Broken, chipped or knocked-out tooth

If a tooth has been knocked out completely — read this first

This is the most time-critical dental emergency there is. Every minute the tooth is out of the socket reduces the chance of saving it.

A knocked-out baby tooth is never put back — reimplanting it can damage the adult tooth developing underneath. Still have the child seen.

Outcomes vary even with prompt, correct care. Time out of the socket, the condition of the tooth and individual healing all affect whether it survives.

Storage media, best to worst

Option Why
Back in the socket The socket is the ideal environment; nothing else comes close
Milk Close to the right salt balance and acidity for the root cells
The person's own saliva, or inside the cheek Better than drying out; not for young children, because of choking risk
Saline Acceptable if milk is unavailable
Plastic wrap or a sealed bag with saliva A last resort that at least prevents drying
Water Avoid — it damages the root surface cells
Dry, in a tissue Avoid — the cells die quickly once dry

Go to a hospital emergency department if

A knocked-out or displaced tooth often comes with a facial injury. Deal with the head first.

Two other things worth mentioning at the hospital: whether the person's tetanus cover is current, particularly if the injury happened outdoors, and whether any tooth fragment is unaccounted for — a missing piece is occasionally embedded in the lip.

A chipped or broken tooth

Meanwhile, avoid chewing on that side and avoid hard or sticky food.

The kinds of breakage, and what each one means

What has happened Typical signs What it usually needs
Craze lines — fine surface cracks in enamel Visible under light; no pain Nothing. Extremely common in adults
Chipped enamel A rough edge; no sensitivity Smoothing, or composite bonding
Fractured cusp — a corner of a back tooth breaks off Often around a large old filling; mild or no pain A filling, onlay or crown
Cracked tooth — a crack running towards the root Sharp pain on releasing a bite; sensitivity to cold A crown, sometimes root canal treatment first
Split tooth — the crack has separated the tooth Clear separation; pain on function Often loss of one segment, or extraction
Vertical root fracture Frequently silent; may present as a gum boil Usually extraction; it cannot be repaired

Cracked tooth syndrome

Worth its own note because it is so often missed. The classic story is a back tooth that hurts for a split second when you release a bite — on something firm, or a seed, or a grain of rice — and is otherwise fine. It may be sensitive to cold. Nothing shows on a radiograph, because a crack running in the same plane as the beam is invisible.

A crack behaves like a hinge: each bite flexes the segments and irritates the nerve inside. Left alone it usually progresses — to a fractured cusp, a need for root canal treatment, or a split tooth that cannot be saved. Treated early, a crown that holds the tooth together often stops the progression.

If this describes you, it is worth an appointment even though nothing looks wrong.

How urgent is it?

Same day, or as soon as possible:

Within a few days:

Any injury to a tooth is worth having checked even if nothing hurts. A knock can kill the nerve months or years later, and the first sign is often the tooth darkening. Getting a baseline recorded now makes that far easier to manage.

After trauma: what follow-up looks like

An injured tooth is monitored rather than signed off, because the nerve's response can take months to declare itself.

When What is checked
Days to 2 weeks Splint check where one was placed; symptoms; bite
6–8 weeks Nerve testing; radiograph; colour
6 months Nerve testing; radiograph; any sign of root resorption
1 year, then annually Long-term monitoring, particularly in children

A tooth turning grey or brown after an injury means the nerve has probably died. It is not an emergency, but it needs assessment, and internal bleaching after root canal treatment can often restore the colour.

Where a tooth has been loosened or repositioned, a flexible splint bonded to the neighbouring teeth holds it while the ligament heals — usually for a couple of weeks. You can eat soft food with it in place and clean around it carefully with a soft brush.

Children and knocked-about front teeth

A blow to a baby tooth can affect the adult tooth forming above it. Even where the baby tooth looks fine, it is worth an examination. If a baby tooth is pushed up into the gum, do not try to pull it down — have it assessed.

In children, a broken front tooth with the nerve exposed is treated with particular urgency, because the root of a young adult tooth is often still forming and keeping the pulp alive is what allows it to finish.

What happens at the appointment

We examine the tooth and surrounding tissues, check whether it is loose or displaced, and take radiographs where clinically indicated — a root fracture or damage to the bone is not visible to the eye. We have an on-site OPG.

We then explain what has been found, what the options are and what each costs before treatment begins.

Depending on the damage, treatment may involve smoothing a rough edge, composite bonding, a veneer, a crown, splinting a loosened tooth, root canal treatment where the nerve is involved, or — where the tooth cannot be saved — removal and a discussion about replacing it.

Your practitioner will try to restore the tooth at the same appointment where possible, though some treatments need laboratory work and a second visit. We are a general dental practice and hold no specialist registration; complex trauma is referred.

