Dental avulsion

Background

• Dental emergency
• Tooth is completely removed from its socket
• Often associated with alveolar ridge fracture

Diagnosis

• Where is the tooth?
  • It may be intruded, aspirated, swallowed, or embedded in the oral mucosa
  • Consider facial films, CXR
• Additional Injuries?
• Age and head bleed risk?

Differential Diagnosis

Dentoalveolar Injuries

• Dental fracture
• Dental subluxation
• Dental avulsion
• Bleeding dental socket

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

• Scurvy
• Gingival hyperplasia
  • Phenytoin
  • Cyclosporine
  • Nifedipine, Amlodipine
  • Leukemia

Management

1. Adult
   1. Replace avulsed tooth as soon as possible (as long as no alveolar ridge fx, no severe socket injury)
      1. If reimplanted within 1hr 66% chance of good outcome
      2. Rinse (no scrubing!) tooth in saline, suction socket (if necessary), reimplant tooth, bond tooth to neighboring teeth
      3. Manipulate tooth only by the crown
   2. Storage solution (in order of efficacy): Hank's balanced salt solution > Milk > saliva > saline
   3. Penicillin or clindamycin
2. Child
   1. Do not re-implant primary teeth
      1. Increased risk of interference with the eruption of the permanent tooth
   2. Refer to pedodontist for space maintainer

See Also

• Dental Problems

Source

• ER Atlas
• Tintinalli
• UpToDate