Knocked out or broken tooth: what to do right now

1. 01Find the tooth and pick it up by the crown, the white part you chew with. Don't touch the root.
2. 02If it's dirty, rinse it for a few seconds with milk or water. Don't scrub it, don't use soap, and don't wrap it in a tissue.
3. 03If you can, gently push it back into its socket, facing the right way, and bite softly on clean gauze or a cloth to hold it there. Don't force it.
4. 04If it won't go back in, keep it moist. Milk is best. For an adult who won't swallow it, tucking it inside the cheek works too. Don't store it in plain water.
5. 05Call us at (972) 288-3200 right away and tell us what happened.

The sooner a knocked-out tooth is back in place, the better its chances. Teeth that are replanted within the first hour or so tend to do best, though even then some can't be saved long term. It's always worth trying.

Most small chips aren't emergencies, but a crack or a break that hurts should be seen soon. In the meantime:

• Rinse your mouth with warm water
• Save any pieces of tooth and bring them with you
• Hold a cold compress on your cheek to keep swelling down
• Cover a sharp edge with dental wax or sugar-free gum so it doesn't cut your tongue
• Chew on the other side, and avoid very hot, cold or hard foods
• Take an over-the-counter pain reliever if you need one, following the label

A tooth that's sensitive to hot and cold, or hurts when you bite, may have a crack that reaches the inside. Try to be seen the same day, because a crack can spread.

Treatment depends on the damage. A small chip can often be smoothed or repaired with tooth-colored bonding. A larger break may need a crown. If the crack reaches the pulp, a root canal may save the tooth; what a root canal actually feels like explains that part. A tooth that's split below the gumline sometimes can't be saved, and we'll talk through replacement options.

• A tooth knocked loose or pushed out of position: don't wiggle it. Bite gently on a cloth to keep it still and call us. A loose tooth can sometimes be splinted to its neighbors while it heals.
• A crown or filling that fell out: keep the crown. Temporary dental cement from the pharmacy can hold it or cover the spot until your visit. Never use household glue.
• A cut lip, tongue or gum: rinse, then press firmly with clean gauze or a cloth for 10 minutes. If it's still bleeding, go to the ER.
• A broken denture: stop wearing it, keep the pieces, and skip the home repair kits and glue. They can make a professional repair harder.

Some injuries need a hospital before a dentist. Go to the nearest emergency room, or call 911, if you have:

• A possible broken or dislocated jaw, or you can't close your teeth together
• Bleeding that won't stop after 10 minutes of firm pressure
• Trouble breathing or swallowing
• Swelling in your face or neck that's spreading
• A head injury, passing out, confusion or vomiting after a fall or a hit

Once you're safe, call us. The ER treats the medical emergency; we can pick up from there with the teeth.

Call first thing, even if you're not sure it's urgent. We'll ask what happened, give you first-aid steps over the phone, and look for a time. We offer same-day emergency visits when we can, during office hours. We can't promise a same-day spot every day, but we'll tell you honestly what's open.

Our hours: Mon, Wed, Thu 9am to 3pm. Tue 10am to 3pm. Fri to Sun closed. After hours, call and leave a message and we'll call you back. Go to the ER for facial swelling that is spreading, trouble breathing or swallowing, bleeding that won't stop, or a jaw injury.

The emergency exam is $40 and covers a limited exam and x-rays of the problem area. If you need treatment, we explain the options and give you the cost in writing before we start. We check your insurance too; many plans cover an emergency exam.

We look at the tooth and the area around it and take digital x-rays to check the root and the bone. If you're in pain, getting you comfortable comes first. Then the dentist shows you what they found and walks through the options.

For a tooth that's been put back in, that often means a flexible splint to hold it steady while it heals, plus follow-up visits. Teeth that have been knocked out often need a root canal later, because the nerve inside is usually damaged. We keep an eye on it with x-rays.

If a tooth can't be saved, you don't have to choose a replacement that day. Implants, bridges and partial dentures can all come later, once things have healed. Dentures or dental implants compares them.

• Wear a mouthguard for contact sports and anything with a ball, a stick or a real chance of falling. A custom guard fits better than a boil-and-bite one.
• If you grind or clench, a night guard helps protect against cracks.
• Don't open packages or bottles with your teeth.
• Go easy on ice, hard candy and popcorn kernels.
• Keep up with checkups. A large old filling or a hidden crack is easier to fix before it breaks.

It's worth keeping a small kit at home or in the car: gauze, a small container with a lid, a cold pack, over-the-counter pain relief, and our number.