For the Dental Professional

Avulsion Treatment

Treatment outcome is strongly dependent on the length of time the tooth is out of the socket and the type of storage media used for the avulsed tooth. Generally, if the tooth has been replaced within the first hour, complete or partial periodontal healing will occur. Total PDL death will occur if the tooth is not replaced within the first hour, and root resorption will ensue in most cases.

Treatment Protocols

The following is are treatment protocols for the avulsed tooth based on the guidelines provided by the American Association of Endodontics.

Avulsed permanent tooth with closed apex:
1. Tooth has been kept in a storage media and has been out of the mouth less than one hour.

1. If contaminated, clean the root surface and apical foramen with a stream of saline. Remove coagulum from the socket, and slowly replant the tooth with slight digital pressure. Be sure to examine the socket for any alveolar fracture.
2. Suture any gingival lacerations, and verify normal tooth placement radiographically.
3. Apply a flexible splint for one week. Place patient on Doxycycline 2x day for 7 days, or penicillin 4x day for 7 days at appropriate dosages for age and weight. Refer patient to a physician to evaluate need for tetanus shot.

2. Tooth has been out of the mouth for over one hour.

1. Remove debris and necrotic PDL ligament, and coagulum from socket.
2. Immerse the tooth in 2.4% sodium fluoride solution acidulated to a pH of 5.5 for a minimum of 5 minutes. Replant tooth slowly with digital pressure.
3. Follow above directions starting with suturing any gingival lacerations.

Avulsed tooth with an open apex:
3. Tooth has been kept in a storage media and has been out of the mouth less than one hour.

1. If contaminated, clean the root surface and apical foramen with a stream of saline. Place the tooth in doxycycline (1 mg/20 ml saline). Remove coagulum from the socket, and slowly replant the tooth with slight digital pressure. Be sure to examine the socket for any alveolar fracture.
2. Suture any gingival lacerations, and verify normal tooth placement radiographically. Apply a flexible splint for one week.
3. Place patient on Pen V 1000 mg stat and 500 mg 4x day for 7 days. For patients not susceptible to tetracycline staining, place on Doxycycline 2x day for 7 days, at appropriate dosages for age and weight. Refer patient to a physician to evaluate need for tetanus shot.

4. Tooth has been out of the mouth for over one hour.

1. Replantation is usually not indicated due to ankylosis and subsequent interference with alveolar growth.

Patient Instructions

These instructions are general and used for all cases of avulsion. The patient must maintain a soft diet for 2 weeks, and brush teeth after each meal with s soft toothbrush. Use chlorhexidine mouthrinse (0.12%) twice a day for one week, and follow-up.