A Tooth For A Tooth - Part 1

1. What is Tooth Avulsion?

Tooth Avulsion is the complete displacement of a tooth from its socket in alveolar bone owing to trauma. The treatment for permanent teeth consists of replantation, immediately if possible.

2. What happens to an avulsed tooth?

  • Periodontal attachment damage
  • Dental pulp necrosis
  • Dental cementum damage

3. What are the critical factors in management of an avulsed tooth?

  • Time interval between injury and treatment
  • Conditions under which the avulsed tooth is stored

4. What are the first aid measures for an avulsed tooth by trauma?

  • Do's
  • Locate the tooth
  • Hold the crown portion of the tooth only
  • Rinse under running tap water
  • Insert tooth back in its original place(socket) and position and gently occlude with gauze
  • Don'ts
  • No scrubbing or scraping while cleansing
  • Do not use soap or alcohol
  • Do not forget to plug the sink while washing under running water

5. If we are not able to position the tooth back in its socket, what is the next step we have to take?

Bring the tooth in a storage medium if not manageable.

6. What are the storage media we can use to bring the tooth?

  • HBSS - Hanks balanced salt solution
  • Milk
  • Saline
  • Contact lens solution
  • Buccal vestibule or under the tongue
  • Unsalted water
  • Saliva
  • In that order of preference.

7. Is there a time period within which I have to reach a dentist?
YES!

  • Within 30 minutes of injury tooth in a storage medium is most ideal
  • Within 20 minutes 'extraoral dry time', is optimal
  • At least within 60 min dry time
  • A dry time of more than 60 minutes, survival of root periodontal ligament is unlikely

8. What if we exceed 60 minutes and not able to carry in a storage medium?

  • Periodontal ligament cells will not survive
  • Endodontic treatment for the tooth is done extra orally
  • Reimplantation is done followed by splinting
  • Tooth gets ankylosed with jaw

9. What if we cannot find the tooth?

  • o be continued.........in "A Tooth for a Tooth - Part 2"
  • Keep smiling till then :)

Article by Dr. Rakesh. U., BDS.,
Dental Surgeon
Kauvery Hospital, Chennai

References: 1. Pediatric dentistry - Principles and Practice, by MS Muthu, N. Sivakumar.

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