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Avulsed Tooth Treatment & Management

  • Author: Lynnus F Peng, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
Updated: Dec 31, 2014

Prehospital Care

See the list below:

  • Guidelines for dental trauma have been updated and were evaluated by military dental professionals.[3]
  • Do not touch the root or clean the tooth. Handle the tooth by the crown only. Attempt reimplantation in the field. If unable to reimplant, use one of the following carrier media (in order of preference):
    • Hanks solution (Save-A-Tooth, Phoenix-Lazerus, Inc, Pottstown, PA): This pH-preserving fluid is best used with a trauma-reducing suspension apparatus.
    • Milk: Shown to maintain vitality of periodontal ligament cells for 3 hours, milk is relatively bacteria-free with pH and osmolarity compatible with vital cells.
    • Saline: Saline is isotonic and sterile.
    • Saliva: Saliva keeps the tooth moist; however, it is not ideal because of incompatible osmolarity, pH, and presence of bacteria.
    • Water: This is the least desirable transport medium because it results in hypotonic rapid cell lysis.

Poi et al conducted a review the literature on the different storage media that have been investigated for avulsed teeth. The authors concluded that regular pasteurized whole milk is the most frequently recommended and with the best prognosis among other solutions that are likely to be available at the scene of an accident, such as water, saline or saliva. Its advantages include its high availability, ready accessibility, physiologically compatible pH and osmolality (fluid pressure) with the root-surface adhered PDL cells, presence of nutrients and growth factors. More research is necessary as there is not yet a single solution that is ideal for storage.[4]


Emergency Department Care

See the list below:

  • Tooth preparation: Handle the tooth by the crown and rinse with normal saline.[5]
    • If extraoral time is less than 20 minutes, gently rinse off the root and reimplant as soon as possible. If the pulp is open, use a bathing solution (doxycycline 1 mg in 20 mL isotonic sodium chloride solution) for 5 minutes to inhibit the amount of pathogens reaching the pulp lumen and enhance vascularization. Consult a dentist prior to use.
    • If extraoral time is longer 60 minutes, soak the tooth in citric acid and fluoride to make the root as resistant to resorption as possible. Consult a dentist.
  • Socket preparation
    • Leave the socket alone as much as possible.
    • If extraoral time is 20-60 minutes, soak in Hanks solution for 30 minutes before attempting reimplantation.
    • Perform light aspiration if a blood clot remains.
    • Gently irrigate for foreign bodies.
  • Tooth stabilization: If untrained in placing arch bars for tooth stabilization, use a zinc oxide preparation (Coe-Pak) for rapid support and stabilization. Mold the zinc oxide mixture over the gingival area and between teeth to provide support.
  • Provide adequate pain management and tetanus vaccination; ensure follow-up care.


See the list below:

  • Consult a dental or oral maxillofacial surgeon for splinting and further evaluation.
Contributor Information and Disclosures

Lynnus F Peng, MD Assistant Clinical Professor, Department of Anesthesia, University of California at Irvine; Chairman of Anesthesia, Department of Surgery, St Jude Medical Center at Fullerton

Lynnus F Peng, MD is a member of the following medical societies: Alpha Omega Alpha, American Society of Anesthesiologists

Disclosure: Nothing to disclose.


A Antoine Kazzi, MD Deputy Chief of Staff, American University of Beirut Medical Center; Associate Professor, Department of Emergency Medicine, American University of Beirut, Lebanon

A Antoine Kazzi, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Willard Peng, DDS, MS Keck School of Medicine of the University of Southern California

Willard Peng, DDS, MS is a member of the following medical societies: American Dental Association, California Dental Association

Disclosure: Nothing to disclose.

Rebecca Cheng Loma Linda University School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians

Disclosure: Nothing to disclose.

Additional Contributors

Michael Glick, DMD Dean, University of Buffalo School of Dental Medicine

Michael Glick, DMD is a member of the following medical societies: American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.


Mark W Fourre, MD Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine; Program Director, Department of Emergency Medicine, Maine Medical Center

Disclosure: Nothing to disclose.

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