Dental avulsion: Difference between revisions
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*Often associated with alveolar ridge fracture | *Often associated with alveolar ridge fracture | ||
== | ==Clinical Features== | ||
* | *Tooth missing from socket | ||
* | *History of recent trauma | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Template:Dental Problems DDX}} | {{Template:Dental Problems DDX}} | ||
==Diagnosis== | |||
===Work-up=== | |||
*Consider facial films, abdominal films, or CXR if possibility of tooth aspiration or ingestion | |||
===Evaluation=== | |||
*Clinical diagnosis | |||
==Management== | ==Management== | ||
===Adult=== | ===Adult=== | ||
*Replace avulsed tooth as soon as possible with local analgesia ± dental block (as long as no alveolar ridge fx | *Replace avulsed tooth as soon as possible with local analgesia ± dental block (as long as no alveolar ridge fx or severe socket injury) | ||
**If reimplanted within 1hr 66% chance of good outcome | **If reimplanted within 1hr 66% chance of good outcome | ||
**Rinse (no scrubing!) tooth in saline | **Rinse (no scrubing!) tooth in saline | ||
**Manipulate tooth only by the crown | **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 | *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 | ||
*[[Penicillin]] or [[ | *[[Penicillin]] or [[Clindamycin]] | ||
===Child=== | ===Child=== | ||
*Do not re-implant primary teeth | *Do not re-implant primary teeth | ||
**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 | *Refer to pediatric dentist for space maintainer | ||
==Disposition== | |||
*Discharge with dental follow-up. | |||
==See Also== | ==See Also== | ||
*[[Dental Problems]] | *[[Dental Problems]] | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:ENT]] | [[Category:ENT]] | ||
Revision as of 01:59, 18 August 2015
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
Diagnosis
Work-up
- Consider facial films, abdominal films, or CXR if possibility of tooth aspiration or ingestion
Evaluation
- Clinical diagnosis
Management
Adult
- Replace avulsed tooth as soon as possible with local analgesia ± dental block (as long as no alveolar ridge fx 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
- Penicillin or Clindamycin
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
Disposition
- Discharge with dental follow-up.
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