Knocked Out a Tooth? Here's What to Do in the Next 30 Minutes (Markham Guide)

A ball to the face during a hockey game. A fall off a bike. A collision on the playground. A knocked-out tooth happens in an instant and what you do in the next 30 minutes matters more than almost any other decision in dentistry.

This is not an exaggeration. A knocked-out permanent tooth is the single most time-critical dental emergency that exists. The difference between acting in the first 30 minutes versus waiting an hour can be the difference between saving your natural tooth for decades and losing it permanently.

This guide gives you the exact, step-by-step protocol to follow right now if you or your child has just knocked out a tooth plus where to find same-day emergency dental care in Markham.

Can a Knocked-Out Tooth Be Saved?

Yes a knocked-out permanent tooth can often be saved, but success depends almost entirely on speed and how the tooth is handled in the minutes immediately following the injury.

The reason for this urgency is biological. The root surface of every tooth is covered by a thin layer of cells called the periodontal ligament (PDL) these are the cells that allow a reimplanted tooth to reattach and heal successfully. The moment a tooth leaves the mouth, these cells begin to die.

According to the International Association of Dental Traumatology (IADT) 2020 guidelines, PDL cells start losing viability after approximately 15 minutes of dry exposure, and the chance of a successful, long-term reimplantation drops sharply once 30 to 60 minutes have passed without the tooth being either reinserted or kept moist in an appropriate storage medium.

This single fact is why dentists are so consistent on this point: a knocked-out tooth handled correctly in the first 30 minutes has a meaningfully better long-term outlook than the same tooth handled correctly an hour later.

Important exception for children: This guidance applies to permanent (adult) teeth only. If a baby tooth is knocked out, do not attempt to reinsert it. Reinserting a primary tooth can damage the developing permanent tooth bud beneath it. Bring the tooth with you to the dentist in milk, but skip the reimplantation step entirely.

What to Do If You Knock Out a Tooth: The 5-Step Protocol

Follow these five steps in order, immediately, before doing anything else.

Step 1 Find the Tooth and Pick It Up by the Crown

Locate the tooth immediately. Pick it up only by the crown the white, visible part you would normally see above the gumline when biting down. Never touch, scrub, or handle the root the narrower, often slightly yellowish lower portion that was embedded in the bone. The root surface carries the fragile periodontal ligament cells that determine whether reimplantation will succeed, and even brief rough handling can damage them irreversibly.

Step 2 Rinse Gently (If Dirty) Do Not Scrub

If the tooth has dirt, debris, or grass on it, rinse it gently under cool running water for no more than 10 seconds. Hold it by the crown while rinsing. Do not scrub it, do not use soap, alcohol, or any disinfectant, and do not wrap it in a cloth or tissue to dry it all of these actions damage the very cells you are trying to preserve. If the tooth has any soft tissue still attached to the root, leave it in place; do not attempt to remove it.

Step 3 Try to Reinsert It Into the Socket Immediately

This is the single most effective thing you can do, and it is the step most people don't realise is possible. If the tooth is a permanent (adult) tooth, gently try to push it back into its socket, facing the correct direction, using only light pressure. Never force it. Once it is in position, bite down gently on a clean piece of gauze, a clean cloth, or even a tea bag to hold it in place while you travel to the dentist.

If reinsertion is genuinely not possible due to pain, resistance, or your own comfort level attempting it do not force the issue. Move to Step 4 instead.

Step 4 If You Cannot Reinsert It, Store It in Milk

If the tooth cannot be put back into the socket, the next best option is to keep it moist in an appropriate storage medium until you reach the dentist. In order of effectiveness:

• Cold whole milk the best widely available option; the proteins and pH balance of milk preserve periodontal ligament cell viability for several hours

• Hank's Balanced Salt Solution (Save-a-Tooth kit) a specialised cell-preservation product, if available

• Saliva hold the tooth in your own cheek pouch (not under the tongue, where it could be swallowed) if milk is not available

• Saline (a pinch of salt in a cup of water) an acceptable alternative if milk is unavailable

Never store the tooth in plain water. Water is hypotonic relative to the cells on the root surface and causes them to swell and rupture destroying the very cells needed for successful reattachment. This is one of the most common and most damaging mistakes people make in this situation.

