WHAT TO DO WHEN A TOOTH IS KNOCKED OUT…

The critical determining factors for success of
replantation are the condition of the alveolar socket (bone) which should be
free from periodontal (gum) disease and be reasonably intact, the time the
tooth is out of the bone socket, the storage and transport medium used to
deliver the tooth to the dentist, and how the tooth is handled between the
accident and arrival at the dentist.
After the accident, the tooth should be located and
picked up by the crown or enamel portion and NOT the root. If the tooth is
dirty or contaminated, it should gently be placed in a transport solution of
Hank’s Balanced Salt Solution. If HBSS is not available, the next best
alternatives are whole cold milk, saline, or saliva. However, it should be
noted that milk, saline, and saliva have their limitations.
Saline solution may be damaging if it is allowed to
soak in it for more than one or two hours. Saliva may be damaging as the tooth
ligament cells may become infected. Cold whole milk is acceptable for short
periods of time however it sours quickly, and milk is usually not available at
a sporting event. Never transport the tooth to the dentist in tissue or gauze.
If none of the above are readily available, use water. The HBSS is
biocompatible with the tooth periodontal ligament cells and can keep these
cells viable for 24 hours because of its ideal pH and osmolality. Research has
shown that this fluid can rejuvenate degenerated ligament cells and maintain a
success rate of over 90% if an avulsed tooth is soaked in it for 30 minutes
prior to replantation. This solution does not need refrigeration and it
preserved in a break resistant, sterilized container.
It is now obvious that a proper transport medium for
tooth avulsion should be part of the first aid kit at schools and most
definitely be part of the sports medicine medical kit of the athletic trainers
and coaches available at all sporting events. It would be beneficial for
parents to keep a container of HBSS in the home medicine cabinet. Once the
dentist receives the tooth preserved in this system he/she may precede to
implant the tooth and do the proper splinting procedures with a favorable
prognosis. It should be noted that if a primary (baby) tooth is knocked out, it
should NOT be replanted as it could damage the permanent tooth is knocked out,
it should NOT be replanted as it could damage the permanent tooth bud in
formation. Parents should NOT try to place the baby tooth back into the socket,
and should immediately seek the advice and treatment of their dentist.
It is advised that if the accident victim shows any
signs of head injury, unconsciousness, nausea, or persistent headaches, they
should be first evaluated for their head injury by proper medical personnel.
Once a head injury is ruled out, they may precede to the dentist for treatment
of the avulsed (knocked out) tooth. This is another reason why a proper storage
medium for the tooth is critical.
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