Difference between revisions of "Dental avulsion"

(Disposition)
(Management: emphasis)
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*Replace avulsed tooth as soon as possible with local analgesia ± dental block (as long as no alveolar ridge fracture or severe socket injury)
 
*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
 
**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 (Avoid touching root to minimize damage to periodontal ligament)
+
**Manipulate tooth '''only by the crown''' (Avoid touching root to minimize damage to periodontal ligament)
 
**Bond tooth to adjacent teeth
 
**Bond tooth to adjacent teeth
 
*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 (helps periodontal ligaments heal)
 
*[[Penicillin]] '''OR''' [[Clindamycin]] are alternatives
 
*[[Penicillin]] '''OR''' [[Clindamycin]] are alternatives

Revision as of 15:39, 8 June 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

Other

Evaluation

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 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 (helps periodontal ligaments heal)
  • Penicillin OR Clindamycin are alternatives

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 on liquid diet.

See Also

References

  1. 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.
  2. 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