minutes	~ Use only if nothing else is available — risk of swallowing
Water (tap)	15 to 20 minutes only	✗ Last resort only — damages cells
Dry (pocket, tissue, cloth)	Damages cells rapidly	✗ Avoid entirely — irreversible damage

What NOT to do: common mistakes that cost teeth

• Do NOT pick the tooth up by the root — periodontal ligament cells are on the root and are essential for reattachment¹

• Do NOT scrub, scrape, or dry the root

• Do NOT wrap the tooth in tissue or cloth

• Do NOT store the tooth in tap water for more than 20 minutes — it is hypotonic and damages cells⁴

• Do NOT delay seeking care because the pain is manageable — the biological clock on the root cells does not stop

• Do NOT attempt to replant a baby tooth (primary tooth) — this can damage the developing adult tooth beneath⁵

What the dentist will do

The dentist will examine the socket and the tooth, take X-rays to check for associated bone fractures, and if conditions allow replant the tooth. According to IADT 2020 guidelines:¹

•       The socket will be gently irrigated with saline

•       The tooth is carefully repositioned and a flexible splint stabilises it against adjacent teeth for two weeks

•       Root canal treatment is usually started within seven to ten days to prevent root infection

•       Follow-up X-rays at one month, three months, six months, and one year monitor healing

Even with ideal management, replanted teeth can be lost to root resorption. A 2026 scoping review of 92 studies reported failure rates of 55 to 96% depending on extra-oral time and storage medium.⁶ However, the IADT notes that not replanting a tooth is an irreversible decision — attempting replantation always preserves options, especially for young patients where maintaining bone volume during facial growth is critical.¹

Special situations

Baby teeth (primary teeth)

Do NOT replant baby teeth. Forcing a baby tooth back into the socket risks damage to the developing permanent tooth beneath it.⁵ Take the child to a dentist for assessment — there may be socket or bone damage, and the underlying adult tooth bud may need monitoring.

Chipped or fractured tooth (not fully knocked out)

A chipped tooth that has not fully come out is a different injury. Keep any fragments if possible — store them in milk or saline — avoid biting on hard foods, take pain relief, and see a dentist urgently. Fragments can often be bonded back onto the tooth.

Multiple teeth or significant facial trauma

If multiple teeth are displaced or there is significant facial swelling, jaw injury, or any loss of consciousness, go directly to an emergency department. Dental trauma from a major impact may be accompanied by other injuries requiring medical assessment.

Frequently Asked Questions (FAQ)

Q: What is the best thing to store a knocked-out tooth in?

A: Full-fat milk is the best widely available medium — it maintains the osmotic environment that keeps periodontal ligament cells alive. Sterile saline is equally effective. Replanting the tooth immediately in the socket is always the best option when feasible.¹

Q: Can I put the tooth back myself?

A: Yes, for permanent teeth. Immediate self-replantation at the scene is actually the recommended first step according to IADT guidelines, provided the socket is visible and clear. Push the tooth gently back in the correct orientation, bite down on cloth to hold it, and go to a dentist immediately for stabilisation and root canal assessment.¹

Q: What if the tooth has been out for more than an hour?

A: Replantation is still attempted even after 60 minutes, though the prognosis is significantly worse. The dentist may treat the root surface to slow resorption before replanting. Attempting replantation is always preferable to accepting permanent tooth loss.²

Q: My child knocked out a baby tooth. Should I replant it?

A: No. Baby teeth should not be replanted, as it risks damaging the developing adult tooth beneath. Take your child to a dentist as soon as possible for assessment of the socket and any associated bone injury.⁵

Q: Can a replanted tooth last a lifetime?

A: Some replanted teeth do survive long-term, particularly when replanted within 60 minutes in correct storage medium and managed per IADT guidelines. Failure rates from root resorption range from 55 to 96% depending on circumstances, but early replantation is associated with significantly better outcomes.^{2 6}

This article is produced by the Education Team of the Modern Dental Global Foundation. MDGF is a non-profit dental charity and education. This content is for informational purposes only and does not constitute individual medical or dental advice. Please consult a qualified dental professional for personal guidance.

References

[1] A Review of Early Childhood Caries: Risk Factors, Management, and Policy Recommendations. PMC. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12145511/

[2] Khan et al. A systematic review of caries risk in children under 6 years of age. International Journal of Paediatric Dentistry. 2024.

[3] Optimal tooth brushing initiation age and frequency for preventing early childhood caries: a systematic review and meta-analysis. BMC Oral Health. 2025.

[4] Systematic Review of Evidence Pertaining to Factors That Modify Risk of Early Childhood Caries (prepared for World Health Organization guidance). PubMed 30931717.

[5] Role of the Early Detection and Prevention of Dental Caries in Children: A Systematic Review of Clinical Outcomes. PMC. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12212394/