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Avulsed permanent tooth (lost adult tooth)

Summary

In around 0.5% to 3% of dental accidents adult teeth are knocked completely out of the mouth. This is one of the most serious dental injuries and the prognosis for the tooth (the likelihood that it can be saved) is very dependent on the actions taken at the place of the accident and PROMPTLY after it happens.

In most cases the best course of action is to REPLANT THE TOOTH. However this SHOULD NOT BE DONE in the following circumstances:

The tooth is very decayed
The tooth had severe gum disease around it
In patients with severe heart issues or in immunocompromised patients.

It is important to note that replanting the tooth does not guarantee that the tooth will survive. Guidelines have been formulated by the International Association of Dental Traumatology (IADT) after reviewing the dental literature and consulting with expert groups. They should be seen as the current best evidence.

See below for detailed instructions on replanting the tooth

Image by Noah Hickman

Home care advice

The protocol for managing an avulsed tooth in lockdown is the same as the protocol in normal circumstances, this is an emergency that REQUIRES a dental visit. In the UK it is therefore important to find an NHS Hub (by calling 111) or attending a Dental Department at a Hospital as soon as possible.

While waiting for an appointment, these steps should be followed:

Try to keep calm, or keep the patient calm if you are helping
Confirm that it is an adult tooth and that it has all the root has come out
Find the tooth and pick it up BY THE CROWN (the white part)
If it is dirty, rinse it briefly (max 10 seconds) under cold running water
Reposition it fully into original position if possible, then bite on a handkerchief to hold it in position
If repositioning is not possible, for any reason then store the tooth in a glass of milk or the patients saliva and take to a clinic. The tooth can also be kept inside the lip or cheek if the patient is conscious - If patient is young and possible they could swallow the tooth then avoid this method.
If you have access to a special transport medium such as tissue culture/transport medium, Hanks balanced storage medium (HBSS or saline) then this is preferable to milk
SEEK EMERGENCY TREATMENT IMMEDIATELY

Avulsed permanent tooth (lost adult tooth)

Summary

Home care advice

Written by Andrew Bain BDS MJDF (RCS Eng)

May 5, 2020