What is the optimal therapy for a patient with avulsed teeth and oral bleeding after being struck in the mouth by a hockey stick?

From the Guidelines

The optimal therapy for a patient with avulsed teeth and oral bleeding after a hockey stick injury requires immediate action, with the most critical step being to control the bleeding and handle the avulsed tooth by the crown, rinsing it gently with saline or milk, and attempting reimplantation within 30 minutes if possible, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.

To manage the avulsed tooth, it is essential to:

• Handle the tooth only by the crown, never the root
• Rinse the tooth gently with saline or milk without scrubbing
• Attempt reimplantation within 30 minutes if possible
• If reimplantation isn't immediately feasible, store the tooth in milk, saline, or saliva (under the tongue) while seeking emergency dental care

For oral bleeding, apply direct pressure with gauze or clean cloth to the affected areas. The patient should receive prompt dental evaluation, as successful reimplantation rates decrease significantly after 30 minutes.

Antibiotics such as amoxicillin 500mg three times daily for 7 days may be prescribed to prevent infection, as suggested by previous guidelines 1. Pain management with acetaminophen or ibuprofen is appropriate. Tetanus prophylaxis should be administered if the patient's immunization status is outdated. Soft diet recommendations and careful oral hygiene instructions are essential during healing.

Quick action is critical because the periodontal ligament cells begin to die rapidly after avulsion, significantly reducing the chance of successful reimplantation and tooth survival. The most recent guidelines from 2024 1 prioritize immediate action and proper handling of the avulsed tooth to optimize outcomes.

From the Research

Optimal Therapy for Avulsed Teeth and Oral Bleeding

The optimal therapy for a patient with avulsed teeth and oral bleeding after being struck in the mouth by a hockey stick involves immediate and appropriate emergency management and treatment.

• Replantation of the avulsed tooth is the treatment of choice, but it cannot always be carried out immediately 2.
• If replantation is not practical, the tooth should be stored in a suitable medium to maintain cell viability, with Hank's Balanced Salt Solution (HBSS), milk, saline, and saliva being preferred storage media 3, 4.
• The tooth should be replanted as soon as possible, with extraoral dry time being a critical factor in determining the prognosis of the tooth 3.
• Endodontic treatment may be necessary, and the use of antiresorptive-regenerative therapy (ART) may support functional healing in teeth with a compromised periodontal ligament 5.
• The patient should be administered systemic antibiotics, such as penicillin V potassium, and chlorhexidine rinses should be used to promote oral hygiene 3.
• A semirigid splint should be used for 7 to 10 days to stabilize the tooth, and the patient should be followed up regularly to monitor the healing process 3.

Management of Oral Bleeding

• Oral bleeding should be controlled with gauze or other hemostatic agents 3.
• The patient should be monitored for signs of infection or other complications, such as swelling, pain, or difficulty swallowing 3.
• The use of analgesics and other medications may be necessary to manage pain and promote healing 3.

Prevention of Future Injuries

• The use of mouthguards, such as custom or boil-and-bite mouthguards, can help prevent oral and dental injuries in athletes participating in high-risk sports like hockey 6.
• Dental practitioners can play a crucial role in promoting the use of mouthguards and encouraging athletes to wear full-face protection to prevent oral and dental injuries 6.