# Saving a Knocked-Out Tooth Part of the Dentistry Merit Badge Digital Resource Guide: [Introduction & Overview](https://merit-badge.university/merit-badges/dentistry/guide/index.md) *2. Dental Disease & Prevention* > **2c.** Explain the first-aid procedure for saving a tooth that has been knocked out. A permanent tooth gets knocked out during a basketball game. What happens in the next 30 minutes determines whether that tooth survives or is lost forever. This is one of the few first-aid situations where your knowledge can literally save a body part. ## Why Speed Matters When a tooth is knocked out (the dental term is **avulsion**), the cells on the root surface begin to die within minutes. These cells — the periodontal ligament fibers — are what allow the tooth to reattach to the bone. If the tooth is reimplanted within 30 minutes, there is a strong chance it will survive. After two hours, the odds drop sharply. > **Did You Know?** > > A knocked-out tooth that is reimplanted within five minutes has up to a 95% survival rate. After 30 minutes, the rate drops to about 50%. After two hours outside the mouth, the chance of long-term survival is very low. ## The Step-by-Step Procedure > **Be Prepared! A Tooth Gets Knocked Out** > > Someone takes an elbow to the mouth during a game and spits out a permanent tooth. Here is exactly what to do: > > - **Step 1: Stay calm and find the tooth.** Pick it up by the **crown** (the white part you normally see). **Never touch the root** — the fragile cells on the root surface are what allow the tooth to reattach. > - **Step 2: Assess the tooth.** Is it a permanent (adult) tooth? Baby teeth should **not** be reimplanted — they could damage the developing permanent tooth underneath. > - **Step 3: Gently rinse if dirty.** If the tooth fell on the ground, rinse it briefly (no more than 10 seconds) under clean running water. **Do not scrub, scrape, or use soap.** Do not wrap it in tissue or let it dry out. > - **Step 4: Try to reimplant it.** If possible, gently push the tooth back into its socket with steady pressure. Have the person bite down on a clean cloth to hold it in place. This is the best option by far. > - **Step 5: If you cannot reimplant it, keep it moist.** Place the tooth in one of these storage solutions (listed from best to worst): > 1. **Tooth preservation kit** (such as Save-a-Tooth or Hank's Balanced Salt Solution) — best option if available > 2. **Cold milk** — the next best choice; the pH and osmolality are close to what root cells need > 3. **Saliva** — have the person hold the tooth inside their cheek (only if they are old enough not to swallow it) > 4. **Saline solution** (contact lens solution) > 5. **Water** — last resort; it will cause root cells to swell and die faster than the other options, but it is better than letting the tooth dry out > - **Step 6: Get to a dentist immediately.** Time is critical. Call ahead so the dentist can prepare. If no dentist is available, go to an emergency room. > **Safety First!** > > If the person is bleeding heavily from the socket, have them bite down on a folded piece of clean gauze or cloth to control the bleeding. Check for other injuries — a blow hard enough to knock out a tooth may also cause a concussion, jaw fracture, or other facial injuries. If you suspect a head injury, keep the person still and call 911. ## What NOT to Do These common mistakes can destroy a knocked-out tooth's chances of survival: - **Do not scrub the root.** Even gentle scrubbing destroys the periodontal ligament cells. - **Do not let the tooth dry out.** A dry tooth is a dead tooth. Keep it moist at all times. - **Do not store it in tap water for a long time.** Water causes root cells to swell and burst (osmotic damage). A few seconds of rinsing is fine, but do not soak the tooth in water. - **Do not wrap it in tissue or cloth.** The tooth will dry out and fibers will stick to the root surface. - **Do not try to reimplant a baby tooth.** If the injured person is a young child, check whether the tooth is a primary (baby) tooth first. Baby teeth are smaller and whiter than permanent teeth. - **Do not handle the root.** Always pick up the tooth by the crown. **Knocked-Out Tooth Response** — Quick reference for the field - [ ] Find the tooth and pick it up by the crown only - [ ] Confirm it is a permanent tooth (not a baby tooth) - [ ] Rinse gently under water if dirty (no scrubbing) - [ ] Reimplant in the socket if possible; bite on gauze to hold - [ ] If reimplantation is not possible, store in milk, saliva, or saline - [ ] Control bleeding with gauze or clean cloth - [ ] Check for other injuries (concussion, jaw fracture) - [ ] Get to a dentist or ER within 30 minutes ![An infographic showing four key steps for a knocked-out tooth: hold by the crown, rinse briefly, try to reimplant, or store in milk](https://ik.imagekit.io/doulacoop/tr:w-800/mbu-assets/merit-badges/dentistry/guide/tooth-first-aid-steps?v=72457195) ## What If You Earned First Aid? If you have already worked on the [First Aid](https://merit-badge.university/merit-badges/first-aid/) merit badge, you know about scene assessment and calling for help. Those same skills apply here — check the scene, check the person, call for help, and then focus on the tooth. The principles of Check, Call, Care work for dental emergencies just like any other. [ADA — Knocked-Out Tooth](https://www.mouthhealthy.org/en/az-topics/k/knocked-out-teeth): The American Dental Association's step-by-step guide for handling an avulsed (knocked-out) tooth. ![A comparison showing three tooth storage options ranked from best to worst: a tooth preservation kit, a glass of cold milk, and the person's own mouth](https://ik.imagekit.io/doulacoop/tr:w-800/mbu-assets/merit-badges/dentistry/guide/tooth-storage-options?v=7043eff2) --- - Previous: [Tooth Trauma & Mouth Guards](https://merit-badge.university/merit-badges/dentistry/guide/req2b/index.md) - Next: [Tobacco & Oral Health](https://merit-badge.university/merit-badges/dentistry/guide/req2d/index.md)