What to Do (and Not Do) for a Knocked-Out Tooth in Houston

If you are reading this on your phone right now and a tooth is in your hand, stop reading and call us at (713) 522-1717. Then come back to this page for the rest. Time is the variable that matters most.

For everyone else, save this article. If a tooth ever gets knocked out, the next 60 minutes set the entire outcome. Most people make the same three mistakes, and most of those mistakes are unrecoverable.

The 60-minute window

A tooth that has been knocked out of the mouth is called an avulsed tooth. The cells on the root surface that allow the tooth to reattach to bone start dying within minutes. The general guidance dental schools teach is that the best chance of saving an avulsed tooth is to get it back in the socket, or into a proper storage medium, within 60 minutes. The first 30 minutes matter the most.

This window applies to adult permanent teeth. Baby teeth are not reimplanted because doing so can damage the permanent tooth developing underneath. If a child loses a baby tooth from trauma, you still need to be seen, but the goal is different.

Do this first

1. Find the tooth. Pick it up by the crown (the white part you normally see). Not the root.
2. If it is dirty, rinse it briefly. Use milk if you have it. Saline works. Plain water for a few seconds is acceptable if nothing else is available. Do not scrub.
3. Try to put it back in the socket. If you can, gently reseat the tooth in its original position with the crown facing the right way. Bite down softly on a clean cloth or gauze to hold it there. This is the best storage medium that exists.
4. If you cannot reseat it, store it correctly. Milk is the best widely-available transport medium. Saliva is second (tucked inside the cheek if the person is alert and not at risk of swallowing it). Saline is third. Do not store the tooth in plain water for long. Water damages the surface cells faster than the other options.
5. Call our office. If we can see you the same hour, that is the goal. If you cannot reach us, go to the nearest emergency department.

Do not do these things

• Do not scrub the root surface. The surface cells you need for reattachment live there. Scrubbing wipes them off.
• Do not let the tooth dry out. A tooth that sits dry on a counter for 30 minutes has a much lower chance of surviving even if it is later reimplanted.
• Do not wrap the tooth in a tissue or paper towel. Same reason. The fibers stick to the root surface and pull the cells off.
• Do not store it in plain tap water for more than a couple of minutes. Cold milk is much better.
• Do not wait to see if it heals on its own. A tooth out of its socket does not reattach on a wait-and-see plan.

What we do when you arrive

When a patient walks in with an avulsed tooth, we move quickly. The general sequence is an exam to rule out other injuries (jaw fracture, swelling, soft tissue trauma), a quick imaging series to confirm the socket is intact, reimplantation if it has not been done already, and stabilization with a flexible splint that holds the tooth in place while the ligament reattaches. The splint typically stays in for 7 to 14 days. We may also prescribe an antibiotic and a course of antiseptic rinse, and we will recommend a tetanus update if the wound is dirty and your last booster is overdue.

After the immediate visit, we follow up at one week, one month, and several times through the first year to watch for two things: whether the ligament reattaches successfully, and whether the nerve inside the tooth needs root canal therapy. Many reimplanted adult teeth eventually need a root canal because the nerve does not always recover from the disruption, even when the ligament does.

If you cannot reach us right away

Hermann Park Smiles is in the Museum District near the Texas Medical Center. We see emergencies during business hours and we keep slots open for them. If your tooth comes out after hours, the priorities are the same: keep the tooth wet in milk or saliva, call our office line so the after-hours message reaches us, and get to the nearest emergency department if you cannot reach a dentist within the hour.

For patients in Third Ward, Texas Medical Center, West University Place, Bellaire, or the Houston Inner Loop, we are usually the fastest option during the day.

Frequently asked questions

What if the tooth is chipped or cracked but still in the mouth?

Bring the broken piece if you can find it. We can sometimes bond it back if the fracture is clean. If not, we have several restoration options depending on how much tooth is missing.

My child knocked out a baby tooth. Do we put it back?

No. We do not reimplant baby teeth. We still want to see your child the same day to make sure the underlying permanent tooth was not damaged and to manage pain and bleeding.

Will insurance cover an emergency visit?

Most dental insurance covers emergency exams and some of the immediate treatment. Coverage for reimplantation, splinting, and follow-up varies. We will run your insurance for you and explain what to expect before we proceed.

What if the tooth was knocked out hours ago?

Still come in. The odds drop sharply after the first hour, but they are not zero. Some teeth survive even after several hours in milk. We need to evaluate the tooth and the socket to know what is possible.

Save this page now, before you need it

If you take one thing away, take this: knocked-out teeth go back in within an hour, stored in milk, handled by the crown. Most outcomes are decided in those first minutes.

For emergencies during business hours call (713) 522-1717. You can learn more about how we handle dental emergencies on our emergency care page, our emergency dentist information, and our pages for patients in Third Ward and the Texas Medical Center.