Step 5 Call Hwy7 Family Dentistry and Go Immediately

Call (905) 604-1995 right away even while you are still travelling. Calling ahead allows our team to prepare for your arrival and see you the moment you reach our Unionville location. Every minute spent deciding what to do is a minute the tooth is not being preserved call first, then travel directly to us.

If it is after our regular hours, dial 811 for Health811's free 24/7 nurse triage line, which can help direct you to the most appropriate emergency option in the Markham area.

Milk vs. Saline vs. Saliva: Which Storage Medium Is Best?

Storage Medium	Effectiveness	Notes
Cold whole milk	✅ Best widely available option	Preserves PDL cell viability for several hours; the most commonly recommended option globally
Hank's Balanced Salt Solution	✅ Ideal if available	Specifically designed cell-preservation medium (Save-a-Tooth kits); not commonly available in most households
Saliva (cheek pouch)	✅ Good alternative	Effective for shorter periods; not suitable for young children due to swallowing risk
Saline (salt + water)	⚠️ Acceptable backup	Less effective than milk but better than nothing
Plain water	❌ Avoid	Damages PDL cells through osmotic rupture actively harmful, not neutral
Dry storage (tissue, paper towel)	❌ Avoid	Cells die rapidly without any moisture the worst possible option after water

What If You Can't Find the Tooth?

This happens more often than people expect particularly with injuries on grass, in snow, in a swimming pool, or in low light. If the tooth genuinely cannot be located after a reasonable search:

• Control any bleeding with clean gauze, applying firm pressure for 10-15 minutes

• Apply a cold compress to the outside of the cheek to reduce swelling

• Call Hwy7 Family Dentistry immediately regardless the empty socket itself needs assessment and care, and we can determine the best path forward even without the original tooth

• Bring the patient in as soon as possible; in some cases the socket can be evaluated for other treatment options, including future tooth replacement planning

Do not delay seeking care simply because the tooth was not recovered. The socket, surrounding bone, and gum tissue still need to be assessed and treated appropriately.

What Happens at the Dental Appointment?

When you arrive at Hwy7 Family Dentistry following a knocked-out tooth, here is what to expect:

Assessment. We will examine the tooth (if recovered), the socket, and the surrounding gum tissue, jaw, and any adjacent teeth for additional injury. An X-ray is typically taken to assess the root and surrounding bone.

Reimplantation (if not already done). If the tooth has not already been reinserted, and it is a viable candidate for reimplantation, we will carefully reposition it into the socket.

Splinting. Once the tooth is in position, it is typically stabilised with a small splint a thin wire or composite material bonded to the adjacent teeth to hold it still while the periodontal ligament heals and reattaches. This splint generally stays in place for one to two weeks, sometimes longer depending on the specific injury.

Follow-up root canal (often required later). In many cases, particularly with a fully avulsed permanent tooth, root canal treatment is needed in the weeks following reimplantation, once initial healing has occurred. This is because the nerve supply to the tooth is often disrupted during the injury itself and does not reliably recover, even when the tooth itself is successfully saved.

Monitoring. Reimplanted teeth require follow-up appointments over the following months to monitor healing, the splint, and the long-term viability of the tooth.

Emergency Dentist vs. ER: Where Should You Go for a Knocked-Out Tooth?

For a knocked-out tooth with no other complicating injury, an emergency dentist is the correct and faster choice not the hospital emergency room.

Hospital emergency rooms in Ontario do not typically have a dentist on staff and cannot reimplant or splint a tooth. An ER visit for an isolated knocked-out tooth typically results in pain management and a referral back to a dentist meaning lost time during the most critical window, plus two separate costs instead of one.

Go to a hospital ER instead of a dentist only if: the injury involves a suspected broken jaw, loss of consciousness, significant head trauma, uncontrolled bleeding that does not stop after firm gauze pressure for 15-20 minutes, or any difficulty breathing or swallowing. In these cases, go directly to Markham Stouffville Hospital ER at 381 Church Street (905) 472-7000, or call 911.

For an isolated knocked-out tooth, calling Hwy7 Family Dentistry directly and coming straight to our Unionville location gives the tooth the best possible chance, in the shortest possible time.

