What To Do When Your Child's Tooth Gets Knocked Out
Updated: 10 hours ago
Written By: Logan Grover, Content Writer |
Reviewed By: Dr. Alison Grover, Board-Certified Diplomate Pediatric Dentist |
Last Reviewed: September 12, 2026 |
If your child just had a tooth knocked out, here's the short version. Find the tooth. Pick it up by the crown, the white chewing part, and keep your fingers off the root. If it's a permanent tooth, put it straight back into the socket and have your child bite gently on a clean cloth. When that isn't possible, drop it in a cup of cold milk.
If it's a baby tooth, do not put it back in the socket, no matter what you read elsewhere.
You have roughly 30 minutes before the living cells on the root start dying off. That single fact is why this page exists, and it's the fact most articles on this topic leave out.
One thing comes before the tooth. Go straight to an emergency room instead if your child lost consciousness, is confused, drowsy, or vomiting, has bleeding you can't stop, or looks like the jaw is broken. Bring the tooth in milk and let the ER team tell us when they're done. A tooth can wait 20 minutes. A head injury can't.
What Is a Knocked Out Tooth?
A knocked out tooth, called an avulsed tooth, is a tooth driven completely out of its socket by an impact. The International Association of Dental Traumatology puts avulsion of permanent teeth at 0.5% to 16% of all dental injuries. Permanent teeth get put back in. Baby teeth do not, because replanting one can damage the adult tooth forming underneath it.
Baby Tooth or Permanent Tooth: How to Tell in 10 Seconds
Age is your fastest clue. Under 6, a knocked out front tooth is almost always a baby tooth. Age 7 and up, it's almost always permanent, and the order adult teeth come in is predictable enough that age alone usually settles it.
Look at the piece in your hand. A baby tooth that gets knocked out usually looks like a small white cap with almost no root, because the root had already dissolved to make room for the adult tooth pushing up behind it. A permanent front tooth has a long pointed root, often as long as the crown or longer. In a 7 to 9 year old, the tip of that root is still open and unfinished, which matters later for follow-up.
When you can't tell, treat it as permanent, put it in milk, and let us sort it out. Storing a baby tooth in milk for 20 minutes costs nothing. Guessing wrong the other way costs the tooth.
Knocked Out Tooth First Aid, Step by Step
Six steps, in order. Do them now and read the rest later.
Find the tooth. Pick it up by the crown. The IADT guideline is blunt about this: "Find the tooth and pick it up by the crown (the white part). Avoid touching the root."
Decide baby or permanent. A baby tooth does not go back in.
If it's dirty, rinse it for a few seconds in milk, sterile saline, or your child's own spit. Not tap water. No scrubbing, no soap, no wiping it on your shirt.
Put a permanent tooth straight back into the socket, facing the same way as its neighbors. Have your child bite gently on gauze or a clean damp cloth to hold it.
A tooth that won't go back belongs in a cup of cold milk. Not water, not a tissue, not their cheek.
Call 303-500-3202, press 2, and drive.
Comfort your child on the way, not before step 4. Every second the root spends dry is a second you don't get back.
The 30 Minute Clock
Thirty minutes is the number that decides most of what happens next. The IADT guideline states it plainly: "After an extra-alveolar dry time of 30 minutes, most PDL cells are non-viable." PDL means periodontal ligament, the thin layer of living cells that anchors a tooth into bone. Kill those cells and the tooth can still be put back, but it stops behaving like a normal tooth.
Time out of the socket | What's happening to the root | What to do |
Under 15 minutes | Best case. Most root cells alive | Put it back at the scene, then call |
15 to 30 minutes, dry | Cells dying quickly | Get it into cold milk right now |
Under 60 minutes, sitting in milk or saliva | Cells can hold on | Keep driving, don't stop to search online |
Over 60 minutes dry | Most cells gone | Bring the tooth anyway |
That last row matters. The American Academy of Pediatrics says the best outcome comes within 15 minutes and to still act within the first hour. The IADT goes further and publishes a separate treatment protocol for teeth that have been dry longer than 60 minutes, so a late tooth is still worth bringing in. The goal shifts from saving the ligament to holding the space in the arch while your child finishes growing.
