Knocked-Out Tooth: What to Do in 30 Minutes (2026 UK Guide)

Last updated: April 2026. Sourced from NHS.uk, NHSBSA, Gov.UK, NHS Inform Scotland, the British Dental Association (BDA), the International Association of Dental Traumatology (IADT) 2020 guidelines, peer-reviewed research, and NHS hospital trust patient information. NHS dental charges verified for 1 April 2026 onward. Reviewed by the Dentists Closeby editorial team.

A knocked-out adult tooth is the most time-critical dental emergency. Re-implanting it within 30 minutes gives the best chance of saving it for life. Wait two hours and the prognosis drops sharply, even if every later step is done well [1]. The next half hour matters more than the next two months of treatment.

This guide gives you the UK first-aid sequence, where to go (and when not to), 2026 NHS treatment costs, what splinting and follow-up look like, and the long-term outlook for re-implanted teeth. It assumes the injured person is conscious and breathing normally. If they are not, stop reading and call 999.

Quick answer: what to do in the first 30 minutes

If an adult tooth has been knocked clean out, hold it by the white crown only, rinse any dirt off with cold milk (never tap water for more than 10 seconds), and push it gently back into the socket. Bite on a clean cloth and call NHS 111 within the hour [2]. Do not replant a baby tooth.

The 30-Minute Window: Why Time Is Everything

The reason the clock matters comes down to a thin layer of living tissue called the periodontal ligament (PDL), which sits between the root and the bone. When the tooth is knocked out, those PDL cells immediately start to die. Once they are gone, the tooth cannot reattach naturally, and even a successful-looking re-implantation tends to fail months or years later [1].

Three timing thresholds shape the prognosis:

• Under 5 minutes: Best outcome. PDL cells are still viable. Most teeth re-implanted at the scene by a calm parent or coach do well long term.
• 5 to 60 minutes: Good outcome possible if the tooth is stored correctly (more on storage below). The 2020 IADT guidelines treat 60 minutes as the practical upper limit before extra protective steps are needed [1].
• Over 60 minutes dry: PDL cells are largely non-viable. Re-implantation is still worthwhile, but the dentist will use an extended splinting protocol to slow the inevitable bone fusion (ankylosis) and the tooth is more likely to be lost in the medium term [1].

A 5-year follow-up study published in the Brazilian Dental Journal found 64% of teeth re-implanted within 60 minutes were still in place at five years, falling to 57% when re-implantation was delayed past two hours, and most of those late losses traced back to time out of the socket [3]. The single biggest variable you control is how fast the tooth gets back where it belongs.

First Aid: The 8 Steps for an Adult Tooth

This sequence follows current NHS guidance, last reviewed by NHS Digital in February 2025 [2], with timing detail from the IADT [1]. Read it in advance if you have children doing contact sports. In the moment, the muscle memory is what matters.

1. Find the tooth. Look on the floor, in clothing, in the mouth. If it is on the ground, pick it up by the crown (the white chewing part) only. Never touch the root surface.
2. Do not scrub or sterilise. Skip the disinfectant, antiseptic, alcohol gel, soap, or scrubbing brush. Anything that wipes the root strips the PDL cells you are trying to save.
3. Rinse only if dirty, and only briefly. If there is visible debris, rinse the tooth in cold milk, saline, or the patient's own saliva. Tap water is a last resort and only for a 10 second rinse, never as a soak.
4. Put it back. With the tooth held by the crown, push it gently and firmly into the empty socket the same way round it came out. Most adults can do this. Re-implantation by the patient or parent at the scene saves the most teeth.
5. Bite on a clean cloth. Once the tooth is back in, get the patient to close gently onto folded gauze, a flannel, or a clean tissue. The pressure holds the tooth in place during the journey to the dentist.
6. If you cannot put it back, store it correctly. In order of preference: cold milk, saliva (held in the mouth between cheek and gum if the patient is old enough not to swallow it), or a small amount of saline. Avoid tap water for storage. Avoid contact-lens solution (it contains preservatives that damage PDL cells). Avoid a dry tissue or pocket [4].
7. Call NHS 111. Dial 111 or use 111.nhs.uk. Tell them an adult tooth has been knocked out. The NHS commits to offering an urgent dental appointment within an hour where possible [5].
8. Watch for signs that need A&E or 999. Loss of consciousness, persistent vomiting, suspected jaw fracture, severe facial swelling that affects breathing, or a child who may have inhaled the tooth all need 999 or A&E, not a dentist.

