Difference between revisions of "Dental avulsion"
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==Background== | ==Background== | ||
| − | *Dental emergency | + | *Dental emergency; for every minute that a permanent tooth remains out of the socket, the chance of successful reimplantation goes down by 1% <ref>Amsterdam JT. Oral medicine. In: Marx JA, Hockberger RS, Walls RM, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 8th ed. St. Louis, MO: Mosby, Inc. 2014; (Ch) 70:895–908.</ref> |
*Tooth is completely removed from its socket | *Tooth is completely removed from its socket | ||
*Often associated with alveolar ridge fracture | *Often associated with alveolar ridge fracture | ||
==Clinical Features== | ==Clinical Features== | ||
| + | [[File:PMC4355813 CRID2015-197202.006.png|thumb|Avulsion of the right upper incisor.]] | ||
| + | [[File:PMC3214533 CCD-2-226-g003.png|thumb|Avulsed tooth]] | ||
*Tooth missing from socket | *Tooth missing from socket | ||
*History of recent trauma | *History of recent trauma | ||
| Line 11: | Line 13: | ||
{{Template:Dental Problems DDX}} | {{Template:Dental Problems DDX}} | ||
| − | == | + | ==Evaluation== |
===Work-up=== | ===Work-up=== | ||
*Consider facial films, abdominal films, or CXR if possibility of tooth aspiration or ingestion | *Consider facial films, abdominal films, or CXR if possibility of tooth aspiration or ingestion | ||
===Evaluation=== | ===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== | ==Management== | ||
===Adult=== | ===Adult=== | ||
| − | *Replace avulsed tooth as soon as possible with local analgesia ± dental block (as long as no alveolar ridge | + | *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 | + | **Rinse ('''no scrubbing'''!) 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) |
| − | ** | + | **Splint tooth with 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 | + | *Storage solution (in order of efficacy): '''Hank's Balanced Salt Solution''' > '''Milk''' > saliva > saline |
| − | *[[Penicillin]] | + | *[[Doxycycline]] 100mg PO BID x 1week (helps periodontal ligaments heal) |
| + | *[[Penicillin]] '''OR''' [[Clindamycin]] are alternatives, especially in pediatrics | ||
| + | *[[Tetanus prophylaxis|Tetanus]] update | ||
===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 pediatric dentist for space maintainer | + | *Refer to pediatric dentist for space maintainer within 1-2 weeks.<ref>Benko, K. Acute Dental Emergencies in EM. EM Practice. 2003, 5(5)</ref> |
| + | ===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 Gausche-Hill, et al. Oral Medicine. Copyright 2017</ref>=== | ||
| + | {| {{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== | ||
| − | *Discharge with dental follow-up | + | *Discharge with dental follow-up on liquid diet |
| + | *Should be seen within 24-48 hours as splint only lasts up to 48 hours | ||
==See Also== | ==See Also== | ||
| Line 43: | Line 67: | ||
<references/> | <references/> | ||
| − | [[Category:ENT]] | + | [[Category:ENT]] [[category:Trauma]] |
Latest revision as of 20:34, 22 October 2019
Contents
Background
- Dental emergency; for every minute that a permanent tooth remains out of the socket, the chance of successful reimplantation goes down by 1% [1]
- 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
- Acute necrotizing ulcerative gingivitis (trench mouth)
- Dental caries (pulpitis)
- Ludwig's angina
- Periapical abscess
- Pericoronitis
- Periodontal abscess
- 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 scrubbing!) tooth in saline
- Manipulate tooth only by the crown (Avoid touching root to minimize damage to periodontal ligament)
- Splint tooth with adjacent teeth
- If extraoral time > 60 min, soak in citric acid/fluoride and consult dentist[2]
- 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
- Tetanus update
Child
- Do not re-implant primary teeth
- Increased risk of interference with the eruption of the permanent tooth[3]
- Refer to pediatric dentist for space maintainer within 1-2 weeks.[4]
Length of Periodontal Ligament Cell Viability Based On Storage Medium [5]
| 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
- Should be seen within 24-48 hours as splint only lasts up to 48 hours
See Also
References
- ↑ Amsterdam JT. Oral medicine. In: Marx JA, Hockberger RS, Walls RM, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 8th ed. St. Louis, MO: Mosby, Inc. 2014; (Ch) 70:895–908.
- ↑ 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
- ↑ Benko, K. Acute Dental Emergencies in EM. EM Practice. 2003, 5(5)
- ↑ Rosen’s Emergency Medicine: Concepts and Clinical Practice, 9th edition, Ron M. Walls, Robert S. Hockberger, Marianne Gausche-Hill, et al. Oral Medicine. Copyright 2017