That clock is why the after-hours line at Mini Miners Pediatric Dentistry goes to a pediatric dentist instead of a voicemail. Call 303-500-3202, press 2, and you reach the dentist on call, who can tell you over the phone whether to reseat the tooth in the car or leave it in milk until you arrive. Ask that in the first 5 minutes and you spend the rest of the window driving instead of reading.
What Should You Put the Tooth In?
Cold milk. It's ranked first for home use by the IADT, and it's the one thing most families already have in the fridge.
The guideline lists the options in descending order of preference: "milk, HBSS, saliva (after spitting into a glass for instance), or saline are suitable and convenient storage mediums. Although water is a poor medium, it is better than leaving the tooth to air-dry."
What to put it in | Why it works | Watch out for |
Cold milk | Ranked first by the IADT for home use. Right salt balance, cells stay alive | Plain cow's milk, not flavored, not warm |
HBSS (sold as Save-A-Tooth) | A 2025 meta-analysis in the Journal of Clinical Medicine pooled 9 lab studies and found root cell survival higher in HBSS than in the other media tested, though 3 of those 9 studies favored other solutions | You have to buy it before you need it. Worth it for a sports bag |
Saliva, spat into a cup | Listed third by the IADT. Better than dry | Into a cup. Not held in the cheek |
Sterile saline | Works short term | Contact lens saline is fine, contact lens solution is not |
Tap water | Last resort only | Never as a rinse, never for storage if you have any other option |
Wrapped in tissue or a napkin | It doesn't | This is the most common way a savable tooth is lost |
One more thing about the cheek. Several popular articles tell you to tuck the tooth between your child's cheek and gum. Don't. A frightened 8 year old can swallow it or breathe it in, and the IADT names aspiration of a tooth as a medical emergency in its guidance on baby teeth. Mayo Clinic's own instruction is to spit into a container. The IADT says the same thing in that parenthetical: into a glass.
Can You Rinse It Under the Tap?
No, and the advice telling you to do it is one of the most copied errors on the internet.
Colgate's widely shared article on knocked out teeth in children tells parents to "briefly clean it in a bowl of lukewarm tap water" and credits Mayo Clinic for the instruction. Mayo Clinic's first aid page says the opposite: "Don't use tap water or hold the tooth under running water, because too much tap water could kill the cells on the root surface that help reattach the tooth." The AAP tells parents the same thing. IADT 2020 says to rinse in milk, saline, or saliva.
When the tooth is caked in dirt and tap water is the only thing in reach, a rinse of 10 seconds or less beats replanting a mouthful of gravel. Count it out. What you must not do is soak it, scrub it, or store it in water. Water pulls the root cells apart. Milk doesn't.
How to Put the Tooth Back In Yourself
Rinse if needed, line the tooth up with its neighbors, and press it into the socket with steady thumb pressure until the top sits level with the teeth on either side. It will not click. It will feel wrong. Do it anyway.
Then have your child bite on gauze, a clean cloth, or a damp paper towel and keep biting until you reach us. If your child is too young, too panicked, or bleeding too heavily to cooperate, stop. Milk, cup, car.
I'd rather reseat a tooth that went in slightly rotated than receive one that spent 40 minutes folded in a napkin. Rotation I can fix in the chair. Dead root cells I can't.
What If It's a Baby Tooth?
Do not put it back. This is the one rule I want every parent in Erie to memorize, because almost every article about knocked out teeth buries it or skips it entirely.
The IADT guideline on injuries in the primary dentition is unambiguous: "An avulsed primary tooth should not be replanted." It gives three reasons. The treatment load on a young child is heavy, including splinting and often root canal treatment. Pushing a baby tooth back can damage the permanent tooth forming right behind it, or knock its eruption off course. And a replanted baby tooth can come loose again and be inhaled, which the guideline calls a medical emergency.
These injuries hit a narrow age band. The same guideline notes that primary dentition trauma most commonly happens between 2 and 6 years of age, which is exactly the age range filling our waiting room.
