Dental avulsion

Background

1. Dental emergency
2. Often associated with alveolar ridge fracture

Diagnosis

1. Where is the tooth?
   1. May be intruded, aspirated, swallowed, or embedded in the oral mucosa
      1. Consider facial films, CXR

Differential Diagnosis

Dentoalveolar Injuries

• Dental fracture
• Dental subluxation
• Dental avulsion
• Bleeding dental socket

Odontogenic Infections

• Acute alveolar osteitis (dry socket)
• Acute necrotizing ulcerative gingivitis (trench mouth)
• Dental abscess
  • Periapical abscess
  • Periodontal abscess
• Ludwig's angina
• Pulpitis (dental caries)
• Pericoronitis
• Peritonsillar abscess (PTA)
• Retropharyngeal abscess
• Vincent's angina - tonsillitis and pharyngitis

Other

• Scurvy
• Gingival hyperplasia
  • Phenytoin
  • Cyclosporine
  • Nifedipine, Amlodipine
  • Leukemia

Management

1. Adult
   1. Replace avulsed tooth as soon as possible (as long as no alveolar ridge fx, no severe socket injury)
      1. If reimplanted within 1hr 66% chance of good outcome
      2. Rinse tooth in saline, suction socket (if necessary), reimplant tooth, bond tooth to neighboring teeth
      3. Manipulate tooth only by the crown
   2. Storage solution (in order of efficacy): Hank's balanced salt solution > Milk > saliva > saline
   3. Penicillin or clindamycin
2. Child
   1. Do not reimplant primary teeth
      1. Refer to pedodontist for space maintainer

See Also

• Dental Problems

Source

• ER Atlas
• Tintinalli
• UpToDate