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

From the Guidelines

For mouth trauma with an avulsed tooth, immediate action is crucial, and the tooth should be handled by the crown, rinsed gently with a recommended solution, and attempts made to reinsert it into the socket, with storage in Hanks Balanced Salt Solution, oral rehydration salt solutions, propolis, or cling film if reinsertion is not possible, as recommended by the most recent guidelines 1. When dealing with an avulsed tooth, it is essential to prioritize the preservation of the periodontal ligament cells to improve the chances of successful reimplantation.

Key Steps in Management

• Handle the tooth by the crown to avoid damaging the root.
• Rinse the tooth gently with a recommended solution, such as Hanks Balanced Salt Solution, oral rehydration salt solutions, or propolis, without scrubbing, to remove any debris.
• Attempt to reinsert the tooth into the socket immediately, as this is the best chance for successful reimplantation.
• If reinsertion is not possible, store the tooth in a recommended medium, such as Hanks Balanced Salt Solution, oral rehydration salt solutions, propolis, or cling film, to prevent dehydration and preserve the periodontal ligament cells.
• Seek emergency dental care within 30 minutes for the best chance of successful reimplantation, as the time between avulsion and reimplantation is critical, with tooth root cells beginning to die after 15 minutes outside the mouth 1.

Additional Considerations

• Control bleeding by applying gentle pressure with clean gauze.
• Take over-the-counter pain relievers, such as acetaminophen or ibuprofen, for pain management.
• Antibiotics, such as amoxicillin, may be prescribed to prevent infection.
• Soft foods and careful oral hygiene are recommended during healing. It is crucial to note that the most recent guidelines, as outlined in the 2024 American Heart Association and American Red Cross guidelines for first aid, provide the best evidence-based approach for managing an avulsed tooth, and their recommendations should be followed to optimize outcomes 1.

From the Research

Definition and Causes of Mouth Trauma and Avulsed Tooth

• Mouth trauma and avulsed tooth are common dental injuries that can occur due to various reasons such as falls, motor vehicle accidents, sports injuries, and violence 2.
• Avulsions are characterized by complete displacement of the tooth from the socket, and it is considered a dental emergency that requires immediate attention 2, 3, 4.

Treatment of Avulsed Tooth

• Avulsed primary teeth should not be replanted because replantation is associated with a risk of damage to the developing permanent tooth 2.
• Avulsed permanent teeth should be replanted by the first individual capable of doing so, and 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 2, 5, 6.
• 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.
• The treatment prognosis depends on intrinsic and extrinsic factors, such as the extra-alveolar time until reimplantation, storage medium, handling, and periodontal ligament condition of the avulsed tooth, as well as the patient's general health 6, 3, 4.

Guidelines for Management of Avulsed Permanent Teeth

• The International Association of Dental Traumatology (IADT) has developed guidelines for the management of avulsed permanent teeth, which represent the current best evidence and practice based on literature search and expert opinions 3, 4.
• The guidelines provide clinicians with the most widely accepted and scientifically plausible approaches for the immediate or urgent care of avulsed permanent teeth, and their application can maximize the probability of favorable outcomes 4.
• Experienced researchers and clinicians from various specialties and the general dentistry community were included in the working group to develop these guidelines, and they were reviewed and approved by the members of the IADT Board of Directors 3, 4.

Case Reports and Studies

• A case report describes a multidisciplinary and conservative approach carrying out the replantation of an avulsed closed apex central incisor stored in dry conditions for a 16-hour period, and the patient remains asymptomatic with no signs of root resorption or ankylosis of the damaged teeth after one year 5.
• Another case report describes the treatment of an 11-year-old boy who suffered an avulsion of the maxillary right central incisor followed by delayed reimplantation after the tooth was stored in a dry medium for 6 days, and the tooth exhibited clinical function, no mobility or pain symptoms, and mild signs of ankylosis after one year 6.