[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Dentistry](https://durgical.com/en/dentistry/) › [Dental emergencies and trauma](https://durgical.com/en/dentistry/areas/emergencies/) › Knocked-out tooth: replant within minutes

# Knocked-out tooth: replant within minutes

- Emergency

A knocked-out permanent tooth has the best chance if it is put back in its socket at once. Baby teeth are never put back.

Updated Nov 12, 2026

**See it in 3D:** [Upper right central incisor](https://durgical.com/en/anatomy/upper-right-central-incisor/) · [Upper left central incisor](https://durgical.com/en/anatomy/upper-left-central-incisor/)

## Key points

- Permanent tooth: replant at once, holding the crown.
- Store in milk or saline, never dry.
- Never replant a baby tooth.

## What it is

Avulsion is complete displacement of a tooth out of its socket, most often an upper central incisor in a child or adolescent after a fall, sport or assault. The survival of a replanted permanent tooth depends on the periodontal ligament cells on the root: they die if the root dries or is scrubbed. Replantation within the first minutes gives the best outcome; if that is not possible, the tooth must be kept moist in a suitable medium while the patient reaches a dentist. Primary (baby) teeth are not replanted, because this can damage the permanent tooth developing underneath.

## How to recognise it

- Permanent tooth: replant immediately if possible.
- Hold the tooth by the crown, never the root.
- If dirty, rinse briefly in cold milk, saline or water for a few seconds; do not scrub.
- Storage if replantation is not possible: milk, saline, a balanced storage solution, or the patient's saliva (in the cheek, only for older children and adults who will not swallow it); never dry or in water for long.
- Primary tooth: do not replant; check the socket and the child.

## What to do at once

- Check the patient first: head injury, loss of consciousness, other injuries, airway (an aspirated tooth).
- Confirm the tooth is permanent (age, size, a full root) and find it.
- Hold it by the crown, rinse briefly if dirty, and push it gently into the socket the right way round.
- Ask the patient to bite on gauze or a handkerchief to hold it, and go to a dentist at once for splinting.
- If it cannot be replanted, place it in milk or saline and go to a dentist immediately.
- Check tetanus immunisation; the dentist decides on antibiotics and follow-up of the pulp.

## Costly mistakes

- Every minute the root is dry reduces the chance of the tooth surviving; after about an hour dry, the ligament cells are dead.
- A tooth that cannot be found may have been swallowed, inhaled or intruded into the bone: consider radiographs, including the chest if aspiration is possible.
- Repeated dental injuries without a clear story in a young child can be a sign of abuse.

## Next step / Initial management

- Replanted or stored tooth: urgent dental care the same hour for a flexible splint, radiographs and the decision on antibiotics.
- Missing tooth with possible aspiration: chest radiograph and referral as needed.
- Primary tooth avulsion: do not replant; refer to the dentist for follow-up of the permanent successor.

## Test yourself

Think of the answer, then tap the question to see it.

## What determines whether a replanted permanent tooth survives?

Survival of the periodontal ligament cells on the root, which die if the root dries or is scrubbed.

## What is a good storage medium for an avulsed tooth if it cannot be replanted?

Cold milk or saline (or a balanced storage solution); not water and never dry.

## Why are avulsed primary teeth not replanted?

Because replantation can damage the developing permanent tooth beneath.

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## Connections

## See it in 3D 2

The structures of Durgical's 3D anatomy where it is found.

- [Upper right central incisor](https://durgical.com/en/anatomy/upper-right-central-incisor/)
- [Upper left central incisor](https://durgical.com/en/anatomy/upper-left-central-incisor/)

## Related 2

- [Broken and displaced teeth: fractures and luxations](https://durgical.com/en/dentistry/broken-and-displaced-teeth-fractures-and-luxations/)
- [Occlusion and malocclusion: Angle classes and when to refer](https://durgical.com/en/dentistry/occlusion-and-malocclusion-angle-classes-and-when-to-refer/)

## In Pharmacology 2

- [Doxycycline](https://durgical.com/en/pharmacology/doxycycline/)
- [Amoxicillin](https://durgical.com/en/pharmacology/amoxicillin/)

[← All of dentistry](https://durgical.com/en/dentistry/)

Educational content; it does not replace assessment by a dentist or doctor and is not a clinical instruction. For facial or neck swelling with difficulty swallowing or breathing, a knocked-out tooth or bleeding that will not stop, go to an emergency department at once.

Sources: [Avulsed Tooth](https://www.ncbi.nlm.nih.gov/books/NBK539876/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Trauma to the Primary Dentition](https://www.ncbi.nlm.nih.gov/books/NBK580475/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Dental Emergencies](https://www.ncbi.nlm.nih.gov/books/NBK589664/) (StatPearls Publishing (NCBI Bookshelf), 2022).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/dentistry/knocked-out-tooth-replant-within-minutes/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/dentistry/knocked-out-tooth-replant-within-minutes/