Trauma--The Avulsed Tooth
Summer is here, school is out, kids are in camp, accidents will happen. A brief review is most appropriate during this season.
- The Oral Surgeon is frequently required to replace teeth that have been partially or completely avulsed. The success of these procedures depends in large part upon the timing of treatment.
- Partially avulsed teeth should be properly positioned and stabilized. To avoid unnecessary tissue damage, surgical intervention is kept to a minimum. Gingival lacerations are sutured, and the alveolar bone is remodeled around the tooth with digital pressure. Intruded teeth are brought back to their proper position, as are teeth that have been extruded. If partially avulsed teeth are stable, they may not require any splinting. When stabilization is required, rigid fixation should be avoided; periodontal packing or acid-etched resin splinting is recommended.
- The prognosis for avulsed teeth is indirectly proportional to the time that the tooth is out of the socket. Teeth replaced within 30 minutes have the best prognosis for long-term success without root resorption.
Avulsed teeth are managed as follows:
- STORAGE: The best recommendation is for the lost tooth to be immediately replaced in its socket. When this is not possible, the tooth should be placed in the buccal sulcus while the patient is transported to the office. Since it may not be a good idea for young child to hold an avulsed tooth in his or her mouth, in these cases the tooth should be transported in milk or tap water.
- ROOT CLEANING: The tooth should be handled by the crown, not the root. The root should not be touched before review unless there is dirt or debris on it, in which case it may be gently rinsed with saline and the debris removed with cotton pliers. The root should not be scraped, brushed, or cleaned with medicines or chemicals of any kind.
- THE SOCKET: The socket should be left alone unless it contains dirt, debris, or a blood clot, in which case it should be gently irrigated and suctioned. The tooth is replanted in the socket, and the socket manually compressed.
- SPLINTING: The tooth is splinted with acid-etched resin with or without an arch wire. In some cases it van be stabilized with sutures over the occlusal surface. It should remain splinted for a least 7-10 days with the patient ingesting a soft diet.
- ENDODONTIC THERAPY: A tooth with an open apex will usually reestablish its blood flow and remain vital. A replanted tooth should be followed closely and, if signs of pulpal disease develop, the pulp extirpated and the canals filled with calcium hydroxide. A tooth whose apex is closed will usually not remain vital, and its pulp should be extirpated within 2 weeks after review. The canals are filled with calcium hydroxide, which should be removed and replaced every 3-4 months; after 1-2 years a permanent root filling(e.g., gutta-percha)can be inserted. However, such therapy should never be started while the tooth is out of the mouth and socket, for this wastes time during which the tooth could be returned to the mouth.
- ANTIBIOTICS: A patient should be given antibiotics for 1 week after treatment and tetanus toxoid as necessary by the history.
Gerald S. Fine, D.D.S.
Practice limited to oral & maxillofacial surgery