AVULSED TEETH ('Tooth knocked-out')

• Avulsed teeth should be reimplanted immediately
• Do not reimplant primary teeth

AVULSED TEETH

Pre-hospital treatment

• Reimplant < 60min after injury (chance of survival = decreases 1% per minute delay in reimplantation)
• Storage medium – saliva (place tooth in buccal sulcus) > milk > water > air

Treatment

Attempt reimplantation up to 24 hrs post-injury

• Avoid handling root surface, hold crown
• Irrigate tooth gently with saline
• LA
• Reimplant tooth in socket (Use rest of the teeth for orientation and position)
• Improve seating by getting patient to bite on gauze for 15 – 20 min
• Update tetanus status
• Amoxycillin 500mg tds
• Transfer to RAH Oral-max-fax surgeon for splint

If tooth or denture missing - CXR (aspiration) Lateral soft tissue of neck (pharyngeal FB)
If > 24 hr do not re-implant and refer to dental surgeon for prosthetic replacement.

Prognosis

Affected by:

• Time to reimplantation (warn patient of limited prognosis with delayed implantation)
• Splinting time – prolonged splinting time will promote ankylosis
• Viability of the pulp

Dr George Chu BDSc MBBS
Ed: Dr. Derek Louey MBBS FACEM