A fall while mountain biking, an elbow during a football match, or a simple trip in the schoolyard: dental trauma usually happens in a split second. The shock is significant, and bleeding can be considerable. Yet it is precisely during the first minutes that it is often decided whether the affected tooth can be saved permanently – or will be lost.
The most important message first: A knocked-out tooth is often not a medical total loss. With correct handling, proper storage and immediate action, it is frequently possible to successfully replant the tooth and allow it to heal back into place.
Below is your emergency guide, based on current dental traumatology standards.
Why speed matters: The biological time window
To understand the urgency, it helps to look at the anatomy. A tooth is not fused to the bone. Instead, it is suspended by thousands of microscopic fibres—the periodontal ligament (PDL). When a tooth is completely knocked out (avulsion), these fibres tear. However, living cells remain attached to the root surface. These cells are crucial for healing. If they die—most commonly due to drying out—the body will later reject the tooth. In many cases, we have only minutes to a maximum of one hour to keep these cells alive.
Step by Step: the emergency chain
1. Stay calm and secure the situation
In case of heavy bleeding, have the patient bite gently on a clean cloth or gauze pad. Briefly check for signs of concussion such as nausea or dizziness.
2. Find the tooth and handle it correctly
This is the most critical step.
- Hold the tooth only by the white crown.
- Never touch the root. The delicate periodontal ligament on the root surface is extremely sensitive. Even light finger pressure can destroy vital cells.
- Do not clean the tooth. Even if it fell on the ground: do not rinse, scrub or disinfect it. Any manipulation causes more damage than dirt. Cleaning will be done professionally and under sterile conditions in the dental practice.
3. Keep the tooth moist (Transport Medium)
The tooth must never dry out. Air is the enemy of periodontal ligament cells.
- Best option (gold standard): A tooth rescue box (available in pharmacies). It contains a special nutrient solution that can keep cells alive for up to 24–48 hours. Tooth rescue boxes should be standard equipment in schools and sports clubs.
- Alternative 1 – Cold UHT milk: Low in bacteria and with a suitable pH value.
- Alternative 2 – Plastic wrap: Wrap the tooth to prevent evaporation (prevents drying but does not nourish cells).
- Alternative 3 – Saline solution: Better than nothing, but suitable only for short periods.
- Never use: Tap water (destroys cells due to osmotic pressure) or dry tissues or paper towels (cause dehydration).
4. Go to a dentist or emergency clinic immediately
A dental injury is always an emergency. Seek dental care or an emergency dental service without delay.
Special Case: Baby Teeth
Dental injuries are common in young children. Here, an important rule applies: Never reinsert a knocked-out baby tooth yourself. There is a high risk of damaging the permanent tooth germ, which lies directly beneath the baby tooth root. Nevertheless, you should still see a dentist immediately to assess possible jaw injuries and properly treat the wound.
Prevention: Protection Is the best strategy
For high-risk sports (e.g. hockey, martial arts, mountain biking, basketball), a custom-made sports mouthguard is the best form of insurance. Studies show that professionally fitted mouthguards significantly reduce the risk of dental and jaw injuries and may even lessen the severity of concussions.
Important for the future: Documentation
Please inform the dental practice where the accident occurred (school, workplace, commuting accident). This information is essential for accident insurance or occupational insurance documentation. Late complications—such as root resorption or tooth discoloration—may only appear years later. Proper documentation ensures that future treatments (e.g. crowns or implants) are covered by insurance.