An avulsed permanent tooth is one of the few real emergency situations in dentistry. In addition to increasing the public awareness by mass media campaigns, healthcare professional, parents and teachers should receive information on how to proceed following these severe unexpected injuries. Also, instructions may be given by telephone to parents at the emergency site.

WHAT TO DO IMMEDIATELY

  • If a tooth is avulsed, make sure it is a permanent tooth (primary teeth should not be replanted).
  • Keep the patient calm.
  • Find the tooth and pick it up by the crown (the white part). Avoid touching the root.

          If the tooth is dirty, wash it briefly (10 seconds) under cold running water and reposition it. Try to encourage the                 patient / parent to replant the tooth. Bite on a handkerchief to hold it in position.

  • If this is not possible, place the tooth in a suitable storage medium, e.g. a glass of milk or a special storage media for avulsed teeth if available (e.g. Hanks balanced storage medium or saline). 
  • The tooth can also be transported in the mouth, keeping it between the molars and the inside of the cheek. If the patient is very young, he/she could swallow the tooth- therefore it is advisable to get the patient to spit in a container and place the tooth in it. Avoid storage in water.
  • your dentist would place the tooth in socket and stabalize it with splinting or suturing.
  • Dentist would recommend RCT of the same tooth.





CARE AFTER DENTAL VISIT

  • Avoid participation in contact sports.
  • Soft food for up to 2 weeks.
  • Brush teeth with a soft toothbrush after each meal.
  • Use a chlorhexidine (0.1 %) mouth rinse twice a day for 1 week.
  • Root canal treatment 7-10 days after replantation. Place calcium hydroxide as an intra-canal medicament for up to 1 month followed by root canal filling with an acceptable material. Alternatively an antibiotic-corticosteroid paste may be placed immidiately or shortly following replantation and left for at least 2 weeks.
  • Splint removal and clinical and radiographic control after 2 weeks.
  • Clinical and radiographic control after 4 weeks, 3 months, 6 months, 1 year and then yearly thereafter.

**Delayed replantation has a poor long-term prognosis. 
    The periodontal ligament will be necrotic and not expected to heal. 
    The goal in delayed replantation is to restore the tooth to the dentition for esthetic, functional , and              psychological reasons and to maintain alveolar contour. 
    The eventual outcome will be ankylosis and resorption of the root.