What to Do if a Permanent Tooth Falls Out

Having a tooth fall out is usually as concerning as it is unexpected. Nevertheless, it can happen due to periodontitis (gum disease), tooth decay or cavities, or trauma in what’s known as tooth avulsion. 

Baby teeth cannot be reinserted and saved, but permanent teeth often can if you act quickly. 

Here’s what to do when you lose an adult tooth to optimize your dentist’s efforts to fix it:

A Tooth Has Fallen Out and You Have the Tooth

The good news is that the tooth may be able to be reinserted; the bad news is that if it’s not reinserted within two hours of being lost, the survival chances for the tooth are poor. 

So time is of the essence–the sooner you get to the dentist, the better!

If the tooth loss occurred outside of normal business hours, you may not be able to get to your usual dentist, but it’s worth calling the office anyway. The answering message or service may have a recommendation for an emergency dentist you can contact. Otherwise, you’ll need to find your own emergency dentist. Just don’t try to go to a typical ER–they won’t be able to save the tooth there.

Is it a medical emergency and not just a dental emergency? If tooth loss is accompanied or caused by trauma to the mouth and/or face such as a fractured or dislocated jaw, serious cuts, or excessive bleeding, then head to the emergency room immediately. Don’t wait to make an appointment with your dentist.

Before you leave, follow these steps to help maximize your chances of saving the tooth:

1. Only touch the crown (aka the chewing surface): When you pick up or handle the tooth, don’t touch the root (aka the bottom) of the tooth. The roots’ surface cells need to be alive and untouched for the tooth to reimplant successfully.

If the tooth fell out onto the ground and is dirty, proceed to step 2.

If it remained in the mouth the entire time, skip to step 3.

2. Carefully clean the tooth: Without scrubbing or using soap or running water, simply swish the tooth around in a bowl of lukewarm water or milk. Do not dry or wrap the tooth after cleaning it. 

If you aren’t sure whether the tooth is a baby tooth or permanent tooth, skip to step 4.

3. Try to reinsert the tooth into its place in your mouth: Either try to push it into place with your fingers, or position it over the hole and gently bite down to push it into place. Remember to avoid touching the root. 

While this step may be difficult, it’s the best way to preserve the tooth. After the tooth is in place, bite down on a bit of gauze or napkin to hold the tooth in place until you see the dentist. 

If you can’t get the tooth back in, proceed to step 4. If you can, you’re ready to head to the dentist. 

4. Store the tooth so that it stays moist: The best storage mediums you are likely to have access to in this kind of emergency are:

• a glass of pasteurized milk, preferably with an ice pack around the outside
• coconut water
• cold green tea
• egg white
• in your mouth between the cheek and your gums (not preferred because of the risk of swallowing tooth

Water will not work as a suitable medium.

A Tooth Has Fallen Out and You Can’t Find the Tooth

It’s still best to contact your dentist immediately even when the tooth can’t be found. 

For one thing, the dentist can advise you on whether you need a chest X-ray to rule out the tooth being swallowed and gone into your lungs. Typically this is not necessary, as swallowed teeth are usually harmless. 

But you’ll also need to replace the missing tooth, and the dentist can explain your options for doing so and get you scheduled for the procedure.

Explore your tooth replacement options

What Happens at the Dentist?

The particulars of your dentist visit will depend on whether you have brought the lost tooth with you, and if so, how you’ve stored it.

The Tooth Can’t Be Reinserted

When there’s no hope of saving the tooth–perhaps you couldn’t find it or it was outside the mouth more than three hours–the dentist will proceed with tooth replacement treatment such as an implant or a bridge.

You Brought the Tooth With You

If you salvaged the tooth and reinserted it yourself, the dentist will first check via X-ray to make sure it is positioned correctly. 

If you’ve been storing the tooth in liquid, the dentist will clean it then reinsert it with local anesthetic. He’ll then verify correct positioning via X-ray and/or having you gently bite down several times to be sure the opposing teeth aren’t moving the reimplanted tooth.  

Next the dentist will do what’s called splinting: he’ll apply strips of flexible paste made from composite resin across the avulsed tooth and onto one or two teeth on either side, ideally on both the front and back of the teeth for the strongest hold. Alternatively, orthodontic wire secured by composite resin may be used to hold the tooth in place. 

Typically the splint is left in place for seven to 10 days, although if the bone around the tooth has been fractured, the splint could be left in place for 6 to 10 weeks. 

Most patients will require a root canal after the splint is removed. And if the tooth was stored in solution before being reinserted, the dentist may put you on antibiotics for several days. He may also inquire about your tetanus shot status.

Visiting a Dentist to Replace a Missing a Tooth Is Crucial

When you have a tooth missing, your other teeth may shift to fill in the gap and cause misalignment of your bite. Also, the empty socket can become infected, you may have difficulty chewing, and there may be bone loss in your jaw. Other teeth may also experience more wear and eventually more complex, expensive repairs will need to be done. 

Even your self-esteem can suffer, as well, both from the aesthetics of missing teeth and the potential of speech being negatively affected.

Most importantly, losing a tooth can be quite stressful and even traumatic.

A good dentist can help put your mind at ease that your smile can be restored in a relatively short amount of time, and that the worst is over.