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Dental avulsion is the complete displacement of a tooth from its socket in alveolar bone owing to trauma. The periodontal ligament is severed and fracture of the alveolus may occur.
Increased overjet and failure to wear a protective mouthguard playing sports are considered as a predisposing factors. Avulsions are more common in younger patients, but can also occur in adults. The maturity of tooth development is an important factor in considering treatment options and outcomes of avulsed teeth.
The immediate treatment in case of a knocked out tooth is very important to increase the chance of conservation of the tooth!
We should first respond for few questions:
- Are there any other injury? Injuries are common in playground, it should be established if there has been any loss of consciousness or sign of concussion.
- Is there any relevant medical history? If any predisposition for infective endocarditis, than reimplantation is contraindicated.
- What age is the child? The age will help to know if it is a primary or permanent teeth, if permanent is it a mature or immature tooth.
- Has the child an up-to-date tetanus immunisation? This is particularly relevant if the avulsion occurred outdoors
- Is the tooth intact?
- Is the tooth contaminated with dirt or debris?
The speed with which the tooth is replanted is the most important factor to keep the tooth.
Do not touch the root. Handle the tooth by the crown only.
If replantation is not possible directly following the trauma, the tooth must be stored correctly until it can be replanted. Suitable storage of the tooth, in order of preference, are fresh milk, saliva and saline. Water should not be used, as its hypotonicity reduces viability of the periodontal ligament cells adhering to the root.
The injured must go to a dentist within one hour of time after the accident, even if the tooth is reimplanted.
No attempt should be made to replant an avulsed primary incisor. Parents should be reassured and warned of possible damage of the permanent successor.