Is bone wax suitable for use in tooth avulsion?

Bone Wax Should Not Be Used for Tooth Avulsion

Bone wax is not recommended for use in tooth avulsion cases as it can interfere with periodontal ligament healing and successful reimplantation. Instead, immediate replantation is the treatment of choice for avulsed permanent teeth 1.

Proper Management of Tooth Avulsion

Immediate Actions

• The most critical factor for successful reimplantation is minimizing the time the tooth is out of its socket 1
• If a permanent tooth is avulsed, handle it only by the crown (not the root) to preserve the fragile fibroblasts on the root surface that are essential for reattachment 1
• If the tooth is dirty, briefly rinse it (<10 seconds) under cold running water, taking care not to damage the tooth or attached tissue 1
• Immediate replantation at the site of injury should be attempted whenever possible 1

When Immediate Replantation Is Not Possible

• If the tooth cannot be immediately replanted, it must be stored in an appropriate medium to preserve periodontal ligament cell viability 1
• Recommended storage media in order of preference:
  • Hanks Balanced Salt Solution, oral rehydration salt solutions, propolis, or rice water 1
  • Cow's milk or patient's saliva (if the above options are unavailable) 1
  • Probiotic solutions, egg white, or almond milk (as last resort options) 1
• Never store an avulsed tooth in tap water as it causes osmotic lysis of the root fibroblasts 1

Follow-up Care

• Immediate dental or medical care is essential after replantation or storage 1
• A flexible splint will need to be placed by a dentist for up to 2 weeks 1
• Most teeth will require root canal therapy within 7-10 days after replantation 1
• Systemic antibiotics are indicated after reimplantation (doxycycline for children >12 years; penicillin for children <12 years; clindamycin for those allergic to penicillin) 1

Why Bone Wax Is Inappropriate for Tooth Avulsion

• Bone wax is a nonabsorbable hemostatic agent used for bleeding bone where bone healing and soft tissue attachment are not desired 2
• Using bone wax would:
  • Prevent reattachment of periodontal ligament fibers necessary for successful reimplantation 2
  • Potentially cause foreign body reactions in the socket 2
  • Increase susceptibility to infection in the area 2
• The goal in tooth avulsion is to preserve the periodontal ligament cells on the root surface, not to block their reattachment 3, 4

Important Considerations

• Primary (baby) teeth should not be replanted due to potential damage to developing permanent teeth 5
• The prognosis worsens significantly with increased extra-oral dry time 3, 4
• Successful replantation can provide psychological benefits and maintain esthetics, arch form, chewing function, and speech 6, 7
• The tooth should be monitored for potential complications including pulpal necrosis, root resorption, or ankylosis 1, 5

Remember that immediate replantation and proper storage of the avulsed tooth are the key factors for successful outcomes, not the application of bone wax or other materials that would interfere with the natural healing process 1.