Emergency dental conditions

Tooth trauma: knocks, chips and loosened teeth after an injury

A fall, a football, a bike or a fist. The first hour after a blow to the mouth decides more about the tooth's future than anything a dentist does later. Here is what to do and what to expect.

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Clinically reviewed by Dr Ibraheem Ijaz, Principal Dentist · GDC 301711 · Last reviewed April 2026

The different ways a knock damages a tooth

Dentists sort injuries by what has happened to the tooth and to the ligament that holds it in its socket. Knowing the name is less important than knowing that each one is treated differently.

Root fractures have their own guide, root fracture: horizontal and vertical breaks, because how they are managed depends on where the break sits.

Injury	What it means	How urgent
Concussion	Tooth knocked, tender to touch, not loose, not moved	Same day if painful, otherwise within a few days
Subluxation	Tooth loosened but still in its normal position	Same day
Luxation (lateral, extrusion, intrusion)	Tooth pushed sideways, partly out of the socket, or driven up into the bone	Same day, within hours
Avulsion	Tooth knocked out completely	Within 60 minutes
Enamel fracture	Small chip, no sensitivity	Within a few days
Enamel and dentine fracture	Larger chip, yellow dentine showing, sensitive to cold	Same day
Complicated crown fracture	Break exposes the nerve; a pink or bleeding dot in the middle	Same day, within hours
Root fracture	Root broken below the gum, crown loose	Same day
Alveolar fracture	The bone holding several teeth moves as one block	Same day; A&E if the jaw itself may be broken

First hour: what to do for each kind of injury

Tooth knocked out completely

This is the one where minutes count. The cells on the root surface begin to die as soon as the tooth dries out. For an adult tooth: pick it up by the crown, not the root. If it is dirty, rinse it for a few seconds in milk or, failing that, saline or the person's own saliva, never tap water for any length of time and never scrub it. Then put it straight back into the socket, root first, the right way round, and hold it there by biting gently on a clean handkerchief. If you cannot replant it, keep it in a small cup of milk, or tucked inside the cheek if the person is an adult who will not swallow it. Milk keeps the root cells alive for about an hour; water kills them in minutes. Ring us on the way. Full steps are on our knocked-out tooth page. Never replant a baby tooth.

Tooth loose or pushed out of line

If the tooth has moved and you can see where it should sit, guide it gently back into place with clean fingers and hold it there with light pressure. Do not force it. If it will not move easily, leave it. Come in straight away; repositioning is far easier before the blood clot around the root organises, which happens within a few hours.

Chipped or broken tooth

Find the piece if you can and keep it in milk or a damp tissue. A clean fragment of a front tooth can sometimes be bonded straight back on, and it looks better than any filling. If there is a pink or bleeding spot in the broken surface, the nerve is exposed and the tooth needs covering within hours. Sharp edges can be covered with sugar-free chewing gum or orthodontic wax for now. More on our broken tooth page.

Cut lip, tongue or gum

Press firmly with a clean cloth for ten minutes. A cold compress on the outside of the lip reduces swelling. Check inside the lip for a fragment of tooth embedded in it; this is common with front-tooth fractures. Cuts that gape, will not stop bleeding, or go right through the lip need stitches at A&E or a minor injuries unit.

For everything above, take photographs on your phone before anything is moved or cleaned. They help us, and they are useful for insurance or a school accident report.

What we examine after a dental injury

Dental injuries are seen first when you ring, and the £30 emergency examination covers the X-rays. After a knock we go through the same sequence each time:

Ask about the accident: how, where, when, and whether there was any loss of consciousness, headache, vomiting or a dirty wound. Anything suggesting a head injury goes to A&E before the tooth.
Check the bite. If the teeth no longer meet as they did, a tooth or a piece of bone has moved.
Feel each tooth in the area for looseness and gently tap it; a dull note suggests a loosened ligament, a high metallic note suggests a tooth driven into the bone.
X-rays at more than one angle to look for root fractures, displaced roots and fragments in the lip. Where a root or bone fracture is suspected, a CBCT 3D scan (£150) shows what a flat film cannot.
A cold test of the injured teeth and their neighbours. Immediately after an injury the nerve is often stunned and gives no response; this is recorded as a baseline rather than treated as bad news.
Check the soft tissues for cuts and embedded fragments, and ask about tetanus cover if the wound was dirty.

Treatment by injury type and what it costs

Treatment follows the International Association of Dental Traumatology guidelines, which we keep to closely because they are based on the best evidence for what actually saves teeth.

Concussion and subluxation:

usually no treatment beyond soft food for a fortnight and a review. A very loose subluxated tooth may have a flexible splint for two weeks.

Luxation:

the tooth is numbed, repositioned and held with a flexible wire-and-composite splint for around two to four weeks, described on our splinting a loose tooth page. Fee quoted at the examination.

