From the Guidelines
Yes, a tooth that has been avulsed can be saved through prompt action, with the best chance of successful reimplantation if it is replanted immediately or stored in a suitable medium and received emergency dental care within 30 minutes. The key to saving an avulsed tooth is to handle it carefully, avoiding touching the root, and to keep the periodontal ligament cells alive by storing the tooth in a medium that preserves their viability, such as Hanks Balanced Salt Solution, oral rehydration salt solutions, propolis, or rice water, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.
When an avulsed tooth cannot be immediately replanted, it is crucial to store it in an appropriate solution to maintain the viability of the periodontal ligament cells. According to the guidelines, storage in Hanks Balanced Salt Solution, oral rehydration salt solutions, propolis, rice water, or cling wrap has demonstrated improved periodontal ligament cell viability compared to storage in cow’s milk 1.
The following steps can be taken to save an avulsed tooth:
- Immediately recover the tooth, handling it only by the crown
- Gently rinse the tooth with a suitable solution if it's dirty, taking care not to damage the tooth or attached tissue
- Attempt to replant the tooth in the socket, facing the correct way
- If reinsertion isn't possible, store the tooth in a recommended medium, such as Hanks Balanced Salt Solution or oral rehydration salt solutions
- Seek emergency dental care within 30 minutes, as this timeframe offers the best chance for successful reimplantation, as emphasized by the 2024 guidelines 1.
It is essential to note that the likelihood of successful reimplantation decreases rapidly as the time the tooth remains out of the socket increases, particularly if the periosteal ligament dies or is injured, highlighting the importance of prompt action and proper storage 1. The dentist will likely splint the tooth to adjacent teeth for stability and may prescribe antibiotics to prevent infection, further improving the chances of tooth survival.
In making these recommendations, it is recognized that survival of an avulsed tooth requires replantation as soon as possible, but this procedure may not be possible in the first aid setting, underscoring the value of temporary storage solutions in aiding tooth survival until professional care can be received 1.
From the Research
Avulsed Tooth Management
- An avulsed tooth can be saved if replanted promptly and properly 2, 3, 4
- Avulsed primary teeth should not be replanted to avoid damage to the developing permanent tooth 2
- Avulsed permanent teeth should be replanted as soon as possible, and if immediate replantation is not possible, the tooth should be stored in cold animal or human milk, or in the mouth adjacent to the buccal mucosa 2
- Water should be avoided as a storage medium, as it can impede healing of the periodontal ligament 2
Interventions for Avulsed Teeth
- Extra-oral endodontics may not be detrimental for teeth replanted after more than 60 minutes dry time 3
- Soaking in thymosin alpha 1 and gentamycin sulphate followed by hyperbaric oxygen may be advantageous, but more evidence is needed to confirm this 3, 4
- The use of root canal medicaments such as Ledermix and Ultracal may not show a significant difference in periodontal healing or tooth survival 4