What is the appropriate care for an extracted tooth?

Management of an Extracted Tooth

For an extracted tooth, the appropriate care depends on whether it's a permanent or primary tooth, with permanent teeth requiring immediate replantation if avulsed, while primary teeth should never be replanted. 1

Permanent Tooth Avulsion (Emergency)

Immediate Actions

• Handle the tooth by the crown only, never touch the root 1
• If dirty, rinse briefly (10 seconds) under cold running water 1
• Replant the tooth immediately at the site if possible 1
• Have patient bite on cloth to hold it in position until reaching dental care 1

If Immediate Replantation Not Possible

• Store in appropriate medium (in order of preference):
  1. Cold milk
  2. Balanced salt solution
  3. Patient's saliva (collected in container)
  4. Never store in water as it causes osmotic lysis of root fibroblasts 1
• Seek immediate dental care for professional replantation 1

Post-Replantation Care

• A flexible splint will be placed for up to 2 weeks 1
• Root canal therapy typically needed within 7-10 days 1
• Systemic antibiotics indicated:
  • For children >12 years: doxycycline
  • For children <12 years: penicillin
  • For penicillin-allergic patients: clindamycin 1

Primary Tooth Avulsion

• Primary teeth should never be replanted to avoid damage to developing permanent tooth germ 1
• If tooth not found, clinical and radiographic examination needed to confirm it's not intruded 1
• Consider chest radiograph if breathing difficulties present to rule out aspiration 1

Extracted Tooth Handling in Educational Settings

• Extracted teeth should be considered infectious and handled with universal precautions 1
• Clean teeth of adherent material by scrubbing with detergent and water or ultrasonic cleaner 1
• Store in sodium hypochlorite solution (household bleach diluted 1:10) or appropriate germicide 1
• Wear gloves when handling extracted teeth and use additional PPE if splatter anticipated 1

Extraction Socket Management

For Nearly Intact Extraction Sockets

1. Extract tooth atraumatically with maximum preservation of alveolar bone 2
2. Avoid reflecting flaps or making releasing incisions to maintain blood supply 2
3. Consider socket preservation techniques if indicated:
   • L-PRF (Leukocyte and Platelet-Rich Fibrin) plugs can be used to fill extraction sockets 1
   • Compress firmly with a graft condenser and absorb surplus exudate 1
   • Cover socket with L-PRF membranes to seal the entrance 1

Post-Extraction Care

• Soft diet for 10 days after extraction 1
• Restrict pacifier or digit sucking if possible 1
• Delay chlorhexidine use until day 3-5 to avoid interfering with early soft tissue healing 1
• Routine use of systemic antibiotics is not indicated unless medically necessary 1, 3

Special Considerations

Diabetic Patients

• Recent evidence suggests antibiotics may not be necessary for controlled Type 2 diabetic patients undergoing simple extractions 3
• No significant difference in alveolar osteitis, infection, or healing delay between antibiotic and placebo groups 3

Acute Infection

• Immediate extraction of teeth in the setting of acute infection is beneficial 4
• Results in faster resolution of infection, decreased pain, and earlier return of function 4
• Risk of seeding infection into deeper spaces by immediate extraction is low 4

Potential Complications to Monitor

• Crown discoloration, pulp canal obliteration, or pulpal necrosis 1
• Gingival swelling, increased mobility, or parulis (gingival abscess) 1
• Alveolar bone loss 2
• Damage to adjacent structures 2

Remember that the management approach should prioritize preservation of alveolar bone and soft tissue for optimal healing and future restoration options if needed.