Difference between revisions of "Dental avulsion"
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==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 scrubing!) tooth in saline | **Rinse (no scrubing!) tooth in saline | ||
Revision as of 05:09, 3 July 2016
Contents
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
- 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
Diagnosis
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
- Penicillin or Clindamycin
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.
See Also
References
- ↑ 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