Has your child just lost, dislodged, or broken one or more permanent teeth?
This situation immediately raises a thousand questions: what to do in the days and weeks that follow? What are the chances of saving the tooth? What treatments are available if it cannot be saved?
I have followed guidelines that represent the best current evidence based on literature search and expert opinion about the subject matter.
Happy reading!😀 and feel free to ask questions in the comments or share your own experience.🙏
Last updated: Feb, 2026. Written by Juliet Semakula, a diagnostic radiographer.
▶️What is a permanent tooth and why is it different from a baby tooth?
When we are born, the first teeth to come out are baby tooth. which are smaller, whiter, and have thinner enamel and shorter roots.
This makes them more prone to decay, and they are designed to fall out as permanent teeth erupt and push them out.
Permanent teeth are stronger, have thicker enamel, longer roots and these are your adult teeth designed to last a lifetime.
The differences between a permanent tooth and baby tooth are:
| Permanent tooth | Baby tooth |
| Have thicker, harder enamel, making them more resistant to acid and decay | Are softer and wear down faster. |
| Have long, deep roots anchored for life. | Have shorter roots that dissolve |
| Are naturally more yellowish and can appear larger. | Are naturally whiter |
| while an adult has up to 32 permanent teeth (including wisdom teeth). | Baby teeth are normally 20 in number |
| A permanent tooth has smaller pulp chambers meaning decay does not reach the nerve quicker. | Baby teeth have larger pulp (nerve) chambers relative to their size, meaning decay reaches the nerve quicker. |
When a permanent tooth is broken or pulled out, it is a real long-term issue, affecting health, nutrition, and aesthetics.
▶️Trauma to baby teeth affects permanent teeth.
Yes, trauma to baby teeth can significantly affect permanent teeth because the developing permanent tooth sits right below the baby tooth and the root tips are very close meaning impact can transfer directly in case of any trauma.
Trauma to the baby tooth can cause issues such as:
⚫Discoloration (white spots, dark spots), shape changes (pitting, malformations).
⚫Delayed or abnormal eruption if the baby tooth is lost too early, because the developing permanent tooth sits right below the baby tooth and the root tips are very close meaning impact transfers directly
⚫Space Issues: If a baby tooth is knocked out prematurely, adjacent teeth can drift into the space, leading to crowding for the permanent teeth.
⚫An infected baby tooth can damage the nerve or germ of the permanent tooth underneath.
Prompt dental evaluation after an injury is crucial to monitor and prevent severe damage to the adult teeth.
▶️Do children often experience dental trauma?
Yes, children often experience dental trauma (injuries to teeth/mouth) because of their high activity levels, developing motor skills, and frequent falls.
Research studies show a significant percentage of children experiencing trauma in both baby and permanent teeth, making it a common childhood issue alongside decay.
Children between the ages of 2 to 4 years and older are more often prone to falls, sports, and accidents.
The latest UK national study (Chadwick 2006) reported a prevalence of 1.2% of 15-year-old children with missing anterior teeth because of trauma
Treatments for these younger age groups may be different than in adults, mainly due to immature teeth and pubertal facial growth.
▶️Permanent tooth knocked out or fall off and what to do
Traumatic dental injuries are common but one of the most severe injuries is when a permanent tooth is knocked completely out of the mouth (avulsed).
What to do immediately after the accident?
In such a case the tooth should be replanted as quickly as possible to help maximise the survival and repair of the tooth as quickly as possible (Day, 2019)
First aid for avulsed teeth at the place of accident.
1️⃣Keep the child calm.
2️⃣Find the tooth and pick it up by the crown (the white part). Avoid touching the root. Attempt to place it back immediately into the jaw.
3️⃣If the tooth is dirty, rinse it gently in milk, saline or in the patient’s saliva and replant or return it to its original position in the jaw.
4️⃣ It is important to encourage the patient/guardian/teacher/other person to replant the tooth immediately at the emergency site.
5️⃣Once the tooth has been returned to its original position in the jaw, the patient should bite on gauze, a handkerchief or a napkin to hold it in place.
Source: Fouad,2022
If replantation at the accident site is not possible, or for other reasons when replantation of the avulsed tooth is not feasible (eg, an unconscious patient),
6️⃣So, if your tooth is broken, keep the piece and consult your dentist immediately.
7️⃣If the tooth is extracted or if the tooth is dislocated, you should seek immediate care to avoid dehydration of the root surface, which starts to happen in a matter of a few minutes.
Image: a, b, c) A 12 year old had trauma to the teeth, resulting in an oblique crown-root fracture (Agel,2022)
Even if you’re not reading this article “in the heat of the moment,” it’s important to know these steps. They could be useful if you ever witness an accident of this type, and these precautions are also valid for adults.
▶️The treatment and interventions normally applied to repair the tooth are:
International Association of Dental Traumatology (IADT) developed guidelines to help clinicians with the most widely accepted and scientifically plausible approaches for the immediate or urgent care of avulsed permanent teeth.
The care and precautions will depend on the situation: broken tooth, pulled out, or dislocated.
Care for a permanent tooth that has been knocked out (avulsed) and put back in (reimplanted) requires immediate, specialized attention to ensure it reattaches successfully.
Often the best option is to replant the tooth as quickly as possible within 5 to 60 seconds.
These guidelines assist dentists, other healthcare professionals, and patients in decision-making.
