If a permanent (adult) tooth is knocked out, pick it up by the crown, rinse it briefly in milk and, if you can, put it back in its socket or keep it in milk, then see a dentist immediately. A knocked-out baby tooth should never be put back. A broken tooth also needs a same-day dental check.
First step: stay calm and check your child
Falls, bicycles, playgrounds and sports cause most dental injuries in children. Before looking for the tooth, look at your child: mouth injuries often bleed a lot and look worse than they are.
- Press a clean, folded cloth or gauze on the bleeding area for about 10 minutes.
- Then see what happened to the tooth: knocked out, broken, loose or pushed into the gum.
If your child lost consciousness, is vomiting or is unusually sleepy, read the emergency room section below first.
Baby tooth or permanent tooth?
This matters most, because the advice is opposite for each. Children usually have only baby teeth (also called milk teeth) until about the age of 6, and the permanent front teeth usually come through between 6 and 8.
- Under 6 years old: almost always a baby tooth.
- Between 6 and 8: it may be either; a new permanent front tooth is larger, often with a slightly wavy edge.
- From about 8 or 9: the front teeth are usually permanent.
If unsure, keep the tooth in milk, do not put it back and call a dentist.
Knocked-out permanent tooth: the first 30 minutes, step by step
A knocked-out permanent tooth (dentists call this avulsion) has the best chance of surviving if it goes back into its socket within minutes: the living cells on the root die as it dries, so speed and moisture matter most.
- Find the tooth and pick it up by the crown (the white part you normally see), never by the root.
- If it is dirty, rinse it for a few seconds in milk or saline. Do not scrub it, use soap or wrap it in a tissue.
- If your child is calm, gently push the tooth back into its socket the right way round, then have your child bite on a clean cloth.
- If you cannot put it back, place it in cold milk, or in saline or a little of your child’s saliva in a cup. Do not use tap water, and do not let a young child hold it in the mouth, as it could be swallowed.
- Call the dentist and come straight away with the tooth, ideally within 30 minutes.
Even if more time has passed, still come. The NHS advice on knocked-out teeth describes the same first steps.
Knocked-out baby tooth: why it is not put back
A knocked-out baby tooth should not be replanted: pushing it back could damage the permanent tooth developing just underneath it in the jawbone. Stop the bleeding, keep the tooth and see the dentist the same day or the next.
The dentist checks the gum and the neighbouring teeth; in most cases the gap needs no replacement. If this is your child’s first time with a dentist, our guide to your child’s first dental visit explains what happens.
Broken, loose or pushed-in tooth
These injuries also need a dentist, usually the same day.
| What you see | What to do now |
|---|---|
| A piece has broken off | Keep the fragment in milk or water; it can sometimes be bonded back on. |
| A pink or red dot in the broken tooth | The nerve (the pulp) may be exposed: come the same day. |
| The tooth is loose or has moved | Do not move it; let your child bite gently on a cloth and come straight away. |
| The tooth looks pushed into the gum | Do not pull on it; come quickly for an examination and an X-ray. |
Rinse gently with water and use a cold compress on the lip or cheek. For pain, paracetamol or ibuprofen at the dose for your child’s age and weight is usually suitable; do not give aspirin to children. If pain returns days later, our article on severe toothache and what to do right now can help.
When to go to the emergency room first
Go directly to the emergency room, before the dentist, if your child:
- lost consciousness, even briefly, or seems confused or unusually sleepy;
- vomits after the fall or has a severe headache;
- has bleeding that does not stop after 10 to 15 minutes of firm pressure;
- cannot close the mouth properly, or the jaw looks out of place;
- has difficulty breathing or keeps coughing after losing a tooth that cannot be found.
Facial swelling that appears days later and spreads, especially with fever, is also urgent: see our guide on facial swelling from a tooth and when to go to the emergency room.
What happens at the dentist, and afterwards
The emergency visit
The dentist examines the mouth and usually takes a small X-ray of the roots and bone. Repositioning a tooth or bonding a fragment is done under local anaesthesia (an injection that numbs only that part of the mouth), so the treatment itself should not hurt. Most emergency visits take about 30 to 60 minutes.
Splint and follow-up
A replanted or loosened permanent tooth is usually held for about two weeks with a thin, flexible splint attached to the neighbouring teeth. Many replanted permanent teeth later need a root canal treatment, and check-ups with X-rays over the following months help catch problems early.
