Dental clinic · Montreal and Outremont · Care
Dental trauma: what to do
A knock during sport, a fall, a blow to the face: the tooth is broken, it has moved, or it has come out. What happens in the minutes that follow counts for more than anything we will do afterwards in the chair. This page sets out what to do in each situation, following the international guidelines for managing traumatic dental injuries. It does not replace an examination: it is here to stop you making the one mistake that compromises the tooth before you even arrive. Call us at (514) 504-6060. If there is loss of consciousness, vomiting, confusion or a significant facial wound, go to the hospital emergency department or call 911 first: the tooth can wait, the rest cannot.
What to do right now
Two questions, and you will know what to do in the next few minutes. This tool does not replace an examination: it is here to stop you making the one move that compromises the tooth before you arrive.
First: is it only the tooth?
Loss of consciousness, vomiting, confusion, unusual drowsiness, a significant facial wound, difficulty breathing or swallowing: call 911 or go to the hospital emergency department. The tooth can wait a few hours, a head injury cannot.
Which tooth is it?
Guidance based on the 2020 recommendations of the International Association of Dental Traumatology. It does not replace examining an individual situation.
Three questions that decide what to do
Before anything else, three things determine the right course of action. Is it a baby tooth or an adult tooth? The answer changes everything, and some steps that are right for one are harmful for the other. What happened to the tooth: is it broken, has it moved without coming out, or has it come out completely? And how long ago? For an adult tooth that has come out, time is the single biggest factor in the outcome, and the minutes genuinely count. If you call, these are the first three answers we will ask for, and they let us guide you on the phone while you are on your way.
An adult tooth has come out
This is the most serious situation and the only one where what you do, before any professional does anything, changes the result. Pick the tooth up by the crown, the part that normally shows above the gum. Do not touch the root and above all do not scrub it: the thin layer of cells covering it is precisely what will let the tooth reattach to the bone. If the tooth is dirty, rinse it for a few seconds in milk or saline — never under the tap, as water destroys those cells. Then put it back in its socket, the right way round, and bite gently on a clean cloth to hold it there. If you do not feel able to, which is common and understandable, keep it in a glass of milk or, failing that, in the injured person's own saliva. Never let it dry out. Then come straight away: here, the delay matters more than anything else.
A baby tooth has come out: do not put it back
This is the exception that alone justifies the first question on this page. An avulsed baby tooth is not put back. The developing adult tooth sits just above it, and replanting the baby tooth risks damaging it permanently — you would be trading a temporary tooth for a permanent one. Still seek care, and promptly: we need to check that no fragment was left behind, examine the gum and bone, and make sure the developing tooth did not suffer from the impact itself. Bring the tooth along, it helps confirm it came out whole.
A tooth has moved without coming out
It may look pushed in, pushed out, tilted backwards or forwards, or simply loose when it was not before. Do not try to force it back into position: a displaced tooth often comes with a fracture of the bone around it, and handling it blindly makes the injury worse. If it stops you closing your mouth, simply avoid biting on it and come in. At the clinic the tooth is repositioned and then held with a flexible splint bonded to the neighbouring teeth while the supporting tissues heal. In children, a baby tooth pushed into the gum is often left to come back down on its own, under observation, precisely so as not to disturb the developing tooth beneath.
A tooth is broken
Find the fragment if you can and keep it in milk or saline, just as you would a whole tooth: it can often be bonded back on, and the result is better than a rebuild. Then look at the broken surface. If it is uniformly white or yellowish, the fracture involves enamel and dentine. If you can see a pink or red point, sometimes a bead of blood at the centre, the pulp is exposed: the tooth is open to the inside, and how quickly it is treated matters a great deal for its survival. In both cases, avoid chewing on that side, cover a sharp edge with orthodontic wax or sugar-free gum, and call. A tooth that does not hurt is not necessarily unharmed: absence of pain means very little in the hours after an impact.
Follow-up is not a formality
This is what patients most often learn too late. An injured tooth can look entirely recovered for months, then lose its nerve, darken, or have its root quietly resorb. These complications arrive long after the impact, they are painless at first, and they are only picked up by comparing successive check-ups — vitality testing and X-rays at set intervals, over months and sometimes years depending on the injury. Missing those appointments means accepting that the problem will be found at the stage where it can no longer be repaired. In a child whose adult tooth was involved, monitoring continues until the root has finished growing.
Where these recommendations come from
The guidance on this page follows the 2020 recommendations of the International Association of Dental Traumatology, published in four parts in the journal Dental Traumatology: a general introduction, a part on fractures and luxations, a part on avulsion of permanent teeth, and a part on injuries in the primary dentition. These are international consensus recommendations, revised from the scientific literature, and they are the ones we apply at the clinic. They guide what is done; they do not replace examining an individual situation.
Your questions about our dental care.
My tooth came out — what should I do right now?
If it is an adult tooth, pick it up by the crown without touching the root, do not scrub it, put it back in its socket if you can, and come straight away. If you cannot, keep it in milk or in saliva. Never let it dry out. If it is a baby tooth, do not put it back.
Why should the tooth not be rinsed under the tap?
Because water destroys the living cells covering the root, and those cells are what let the tooth reattach to the bone. If the tooth is dirty, a few seconds in milk or saline is enough.
Can a baby tooth be put back after it is knocked out?
No. The developing adult tooth sits just above it, and replanting the baby tooth risks damaging it permanently. Still seek care quickly, to check that no fragment was left behind and that the developing tooth was not harmed by the impact.
How long do I have to act?
For an adult tooth that has come out, time outside the mouth is the single biggest factor in the outcome. It is the one dental emergency where minutes genuinely count. Replant it or place it in milk without delay, and come straight away.
My tooth is broken but does not hurt — is that serious?
Absence of pain in the hours after an impact does not mean the tooth is unharmed. Look at the broken surface: a pink or red point at the centre means the pulp is exposed and time matters. Have the tooth examined either way.
What should I do with the broken piece?
Keep it in milk or saline and bring it with you. A fragment can often be bonded back on, and the result is better than a rebuild, in shape as well as in colour.
My tooth has moved — can I straighten it myself?
No. A displaced tooth often comes with a fracture of the surrounding bone, and forcing it makes the injury worse. Avoid biting on it and come in: the tooth will be repositioned and held with a flexible splint while it heals.
Why do I need several follow-up visits after an injury?
Because complications arrive late and without pain. An injured tooth can lose its nerve, darken or have its root resorb months after the impact. Only successive check-ups, with vitality testing and X-rays, catch these at a stage where they can still be treated.
Should I go to hospital or to the dentist?
Hospital first if there is loss of consciousness, vomiting, confusion, a significant facial wound or difficulty breathing. The tooth can wait a few hours; a head injury cannot. Otherwise, call the clinic at (514) 504-6060.