Dentists should always be prepared to give appropriate advice to public about first aid for avulsed teeth. An avulsed permanent tooth is one of the few real emergency situations in dentistry.
If a tooth is avulsed, make sure it is a permanent tooth (primary teeth should not be replanted).
- Keep the patient very calm and reassure him or her.
- Find the tooth and pick it up by the crown (the white part). Avoid touching the root.
- If the tooth is dirty, wash it briefly (10 seconds) under cold running water and reposition it. Try to encourage the patient / parent to replant the tooth. Bite on a handkerchief to hold it in position.
- If this is not possible, place the tooth in a suitable storage medium, e.g. a glass of milk or a special storage media for avulsed teeth if available (e.g. Hanks balanced storage medium or saline). The tooth can also be transported in the mouth, keeping it between the molars and the inside of the cheek. If the patient is very young, he/she could swallow the tooth- therefore it is advisable to get the patient to spit in a container and place the tooth in it. Avoid storage in water!
- Seek emergency dental treatment immediately.
Careful follow-up is required and good communication is necessary to ensure the patient and guardian of likely outcome and complications too.Never tell the patient the treatment is going to be hundred percent successful.Many a time good dental treatment in such cases do not give desired results.
- 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). 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.
- Emergency dental care
Tooth preparation: Handle the tooth by the crown and rinse with normal saline.
Hold tooth firmly in socket for 5 mins - 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.
Patient instructions
- Avoid contact sports.
- One should have soft food for up to 2 weeks.
- Brush teeth with a soft toothbrush after each meal.
- Use a chlorhexidine (0.1%) mouth rinse twice a day for 1 week.
- Whatever the cause of avulsion of tooth its wise to see a dentist immediately and seek timely dental treatment for it.
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