The first sixty minutes after a dental injury matter more than most people realise. Quick action at home can save a tooth that would otherwise be lost. Knocked-out teeth, broken crowns, bitten lips, the lot. We’ll cover what to do, what not to do, and when to ring the dentist versus when to head for A&E. If you’re a parent, a teacher, or anyone with a sport in your life, read this once and you’ll be ready when it happens.
The golden hour for knocked-out teeth
An adult tooth that’s been completely knocked out (the technical term is “avulsion”) has the best chance of survival if it’s reimplanted within sixty minutes. After two hours, prognosis drops sharply. After six hours out of the mouth, the chances of long-term success are slim.
So speed matters. Here’s what to do, in order:
- Find the tooth. Pick it up by the white crown only, never the root.
- If it’s dirty, rinse it briefly under cold milk or saline. Do not scrub. Do not use soap. Do not let it soak.
- If you can, gently push the tooth back into the socket the right way round. Bite on a clean cloth to hold it.
- If you can’t reimplant it, store it in cold milk. Saliva is second best (in the cheek of an older child or adult, never a small child who might swallow it). Saline is third. Water is last resort because it damages the cells on the root surface.
- Ring an emergency dentist immediately and travel.
Baby teeth that are knocked out are different. Don’t reimplant baby teeth. Pushing them back in can damage the developing adult tooth above. If a baby tooth comes out from trauma, ring the dentist for advice and check the area for the rest of the day for swelling or bleeding.
Why milk, specifically
Plain whole milk has the right osmotic pressure to keep the cells on the root surface alive for several hours. Water causes those cells to burst from osmotic shock within fifteen minutes. Saline (salt water) is fine but no one keeps it at home. Milk is in the fridge.
The Wikipedia article on dental emergencies is a reasonable overview if you want to read more, though it skews international.
Broken or chipped teeth
Less time-critical, but still worth acting on the same day. Look for the broken piece. If you find it, drop it in milk and bring it with you. Sometimes we can bond the original fragment back on, which gives a much better result than building it up with composite.
If the break has exposed pink or red tissue inside the tooth, that’s the pulp, and it needs covering quickly to prevent infection. Same-day appointment.
If the break is small and the tooth doesn’t hurt, you can usually wait until the next working day. Eat soft food. Avoid hot or cold drinks on that side. Smooth any sharp edge with sugar-free chewing gum or orthodontic wax if it’s cutting your tongue.
Bleeding from the gum or socket
Most dental bleeding stops with firm, sustained pressure. Use a clean folded handkerchief or piece of gauze. Bite down hard for fifteen minutes. Don’t keep checking. Constant peeking disturbs the clot.
If bleeding hasn’t stopped after thirty minutes of solid pressure, or if you’re on blood thinners (warfarin, apixaban, rivaroxaban, dabigatran), ring us or A&E sooner. In our experience, anticoagulated patients sometimes need additional measures like a haemostatic sponge in the socket.
A teabag works in a pinch. The tannins help clotting. Use a damp black tea bag, not a herbal one, and bite firmly for ten minutes.
Bitten lips and tongue
Lacerations to the tongue and lip can bleed dramatically. Volume of blood is rarely a real indicator of severity because the mouth has a lot of blood vessels close to the surface.
Apply firm pressure with a clean cloth for ten minutes. Most cuts stop on their own. Check the wound after the bleeding has stopped. If you can see a clean line, no debris, edges close together, you can probably manage at home with salt water rinses and soft food.
If the cut goes through the lip vermilion border (the line where the lip meets facial skin), if there’s gaping, if it’s longer than about a centimetre, or if it’s ragged or contaminated, that’s an A&E job rather than a dentist. Lip lacerations need careful suturing because cosmetic alignment matters.
| Injury | First Action | Where to Go | Time Frame |
|---|---|---|---|
| Adult tooth knocked out | Reimplant or store in milk | Emergency dentist | Within 1 hour ideal |
| Baby tooth knocked out | Do NOT reimplant; control bleeding | Dentist next day | Within 24 hours |
| Broken tooth, no pulp visible | Find fragment, store in milk | Dentist same day | Within 24 hours |
| Broken tooth, pulp exposed | Avoid hot/cold; pad with wax | Emergency dentist | Same day |
| Loose tooth from trauma | Soft diet; do not wiggle | Dentist same day | Within 24 hours |
| Severe gum/mouth bleeding | Firm pressure 15 min | Dentist or A&E if continues | Immediate if not stopping |
| Lip laceration, deep/long | Pressure to stop bleeding | A&E for suturing | Within 8 hours |
| Jaw appears displaced | Support with cloth, do not eat | A&E immediately | Immediate |
Pain relief: what’s safe at home
Paracetamol and ibuprofen are the workhorses of dental pain. The best evidence-based combination is 1g paracetamol with 400mg ibuprofen, taken together every six hours. Adults under 70 with no kidney, liver, or stomach issues can use this safely for a few days.
Avoid aspirin if you’re going to need a dental procedure soon: it thins the blood and makes any subsequent treatment messier. Never put aspirin directly on the gum. The old wives’ tale of crushing aspirin onto a sore tooth causes chemical burns and we still see the white patches in the mouth from time to time. Actually, you’d be surprised how often.
Cloves, clove oil, or clove-based pastes are reasonable temporary measures. They contain eugenol, which is a mild local anaesthetic. Don’t apply neat clove oil to soft tissue, it burns. A whole clove pressed gently against the tooth is safer.
What to avoid
- Heat. Hot compresses to a swollen face encourage the swelling. Ice or cool compresses are better.
- Sucking on the wound or rinsing vigorously. Both can dislodge a clot.
- Smoking. Slows healing and increases dry socket risk after extractions.
- Alcohol-based mouthwash. Stings and dries the wound.
- Putting whisky or brandy on a child’s gum for teething. Outdated advice. Don’t.
- Lying flat. Keep your head propped up to reduce pressure and bleeding.
When it’s not just a dental problem
Sometimes facial trauma involves more than the teeth. Watch for:
- Numbness in the lip, chin, or cheek that wasn’t there before
- Difficulty closing the teeth together properly (bite feels off)
- Bruising under the eye or around the ear
- Clear fluid from the nose or ear after a head impact
- Loss of consciousness, even briefly
Any of those, and it’s an A&E case rather than a dentist. We can sort the teeth later, but a fractured jaw or a possible head injury needs hospital first.
Building a small dental first aid kit
It takes ten minutes and lives in your bathroom drawer. You need:
- A small bottle of saline or a sealed pack of UHT milk (long shelf life)
- Sterile gauze pads
- Orthodontic wax (chemists sell it)
- A small mirror
- The phone number of your dentist and the local out-of-hours service
- Paracetamol and ibuprofen
Worth doing if you have kids who play sport, anyone with braces, or an older person prone to falls.
When to ring us versus 111 versus A&E
Quick rule of thumb. Pain or broken tooth without swelling: dentist. Significant facial swelling, fever, or difficulty swallowing: 111 or A&E. Suspected jaw fracture, head injury, or anything affecting the airway: 999 or straight to A&E. We’d always rather you ring and ask than not ring at all.
If the injury happens during our working hours, ring Westcliff Dental Practice on 01702 344 500. Our reception team will triage and get you seen as quickly as we possibly can. Out of hours, NHS 111 will direct you to the nearest urgent dental service.