What NOT to Do

The same NHS guidance is explicit about the things that turn a savable tooth into an extraction [2]:

• Do not scrub, wipe, brush, or polish the root.
• Do not put the tooth in tap water for storage. Hypotonic water bursts PDL cells in minutes.
• Do not wrap the tooth in a dry tissue, kitchen roll, or pocket lining.
• Do not use disinfectant, antiseptic, alcohol gel, mouthwash, or soap on the tooth.
• Do not put a baby tooth back in. Re-implantation can damage the developing adult tooth above. See the children's section below.
• Do not delay because the tooth "looks fine". A clean knocked-out tooth still loses its PDL by the minute.

Storage: What to Carry the Tooth In

Where re-implantation at the scene is not possible (the patient is unconscious, panicking, or the tooth has come out in fragments), the tooth is racing the clock in transit. UK and international dental trauma research broadly agree on the order of preference [4]:

Cold milk is the right answer for almost every UK household. A glass of fridge milk, a clean container, lid on, straight to the dentist. Importantly, contact-lens solution is not the same as saline and contains preservatives that are toxic to PDL cells, so leave it in the bathroom cabinet.

Children: When NOT to Re-Implant

For babies and young children with milk teeth (typically under age 6), the rule is the opposite of the adult sequence: do not put the tooth back in. NHS guidance states this directly: "Do not put a baby tooth back in as it could damage the tooth growing underneath." [2]

The adult tooth bud sits directly below each milk tooth. Pushing the milk tooth back into the socket can crush, tilt, or scar that developing tooth, leading to enamel defects, eruption problems, or a permanently displaced root years later. There is also an aspiration risk in very young children that makes home re-implantation unsafe.

What to do instead:

• Reassure the child and control bleeding with clean gauze.
• Keep the tooth in milk and bring it to the dentist for assessment, even though it will not be replanted.
• Call NHS 111 or your dentist for an urgent assessment of the empty socket and any damage to the adult tooth bud.
• Plan a follow-up review of the adult tooth as it erupts, usually around age 7 to 8 for upper front teeth.

For broader guidance on dental visits in early childhood, see our child's first dental visit guide.

Where to Go in the UK: Emergency Dentist or A&E?

Most knocked-out teeth need an emergency dentist, not A&E. Hospital A&E departments are not staffed to re-implant or splint teeth and will usually redirect you. NHS.uk is unambiguous: "Don't go to A&E with a dental issue as they are unlikely to be able to help. Always use NHS 111 first." [5]

Use this triage:

Call your own dentist first, even out of hours. Most practices have an answerphone message that redirects to an out-of-hours service.

Call NHS 111 (free, 24/7 by phone or 111.nhs.uk) if you do not have a dentist or your practice is closed. NHS 111 can triage your symptoms and book you straight into an urgent dental care provider commissioned by your local Integrated Care Board.

Go to A&E or call 999 only if there is also a head injury, the patient has lost consciousness, there is severe facial swelling threatening the airway, there is a suspected jaw fracture, or a young child may have inhaled the tooth.

For the wider triage of urgent dental access, see our emergency dentist UK guide. If you are struggling to find an NHS slot at all, our dental emergency guide for when no NHS appointment is available covers the alternatives.

NHS Treatment Costs in 2026

Re-implantation is normally delivered as a course of NHS treatment with a single band charge that covers everything from the splint to follow-up appointments within that course [6]. NHS England charges from 1 April 2026:

The standard wire-and-composite splint used in the UK falls under Band 2 [7]. A more elaborate acrylic splint, occasionally needed for complex injuries, falls under Band 3. If a root canal is performed within the same course as the splint, it is included in the Band 2 charge rather than billed separately. A crown placed later as a separate course of treatment is its own Band 3 charge.

Free NHS Dental Treatment

You pay nothing on the NHS for a knocked-out tooth and any related treatment if you fall into one of these categories [8]:

• Aged under 18, or under 19 in full-time education
• Pregnant, or have given birth in the past 12 months
• Receiving Income Support, income-based JSA, income-related ESA, Pension Credit Guarantee Credit, or Universal Credit at the qualifying threshold
• Holding a valid HC2 certificate from the NHS Low Income Scheme

Bring evidence of exemption to the appointment. For a full breakdown of who qualifies, see our free NHS dental treatment guide.

Devolved Nation Variations

Outside England, charging works differently. Scottish patients pay 80% of treatment cost up to a £384 cap, with all examinations free and treatment free for under-26s [9]. Wales has moved to a care-package model from April 2026, with set fees for individual procedures and free examinations for under-25s and over-60s [10]. Northern Ireland operates an 80% model capped at £384.

For the full English picture, see our NHS dental charges 2026 guide.

Splinting and Follow-Up

Once the tooth is back in, the dentist bonds a thin flexible splint (a wire or fishing-line strand) to the front of the affected tooth and the two teeth either side. The splint stabilises the tooth while the periodontal ligament heals.

