What are the treatment options for a tooth avulsed from its socket?

Management of Avulsed Teeth

For an avulsed permanent tooth, immediate replantation is the treatment of choice to maximize tooth survival and should be performed as soon as possible, handling the tooth only by the crown to preserve the root fibroblasts necessary for reattachment. 1, 2

Immediate Actions for Avulsed Permanent Teeth

• If immediate replantation is possible:

  • Handle the tooth by the crown portion only, not the root 1
  • If dirty, wash briefly (10 seconds) under cold running water 1
  • Reposition the tooth in its socket 1
  • Have the patient bite on a cloth to hold it in position until reaching dental care 1

• If immediate replantation is not possible, store the tooth in a suitable medium:

  • Best options (in order of preference):
    • Balanced salt solution 1, 3
    • Cold milk 1, 4, 3
    • Saliva (patient can drool into a container) 1, 3
  • Avoid storing in water as it causes osmotic lysis of root fibroblasts 1, 4
  • Even storage in water is better than keeping the tooth dry 4

Professional Dental Treatment

• After replantation or proper storage, seek immediate dental care 1
• A flexible splint will be placed by the dentist for up to 2 weeks 1
• Most teeth will require root canal therapy within 7-10 days after replantation 1, 3
• Systemic antibiotics are indicated after reimplantation: 1
  • For children >12 years: doxycycline 1
  • For children <12 years: penicillin 1
  • For penicillin-allergic patients: clindamycin 1

Special Considerations

• Primary (baby) teeth should NOT be replanted to avoid damage to the developing permanent tooth bud 1, 2, 4
• The longer the tooth remains out of the socket, the worse the prognosis: 3
  • <20 minutes dry time: excellent prognosis with proper management
  • 20-60 minutes: fair prognosis

  • 60 minutes: poor prognosis, may require special preparation procedures 3

Follow-up Care and Monitoring

• The tooth should be monitored for potential complications: 1, 2
  • Pulpal necrosis
  • Root resorption
  • Ankylosis (fusion to bone)
• Regular dental follow-up is essential: twice per year for 3 years and yearly thereafter 3

Common Pitfalls to Avoid

• Never handle the avulsed tooth by the root surface 1, 2
• Never scrub or sterilize the tooth 1
• Never store the tooth dry 4, 3
• Never delay seeking professional dental care even after successful replantation 1
• Never replant primary (baby) teeth 1, 2, 4

Dental avulsion is a true dental emergency where time is critical for tooth survival. The prognosis depends significantly on the actions taken immediately after the injury occurs, with immediate replantation offering the best chance for tooth survival 1, 2.