What is the initial treatment for dental trauma with an avulsed (tooth that has been completely displaced from its socket) tooth?

From the Guidelines

The initial treatment for trauma to the mouth and an avulsed tooth should involve immediate replantation of the tooth in the socket, or if not possible, storage in a suitable medium such as Hanks Balanced Salt Solution, oral rehydration salt solutions, propolis, or rice water, while seeking dental or medical care immediately. When a permanent tooth becomes avulsed, the first step is to remove visible debris from the tooth by brief rinsing (<10 seconds) with care not to damage the tooth or attached tissue, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.

Key Considerations

• Handle the tooth only by the crown to preserve the periodontal ligament cells.
• Gently rinse the tooth without scrubbing or using chemicals.
• Replant the tooth back into its socket as soon as possible, ideally within minutes, to improve prognosis.
• If immediate replantation isn't possible, consider storage mediums like Hanks Balanced Salt Solution, oral rehydration salt solutions, propolis, or rice water, or as alternatives, cow’s milk, saliva, probiotic, egg white, or almond milk if the preferred options are not available 1.
• Avoid storing the tooth in tap water, as it is not recommended 1.

Additional Care

• Control bleeding by applying gentle pressure with gauze.
• For pain management, recommend over-the-counter pain relievers such as acetaminophen or ibuprofen at appropriate doses.
• The patient should seek emergency dental care immediately, even after successful replantation, for further evaluation and treatment, including stabilization of the tooth with a splint for a period of time.

From the Research

Initial Treatment for Trauma to Mouth and Avulsed Tooth

• The initial treatment for trauma to the mouth and an avulsed tooth involves prompt action to increase the chances of successful replantation and tooth survival 2, 3, 4.
• Avulsed permanent teeth are considered a dental emergency and should be replanted by the first individual capable of doing so 2.
• If immediate replantation is not possible, the tooth should be stored in cold animal or human milk, or in the mouth, adjacent to the buccal mucosa, if the patient is capable of doing so 2, 3.
• Water should be avoided as a storage medium because it impedes healing of the periodontal ligament, but storage in water is superior to dry storage 2.

Storage and Replantation

• The preferred storage medium for avulsed teeth is milk 3, 4.
• The tooth should be reimplanted at the site of the accident if possible 3.
• Conditioning the roots of teeth that have been avulsed is recommended 3.
• For teeth that have not finished development, the preferred treatment is to allow the continued development of the root 3.

Importance of Prompt Treatment

• Avulsed frontal teeth often cannot be saved because of improper or lack of initial treatment, resulting in a need for multiple interventions over the patient's lifetime 4.
• Timely treatment of injured anterior teeth prevents much further damage and expensive treatment for the affected young patients 4.
• The estimated prevalence of anterior dental trauma in children and adolescents ranges from 6.4% to 37.9% 4.

Use of Antibiotics and Other Interventions

• There is insufficient evidence to support or refute the effectiveness of different interventions for avulsed and replanted permanent front teeth, including the use of antibiotics 5, 6.
• The overall quality of existing evidence is very low, and therefore great caution should be exercised when generalising the results of the included trials 5.
• Currently, there is no high-quality evidence to support the use of systemic antibiotics at replantation of avulsed permanent teeth in medically fit patients 6.