Your child still needs to be seen. Follow-up in the guideline runs to a clinical exam at 6 to 8 weeks, then another look around age 6 to check that the adult tooth is coming in on schedule and in the right shape. If a piece of root stays behind in the gum, that fragment sometimes has to be removed so the adult tooth has a clear path. That's a different situation from a stubborn baby tooth that won't come out on its own, which is never an emergency.
You'll also read that a knocked out baby tooth "will most likely require a space maintainer." That isn't what the specialty says. The American Academy of Pediatric Dentistry's guidance on managing the developing dentition, revised in 2024, says "it is prudent to consider space maintenance when primary teeth are lost prematurely," and then lists 10 separate factors to weigh before placing one. Consider, with 10 inputs, is not the same as usually required. Whether your child needs an appliance depends on which tooth came out, their age, and how the rest of the bite is developing. That's a call made at the visit, not a default.
What Happens at the Emergency Visit
We confirm the tooth is seated correctly, splint it, and check for everything the impact did that you can't see.
An x-ray tells us whether the root is fully in the socket, whether the bone around it is fractured, and whether any other tooth was pushed up into the gum. We take x-rays in the treatment room with a camera-style machine, so your child can keep watching their movie while we work. Every room here is plumbed for nitrous oxide, and we offer mild, moderate, and deep sedation, which matters when a scared 4 year old needs to hold still. All our instruments and sensors are sized for children's mouths. You can stay in the room.
Two medical items come up at this visit. The IADT lists amoxicillin or penicillin as first choice antibiotics after replantation, and notes that tetracycline and doxycycline are generally not recommended under age 12. It also says to check whether a tetanus booster is due, especially when the tooth hit soil.
Tell us when you can't find the tooth at all. A missing tooth might have been pushed up into the gum rather than knocked out, or swallowed, or inhaled. We rule those out rather than assume.
The Splint Comes Off in 2 Weeks. The Follow-Ups Run 5 Years.
A replanted tooth is stabilized for 2 weeks with a passive flexible splint, which the IADT specifies as wire up to 0.016 inch, or 0.4 mm, bonded to the neighboring teeth.
The follow-up schedule is longer than parents expect, and no other article on this topic prints it:
Root tip | Follow-up visits |
Closed apex (older child, finished root) | 2 weeks (splint out), 4 weeks, 3 months, 6 months, 1 year, then yearly for at least 5 years |
Open apex (recently erupted tooth) | 2 weeks (splint out), 1 month, 2 months, 3 months, 6 months, 1 year, then yearly for at least 5 years |
Most 7 to 9 year olds who lose a front tooth fall into the open apex group, because that tooth came in only a year or two ago and its root tip is still unfinished. That's the busier schedule, and it's the one that catches problems early.
At those visits we watch for two things in particular: the tooth darkening, and signs the nerve inside has died, which is what leads to root canal treatment. Neither is a failure. Both are common after this injury, and both are far easier to manage when they're caught at the 3 month check instead of two years later.
Can My Child Get an Implant?
Not while they're still growing, and this is the part most articles get wrong.
A systematic review by Kamatham and colleagues in the Journal of Clinical Pediatric Dentistry (2019) pulled together 8 published studies covering 16 implants in 11 adolescents, placed at a mean age of 13.4 years. In 6 of those cases, followed for 3 to 13 years, the implant ended up sitting below the neighboring teeth. One was 9 mm short after 13 years. The authors concluded that "no fixed chronological age that guides the implant placement can be suggested," recommended assessing skeletal maturity first, and cautioned that all of the evidence comes from case reports.
Here's the mechanism in plain terms. A natural tooth drifts as the jaw grows. An implant is fused to bone and stays exactly where you put it. So the jaw grows up past it and the crown ends up looking sunken, years after everyone thought the case was finished.
The usual holding options in the meantime are a removable partial, a bonded bridge, or closing the space with braces. Which one fits depends on the bite and how much growing is left. That conversation happens once, properly, not in a panic on the night of the injury.
When It Happens at School or at Practice
Tell whoever is with your child to get the tooth into milk from the cafeteria or a teammate's cooler, and to call you and us at the same time.
