What is the appropriate care for an extracted tooth?

Management of an Extracted Tooth

For an extracted tooth, proper care includes placing it in an appropriate storage medium like milk or balanced salt solution if it's a permanent tooth that needs replantation, or proper disposal if replantation is not indicated.

Permanent vs. Primary Teeth Management

Permanent Teeth (Adult Teeth)

• If avulsion occurred (tooth completely knocked out):
  • Immediate replantation is the treatment of choice 1
  • Handle the tooth by the crown only, not the root 1
  • If dirty, rinse briefly (10 seconds) under cold running water 1
  • If immediate replantation isn't possible, store in appropriate medium:
    1. Cold milk (preferred)
    2. Balanced salt solution
    3. Patient's saliva in a container
    4. NEVER store in water as it causes osmotic lysis of root fibroblasts 1, 2
  • Seek immediate dental care for splinting and possible root canal therapy 1

Primary Teeth (Baby Teeth)

• Do NOT replant avulsed primary teeth to avoid damage to developing permanent tooth germ 1
• If the tooth was found, no treatment is indicated 1
• If not found, clinical and radiographic examination should confirm it wasn't intruded 1
• A chest radiograph may be needed if breathing difficulties occur to ensure the tooth wasn't aspirated 1

Handling Extracted Teeth in Clinical/Educational Settings

• Extracted teeth should be considered infectious and handled with universal precautions 1
• For educational purposes, teeth should be:
  1. Cleaned of adherent material by scrubbing with detergent and water or using an ultrasonic cleaner
  2. Stored immersed in sodium hypochlorite solution (household bleach diluted 1:10 with tap water) or other suitable germicide 1
  3. Handled with gloves and appropriate personal protective equipment 1

Post-Extraction Socket Care

• For extraction sites:
  1. Maintain good oral hygiene
  2. Follow a soft diet for 10 days after extraction 1
  3. Restrict sucking on pacifiers or digits if possible 1
  4. Monitor for signs of complications:
     • Gingival swelling
     • Increased mobility of adjacent teeth
     • Parulis (gingival abscess) 1

Antibiotic Use After Extraction

• Routine use of systemic antibiotics for post-extraction care is generally not indicated 1, 3
• A recent randomized controlled trial showed no significant difference in alveolar osteitis, infection, or healing delay between controlled diabetic patients receiving amoxicillin or placebo after simple dental extractions 3
• For avulsed permanent teeth that are replanted, systemic antibiotics are indicated:
  • Doxycycline for children older than 12 years
  • Penicillin for children younger than 12 years
  • Clindamycin for those allergic to penicillin 1

Alveolar Ridge Preservation (If Needed)

• For preservation of the extraction socket:
  1. Extract the tooth atraumatically with maximum preservation of alveolar bone 1
  2. Do not reflect a flap or make releasing incisions to maintain blood supply 1
  3. Consider using L-PRF (Leukocyte and Platelet-Rich Fibrin) plugs or membranes in the extraction socket 1

Common Pitfalls to Avoid

1. Storing avulsed permanent teeth in water - causes cell death and reduces successful replantation
2. Attempting to replant primary teeth - can damage developing permanent tooth buds
3. Handling extracted teeth without proper infection control - extracted teeth should be treated as infectious material
4. Delaying treatment for avulsed permanent teeth - time is critical for successful replantation
5. Unnecessary antibiotic prescription - not routinely needed for simple extractions in healthy patients

Remember that immediate extraction of teeth in the setting of acute infection has shown to be beneficial, resulting in faster resolution of infection, decreased pain, and earlier return of function 4.