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A recent study by the
National Institute of Dental Research found that over one-quarter of the
population is affected by dental trauma. This study suggested that the
incidence of dental trauma would soon exceed that of caries and periodontal
disease among children and teenagers. All oral-facial injuries require
proper and prompt treatment. However, when trauma results in the
displacement of a permanent tooth from its socket, immediate treatment
consisting of replantation is necessary to prevent the ultimate loss of the
tooth. In cases of tooth avulsion, then, treatment must begin by the
patient or a family member before the patient arrives at the dentist's
office.
Tooth avulsion results
in the severance of nerve and blood vessels that supply blood to the tooth
as well as the periodontal ligament which surrounds the tooth and holds it
in place. Tooth avulsion can also cause damage to the surrounding jaw bone,
root and gum tissue. Studies over the past 30 years have shown that in
cases of tooth displacement, the timeliness of replantation is the most
important factor in the survival of the avulsed tooth. If too much time
elapses between the displacement of the tooth and replantation, the
survival success rate decreases dramatically due to an increased likelihood
of root resorption occurring. Root resorption is an inflammatory response
to trauma in which gross areas of the tooth root surface become destroyed
causing early tooth loss. In other instances, root resorption causes the
replanted tooth to fuse to surrounding bone. Over time the tooth will
become immobilized, and as a result is usually lost. Studies have shown
that 90% of teeth replaced within 30 minutes exhibit no root resorption if
proper follow-up treatment is commenced.
In cases of trauma
resulting in tooth avulsion, immediately replant the displaced tooth in its
socket whenever possible. When handling the tooth avoid touching the root.
If the root is grossly contaminated, gently rinse the tooth in tap water
prior to replacing the tooth in its socket. If instantaneous replantation
is not possible, the tooth must be placed in a suitable storage medium
until the patient can get to the dentist's office. The storage medium of
choice is a tissue culture known as Hank's Balanced Salt Solution. However,
Hank's Balanced Salt Solution is generally not available to the patient in
an emergency situation, and it is not recommended that the patient proceed
to a pharmacy to try and locate this solution. The second storage medium of
choice is milk. Studies have shown milk to be successful in maintaining the
vitality of the periodontal ligament, and milk is generally readily
available. Skim or low fat milk at a cool temperature is a preferable
storage medium to whole milk. If milk is unavailable, saline or salvia may
be used. If nothing else is available, transport the tooth in water. Do not
use items such as contact lens solution or Gatorade as recent studies have
found that these mediums are harmful to the tooth root surface.
Once at the dentist's
office the tooth will be splinted to provide stability during the initial
stages of healing. Antibiotic therapy may be necessary at this time to
prevent periodontal healing complications. An updated tetanus shot may also
be recommended. As soon as the splint is removed, endodontic treatment will
usually begin to prevent the development of root resorption.
Avoiding root
resorption and retaining an avulsed tooth is of the utmost importance in
still growing children. When replantation of an avulsed tooth is
unsuccessful, treatment options that exist for the adult patient do not
exist for children. For instance, in the adult patient an implant is a
viable alternative when a tooth is not successful replanted. However, in
the still growing child the use of an implant will prevent the patient's
jaw bone from continuing to grow in the area of the implant. As such,
children are limited to a bridge that will need to be replaced as the child
grows or a flipper that is essentially a removable one tooth denture.
As always, my staff
and myself are available to answer any questions you may have about tooth
avulsion or any other matter.
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