Avulsion is the total displacement of a tooth from its socket. There is usually a history of trauma; however, infectious etiologies may result in complete disruption of the periodontal ligament from the affected tooth. Various degrees of bleeding from the socket and surrounding gingiva may be noted, and there may be underlying alveolar fracture depending on the mechanism of injury. Prompt inquiry into the location of any unaccountable tooth is indicated. Radiographic evaluation to rule out aspiration, soft tissue entrapment, impaction, or dentoalveolar fracture is required when teeth are missing.
Management and Disposition
Successful reimplantation decreases by approximately 1% for every minute the tooth is out of its socket. Permanent teeth should be replaced in their sockets as soon as possible. Successful reimplantation depends on the survival of periodontal ligament fibers; the tooth should be rinsed with saline, but not scrubbed, with care not to handle the root while replacing it in the socket. Emergent dental consultation, tetanus prophylaxis, and antibiotics targeting mouth flora are indicated. If not replaced, the avulsed tooth should be stored in the mouth of the patient or parent, or in a container of milk. Normal saline and commercial preservatives are reasonable alternatives, but tap water should not be used. Prior to reimplantation, rinse alveolar socket with saline to remove any clot. Primary teeth are not reimplanted; reimplanted teeth may interfere with eruptions of permanent teeth because of ankylosis and fusion to the bone. Patients should use antibiotics for oral microbiota and maintain good oral hygiene using chlorhexidine 0.12% topically twice a day for a week.
Tooth Avulsion. Avulsion injury with angulation and displacement of teeth from the alveolar socket. (Photo contributor: James F. Steiner, DDS.)
Follow-up should be obtained for possible orthodontia until the permanent tooth erupts.
Primary teeth should not be reimplanted.
Successful reimplantation occurs best within the 1st 30 minutes.
Storage and transport media in decreasing order for preserving tooth viability include balanced salt solution or a tissue culture medium, chilled low-fat milk, saline, and saliva.
Tooth Avulsion. Significant avulsion injury of tooth #8 in a patient with direct oral trauma. (Photo contributor: Lawrence B. Stack, MD.)
Tooth Avulsion Reimplanted. Reimplantation of the avulsed tooth in Fig. 6.5 was performed by an oral surgeon with the use of an arch bar to secure the tooth. (Photo contributor: Lawrence B. Stack, MD.)