Management of Partially Avulsed Tooth
For a partially avulsed (extruded/laterally luxated) permanent tooth, immediately reposition it gently back into the socket, have the patient bite on gauze to stabilize it, and refer urgently to a dentist for splinting and definitive care. 1
Immediate Assessment and Action
Determine Tooth Type
- Confirm whether the tooth is permanent or primary before any intervention, as management differs completely between the two 1
- For a 14-year-old or older patient, the tooth will be permanent and should be repositioned 2
- Primary teeth should never be repositioned or replanted due to risk of damaging the underlying permanent tooth germ 1
Assess Degree of Displacement
- Minor extrusion (<3mm): Gentle repositioning is indicated immediately 1
- Severe extrusion (>3mm): Extraction may be required - immediate dental referral is critical 1
- Lateral luxation: Check if the tooth interferes with occlusion by having the patient bite down gently 1
On-Site Management Steps
Repositioning Technique
- Handle the tooth only by the crown, never touch the root surface, as it contains fragile periodontal ligament fibroblasts essential for successful reattachment 2
- Gently reposition the tooth back into its normal anatomic position in the socket 1
- Have the patient bite down on clean gauze or cloth to hold the tooth in position 2
- Ensure posterior teeth (molars) can fully interdigitate and that the repositioned tooth does not interfere with the bite 1
Control Bleeding
- Apply direct pressure with clean gauze or cloth to the bleeding socket to control expected bleeding from gingival tissues and alveolar socket 2
Urgent Dental Referral
Timing
- Immediate referral to a dentist is mandatory for all partially avulsed permanent teeth, regardless of whether repositioning was successful 1, 2
- The likelihood of successful outcome decreases rapidly with time, as periodontal ligament cells die quickly 1, 2
Expected Dental Treatment
- A flexible splint will be placed by the dentist for up to 2 weeks after repositioning 2
- Most partially avulsed teeth will require root canal therapy within 7-10 days after the injury 2
- Radiographic examination will be performed to assess for root fracture or alveolar bone involvement 1
Antibiotic Prophylaxis
- For patients over 12 years old: Doxycycline is the recommended systemic antibiotic after repositioning 2
- For patients under 12 years old: Penicillin is recommended, or clindamycin if penicillin-allergic 2
Critical Pitfalls to Avoid
- Do not delay repositioning - immediate action maximizes tooth survival 1, 2
- Never scrub or handle the root surface, as this damages periodontal ligament cells 2
- Do not accept malposition if it interferes with occlusion - this requires immediate correction 1
- Do not assume minor displacement will self-correct if it affects the bite - dental intervention is needed 1