Can a tooth be reimplanted after a traumatic tooth loss if it was found at the bottom of a pool?

Management of Traumatic Tooth Loss Found at the Bottom of a Pool

For a permanent tooth found at the bottom of a pool after traumatic avulsion, immediate replantation should NOT be attempted as the chlorinated pool water likely damaged the periodontal ligament cells, significantly reducing chances of successful reimplantation. 1

Assessment of Tooth Type and Condition

• Primary (baby) teeth: Should NEVER be replanted after avulsion to avoid damage to the underlying permanent tooth germ 1
• Permanent teeth: While normally considered for replantation, a tooth found in pool water presents special considerations:
  • Chlorinated pool water is similar to tap water, which causes osmotic lysis of root fibroblasts 1
  • Pool water is not listed among recommended storage media in the 2024 American Heart Association guidelines 1

Why Pool Water Compromises Reimplantation Success

• Successful reimplantation depends on:
  • Minimizing extra-alveolar dry time
  • Preserving viability of periodontal ligament cells
  • Using appropriate storage media 1
• Pool water (chlorinated) damages periodontal ligament cells similar to tap water, which is explicitly contraindicated for tooth storage 1

Immediate Actions After Finding the Tooth

1. Confirm it's a permanent tooth (primary teeth should not be replanted)
2. Seek immediate dental or medical care
3. Transport the tooth properly:
   • Do NOT store in pool water or tap water
   • If available, place in one of these media (in order of preference):
     • Hanks Balanced Salt Solution
     • Oral rehydration salt solutions
     • Propolis
     • Rice water
     • Cling film (to prevent dehydration)
   • If above options unavailable, use:
     • Cow's milk
     • Patient's saliva
   • Last resort options:
     • Probiotic solution
     • Egg white
     • Almond milk 1

Follow-up Care

• Immediate dental evaluation is essential
• If reimplantation is attempted by a dentist:
  • A flexible splint will need to be placed for up to 2 weeks
  • Root canal therapy will likely be needed within 7-10 days
  • Systemic antibiotics are indicated (doxycycline for children >12 years; penicillin for children <12 years; clindamycin for penicillin-allergic patients) 1
• Monitor for potential complications:
  • Root resorption
  • Pulpal necrosis
  • Ankylosis 1

Long-term Considerations

• If the tooth cannot be saved, future replacement options include:
  • For growing individuals: Temporary prosthesis until growth completion
  • For adults: Dental implant, fixed bridge, or removable prosthesis 2, 3
• Dental implants should not be placed in growing individuals due to risk of infraposition 2

Remember that the prognosis for a tooth found in pool water is generally poor due to damage to the periodontal ligament cells, but proper emergency management can maximize whatever chance remains for tooth survival.