An avulsed tooth refers to a tooth that has been completely dislodged from its socket in the jawbone due to trauma. This type of injury is considered a dental emergency. Prompt attention is necessary to improve the chances of successfully reinserting and saving the tooth.
What to Do Immediately
When a tooth is knocked out, remaining calm is important. The first step is to locate the avulsed tooth. Once found, handle the tooth only by its crown, which is the white visible part, and avoid touching the root surface. The root contains delicate cells that are important for reattachment.
If the tooth is dirty, gently rinse it with cold running water for about 10 seconds. Do not scrub or use soap, as this can damage the root surface cells. After rinsing, attempt to reinsert the tooth back into its socket.
If immediate replantation is not possible, place the tooth in a suitable storage medium to preserve root cells. Options include:
- Milk
- Hank’s Balanced Salt Solution (HBSS), an ideal but often unavailable medium
- Saline solution
- The patient’s own saliva (held inside the cheek, if old enough to prevent swallowing)
Avoid storing the tooth in plain water, as it can damage root cells. Transport the patient and tooth to a dental professional or emergency room as quickly as possible, ideally within 30 minutes to an hour. Replantation success decreases significantly with increased dry time.
Professional Dental Care and Outcomes
Upon arrival at the dental office, professional treatment for an avulsed tooth focuses on replantation and stabilization. The dentist will first assess the tooth and the socket, removing any blood clots or debris with sterile saline. Local anesthesia is administered to ensure patient comfort during the procedure. The tooth is then carefully reinserted into its socket.
Following replantation, the tooth is stabilized using a flexible splint, connecting the injured tooth to adjacent healthy teeth. This splint holds the tooth in place while surrounding tissues heal, typically for one to two weeks, varying based on root development and mobility. After splint removal, follow-up appointments monitor healing and check for complications.
The success rate of tooth replantation is influenced by several factors. The most important factor is extraoral dry time—the amount of time the tooth is out of the mouth and not in a suitable storage medium. If dry time is less than 30 minutes, chances of successful reattachment of periodontal ligament cells are significantly higher. The type of storage medium used also plays a role in maintaining root surface cell viability. The patient’s age and stage of root development also affect the prognosis, with immature teeth having a better chance of pulp revascularization.
Long-Term Considerations
Even after successful replantation, several long-term issues can arise with an avulsed tooth. Two common complications are root resorption and pulp necrosis. Root resorption involves the breakdown and loss of the tooth’s root structure. External inflammatory resorption occurs when infection in the pulp chamber or periodontal ligament stimulates cells to resorb the root surface. This can often be managed with timely root canal treatment.
Replacement resorption, also known as ankylosis, occurs when the root surface is replaced by bone, fusing the tooth with the jawbone. This can stop normal eruption and eventually lead to tooth loss. Pulp necrosis, or the death of the tooth’s nerve, is another common outcome, especially if the tooth was out of the mouth for an extended period. This requires root canal treatment within 7 to 14 days post-replantation to prevent infection and further complications. Ongoing monitoring by a dental professional is necessary to detect and manage these complications early, often involving regular X-rays and clinical examinations.
Differences Between Baby and Adult Teeth
The management and prognosis for avulsed primary (baby) teeth differ from permanent (adult) teeth. For primary teeth, replantation is not recommended. This is due to the risk of damaging the developing permanent tooth germ located underneath. Replanting a primary tooth could interfere with the eruption path or cause developmental defects in the underlying permanent tooth.
When a primary tooth is avulsed, management involves not replanting it. The dental professional will assess the situation and may recommend leaving the space open. A space maintainer might be used to prevent adjacent teeth from shifting into the gap, which could affect the eruption of the permanent tooth. Conversely, for avulsed permanent teeth, the primary goal is always replantation, as these teeth are meant to last a lifetime.