The instructions a coach or school nurse needs fit on an index card: crown only, no scrubbing, no dry napkin, cold milk, call. For a child in any contact sport, a small container of HBSS solution in the gear bag turns a 30 minute problem into a much longer window.
We're at 61 Erie Pkwy, Unit 101, in the Erie Commons shopping area at the corner of Briggs Street and Erie Parkway, between I-25 and 287. That puts us a couple of minutes from most local schools, and parking is easy, which is not a small thing when you're carrying a crying child and a cup of milk.
Mouthguards, and What the Numbers Actually Say
A mouthguard is the only item on this page that prevents the whole problem instead of managing it.
The American Dental Association's review of the mouthguard evidence reports that mouthguard users were between 82% and 93% less likely to suffer dentofacial injuries, and that the risk of orofacial injury runs 1.6 to 1.9 times higher in players who don't wear one. The ADA also notes that the NFHS and NCAA require mouthguards for football, field hockey, ice hockey, and lacrosse.
Look at that list again. Basketball isn't on it, and neither is soccer, a scooter, a trampoline, or a driveway. The requirement lists cover a fraction of the situations that put a child's front teeth in the way of something hard.
Getting Seen in Erie Tonight
Call 303-500-3202 and press 2. That reaches our pediatric dentist on call, not an answering service reading from a script. For patients of record we work to get your child in the same business day, because we treat our own patients' emergencies as the first thing on the schedule.
Office hours are Monday to Friday, 8 AM to 5 PM, with Friday closing at 3:30 PM. You can also text 720-734-5890. Families come to us from Erie, Lafayette, Louisville, Broomfield, Boulder, Westminster, Thornton, and Longmont, and if you're not a patient yet, new families are welcome. Either way, call before you drive so we know a knocked out tooth is on its way in.
Put the tooth in milk. Then call.
FAQs
How long do I have to save a knocked out tooth in a child?
About 30 minutes before most of the living cells on the root die off. The IADT guideline states that after 30 minutes of dry time, most periodontal ligament cells are no longer viable, and the best results come from putting the tooth back within about 15 minutes. If the tooth sits in cold milk instead of drying out, the window stretches toward an hour. Bring the tooth even if you are past that.
Should I put a knocked out baby tooth back in?
No. The IADT guideline on injuries in the primary dentition states that an avulsed primary tooth should not be replanted. Pushing it back can damage the permanent tooth forming behind it, and a loose replanted baby tooth can be inhaled. Your child still needs to be seen, just without the tooth going back in.
What do I put a knocked out tooth in if we have no milk?
Have your child spit into a clean cup and put the tooth in their own saliva. The IADT ranks storage media as milk first, then HBSS solution, then saliva, then saline. Tap water is the last resort and should never be used for storage if anything else is available, because it damages the root surface cells.
Can a tooth be saved after an hour out of the socket?
Often yes, though what saving it means changes. Past 60 minutes of dry time most of the root cells are gone, so the tooth is unlikely to reattach normally, but the IADT publishes a separate protocol for exactly this situation. A late replanted tooth can still hold the space in the arch while your child grows, which protects the bite.
Does a knocked out baby tooth mean my child needs a space maintainer?
Not automatically, despite what a lot of articles say. The American Academy of Pediatric Dentistry's 2024 guidance says it is prudent to consider space maintenance after premature loss of a primary tooth, then lists 10 factors to weigh first. Which tooth came out, your child's age, and how the bite is developing all change the answer.
Should we go to the emergency room or the dentist?
Call the dentist first if you can reach one, because an ER usually cannot replant or splint a tooth. Mini Miners patients can call 303-500-3202 and press 2 to reach the pediatric dentist on call. Go to the ER instead if there is a head injury, loss of consciousness, heavy bleeding that will not stop, or a suspected jaw fracture.
Will a replanted tooth turn dark or need a root canal?
Both are common after this injury and neither means the treatment failed. The nerve inside the tooth often dies after an avulsion, which shows up as darkening and is treated with root canal therapy. This is why the follow-up schedule runs at 2 weeks, 4 weeks, 3 months, 6 months, 1 year, and yearly for at least 5 years.
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