Tuesday, September 14, 2010

Tuesday's Teeth: How to Manage a Knockout

Warning - bloody picture below.

So today I want to talk about how to manage an avulsed permanent tooth.  Obviously kids lose baby teeth all the time, and if those are avulsed, or knocked out, its not likely that we'll reimplant them. Doing so can cause the primary tooth to fuse with the bone, or ankylose, and cause problems for the eruption of the permanent tooth. .
Children most often will have an avulsed tooth at home or at school, and its usually a front tooth on the upper jaw, aka a maxillary anterior tooth. These teeth tend to erupt in an anterior direction towards the lips, and this splayed eruption pattern predisposes these teeth to avulsion. If this ever happens with your child, time is critical, and if you can manage a few of the primary steps at home immediately after the accident then it will considerably help with the outcome.

So first things first - find the tooth. If the tooth is dirty, rinse it under cold water. Do not scrub the root. You do not want to cause any further damage to the periodontal ligament, or PDL, which is the ligament that adheres the tooth to the bone. There will be PDL cells on the root, and you do not want them to be removed by vigorous cleaning.

Second, reimplant the tooth. I realize this might be scary, and you might not be sure which way the tooth should face. Hopefully your child's adjacent tooth will be erupted and not damaged, and can serve as a guide. If it is a maxillary anterior tooth, there will be a concave side and convex side, the concave side should face the tongue/palate, and the convex side should face the lips. The above picture is a side view, the left side is the tongue/palate side, and the right side is the lip side. Hold the tooth by the crown only, not the root. Do your best to reimplant the tooth, because if this is done immediately, the prognosis for the tooth is much more favorable. Have your child bite gently to hold the tooth in place.

If you're unable to reimplant the tooth, store it in either milk, or something called Hank's Balanced Salt Solution, or HBSS. I realize you probably don't have this at home, but you can purchase something like this:

You can click here to read more about the product.

Ideally, the tooth should be reimplanted within the first 15 minutes. If the tooth is out of the mouth for 60 minutes it is unlikely that reimplanting the tooth will be successful.

Third - get to a dentist ASAP. He or she will evaluate the tooth, reimplant if necessary, and likely place a splint to hold the tooth in place.

The dentist may elect to do root canal therapy on the tooth at this visit as well. The trauma sustained to the tooth makes in unlikely for the tooth be remain viable, and root canal therapy will prevent necrosis and/or infection of the nerve and blood supply inside of the tooth. Your dentist will follow your child and determine how long the splint should be worn, and when root canal therapy should be initiated.

I should point out that this same protocol is followed for adults, so if you're playing softball with someone and this happens, or you get into a bar room brawl, follow the same steps.

Happy Tuesday everyone!

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