Difference between revisions of "Dental avulsion"

(Evaluation: clinical edits)
(Management)
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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}}
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| align="center" style="background:#f0f0f0;"|'''Storage Medium'''
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| 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

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

  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
  3. Rosen’s Emergency Medicine: Concepts and Clinical Practice, 9th edition, Ron M. Walls, Robert S. Hockberger, Marianne