Care at home
- Soft food for a few days, without biting on the injured teeth.
- Gentle brushing with a soft toothbrush.
- Call the dentist if the tooth darkens, hurts more, or if a small bump or swelling appears on the gum.
What determines the cost
The cost depends on the type of injury, the number of teeth, the X-rays, any splint, bonding or later root canal treatment, and follow-up visits. The dentist explains the plan and its cost after the examination.
Children’s dental emergencies at our clinic in Tripoli
At Ajam Dental Clinic, all dental care for babies, children and teenagers is handled by Dr. Soumaya Ajam, who holds a University Diploma in Paediatric Dentistry from Université Saint-Joseph de Beyrouth. More about our children’s dentistry.
Patients come to our clinic on Fouad Chehab Boulevard from across Tripoli — Abu Samra, Al-Qobbeh, El Mina, Al-Haddadine and the old souks — as well as from Akkar and the rest of North Lebanon. After a dental injury, call or send a WhatsApp message before you set off; all our numbers are on the contact page.
Frequently asked questions
We cannot find the knocked-out tooth. What should we do?
Look carefully where the accident happened and on your child's clothes, but do not lose too much time searching. A tooth that seems missing may have been swallowed, which is usually harmless, or it may have been pushed up into the gum so that it only looks missing. More rarely, it can be breathed in. If your child keeps coughing, wheezes or has any difficulty breathing, go to the emergency room. Otherwise, come to the dentist the same day: an examination and an X-ray will show whether the tooth is hidden in the gum and whether the surrounding teeth and bone are affected.
Will a replanted permanent tooth last?
Many replanted teeth stay in place for years, but the outcome depends mainly on how quickly the tooth was put back and how it was stored in the meantime. A tooth replanted within minutes, or kept in milk, has a much better chance than one that dried out. Even when it heals well, the nerve often needs a root canal treatment. In some cases the body slowly replaces the root with bone over the years; in a growing child, the dentist then plans the right moment for a replacement. Regular follow-up visits are the best way to keep the tooth as long as possible.
Can a knocked-out baby tooth harm the adult tooth underneath?
Sometimes. The root of a baby tooth sits very close to the developing permanent tooth, so a hard knock can occasionally affect it. The most common sign is a white or yellow-brown spot on the permanent tooth when it comes through; more rarely, its shape or position can change. This is one reason the dentist examines the area after the injury, and why baby teeth are never pushed back into place. In most cases the permanent tooth comes through normally. If you notice anything unusual when it appears, mention it at your child's next check-up.
My child's baby tooth turned grey after a fall. Is this serious?
A front tooth that turns grey, pink or yellowish after a knock is common in young children. It is caused by bleeding or changes inside the tooth, a little like a bruise. Some teeth slowly become lighter again over weeks or months, while others stay darker without causing any problem. It becomes a concern if there is pain, swelling, a small bump like a pimple on the gum above the tooth, or a bad taste. In those cases the nerve may be infected, and your child should see the dentist soon to protect the permanent tooth underneath.
Does my child need a tetanus vaccine after a dental injury?
It depends on the injury and on your child's vaccination record. If the tooth or the wound came into contact with soil or dirt, for example after a fall in a garden or in the street, it is sensible to check that tetanus vaccination is up to date. Most children who follow the usual vaccination schedule are already protected. Look at your child's vaccination booklet and, if in doubt, ask your paediatrician or family doctor the same day. The dentist may also ask about vaccinations during the emergency visit.
My child chipped a tooth but feels no pain. Can we wait?
A small chip without pain is not usually an emergency in the middle of the night, but it should still be checked within a day or two. Even when nothing hurts, the tooth may have a crack, the nerve may be bruised or the root may be injured, and an X-ray helps to see this. Keep any broken fragment in milk or water, because it can sometimes be bonded back on. If you see a pink or red spot in the broken area, or if your child becomes sensitive to cold or hot food and drinks, come the same day.
Have a question about your teeth?
Send a WhatsApp message to Dr. Abdel Rahman Ajam or Dr. Soumaya Ajam, or call the clinic to book a consultation.
This article provides general information for patients. It does not replace an examination by a dentist, who can advise you on your own situation.