Knocked-Out Tooth in Children (Dental Avulsion)

Baby Tooth or Permanent Tooth — Why It Matters

The first and most important question is whether the tooth that has been knocked out is a baby tooth (primary tooth) or a permanent tooth. The answer completely changes what you should do next.

Baby teeth are typically present from around six months of age and begin falling out naturally from around age six. If your child is under six and has lost a front tooth due to trauma, it is most likely a baby tooth.

Permanent teeth begin erupting from around age six. If your child is older, or if the lost tooth appears larger than a typical baby tooth, it may be a permanent tooth.

If you are not sure which type of tooth has been knocked out, take your child to a dentist immediately and bring the tooth with you. Do not attempt to replant it until a dentist has confirmed what it is.

If Your Child Has Lost a Baby Tooth

Do not attempt to replant a knocked-out baby tooth. This is the single most important rule.

Reinserting a baby tooth into the socket risks damaging the permanent tooth bud developing beneath the gum. That damage could affect how the adult tooth grows and erupts — which is a far more serious long-term consequence than the early loss of a baby tooth.

What you should do instead:

1. Stay calm and reassure your child.
2. Apply gentle pressure with a clean cloth if there is bleeding from the gum.
3. Do not place the tooth back in the socket.
4. Call your dentist and take your child in as soon as possible, even if the bleeding has stopped and your child seems fine.

In most cases, the permanent tooth will still erupt. However, avulsion of a baby tooth does carry a risk of developmental effects on the permanent tooth beneath — most commonly mild discoloration or enamel changes. The younger your child is at the time of injury, the higher that risk. This is one reason why follow-up monitoring until the permanent tooth erupts is important, not just an immediate appointment.

One important note: if your child has had facial trauma and the tooth cannot be found, do not assume it has simply been knocked out. In some cases the tooth has been pushed up into the gum — a condition called intrusion — rather than displaced outward. There is also a small risk of the tooth being swallowed or inhaled. If there is any uncertainty about where the tooth has gone, seek dental care immediately and tell your pediatric dentist. X-rays may be needed to confirm the tooth's location.

If Your Child Has Lost a Permanent Tooth

A knocked-out permanent tooth is a dental emergency — and time is critical. The delicate living fibers on the root surface begin to die the moment the tooth leaves the socket. After approximately 30 minutes of dry time outside the mouth, most of those fibers are no longer viable.

Follow these steps immediately, in order:

1. Stay calm and find the tooth. Pick it up by the crown — the white part normally visible in the mouth. Never hold it by the root.
2. If the tooth is visibly dirty, rinse it briefly and gently under cold running water for no more than 10 seconds. Do not scrub it. Do not use soap.
3. If your child is cooperative and old enough, try to place the tooth back into the socket. Seat it gently with finger pressure and have your child bite down softly on a clean cloth to hold it in place. This is the single best step you can take before reaching a dentist.
4. If you cannot replant the tooth, keep it moist immediately. Submerge it in cold whole milk, store it in a small clean container of your child's saliva, or — for an older child who can cooperate safely — tuck it between their cheek and gum. Do not use tap water for extended storage, as its low salt content damages the root fibers. Do not wrap the tooth in tissue or paper.
5. Call a dentist immediately and go straight there. Bring the tooth regardless of what condition it appears to be in.

What Not to Do

• Do not replant a baby tooth
• Do not hold the tooth by the root
• Do not scrub, wipe, or dry the tooth
• Do not wrap the tooth in tissue or paper — this dries it out within minutes
• Do not store the tooth in tap water for any extended period
• Do not delay getting to a dentist

How a Knocked-Out Permanent Tooth Is Treated in Children

Treatment depends on how quickly the tooth was recovered, how it was stored, and — critically in children — the stage of root development.

Replantation

If the tooth arrives in good condition within the critical window, the dentist will clean the socket, assess the surrounding tissue, and carefully replant the tooth. A soft, flexible splint is then attached to the neighboring teeth for approximately two weeks to stabilize it while the socket heals. A more rigid splint may be used for longer if there is an associated fracture of the surrounding bone.

A course of antibiotics is typically prescribed following replantation to reduce the risk of infection and support healing.

Monitoring for Revascularization

In children whose permanent tooth roots are not yet fully formed — what dentists call an open apex — root canal treatment is not automatically performed after replantation. The goal is revascularization: the natural recovery of the tooth's own blood supply, which can allow the root to continue developing.

The dentist will monitor the tooth closely at regular intervals through clinical examination and X-rays. Root canal treatment, apexification, or a related procedure is only initiated if monitoring confirms that the pulp has not survived — typically identified by signs of infection or bone changes around the root.

This distinction matters because inflammatory root resorption progresses more rapidly in children than in adults, which is why close follow-up is essential.

Long-Term Monitoring

Replanted teeth in children require careful monitoring over months and years — typically at one month, three months, six months, one year, and annually for at least five years. Your dentist will advise on the follow-up schedule.

This is important because complications such as root resorption can develop gradually and may not be visible for some time after the injury. Early detection significantly improves the outcome.

When Replantation Is Not an Option

In some cases, replantation is not appropriate — for example, if the tooth has been out of the mouth for a long time without storage, or if there is significant root damage. When this is the case, your dentist will discuss the situation with you and outline the options for monitoring and future tooth replacement once your child is old enough.

A Note for Teenagers

For teenagers whose permanent teeth are fully formed, the treatment path after replantation follows the adult protocol — including root canal treatment initiated within 7 to 10 days of replantation. Your dentist will confirm which situation applies to your child and refer them to a Specialist Endodontist if required.

If you are unsure whether your teenager's roots are fully developed, your dentist can confirm this from an X-ray taken at the time of the injury.

Can a Knocked-Out Tooth Be Prevented?

Not every avulsion is preventable, but the risk can be meaningfully reduced:

• Ensure your child wears a custom-fitted mouthguard for contact sports and physical activity — this is the single most effective protection against dental trauma
• Encourage mouthguard use during sport at school
• Supervise young children around hard surfaces, stairs, and playground equipment
• Ensure your child wears a seatbelt at all times in a vehicle

A mouthguard custom-fitted by a dentist provides far better protection than any over-the-counter alternative. If your child plays contact sports regularly, ask your dentist about having one made.