Dental avulsion
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 (dry socket)
- Acute necrotizing ulcerative gingivitis (trench mouth)
- Dental abscess
- Periapical abscess
- Periodontal abscess
- Ludwig's angina
- Pulpitis (dental caries)
- Pericoronitis
- 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 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 (helps periodontal ligaments heal)
- Penicillin OR Clindamycin are alternatives
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 on liquid diet.
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