Dental Avulsion

When a patient presents to the ED with a completely missing tooth after sustaining trauma, there are many places the tooth can be.  It can be lost, swallowed, or brought to the ED.  It can also be intruded up into the bone (which can be missed if you don’t think about it.)

If the patient does present with the tooth, consider the following:

1.       Primary teeth should not be replanted.

2.       Patients should be made aware that teeth that are out of their natural environment for more than 60 minutes, are not stored properly and are not seen by a dental specialist in the immediate post avulsion period have a very poor success rate of re-implantation.

3.       If the tooth is found, gently clean it of any debris by gently rinsing off the root with water.  Do not scrub it.

4.       Do not handle the tooth by the root.

5.       Teeth should be stored in the best environment that is safest for the patient.  Patients need to be alert, able to follow directions and no suspected of having a fracture of the location the tooth was avulsed from.

a.       The best location is in the socket.  Alternatively, you can have the patient pocket it in their mouth

b.      Milk

c.       Hank’s Balanced Salt Solution or Save-A-Tooth solution

d.      Have the patient spit saliva  into a cup and place the tooth there.

Roberts and Hedges

Linda Regan, MD FACEP

Program Director, Emergency Medicine Residency

Johns Hopkins Medical Institutions