Standard UK protocol:

• Splint duration: 2 weeks for a tooth re-implanted promptly, or 4 weeks if it was outside the mouth for over an hour [1].
• Follow-up appointments: typically at 1 to 2 weeks for splint review or removal, 4 weeks for clinical and radiographic check, 3 months, 6 months, and 12 months [11].
• Root canal treatment: usually started within 7 to 14 days of re-implantation for a mature tooth (one with a closed root tip), to prevent inflammatory resorption. Immature teeth in younger patients may be monitored for natural pulp recovery instead [1].
• Antibiotics: amoxicillin is most often prescribed first-line, with clindamycin or doxycycline as alternatives for penicillin allergy. The decision is clinician-led; there is no single mandatory UK protocol [1].
• Tetanus: any dental trauma sustained in a contaminated environment (a sports field, soil, gravel) should prompt a tetanus vaccination check. A booster is needed if your last dose was over 10 years ago, or if your vaccination history is uncertain [12].

Long-Term Outlook

Honest expectations matter here. A re-implanted tooth is usually saved in the short term, but the long-term picture is mixed. Published outcomes data from a UK and international cohort review found:

• Around 27% of re-implanted teeth heal without complication and behave like a normal tooth long term [13].
• Roughly 51% develop replacement resorption (ankylosis), where the body slowly replaces root with bone. The tooth is gradually lost over years, with about a quarter of those eventually extracted at a mean of six years [13].
• Around 23% show inflammatory resorption, which is faster, with the average tooth lost at 1.7 years [13].
• Five-year retention sits at roughly 50% to 65% across studies [3] [13].

Most mature re-implanted teeth need root canal treatment at some point, often early. Discolouration of the crown is common as the pulp dies. Children's immature teeth (open root tip) sometimes recover their pulp without root canal, so the protocol differs.

If the Tooth Cannot Be Saved

When re-implantation fails or the tooth is too damaged to replant in the first place, the gap can be restored with a dental implant, a bridge, or a partial denture. Each route has its own UK price band:

• Dental implant: £2,000 to £3,000 privately for a single implant and crown. Not normally available on the NHS for a single missing tooth in adults. Not suitable in growing children, generally not before age 18 to 20.
• Bridge: NHS Band 3 (£332.10) where clinically indicated, or £700 to £1,500 privately for a conventional bridge, less for a Maryland (resin-bonded) bridge.
• Partial denture: NHS Band 3 (£332.10) covers an acrylic or chrome partial denture. Reversible and the lowest-cost option.

For the longer comparison, see our missing tooth replacement options guide and our dental implants cost UK guide.

Prevention: Mouthguards for Sport

The single biggest preventable cause of avulsions in adults is contact sport. Boxing requires a custom mouthguard under regulation. Rugby Football Union and England Hockey strongly recommend them. Football, basketball, and martial arts have no UK-wide mandate but the dental case is the same: a fitted guard absorbs the kind of impact that knocks teeth clean out.

There are three options on the UK market:

• Custom-made by a dentist: best fit and protection, lasts several years. Roughly £50 to £150 privately. Not available on the NHS for sport [14].
• Boil-and-bite from a sports shop: heat in water, bite to mould. Around £5 to £30. Acceptable protection if fitted carefully.
• Stock ready-made: cheapest, poorest fit, not recommended.

Mouthguards are not free on the NHS for sport. NHSBSA confirms sports guards sit outside Band 3 [14]. If your child does contact sport, budget for a custom guard at the next check-up.

When to Worry After the Tooth Is Back In

Most knocked-out teeth settle within a few days. Call your dentist sooner rather than later if you notice:

• Increasing pain or throbbing instead of slow improvement
• A pimple or swelling on the gum above the tooth
• The tooth changes colour, especially turning grey or pink
• The tooth feels loose or moves at all once the splint is off
• Bad taste or pus near the gum line

These can all indicate the tooth is rejecting, abscessing, or losing its pulp, and earlier review is much better than later. A linked guide on dental abscess symptoms covers what to watch for.

Frequently Asked Questions

How long do I have to put a knocked-out tooth back in?

The first 5 minutes give the best chance, with a meaningful chance of long-term success up to about 60 minutes if the tooth has been stored correctly in cold milk or saliva. After that, the odds drop sharply because the periodontal ligament cells dehydrate and die. Even outside the 60-minute window, dentists will still try to re-implant the tooth.

Can I put a knocked-out tooth in water?

Use cold milk, not tap water. Tap water is hypotonic and bursts the living cells on the root within minutes, which makes re-implantation more likely to fail later. A 10-second rinse under tap water is acceptable to remove visible debris, but never store the tooth in water. Cold fridge milk is the best home option in the UK.

Should I put a baby tooth back in?

No. The NHS is explicit about this. Pushing a baby tooth back into the socket can damage the developing adult tooth that sits directly above and lead to enamel defects or eruption problems years later. Reassure the child, control any bleeding with clean gauze, keep the tooth, and call NHS 111 or your dentist for an urgent assessment.

