Your dog’s tooth has been knocked out or pushed out of place:first aid and what to do in the first hour

Has the tooth shifted or come out completely?

A tooth sits in a bony socket, held there by the periodontal ligament — a thin layer of fibres and living cells between the root and the bone. A blow tears this ligament partly or completely. That determines what you will see and what to do next.

Why the first hour matters

When a tooth is knocked out, some of the periodontal ligament cells stay on the root. If they are alive, the ligament can heal once the tooth is back in its socket, and the tooth can be held in the bone again. But these cells are very sensitive to drying out: in the air they die quickly — it is a matter of minutes.

If the cells on the root have died, the body no longer reattaches the root; instead it gradually resorbs it and replaces it with bone. The tooth may hold for a while, but over the years the root breaks down. So the best chance belongs to a tooth that goes back into its socket as soon as possible, ideally within the first hour, and that has been kept in a suitable liquid all along.

Water is not suitable: the cells swell and break apart in it. In cold milk or saline (0.9% sodium chloride solution from a pharmacy) the cells do not break down as quickly and can survive while you travel.

What to do if your dog’s tooth has been knocked out

Here is what to do in the first few minutes. If someone else is with you, let one person look after the dog while the other deals with the tooth and phones the clinic.

1. 01

   The dog comes first

   Check that your dog is breathing normally, responds to you and is not bleeding heavily. After a road accident, a fall from a height or a hard blow, go to an emergency clinic first: the dog’s overall condition matters more than the tooth. Be careful — pain and fright can make even a calm dog bite.

2. 02

   Pick the tooth up by the crown

   The crown is the smooth white part you could see in the mouth. The root is the yellowish or pinkish part that sat in the bone; in a canine it is longer than the crown. Do not touch the root with your fingers, wipe it with a tissue or scrape it.

3. 03

   If it is dirty, rinse it briefly

   If there is sand or soil on the tooth, pour saline or milk over it for a few seconds while holding it by the crown. Do not rub it, wash it with soap or treat it with alcohol, hydrogen peroxide or any other antiseptic.

4. 04

   Put the tooth in milk or saline

   Any small clean container will do: a jar, a tub or a zip-lock bag. Add enough cold milk or saline to cover the tooth completely. Do not wrap it in a dry tissue or cloth, and do not keep it in water. If you have neither at home, you can buy milk on the way.

5. 05

   Phone ahead and go straight away

   Let the veterinary dentist know you are bringing a knocked-out tooth so the clinic can prepare. If you cannot get through, go to the nearest emergency clinic. Remember or note down when the injury happened.

6. 06

   On the way

   If the socket is bleeding and your dog allows it, press a clean piece of gauze gently against it. Do not feed your dog until you have spoken to the vet, and do not let them chew anything: an anaesthetic will most likely be needed.

What to do if the tooth has shifted but not come out

Do not try to push a displaced tooth back with your fingers, wiggle it or pull it out. The root may be fractured inside the bone and the socket wall may be cracked, and none of this is visible without an X-ray. Extra movement only adds damage and pain.

Put away sticks, balls, bones and tug toys, do not brush the teeth in that area, and come in the same day. A fresh luxation is usually easier to put back than one that has been in place for several days: over time the tissues around the root start to heal in the wrong position.

If the tooth stays straight after a knock but is loose, sore, or turns pink or grey over the next few days, that is also a reason for an examination within days. The blow may have damaged the pulp — the nerve and blood vessels inside the tooth — even without a fracture. I explain what a change in colour means in Why has a tooth changed colour?.

What happens at the clinic

First I assess your dog’s general condition: after a hard blow, the tooth may not be the main injury. The mouth examination, X-rays and treatment are done under general anaesthesia: a conscious dog in pain will not allow the socket to be examined safely, and the tooth has to go back in exactly the right position.

Dental radiography shows whether the root is intact, whether the socket wall or the jaw is fractured and whether neighbouring teeth have been injured. The plan depends on this:

• Reimplanting a knocked-out tooth. The socket is gently rinsed, the tooth is put back and held with a splint. This is considered mainly for canines — when the root is intact, the tooth has not been out of the mouth for long and there is enough bone around it.
• Repositioning a displaced tooth. The tooth is carefully moved back into the correct position, the bite is checked and the tooth is also held with a splint.
• A splint is a thin “bridge” of composite material, sometimes with wire, bonded to the neighbouring teeth. It keeps the tooth still for several weeks while the ligament heals. The splint is usually removed under a short anaesthetic.
• Treating the socket without reimplantation. If the root is fractured, the tooth has been lying dry for a long time or periodontitis has already destroyed the surrounding bone, the socket is cleaned of fragments and dirt and closed with the gum. For small incisors the decision is made case by case. Dogs live well without individual teeth.

We decide together, after the X-rays, whether to try to save the tooth. More about treating injuries is on the Dental and jaw trauma page.

What happens after reimplantation

When a tooth is knocked out, the nerve and blood vessels that enter it through the tip of the root are torn. In an adult dog the pulp (the living tissue inside the tooth) does not usually recover and dies, and dead pulp becomes a source of inflammation and speeds up the breakdown of the root. That is why a reimplanted tooth usually needs root canal treatment. It is planned within the first weeks after the injury; the exact timing is decided by the vet.

After a luxation the pulp may survive, or it may die weeks or months later. Such a tooth is monitored on X-rays, and if the pulp dies, the root canal is treated too.

While the splint is in place, your dog needs soft food and no sticks, balls, chew toys or tug games. The splint is cared for according to my instructions, and pain relief after the procedure is prescribed by the vet.

Even after a successful reimplantation the outcome cannot be predicted in advance: the root may start to resorb months or years later. That is why follow-up X-rays are needed even when the tooth seems to have settled.

A puppy has lost a temporary tooth in an accident: why it is not put back

Temporary teeth (also called baby or milk teeth) are not put back in the socket. Their roots lie right next to the developing permanent tooth forming in the jaw. Reimplantation or a splint can damage it, and the permanent tooth may then grow with enamel defects, in the wrong position, or fail to erupt.

A displaced temporary tooth that is in the way or painful is usually removed carefully, without disturbing the developing tooth. But an examination after an injury is needed even when the tooth has come out completely: a fragment of root may remain in the socket, and an X-ray will show whether the permanent tooth has been affected. When puppies change their teeth is explained in When do puppies lose their baby teeth?.

While the teeth are changing, the mouth contains both temporary and permanent teeth, so telling them apart at home is not always easy. If in doubt, treat the tooth you have found as a permanent one: into milk, and off to the vet.

How to tell it might be a jaw fracture

A blow hard enough to knock out a tooth can also break the bone around the socket or the jaw itself. These signs suggest a fracture:

• the mouth does not close fully, or your dog cannot or will not open it;
• the teeth meet differently from before, or the jaw is shifted to one side or hangs down;
• several teeth move together as a block, or a step or gap has appeared in the row of teeth;
• bleeding from the mouth or nose does not stop, or the saliva is bloodstained;
• swelling or asymmetry of the face, sharp pain when touched, refusing food.

In that case get your dog examined the same day and do not try to “set” the jaw yourself. How these injuries are diagnosed and stabilised is described on the Jaw fractures page, and a mouth that will not close is covered on Cannot close or open the mouth.

Frequently asked questions