Dental avulsion: Difference between revisions
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*If extraoral time > 60 min, soak in citric acid/fluoride and consult dentist<ref>Mayersak, RJ. Facial trauma, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 42: 368-81.</ref> | *If extraoral time > 60 min, soak in citric acid/fluoride and consult dentist<ref>Mayersak, RJ. Facial trauma, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 42: 368-81.</ref> | ||
*Storage solution (in order of efficacy): '''Hank's Balanced Salt Solution''' > '''Milk''' > saliva > saline | *Storage solution (in order of efficacy): '''Hank's Balanced Salt Solution''' > '''Milk''' > saliva > saline | ||
*Doxycycline (helps periodontal ligaments heal) | *[[Doxycycline]] 100mg PO BID x 1week (helps periodontal ligaments heal) | ||
*[[Penicillin]] '''OR''' [[Clindamycin]] are alternatives | *[[Penicillin]] '''OR''' [[Clindamycin]] are alternatives, especially in pediatrics | ||
===Child=== | ===Child=== | ||
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**Increased risk of interference with the eruption of the permanent tooth<ref>Amsterdam JT: Oral Medicine, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 68:p 853-856</ref> | **Increased risk of interference with the eruption of the permanent tooth<ref>Amsterdam JT: Oral Medicine, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 68:p 853-856</ref> | ||
*Refer to pediatric dentist for space maintainer | *Refer to pediatric dentist for space maintainer | ||
===Length of Periodontal Ligament Cell Viability, Based On Storage Medium=== <ref>Rosen’s Emergency Medicine: Concepts and Clinical | |||
Practice, 9th edition, Ron M. Walls, Robert S. Hockberger, Marianne</ref> | |||
Gausche-Hill, et al. Oral Medicine. Copyright 2017 | |||
{| {{table}} | |||
| align="center" style="background:#f0f0f0;"|'''Storage Medium''' | |||
| align="center" style="background:#f0f0f0;"|'''Length of Periodontal Ligament Viability''' | |||
|- | |||
| Dry (no storage medium)||< 60 minutes | |||
|- | |||
| Milk||3 to 8 hours | |||
|- | |||
| Oral rehydration solution||12 to 24 hours | |||
|- | |||
| Hanks’ balanced salt solution||12 to 24 hours | |||
|} | |||
==Disposition== | ==Disposition== | ||
Revision as of 00:45, 19 July 2017
Background
- Dental emergency
- Tooth is completely removed from its socket
- Often associated with alveolar ridge fracture
Clinical Features
- Tooth missing from socket
- History of recent trauma
Differential Diagnosis
Dentoalveolar Injuries
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
Evaluation
Work-up
- Consider facial films, abdominal films, or CXR if possibility of tooth aspiration or ingestion
Evaluation
- Determine when avulsion occurred and what storage solution used
- If re-implanting, best viability with immediate storage in Hank's Balanced Salt Solution, worst viability without any storage medium
- Account for all teeth
- Aspiration or swallowed
- Rule out fragments in lacerations/oropharyngeal space, or significant intrusive luxation/impaction
- Determine if tooth is primary or secondary
- Tetanus status
Management
Adult
- Replace avulsed tooth as soon as possible with local analgesia ± dental block (as long as no alveolar ridge fracture or severe socket injury)
- If reimplanted within 1hr 66% chance of good outcome
- Rinse (no scrubing!) tooth in saline
- Manipulate tooth only by the crown (Avoid touching root to minimize damage to periodontal ligament)
- Bond tooth to adjacent teeth
- If extraoral time > 60 min, soak in citric acid/fluoride and consult dentist[1]
- Storage solution (in order of efficacy): Hank's Balanced Salt Solution > Milk > saliva > saline
- Doxycycline 100mg PO BID x 1week (helps periodontal ligaments heal)
- Penicillin OR Clindamycin are alternatives, especially in pediatrics
Child
- Do not re-implant primary teeth
- Increased risk of interference with the eruption of the permanent tooth[2]
- Refer to pediatric dentist for space maintainer
===Length of Periodontal Ligament Cell Viability, Based On Storage Medium=== [3] Gausche-Hill, et al. Oral Medicine. Copyright 2017
| Storage Medium | Length of Periodontal Ligament Viability |
| Dry (no storage medium) | < 60 minutes |
| Milk | 3 to 8 hours |
| Oral rehydration solution | 12 to 24 hours |
| Hanks’ balanced salt solution | 12 to 24 hours |
Disposition
- Discharge with dental follow-up on liquid diet.
See Also
References
- ↑ Mayersak, RJ. Facial trauma, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 42: 368-81.
- ↑ Amsterdam JT: Oral Medicine, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 68:p 853-856
- ↑ Rosen’s Emergency Medicine: Concepts and Clinical Practice, 9th edition, Ron M. Walls, Robert S. Hockberger, Marianne