Avulsion:

the tooth is replanted if it has not already been, and splinted for two weeks. Where the tooth has been dry for over an hour it may still be replanted, but with a poorer outlook, and root canal treatment follows within a fortnight for a fully formed tooth. See knocked-out tooth reimplantation.

Enamel and dentine fractures:

the fragment is bonded back on, or the tooth is rebuilt with a bonded white filling, £150–£220. A large break on a front tooth may later need a crown or veneer.

Nerve exposure:

in a young tooth a small dressing is placed over the exposed nerve to keep it alive; in a mature tooth the nerve is usually removed and root canal treatment started, from £200 for the emergency stage and from £450 in total.

Alveolar fracture:

the block of teeth is repositioned and splinted for about four weeks. A suspected jaw fracture is referred to the maxillofacial unit.

Outlook depends most on the time to treatment and on the type of injury. A subluxated tooth almost always survives. A replanted tooth that was back in its socket within the hour has a good chance of lasting many years; one stored dry for several hours will usually be lost eventually, though it can serve for some time. Every price is agreed in writing before treatment, and finance through Tabeo is available for larger work, subject to status.

Children's teeth and baby teeth

Toddlers fall constantly and baby front teeth take the brunt. The rules are different. A knocked-out baby tooth is never replanted, because pushing it back can damage the adult tooth developing just above it. A baby tooth pushed up into the gum is usually left to re-erupt by itself over a few months. A loose baby tooth is often simply watched, and taken out only if it is so loose it could be inhaled. What matters most is a gentle check that the adult tooth bud has not been harmed and that the child can eat and sleep. Bring them in the same day; a frightened child is easier to examine sooner rather than later, and Dr George is particularly good with anxious children.

For an older child with adult front teeth, injured teeth are often not fully formed, which is good news: an immature tooth has a wide-open root tip with a rich blood supply and the nerve is more likely to recover. Treatment is planned to keep it alive so the root can finish growing.

Follow-up: why the nerve is checked for a year

The knock is not the end of the story. Bruised nerves can die quietly weeks or months later. The warning signs are a tooth that slowly darkens to grey, a gum boil appearing above it, or an ache that starts long after the injury. We review injured teeth at set intervals, typically around two weeks, a month, three months, six months and a year, with a cold test and an X-ray each time. If the nerve dies, prompt root canal treatment keeps the tooth. Teeth that were badly displaced are also watched for a process called resorption, in which the root is slowly eaten away from outside; it is uncommon but it is the main reason replanted teeth are eventually lost.

If you or your child plays contact sport, a custom-made mouthguard is the single most effective way to avoid being back here. Ask at any visit.

When it is more than a dental problem

Go to A&E first, and worry about the teeth second, if the person was knocked out even briefly, is drowsy, confused, vomiting or has a severe headache; if the jaw may be broken (teeth no longer meeting, numbness of the lower lip, inability to open); if bleeding will not stop with pressure; if an eye or the bones around it are injured; or if a tooth cannot be found and may have been inhaled, which needs a chest X-ray. The Northern General Hospital on Herries Road has the maxillofacial unit for Sheffield and is about 20 minutes from Deepcar. Call 999 for any difficulty breathing.

Questions, answered

Common questions

What should I do if a tooth is knocked out?

For an adult tooth, hold it by the crown, rinse it briefly in milk if dirty, and put it back in the socket if you can. Otherwise keep it in milk or inside the cheek and get to a dentist within an hour. Never store it in water and never replant a baby tooth.

Can a chipped tooth be repaired the same day?

Usually, yes. A clean fragment can often be bonded back on, or the tooth rebuilt with a white filling at the emergency visit. If the nerve is exposed we cover it the same day and plan further treatment.

My tooth is loose after a knock. Will it tighten up?

A mildly loosened tooth usually firms up over a couple of weeks with soft food. A tooth that has moved position needs repositioning and a splint, and the sooner that is done the better it heals.

Why has my tooth gone grey after an injury?

The nerve inside has died and the breakdown products have stained the dentine. The tooth needs root canal treatment to prevent an abscess, and the colour can then be improved with internal bleaching or a veneer.

Should I take my child to A&E or the dentist for a knocked tooth?

Dentist, unless there are signs of a head injury, a possible broken jaw, uncontrolled bleeding or a tooth that cannot be found. Ring us on 0114 288 2121 and injuries are seen the same day.

How much does emergency treatment for dental trauma cost?

The examination with X-rays is £30. A bonded repair is £150–£220, root canal treatment from £450, and splinting is quoted at the visit. Everything is agreed in writing first.

Do I need a tetanus jab after a mouth injury?

Only if the wound was contaminated with soil or dirt and your tetanus cover is out of date. We will ask, and your GP or A&E can give a booster if needed.

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