Avulsed Tooth Clinical Presentation

Updated: Nov 23, 2021
  • Author: Lynnus F Peng, MD; Chief Editor: Anil P Punjabi, MD, DDS  more...
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Presentation

History

The following are considerations in patients with avulsed teeth:

  • Patient's age: Anterior primary teeth are usually present until age 6-7 years.

  • Mechanism of injury: Rule out concomitant injuries.

  • Location of the tooth when recovered: This helps assess contamination.

  • Time out of socket: If the tooth was absent for less than 20 minutes, the prognosis is better. All periodontal ligament cells die if the tooth is out of the socket longer than 60 minutes.

  • Storage media: Determine if the tooth was stored dry or in solution.

  • Transport method: Determine how the tooth was carried. Holding it by the root is typically worse.

  • Primary or permanent tooth: Do not replace primary teeth, because loss of these teeth early does not hinder development of succedaneous teeth. When loss of a primary tooth is early, eruption of permanent successors may be delayed. If replaced, primary teeth have a high likelihood of fusing to underlying alveolar bone, which causes dentoalveolar ankylosis and can result in facial deformities. Histologically, dentoalveolar ankylosis is characterized by direct contact between bone and cementum without separation by the periodontal ligament.

Next:

Physical Examination

Inspection

Evaluate the surrounding soft tissue area for laceration, discoloration, ecchymosis, and embedded foreign bodies (eg, chipped teeth). [3]

Evaluate teeth for fractures, chips, and other deformities. Embedded tooth fragments may lead to chronic infection or fibrosis.

Palpation

Determine if the tooth or if an entire segment is mobile.

If possible, have patients bite down to further localize the suspected area.

Percussion and sensitivity

Percuss with a tongue blade to evaluate overall sensitivity.

Evaluate the patient's sensitivity to air and hot and cold solutions.

Missing tooth

If the tooth is not found, consider complete intrusion of the tooth into underlying alveolar bone.

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