Tooth avulsion

Background

• Dental emergency
• Tooth is completely removed from its socket
• Often associated with alveolar ridge fracture

Clinical Features

• Tooth missing from socket
• History of recent trauma

Differential Diagnosis

Dentoalveolar Injuries

• Tooth fracture
• Tooth subluxation
• Tooth avulsion
• Bleeding dental socket

Odontogenic Infections

• Dental caries (pulpitis)
• Ludwig's angina
• Periapical abcess
• Periodontal abscess
• Peritonsillar Abscess (PTA)
• Retropharyngeal abscess
• Trench Mouth (Acute Necrotizing Ulcerative Gingivitis)
• Vincent's angina - tonsillitis and pharyngitis
• Acute alveolar osteitis

Other

• Scurvy
• Gingival hyperplasia
  • Phenytoin
  • Cyclosporine
  • Nifedipine, Amlodipine
  • Leukemia

Evaluation

Work-up

• Consider facial films, abdominal films, or CXR if possibility of tooth aspiration or ingestion

Evaluation

• Clinical diagnosis

Management

Adult

• Replace avulsed tooth as soon as possible with local analgesia ± dental block (as long as no alveolar ridge fracture or severe socket injury)
  • If reimplanted within 1hr 66% chance of good outcome
  • Rinse (no scrubing!) tooth in saline
  • Manipulate tooth only by the crown (Avoid touching root to minimize damage to periodontal ligament)
  • Bond tooth to adjacent teeth
• If extraoral time > 60 min, soak in citric acid/fluoride and consult dentist
• Storage solution (in order of efficacy): Hank's balanced salt solution > Milk > saliva > saline
• Doxycycline (helps periodontal ligaments heal)
• Penicillin OR Clindamycin are alternatives

Child

• Do not re-implant primary teeth
  • Increased risk of interference with the eruption of the permanent tooth
• Refer to pediatric dentist for space maintainer

Disposition

• Discharge with dental follow-up on liquid diet.

See Also

• Dental Problems

References

Authors

Ross Donaldson, Aaron Snyder, Kevin Lu, Tianjiang Ye, Michael Holtz, Jordan Swartz, Neil Young