Avulsed Tooth Treatment & Management
- Author: Lynnus F Peng, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP more...
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- Guidelines for dental trauma have been updated and were evaluated by military dental professionals.
- 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.
Emergency Department Care
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- 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.
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- Consult a dental or oral maxillofacial surgeon for splinting and further evaluation.
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