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4.13 Avulsed Tooth (tooth loss)


Presentation

After a direct blow to the mouth the patient may have a permanent tooth knocked from its socket. The tooth is intact, down to its root, from which hangs the delicate periodontal ligament that used to attach to alveolar bone and provide the tooth with its blood supply.

What to do:

What not to do:

Discussion

Before commercially-available 320mOs, pH 7.2 reconstitution solutions, the best we could offer the avulsed tooth was rapid reimplantation. Without a preservation solution, the chances of successful reimplantation decline one percentage point every minute the tooth is absent from the oral cavity. In mature teeth, over age 10, the pulp will not survive avulsion even if the periodontal ligament does, and at the one-week follow-up visit with the dentist, the necrotic pulp will be removed to prevent a chronic inflammatory reaction from interfering with the healing of the periodontal ligament.

References:

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD