What is the management for a patient with an avulsed permanent tooth?

Management of an Avulsed Permanent Tooth

For an avulsed permanent tooth, immediate replantation is the treatment of choice, followed by prompt dental care. 1

Immediate Actions

1. Confirm it's a permanent tooth - Primary (baby) teeth should NOT be replanted 1

2. Handle the tooth properly:

   • Hold it by the crown only, not the root 1
   • The root contains fragile fibroblasts essential for reattachment 1

3. Clean the tooth if dirty:

   • Briefly rinse for less than 10 seconds under cold running water 1
   • Do not scrub, brush, or use chemicals on the root 1
   • Take care not to damage the tooth or attached tissue 1

4. Immediate replantation:

   • Attempt to reposition the tooth in its socket immediately 1
   • Have the patient bite on a cloth to hold it in position 1
   • The likelihood of successful reimplantation decreases rapidly with time 1

If Immediate Replantation Is Not Possible

Store the tooth in one of these media (in order of preference):

1. First choice storage media 1:

   • Hanks Balanced Salt Solution
   • Oral rehydration salt solutions
   • Propolis
   • Rice water (if preprepared)
   • Wrap in cling film to prevent dehydration

2. Second choice storage media 1:

   • Cow's milk (cold)
   • Patient's saliva (spit into a container)

3. Third choice storage media 1:

   • Probiotic
   • Egg white
   • Almond milk

4. NEVER store in tap water - causes osmotic lysis of root fibroblasts 1

Seek Immediate Dental Care

• Dental care should be obtained immediately after replantation or proper storage 1
• Bring the tooth if not successfully replanted 1

Follow-up Treatment (by Dentist)

1. Stabilization:

   • A flexible splint will be placed for up to 2 weeks 1

2. Root canal therapy:

   • Most avulsed teeth will require root canal therapy 1
   • Should be instituted within 7-10 days after replantation 1

3. Antibiotics:

   • Systemic antibiotics are indicated after reimplantation 1
   • For children >12 years: doxycycline 1
   • For children <12 years: penicillin 1
   • For penicillin-allergic patients: clindamycin 1

4. Monitoring:

   • The tooth should be monitored for potential bodily rejection (root resorption) 1

Factors Affecting Prognosis

• Extra-alveolar time (time tooth is out of socket) 1, 2
• Storage medium used 1, 2
• Condition of periodontal ligament cells 1
• Maturity of the root 1

Common Pitfalls to Avoid

• Handling the tooth by the root surface 1
• Scrubbing or brushing the tooth 1
• Storing in tap water 1
• Delaying replantation or professional care 1
• Failing to provide appropriate antibiotics after replantation 1
• Not monitoring for root resorption during follow-up 1, 3

Even teeth that may initially seem "hopeless" can often be maintained for many years with proper management, preserving bone and providing function until definitive treatment can be provided 3.