What is the emergency treatment for an adult with a traumatically avulsed tooth?

Emergency Treatment for Traumatically Avulsed Permanent Tooth

Immediate replantation of the avulsed tooth is the treatment of choice for the best prognosis, followed by seeking immediate dental care. 1

Immediate Actions

1. Handle the tooth by the crown only (not the root) to preserve the fragile fibroblasts on the root surface that are critical for reattachment 1

2. Briefly rinse the tooth if dirty (less than 10 seconds) under cold running water, taking care not to damage the tooth or attached tissue 1

3. Attempt immediate replantation of the tooth back into its socket 1

   • Have the person bite on a cloth to hold the tooth in position
   • Confirm it's a permanent tooth (primary teeth should NOT be replanted)

4. Seek immediate dental care whether the tooth is successfully replanted or not 1

If Immediate Replantation Is Not Possible

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

First Choice Options:

• Hanks Balanced Salt Solution (HBSS)
• Oral rehydration salt solutions
• Propolis (0.04 mg to 2.5 mg per mL 0.4% ethanol)
• Rice water (if pre-prepared)
• Cling film (wrap the tooth to prevent dehydration) 1

Second Choice Options (if above not available):

• Cow's milk (any percent fat) 1, 2
• Patient's saliva (have patient drool into a container) 1

Third Choice Options (if above not available):

• Probiotic
• Egg white
• Almond milk 1

Never Use:

• Tap water (causes osmotic lysis of root fibroblasts) 1
• Buttermilk
• Castor oil
• Turmeric extract 1

Post-Replantation Care

1. Immediate dental referral for professional stabilization with a flexible splint 1

2. Antibiotics are indicated after reimplantation:

   • For patients >12 years: doxycycline
   • For patients <12 years: penicillin
   • For penicillin-allergic patients: clindamycin 1

3. Root canal therapy will likely be needed within 7-10 days after replantation 1

Key Factors Affecting Prognosis

• Extra-alveolar time - The likelihood of successful reimplantation decreases rapidly the longer the tooth remains out of the socket 1
• Storage medium - Proper storage medium preserves periodontal ligament cell viability 1, 2
• Handling technique - Touching the root surface can damage critical fibroblasts 1

Common Pitfalls to Avoid

• Handling the tooth by the root instead of the crown
• Scrubbing or excessive cleaning of the tooth
• Delayed replantation without proper storage medium
• Storing the tooth in tap water
• Failing to seek immediate dental care after replantation
• Attempting to replant primary (baby) teeth 1

The success of replantation depends significantly on minimizing the time the tooth is out of its socket and proper handling and storage during that time. Even with optimal emergency management, follow-up dental care is essential for long-term tooth survival.