Can I go to A&E with a knocked-out tooth?

A&E will usually not be able to help with the tooth itself. NHS guidance is to call NHS 111 first for any dental issue. Go to A&E or call 999 only if there is also a head injury, loss of consciousness, suspected jaw fracture, severe facial swelling affecting breathing, or a young child who may have inhaled the tooth.

How much does it cost on the NHS to put a tooth back in?

The standard wire-and-composite splint and any follow-up treatment within the same course of treatment fall under NHS Band 2, which is £76.60 in England from 1 April 2026. Root canal treatment performed in the same course is included in that fee. A subsequent crown is a separate Band 3 charge of £332.10. Free if you qualify for exemption.

Will the tooth survive long term?

Honestly, often not forever. About 27% of re-implanted teeth heal without complication. Roughly half develop slow replacement resorption (ankylosis) over several years. Five-year retention sits around 50% to 65%. Most mature re-implanted teeth need root canal treatment, and many will eventually need replacement with an implant, bridge, or denture.

Do I need an antibiotic after a knocked-out tooth?

Often yes. The 2020 IADT guideline recommends a course of systemic antibiotics, with amoxicillin most commonly first-line and alternatives for penicillin allergy. There is no single mandatory NHS protocol, so the decision is your dentist's. They will consider the contamination of the wound, your medical history, and how long the tooth was outside the mouth.

Can a tooth be re-implanted hours later?

The chance of saving it drops sharply after the first hour, but re-implantation is sometimes attempted at 24 hours or later for cosmetic reasons, especially for visible front teeth in children. The dentist may use an extended splinting protocol and warn you that the tooth is likely to be lost over time. It buys time and appearance more than longevity.

Get an Emergency Appointment

If your tooth is in your hand or in milk right now, do not finish reading. Call NHS 111 or your nearest emergency dentist. If you are searching for an emergency dentist for the future, search for a dentist near you on Dentists Closeby and filter for practices accepting urgent appointments.

Sources

1. International Association of Dental Traumatology, "Guidelines for the Management of Traumatic Dental Injuries: 2. Avulsion of permanent teeth" (Fouad et al., Dental Traumatology, 25 May 2020). https://onlinelibrary.wiley.com/doi/10.1111/edt.12573
2. NHS.uk, "Knocked-out tooth", last reviewed 06 February 2025. https://www.nhs.uk/conditions/knocked-out-tooth/
3. Brazilian Dental Journal, "Long-term Outcomes of Replanted Avulsed Permanent Teeth: A 5-year Follow-up" (PMC10208297, 2023). https://pmc.ncbi.nlm.nih.gov/articles/PMC10208297/
4. De Brier et al., "Storage of avulsed teeth: A systematic review" (Dental Traumatology, 2020). https://onlinelibrary.wiley.com/doi/10.1111/edt.12564
5. NHS.uk, "How to find an emergency or urgent NHS dentist". https://www.nhs.uk/nhs-services/dentists/how-to-find-an-nhs-dentist-in-an-emergency/
6. NHS.uk, "How much NHS dental treatment costs". https://www.nhs.uk/nhs-services/dentists/how-much-nhs-dental-treatment-costs/
7. NHSBSA, "Trauma splint band classification" (FAQ KA-02026). https://faq.nhsbsa.nhs.uk/knowledgebase/article/KA-02026/en-us
8. NHS.uk, "Who can get free NHS dental treatment". https://www.nhs.uk/nhs-services/dentists/who-can-get-free-nhs-dental-treatment/
9. NHS Inform Scotland, "Receiving NHS dental treatment in Scotland". https://www.nhsinform.scot/care-support-and-rights/nhs-services/dental/receiving-nhs-dental-treatment-in-scotland/
10. NHSBSA, "Wales dental charges" (FAQ KA-03999). https://faq.nhsbsa.nhs.uk/knowledgebase/article/KA-03999/en-us
11. Guy's and St Thomas' NHS Foundation Trust, "Splints for damaged adult teeth in children". https://www.guysandstthomas.nhs.uk/health-information/splints-damaged-adult-teeth-children
12. Gov.UK, "Tetanus: advice for health professionals" (updated June 2025). https://www.gov.uk/government/publications/tetanus-advice-for-health-professionals/guidance-on-the-management-of-suspected-tetanus-cases-and-the-assessment-and-management-of-tetanus-prone-wounds
13. Karayilmaz et al., "Survival and complication rates of replanted avulsed teeth" (PMC7028940). https://pmc.ncbi.nlm.nih.gov/articles/PMC7028940/
14. NHSBSA, "Sports guards on the NHS" (FAQ KA-02019). https://faq.nhsbsa.nhs.uk/knowledgebase/article/KA-02019/en-us