Guidelines are to be applied with the clinician’s judgment of the specific clinical circumstances and patient characteristics.
⚪Splinting: The dentist will clean the area, reposition the tooth, and bond it to adjacent teeth for 7–10 days (or up to 6–10 weeks if bone is fractured).
⚪Root Canal Therapy: Usually necessary for an adult tooth that has been knocked out to remove damaged pulp and prevent infection, often starting a few weeks after the initial treatment.
⚪Antibiotics/Tetanus Shot: May be prescribed to prevent infection
Once replanted the tooth can heal in two ways if managed correctly.
1️⃣Periodontal healing: Ideally the ligament around the root reforms and the tooth can be expected to last as long as any other tooth
2️⃣Bony healing: When there is too much damage to the ligament, healing occurs by bony replacement, and the tooth is replaced by bone and lost over a few years.
Day,2010
Note: The benefits of these treatments require further investigation before specific medications can be advised. This is because the studies had weaknesses in their design which may have influenced the benefits they found.
▶️What care and follow up will be required in the weeks and months that follow?
The care and precautions will depend on the situation: broken tooth, pulled out, or dislocated (that is, displaced in its axis).
Here is the breakdown of care and follow-up based on dental guidelines:
♦️Soft diet: Your dentist may recommend you eat only soft foods (e.g., yogurt, soup, pasta, mashed potatoes) for at least 1–2 weeks.
♦️You will be advised to avoid chewing on the affected side.
♦️ Mouth hygiene: you may need to use a soft-bristled toothbrush when cleaning your mouth.
♦️ Monitoring: Regular check-ups are required to ensure the tooth is stable and to check for any complications.
▶️What solutions are there if the tooth cannot be saved?
If the tooth cannot be replanted, the following options are available to fill the gap
♦️Dental Implant: A titanium post placed in the jawbone that supports a crown. This is the most permanent solution, lasting for many years.
Advantages of a dental implant:
⚪Acts like a natural tooth, providing unmatched stability and function.
⚪Prevents jawbone deterioration by stimulating the bone.
⚪Does not require modification of adjacent healthy teeth.
⚪Dental Bridge: A false tooth anchored to adjacent healthy teeth.
The only disadvantage is, it is more expensive and requires adequate jawbone density.
♦️Partial Denture: A removable appliance with artificial teeth.
Advantages of partial denture:
⚪Most affordable and least invasive option
⚪Can be a good solution for replacing multiple missing teeth or an entire arch.
⚪Can be fabricated relatively quickly.
⚪Must be removed nightly for cleaning.
Removable and may feel less stable or comfortable than fixed options.
Do not prevent jawbone deterioration, which can cause them to become loose over time and affect facial shape
▶️Should teeth be protected after this type of accident?
Yes, permanent teeth must be protected after being replanted to ensure successful healing and reattachment to the socket
🔵 Activity Limits: Avoiding contact sports or strenuous activities for a period after treatment is recommended to prevent further mouth injury during the initial healing phase.
🔵To help prevent future dental trauma, particularly during activities with a risk of impact, the use of a custom-fitted mouthguard is strongly recommended.
A mouth guard may seem reassuring, but outside of sports it may:
🔵Prevent the tooth from regaining its normal function: eating, speaking, chewing. However, these stimulations are precisely what is important for the healing and strength of the tooth.
🔵It can create abnormal pressure on the gums or neighbouring teeth, which slows recovery.
🔵It sometimes promotes local irritations or infections, especially if the child keeps it on for a long time or if hygiene is not perfect.
Regular follow-up appointments with a dental professional are necessary to monitor the replanted tooth for complications like infection, root resorption, or the need for a root canal.
We have come to the end of this article, any questions in the comments section. Wishing you a quick recovery!🙋
📚Source:
Day PF, Duggal M, Nazzal H. Interventions for treating traumatised permanent front teeth: avulsed (knocked out) and replanted. Cochrane Database Syst Rev. 2019 Feb 5;2(2):CD006542. doi: 10.1002/14651858.CD006542.pub3. PMID: 30720860; PMCID: PMC6363052.
Chadwick BL, White DA, Morris AJ, Evans D, Pitts NB. Non-carious tooth conditions in children in the UK, 2003. Br Dent J. 2006 Apr 8;200(7):379-84. doi: 10.1038/sj.bdj.4813424. PMID: 16607325.
Agel, M., Alani, A. The paediatric dentistry-restorative dentistry interface. Br Dent J 233, 475–482 (2022). https://doi.org/10.1038/s41415-022-4983-2
Bourguignon C, Cohenca N, Lauridsen E, Flores MT, O’Connell AC, Day PF, Tsilingaridis G, Abbott PV, Fouad AF, Hicks L, Andreasen JO, Cehreli ZC, Harlamb S, Kahler B, Oginni A, Semper M, Levin L. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations. Dent Traumatol. 2020 Aug;36(4):314-330. doi: 10.1111/edt.12578. Epub 2020 Jul 17. PMID: 32475015.
Fouad AF, Abbott PV, Tsilingaridis G, Cohenca N, Lauridsen E, Bourguignon C, O’Connell A, Flores MT, Day PF, Hicks L, Andreasen JO, Cehreli ZC, Harlamb S, Kahler B, Oginni A, Semper M, Levin L. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol. 2020 Aug;36(4):331-342. doi: 10.1111/edt.12573. Epub 2020 Jun 13. PMID: 32460393.