Re-implanting avulsed teeth in 6 easy steps

11 Dec

Avulsion= total displacement of tooth from its socket dental1

 

This is a dental emergency as the periodontal ligament may become necrosed and will be unable to heal to normally attach.  The tooth will then not be viable.

 

Success rate of re-implantation decreases by ~1% every minute the tooth is out.  There is a ~85-97% chance of success if the tooth is re-implanted within 5 minutes.  If interval is >30 minutes, success rate is <20%. 

 

Which teeth you should NOT re-implant: primary teeth and avulsed teeth with gross caries or fractures

 

Also, beware that teeth that are not fixed in place are an aspiration risk.  Do not re-implant teeth in an altered, supine, high risk patient who you cannot splint.

 

Basic steps:

1.  Prepare tooth.  If tooth has been in Tooth saver solution/milk/other appropriate storage medium, simply rinse the tooth with saline.  Be sure to only hold the tooth by the crown as to avoid damaging the periodontal fibers.  If the tooth has been transported dry, soak the tooth in 2% stannous fluoride solution if available for 20 minutes (or Tooth Saver/Hank’s solution if fluoride is unavailable). 

 

2. Gently remove clots from socket and gently irrigate with NS. dental2

 

3. With gentle pressure, re-insert the tooth into the socket.  You may perform a peri-apical block for anesthesia if needed.

 

4. Splint tooth

*Dentistry may be able to place wire in the ED (they have splinted avulsed teeth for 2 of my pts at UVA)

*Some ED’s have dental splint supplies (I do not think we do)

*One option relayed to me by an OSH attending is using dermabond and the metal clip from the respirator mask as a makeshift dental splint

*On online blogs, some people have used Blu-tac or aluminum foil to mold to the teeth, but this makes me somewhat uneasy if the patient is sleeping with this in before their dentistry appointment…

 

5. Obtain periapical x-rays to verify position. You may need other views if you are suspicious for fractures.

 

6. Aftercare:

*Antibiotics-Doxycycline 100 mg PO BID x 7 days or Penicillin V QID x7 days

*Chlorhexidine rinse BID x 7 days

*Tetanus booster if needed

 

7. Follow up with dentistry as soon as possible

 

Submitted by H. Groth.

 

SourcesAO Foundation of Dentoalveolar Trauma websiteMcIntyre J, Lee J, Trope M, Vann WJ, Permanent tooth replantation following avulsion: Using a decision tree to achieve the best outcome. Pediatr Dent 2009;31(2):137-44.; Tintinalli’s Emergency Medicine

 

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