The 60-minute rule, exactly
A knocked-out adult tooth (avulsed tooth) can often be re-implanted successfully — but the window is brutal. Inside 30 minutes, excellent outcomes. Inside 60 minutes, usually still possible. After two hours, the cells on the root have died and re-implantation rarely takes.
This article has the full protocol, but if you're reading it right now because it just happened: do steps 1-3 above, call us on (02) 9649 6468, and read the rest later. The tooth doesn't care how much you know; it cares how fast you move.
Why the root matters more than the crown
The crown (the white part you see) is essentially bone-like calcium. It's inert. It doesn't need to "survive."
The root is different. It's covered in a thin layer of living cells called the periodontal ligament — cells that would normally attach the tooth to bone. When the tooth is knocked out, those cells are exposed to air. They dry out and die within minutes. If they die completely, the re-implanted tooth can't reattach properly — it fuses directly to bone instead, and over years it gets absorbed and lost.
Every step of the protocol is designed to keep those root cells alive long enough for us to re-implant the tooth.
The 4-step protocol in detail
Step 1: Pick it up by the crown only
The crown is the white part. The root is the yellowish/cream part. Hold the crown. Don't touch the root with fingers if you can avoid it — skin contact damages the cells.
Step 2: Rinse gently — milk or saline only
The ranking of rinse fluids from best to worst:
- Hank's Balanced Salt Solution — the gold standard, kept in some school first-aid kits. Keeps cells alive for hours.
- Cold milk — best household option. Keeps cells alive for 30-60 min.
- Saline (contact lens solution) — fine.
- Saliva — tooth in the cheek pouch. Works if the person can reliably not swallow it.
- Tap water — last resort. Water is hypotonic and ruptures cells in minutes. Better than letting it dry out, worse than anything else.
Rinse for max 10 seconds. Do not scrub. Do not use soap, mouthwash, or toothpaste.
Step 3: Re-implant, or store
The absolute best move is putting the tooth straight back in its socket. Yes, without anaesthetic. Yes, it will hurt. But it's the most effective thing you can do for the outcome.
How: hold the crown, gently push the tooth back into the socket with the same orientation it came out. Bite gently on a clean cloth to hold it. Don't force it — if it won't go, don't push hard. Store it in milk and come in.
For children under 10-12, if the knocked-out tooth is a baby tooth — do NOT re-implant. Baby tooth re-implantation can damage the adult tooth developing underneath. Come in, but don't put it back.
Step 4: Call us, come in immediately
Ring (02) 9649 6468. Tell reception it's an avulsed tooth. We'll hold the slot. If you're closer to another emergency clinic, go there — it's always speed over specific practice. Bring the tooth in milk even if you've re-implanted it (sometimes it needs repositioning).
Why speed matters more than technique: published dental trauma research consistently shows that teeth re-implanted within 20-30 minutes have dramatically better long-term outcomes than teeth re-implanted hours later — even if the early re-implantation is done clumsily. A quick, imperfect re-implantation almost always beats a careful, late one. Act fast; the professional clean-up can happen once you're at the practice.
What we do at the practice
If you've re-implanted it: we check the position, take an x-ray, splint it to the neighbouring teeth with a thin wire-and-composite splint (stays in 2 weeks), and monitor the nerve over the next 6-12 months. Root canal is often needed later even when re-implantation works — but you keep your tooth.
If you haven't re-implanted: we do it ourselves, numbed, with proper positioning. Same splint, same follow-up.
If the tooth is too damaged or too late: we plan an implant for once the socket has healed (3 months). Not ideal, but it works.
Common mistake: parents worry they'll do it wrong and wait to come in "to get it done properly". Don't. A clumsily re-implanted tooth in 10 minutes beats a perfectly re-implanted tooth in 2 hours every single time. We can fix positioning; we can't resurrect dead cells.