If a permanent tooth is knocked out, pick it up by the crown (never the root), rinse briefly with milk if dirty, and gently place it back in the socket. If that isn't possible, store it in cold milk and call Line Dental Aloha immediately. Replantation within 30 to 60 minutes gives the best chance of saving the tooth.

We wrote this guide for a very specific moment. You're standing on the sideline at Aloha High School. Your kid just took an elbow to the mouth. A tooth is on the grass. You have one hour, and the clock already started.

At Line Dental Aloha, we've walked Beaverton School District families through this exact scenario by phone. Here is the plan, minute by minute.

Why does the first hour matter so much?

The tooth is alive. Tiny periodontal ligament cells coat the root surface, and those cells are what allow a replanted tooth to reattach to the bone. When the tooth dries out, those cells start dying within minutes.

According to the International Association of Dental Traumatology (IADT) 2020 guidelines, the best outcomes for an avulsed permanent tooth happen when it is replanted within 30 to 60 minutes. After about an hour outside the socket, the prognosis drops sharply. The window is real. That's why every step below is timed.

Minutes 0 to 5: How should I pick up the tooth?

Find the tooth fast. Grass, dirt, gym floor, car seat. It does not matter where it landed.

Hold it by the crown. The crown is the white chewing part. The root is the yellowish, pointier end, and that's the part covered in the living ligament cells you need to protect. Per the ADA and IADT, touching the root or wiping it clean can destroy those cells.

• Do not scrub the tooth.

• Do not use soap, alcohol, or hydrogen peroxide.

• Do not wrap it in a tissue or paper towel.

If the tooth is visibly dirty, rinse it for about 10 seconds with cold milk or saline. Skip tap water if you can. The IADT notes that tap water damages root cells through osmotic shock. Brief is better than thorough.

Minutes 5 to 15: Can I put the tooth back in the socket?

Yes, and this gives the best prognosis of all. Replanting the tooth yourself, on the field, is often the right move for a calm older child or an adult.

Line up the tooth the same way it sat before. The flat front faces forward. Push it gently into the socket with steady finger pressure until it sits even with the neighboring teeth. Then have the person bite down softly on a clean cloth, gauze, or even a folded paper napkin to hold it in place.

Then drive. Call us on the way.

Skip replantation if the child is too young to cooperate, if the tooth is heavily contaminated, or if there's any risk of swallowing it. In those cases, move straight to storage.

Minutes 15 to 30: What's the right way to store the tooth?

Storage medium matters more than most parents realize. The American Association of Endodontists ranks them this way:

• Best: Hank's Balanced Salt Solution, sold in Save-A-Tooth kits. Some athletic trainers and school nurses stock these.

• Very good: Cold whole milk. Pull a carton from any concession stand or gas station.

• Acceptable: Saline solution (the kind used for contact lenses works in a pinch).

• Acceptable for adults only: The patient's own saliva, held inside the cheek. Never do this with a young child.

• Avoid: Tap water, ice, a dry container, or a tissue.

Cold milk is the realistic winner. It's everywhere. It has the right pH and the right concentration of nutrients to keep ligament cells viable for a couple of hours. A small jar or a clean cup with a lid is perfect.

Minutes 30 to 60: When should I call Line Dental Aloha?

Call us before you leave the field. Not from the parking lot. Not from the car.

Our number is (503) 259-8641. When you call, our team can start prepping the operatory while you drive in, whether you're coming from Aloha, Beaverton, Hillsboro, or off Highway 217 from Tigard. We sit just off TV Highway, which keeps the drive short for most Washington County families.

Bring three things:

• The tooth, ideally already replanted or sitting in cold milk.

• Any broken fragments you found on the ground.

• The injured person, of course, and a second adult if possible so one can drive.

After hours, leave a message on our emergency line. We return those calls. Every single time.

Baby tooth vs adult tooth: does the rule change?

Yes, and this surprises a lot of parents.

Per the American Academy of Pediatric Dentistry, a knocked-out primary (baby) tooth is generally not replanted. Pushing a baby tooth back into the socket risks damaging the permanent tooth bud developing right above it. The trade-off is not worth it.

Still call us the same day. We check the socket, the neighboring teeth, and the lip and gum tissue. Sometimes there are fragments we need to remove. Sometimes the adjacent baby teeth are loose too.

For adult teeth, the rule is the opposite. Always try to save it. That's the whole trick.

What happens at our office after a knocked-out tooth?

Once you arrive, Dr. Paul Kyu Choi or Dr. Mijin Choi will examine the tooth and the socket, take an X-ray, and replant the tooth if it isn't already in place. We then splint it to the neighboring teeth with a small flexible wire for about two weeks. The splint stabilizes the tooth while the ligament reattaches.

Per AAE endodontic standards, root canal therapy is usually started 7 to 14 days after replantation for mature permanent teeth. This prevents the inside of the tooth from breaking down after the blood supply was severed. Younger patients with open root tips sometimes have a different protocol, and we'll walk you through it.

Follow-ups continue for several months. We watch for healing, root resorption, and bone fill on X-rays.

If the tooth cannot be saved, a dental implant is the long-term restoration we usually recommend once growth is complete. An implant replaces the root and crown together and protects the bone. We'll cover that path only if and when we need to.

Frequently Asked Questions

Can a tooth be saved if it's been out for more than an hour?

Sometimes, but the odds drop. After 60 minutes of dry storage, the ligament cells are usually dead, and the body tends to treat the tooth as a foreign object over time. Long-term retention is less predictable. We still want to see you. Even a tooth with a guarded prognosis can buy you years and keep the bone healthy while you plan a permanent solution.

Should I put a knocked-out tooth in water?

No. Plain tap water damages the root surface cells through osmotic shock, per IADT guidelines. Cold whole milk is the practical best storage medium. Saline works. Save-A-Tooth solution is ideal if your school or athletic program stocks it. A dry tissue or paper towel is the worst choice.

What if my child knocks out a baby tooth?

Do not push it back in. The American Academy of Pediatric Dentistry advises against replanting primary teeth because of the risk to the developing adult tooth underneath. Call us the same day so we can check the socket, the lips, and the surrounding teeth. Most kids do beautifully and grow in their permanent tooth on schedule.

How much does emergency tooth replantation cost?

Costs vary based on the X-rays needed, the splint, and any follow-up root canal therapy. Most PPO dental insurance plans cover a significant portion of emergency trauma care. Our front office verifies your benefits before we begin and explains your share clearly. Flexible payment plans are available if you don't have insurance.

Will I need a root canal after my tooth is put back in?

For most mature adult teeth, yes, typically within 7 to 14 days. The trauma severs the blood supply inside the tooth, and a root canal prevents infection and inflammation that would otherwise destroy the result. Younger patients with still-developing roots sometimes follow a different protocol. We'll explain exactly what your case calls for.

If you're reading this after the fact, call Line Dental Aloha at (503) 259-8641. We see emergency patients from Aloha, Beaverton, and Hillsboro the same day whenever we can. Bring the tooth. We'll take it from there.