Avulsed Tooth Treatment & Management

  • Author: Lynnus F Peng, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...
 
Updated: Aug 12, 2009
 

Prehospital Care

  • Guidelines for dental trauma have been updated and were evaluated by military dental professionals.[2]
  • 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.
Next

Emergency Department Care

  • Tooth preparation: Handle the tooth by the crown and rinse with normal saline.
    • 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.
Previous
Next

Consultations

  • Consult a dental or oral maxillofacial surgeon for splinting and further evaluation.
Previous
Proceed to Medication
 
 
Contributor Information and Disclosures
Author

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 and American Society of Anesthesiologists

Disclosure: Nothing to disclose.

Coauthor(s)

A Antoine Kazzi, MD  Chair and Medical Director, 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 and California Dental Association

Disclosure: Nothing to disclose.

Rebecca Cheng  Loma Linda University School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael Glick, DMD  Professor and Acting Chair, Department of Diagnostic Sciences, New Jersey Dental School, University of Medicine and Dentistry of New Jersey

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

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

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

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP  Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, 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 Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

  1. Qin M. [Pulp treatment of young permanent teeth after traumatic dental injury]. Hua Xi Kou Qiang Yi Xue Za Zhi. Jun 2009;27(3):237-40. [Medline].

  2. Zadik Y, Marom Y, Levin L. Dental practitioners' knowledge and implementation of the 2007 International Association of Dental Traumatology guidelines for management of dental trauma. Dent Traumatol. Jul 9 2009;[Medline].

  3. Santos Filho PC, Quagliatto PS, Simamoto PC Jr, Soares CJ. Dental trauma: restorative procedures using composite resin and mouthguards for prevention. J Contemp Dent Pract. 2007;8(6):89-95. [Medline].

  4. Al-Jundi SH. Type of treatment, prognosis, and estimation of time spent to manage dental trauma in late presentation cases at a dental teaching hospital: a longitudinal and retrospective study. Dent Traumatol. Feb 2004;20(1):1-5. [Medline].

  5. Bakland LK, Andreasen JO. Examination of the dentally traumatized patient. J Calif Dent Assoc. Feb 1996;24(2):35-7, 40-4. [Medline].

  6. Cobankara FK, Ungor M. Replantation after extended dry storage of avulsed permanent incisors: report of a case. Dent Traumatol. Aug 2007;23(4):251-6. [Medline].

  7. Devlin DH. A historical review of dental and facial skeletal trauma. J Calif Dent Assoc. Feb 1996;24(2):29-34. [Medline].

  8. [Guideline] Flores MT, Andersson L, Andreasen JO, Bakland LK, Malmgren B, Barnett F. Guidelines for the management of traumatic dental injuries. II. Avulsion of permanent teeth. Dent Traumatol. Jun 2007;23(3):130-6. [Medline].

  9. Gutmann JL, Gutmann MS. Cause, incidence, and prevention of trauma to teeth. Dent Clin North Am. Jan 1995;39(1):1-13. [Medline].

  10. Harwood-Nuss A, Linden C, Luten R, eds. Dental injuries. In: The Clinical Practice of Emergency Medicine. 2nd ed. Philadelphia: Lippincott, Williams & Wilkins; 1996:418-421.

  11. Josell SD. Evaluation, diagnosis, and treatment of the traumatized patient. Dent Clin North Am. Jan 1995;39(1):15-24. [Medline].

  12. Josell SD, Abrams RG. Traumatic injuries to the dentition and its supporting structures. Pediatr Clin North Am. Jun 1982;29(3):717-41. [Medline].

  13. Kinoshita S, Kojima R, Taguchi Y, Noda T. Tooth replantation after traumatic avulsion: a report of ten cases. Dent Traumatol. Jun 2002;18(3):153-6. [Medline].

  14. Krasner P, Rankow HJ. New philosophy for the treatment of avulsed teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. May 1995;79(5):616-23. [Medline].

  15. Pohl Y, Filippi A, Kirschner H. Results after replantation of avulsed permanent teeth. II. Periodontal healing and the role of physiologic storage and antiresorptive-regenerative therapy. Dent Traumatol. Apr 2005;21(2):93-101. [Medline].

  16. Rai P, Gupta U, Kalra N. Self-replantation of an avulsed tooth in torsoversion: a 10-year follow-up. Dent Traumatol. Jun 2007;23(3):158-61. [Medline].

  17. Robert JR, Hedges JR. Emergency dental procedures. In: Clinical Procedures in Emergency Medicine. 2nd ed. Philadelphia: WB Saunders Co; 1991:1045-1064.

  18. Rosen P, Barkin R. Dental emergencies. In: Emergency Medicine Concepts and Clinical Practice. Vol 3. 3rd ed. 1992:2381-2398.

  19. Schaider J. Rosen & Barkin's: The 5-Minute Emergency Medicine Consult 2003. 2003:202-3.

  20. Tintinalli JE, Kelen GD, Stapczynski, JS, eds. Emergency Medicine. In: A Comprehensive Study Guide. 6th ed. McGraw-Hill Professional; 2003:1490-3.

  21. Trope M. Protocol for treating the avulsed tooth. J Calif Dent Assoc. Mar 1996;24(3):43-9. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.