A child knocked out or broke a tooth: what to do now

If you are reading this on your phone on the way, here is the essential part in three sentences. Find the tooth and hold it by the crown, never by the root. If the tooth is permanent and dirty, rinse it in milk or saline — not water, and do not scrub. Put it in a glass of milk and get your child to a dentist within the hour. The rest is below and can be read on the way.

The first 30 minutes, step by step

1. Calm your child, and yourself. Blood from a lip or gum looks worse than it is: the mouth has a rich blood supply, so even a small wound bleeds a lot.

2. Stop the bleeding. Clean gauze or a napkin, pressed for ten minutes. Do not check every minute — the clot needs time to form.

3. Find the tooth or the fragment. Even if it looks shattered, bring everything you found. A fragment of a front tooth can often be bonded back, and it looks better than any filling.

4. Hold the tooth by the crown only. By the part normally visible in the mouth. The root carries living ligament cells — they are what allow the tooth to reattach, and touching them damages them.

5. Do not rinse under the tap and do not scrub. Water kills the ligament cells within minutes. If the tooth is covered in soil, rinse it for a few seconds in milk or saline.

6. Put it in milk. Ordinary cold milk is the best thing most homes have. Saline works too, as does the child's own saliva (the tooth held in the cheek — but only for teenagers; a small child could swallow it). Water does not.

7. Apply cold to the lip or cheek from outside to limit swelling.

8. Call and come. Every ten minutes reduces the chances.

Baby tooth or permanent — the difference matters

This is the first thing that decides what happens next.

A knocked-out permanent tooth is repositioned and splinted for a few weeks. The chance of reattachment depends directly on time out of the socket: within 30 minutes it is high, after two hours it is minimal.

A knocked-out baby tooth is never put back. Underneath it sits the developing permanent tooth, and pushing the baby tooth back can damage it — the permanent tooth then erupts with an enamel defect or in the wrong place. This is not cutting corners; it protects the tooth still to come.

How to tell at home: under the age of six teeth are almost always baby teeth; baby teeth are smaller, whiter and have a straighter edge. But do not spend time deciding — bring the tooth in milk either way and the dentist will sort it out.

The empty space after a baby tooth needs attention too: if the change of dentition is still years away, the neighbouring teeth drift into the gap and the permanent tooth ends up short of room. Sometimes a space maintainer is fitted.

The tooth is not out but broken or loose

This happens more often than a fully knocked-out tooth.

A chipped edge. If you have the fragment, bring it — it is often bonded back. If not, the tooth is rebuilt with composite. Urgent if you can see a pink or red dot at the fracture: that is exposed nerve, and there the clock runs in hours.

A tooth loose after a blow. Do not wiggle it, do not test with a finger how loose it is. Soft food, and see a dentist the same day.

A tooth pushed up into the gum. It looks as though the tooth has disappeared or become shorter. Do not pull and do not press. See a dentist urgently, particularly with a baby tooth: it may have been driven towards the permanent tooth bud.

A tooth displaced sideways or forwards. Do not reposition it yourself. The dentist will do it under anaesthetic.

A tooth that darkens a week or two after the injury. Everything looks intact but the tooth turns grey — a sign the nerve inside has died. Not an emergency, but it needs looking at: sometimes treatment is required, sometimes observation is enough.

When to come immediately and when morning will do

Immediately, without waiting for morning: a knocked-out permanent tooth; a tooth pushed into the gum; visible exposed nerve at a fracture; bleeding that has not stopped after 15 minutes; a markedly mobile tooth; an injury combined with a cut lip or chin.

Next morning is fine: a small painless enamel chip; a tooth slightly sensitive but firmly in place; a bruised lip with the teeth undamaged.

Separately — to a paediatrician or emergency department rather than only a dentist: the child lost consciousness even briefly, is nauseous, drowsy, or does not remember the fall; a head injury more serious than a split lip. The tooth can wait; the head cannot.

We work every day: Mon–Sat 9:00–19:00, Sun 10:00–18:00. Injuries are seen out of turn — phone rather than using the form, it is faster.

What happens at the appointment, and afterwards

First an examination and an X-ray — even when everything looks intact from outside. The image shows a cracked root, displacement and the state of the permanent tooth bud, none of which the eye can see.

Then, depending on the situation: the tooth is repositioned and splinted for two to four weeks; a fragment is bonded back; a fracture is sealed; an exposed nerve is treated. A baby tooth with a poor prognosis sometimes has to be removed so the permanent one is not harmed.

A consultation is UAH 690; with a treatment plan — UAH 1,000. The cost of treatment itself depends on what happened; the dentist gives it after the X-ray, before any work starts.

Then comes follow-up, and it matters. An injured tooth is checked at one month, three months, six months and a year. The nerve may die not at once but months later, and only a check-up reveals it. A missed review is the commonest reason a tooth injured at seven has to be treated at ten.

What lowers the risk next time: a sports mouthguard for contact sports and scooters; orthodontic treatment if the upper teeth protrude noticeably — such teeth are injured several times more often.

Frequently asked questions

Iryna Biletska

Restorative dentist

Restorative dentistry and paediatric appointments at Houston clinic. Prevention, helping children adapt to treatment, treatment of baby teeth.

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