Preventing Knocked-Out Teeth: Mouthguards Matter

The majority of knocked-out teeth in Markham happen during sports hockey, basketball, soccer, martial arts, and cycling are among the most common causes we see. A properly fitted custom mouthguard significantly reduces the risk of this exact emergency happening in the first place.

Over-the-counter boil-and-bite mouthguards offer some protection but fit loosely and can be uncomfortable enough that children and teens avoid wearing them consistently. A custom-fitted mouthguard from Hwy7 Family Dentistry is moulded specifically to your teeth, fits comfortably enough to be worn every practice and game, and offers significantly better impact protection particularly for the front teeth, which are by far the most commonly knocked out.

If your child plays any contact sport in Markham, a custom mouthguard is one of the most effective preventive investments you can make.

Build a Dental Emergency Kit at Home

Having the right supplies ready before an emergency happens means you can act in seconds rather than scrambling. A simple home dental emergency kit should include:

• Clean gauze pads

• A small lidded container for storing a tooth in milk

• Orthodontic wax

• OTC temporary dental cement

• Ibuprofen and acetaminophen

• Hwy7 Family Dentistry's number saved in your phone: (905) 604-1995

• Health811 saved in your contacts: 811

Keep a small carton of milk easily accessible in the fridge if you have children playing contact sports knowing exactly where it is saves precious seconds in a genuine emergency.

Frequently Asked Questions

Can a knocked-out tooth be saved? 

Yes, often but success depends heavily on speed. A knocked-out permanent tooth has the best chance of being saved if it is reinserted into the socket or placed in an appropriate storage medium like milk within 30 minutes, and reaches a dentist within 30 to 60 minutes. The periodontal ligament cells on the root surface that allow successful reattachment begin losing viability after about 15 minutes outside the mouth.

What do I do if I knock out a tooth? 

Pick the tooth up by the crown only, never the root. Rinse it gently under cool water for no more than 10 seconds if dirty do not scrub it. Try to reinsert it into the socket immediately, biting gently on gauze to hold it in place. If reinsertion isn't possible, store it in cold whole milk. Call your dentist immediately and go straight there for Markham residents, call Hwy7 Family Dentistry at (905) 604-1995.

How long can a knocked-out tooth survive outside the mouth? 

The ideal window for successful reimplantation is within 30 minutes of the injury, with a meaningfully reduced but still possible chance of success up to 60 minutes. Proper storage in milk or saliva significantly extends viability compared to dry storage, which causes cell death within about 15 minutes.

Should I put a knocked-out tooth in water? 

No never store a knocked-out tooth in plain water. Water is hypotonic and causes the periodontal ligament cells on the root surface to swell and rupture, destroying the cells needed for successful reattachment. Use cold whole milk, saliva, or saline instead.

What if my child's baby tooth gets knocked out? 

Do not attempt to reinsert a knocked-out baby (primary) tooth. Reinserting a primary tooth risks damaging the developing permanent tooth bud beneath it. Bring the tooth to the dentist in milk for assessment, but skip the reinsertion step for baby teeth specifically.

Should I go to the ER or a dentist for a knocked-out tooth? 

For an isolated knocked-out tooth with no other injury, go directly to an emergency dentist not the ER. Hospital emergency rooms cannot reimplant or splint a tooth and will typically just refer you back to a dentist afterward, costing valuable time. Go to the ER only if there is a suspected broken jaw, loss of consciousness, uncontrolled bleeding, or difficulty breathing.

Will a knocked-out tooth need a root canal even if it's successfully saved?

Often, yes. Even when a knocked-out tooth is successfully reimplanted and reattaches to the bone, the nerve supply is frequently disrupted by the injury and does not reliably recover on its own. Root canal treatment is commonly performed in the weeks following successful reimplantation as part of the complete treatment process.

Same-Day Emergency Dental Care in Markham

A knocked-out tooth is one of the few genuine dental emergencies where every single minute counts. Knowing the correct steps and acting on them immediately gives your tooth the best possible chance of survival.

Hwy7 Family Dentistry is located at 4560 Hwy 7 E, Unit 500, Unionville, Markham, with same-day emergency appointments available and extended hours Thursday evenings until 9 PM and Saturdays from 9 AM to 4 PM. Save our number now, before you need it.

📞 Call us at (905) 604-1995 🌐 Learn more about our emergency dental services