Preventing the next one

Outside our hours

We are open Monday to Friday, 8:00am to 5:00pm and do not run an after-hours service.

Questions we are asked

Can the broken piece be glued back on? Sometimes, if you kept it moist and it is a reasonably clean break. It is worth bringing in even if you are doubtful.

Will it happen again to the same tooth? A restored tooth is not as strong as an intact one, which is why the treatment chosen matters — a crown or onlay that covers the cusps protects a broken back tooth far better than a large filling.

Does a chipped tooth have to be fixed? A small enamel chip with no sensitivity does not have to be, though a rough edge usually gets smoothed. Anything exposing the yellower dentine underneath is worth restoring, because it wears and stains faster.

Is a knocked-out tooth covered by health insurance? Depends on your policy and your remaining limits. We will give you the item numbers so you can check, and claim on the spot through HICAPS where we can.

Cost

Fees depend on what is required, which is not known until the tooth has been examined. You are given the cost before treatment starts. HICAPS on-the-spot claiming; Afterpay and Zip accepted.

Victorian Dental Group — 291 Wattletree Road, Malvern East VIC 3145 · (03) 9088 5808 · Monday to Friday, 8:00am–5:00pm · book online

Read more about dental emergencies, toothache or mouthguards for sport.

This page is general information and does not replace advice from a registered dental practitioner about your own circumstances, and it is not a substitute for being examined. Please see our Disclaimer.

What should I do immediately if I break a tooth?

Rinse your mouth with warm water and use a cold pack on the outside of the face to limit swelling. If there is bleeding, press a clean gauze or cloth on the area for ten minutes. Find the broken piece if you can, handle it as little as possible, and keep it in milk or saliva — not water and not dry — because a fragment can sometimes be bonded back on. Cover a sharp edge with sugar-free chewing gum or dental wax so it does not cut your tongue or cheek, avoid chewing on that side, and phone the practice.

When is a broken tooth urgent?

Phone the same day if the tooth is painful, sensitive to air or cold, loose, pushed out of position, or if you can see a pink or red spot in the middle of the break — that is the nerve exposed, and it needs covering promptly. Go to a hospital emergency department or call 000 for a significant blow to the face, a jaw that will not close properly or move normally, heavy bleeding that will not stop, loss of consciousness, vomiting or confusion after the injury, or spreading facial swelling.

What if a whole tooth is knocked out?

For an adult tooth this is time-critical. Hold it by the crown, never the root, and do not scrub it. Rinse briefly in milk or saline if dirty, then put it back in the socket and bite gently on a cloth. If you cannot, keep it in milk or in the person's own saliva — never water — and get to a dentist or emergency department immediately. Do not put a knocked-out baby tooth back, as it can damage the adult tooth forming underneath.

Does a small chip still need attention?

Have it looked at, even if it does not hurt. A sharp edge will irritate the tongue and lip, the break can leave enamel unsupported so more chips away later, and a crack that is not visible can extend over time. A chip examined early is usually a simple repair; the same tooth left for months can need considerably more.

What is a cracked tooth?

A crack running through the tooth that may not be visible on an X-ray. The typical sign is a sharp pain when you release pressure after biting, rather than when you bite down, sometimes with sensitivity to cold. Cracks are unpredictable — some are stabilised with a crown or onlay that holds the tooth together, some progress and need root canal treatment, and a tooth that splits below the gum usually cannot be saved. Early treatment gives the best chance of keeping it.

How is a broken tooth repaired?

It depends on how much is lost and whether the nerve is involved. A small chip may be smoothed or built up with tooth-coloured composite in one visit. A larger break usually needs an onlay or crown to cover and protect the remaining tooth. If the nerve is exposed or has died, root canal treatment is needed before the tooth is restored. A tooth broken below the gum level, or split vertically, generally has to be removed and replaced.

Can the broken piece be glued back on?

Sometimes, particularly with a clean break on a front tooth where the fragment has been kept moist. It can give an excellent match because it is the original tooth. It is not always possible or durable, and it may still chip off later, in which case the tooth is rebuilt with composite instead. Bring the fragment even if you are unsure — it costs nothing to try.

Why did it break?

Often a bite on something hard — ice, olive stones, popcorn kernels, bones — or a knock. But a tooth that breaks easily usually had a reason: a large old filling with little tooth left around it, decay undermining the enamel, a root-treated tooth without a crown, or grinding. Part of the appointment is finding out which, because that determines whether other teeth are at risk and whether a night splint is worth considering.

How do I get seen?

Phone Victorian Dental Group on (03) 9088 5808 rather than booking online, so the problem can be triaged and given enough time. 291 Wattletree Road, Malvern East VIC 3145, Monday to Friday 8:00am to 5:00pm. Outside those hours, or for any of the emergency signs above, attend a hospital emergency department.

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