Treatment of Avulsed Teeth
 

The incidence of traumatic dental injuries ranges from 23.5% to 27.1% in the general population.  This number is greater in children and adolescents.  With the increase in girls' participation in sports activities, the number of dental injuries has dramatically increased.  Of the dental trauma cases, 42.7% involved one tooth, 38.5% invovled two teeth, and 11.4% involved 3 or more teeth.

Dental trauma research has shown that the best prognosis for an avulsed tooth occurs when the tooth is properly treated within the first 30 minutes of the exarticulation.  The research has also shown that the critical factor for reduction of replacement resorption (after reimplantation of avulsed teeth) is maintenence of normal periodontal ligament cell physiology and metabolism.  To maintain this normalcy, the environment in which the teeth are stored must supply the optimal osmolarity cell nutrients and pH.

There are many storage media available for avulsed teeth including water, ice, saliva, physiologic saline solution, milk, etc.  All of these media have their advantages and disadvantages.  However, the optimal storage media available are pH-balanced cell-preserving solutions.  The best known and extensively tested is Hank's Balanced Salt Solution (HBSS.)  Studies show that replacement resorption of avulsed teeth can be reduced by soaking the teeth in HBSS for 30 minutes before reimplantation.  In these studies, dog teeth were extracted and allowed to dry for 30, 45, and 60 minutes then soaked in HBSS for 30 minutes.  These teeth showed 50% less root resorption after reimplantation.

Once the avulsed tooth or teeth have been stabilized, an antibiotic such as Amoxicillin 500mg or Doxycycline 100mg (depending on the patient's age) should be prescribed for two weeks.  Endodontic therapy evaluation should proceed within seven to ten days of stabilization.


Dr. Gary Borden
Drs. Akers, Stohle & Borden, Ltd.

Ref: Dr. Paul Krasner, Journal of Oral & Maxillofacial Surgery

Next Issue: April 2011