Difference between revisions of "Dental avulsion"

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==Management==
 
==Management==
 
===Adult===
 
===Adult===
*Replace avulsed tooth as soon as possible (as long as no alveolar ridge fx, no severe socket injury)
+
*Replace avulsed tooth as soon as possible with local analgesia ± dental block (as long as no alveolar ridge fx, no 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, suction socket (if necessary), reimplant tooth, bond tooth to neighboring teeth
 
**Rinse (no scrubing!) tooth in saline, suction socket (if necessary), reimplant tooth, bond tooth to neighboring teeth
 
**Manipulate tooth only by the crown
 
**Manipulate tooth only by the crown
 
**Avoid touching root to minimize damage to periodontal ligament
 
**Avoid touching root to minimize damage to periodontal ligament
 +
*If extraoral time > 60 min, soak in citric acid/fluoride, then c/s 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 [[clindamycin]]
 
*[[Penicillin]] or [[clindamycin]]

Revision as of 18:44, 17 August 2015

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

Odontogenic Infections

Other

Management

Adult

  • Replace avulsed tooth as soon as possible with local analgesia ± dental block (as long as no alveolar ridge fx, no severe socket injury)
    • If reimplanted within 1hr 66% chance of good outcome
    • Rinse (no scrubing!) tooth in saline, suction socket (if necessary), reimplant tooth, bond tooth to neighboring teeth
    • Manipulate tooth only by the crown
    • Avoid touching root to minimize damage to periodontal ligament
  • If extraoral time > 60 min, soak in citric acid/fluoride, then c/s 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 pedodontist for space maintainer

See Also

Source

  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