Dental Trauma or Infection Clinical Pathway — Emergency Department
Dental Trauma or Infection Clinical Pathway — Emergency Department
Avulsion Injuries of Permanent Teeth
Avulsion of primary teeth do not require reimplantation. Avulsion of permanent teeth require immediate treatment and long-term prognosis is improved with prompt reimplantation. Two considerations for successful reimplantation:
- Extent of time the tooth is spent outside of the mouth
- The medium in which the tooth has been stored before reimplantation
| Extra-Oral Dry Time < 60 Mins | Extra-Oral Dry Time > 60 Mins |
|---|---|
| If tooth is placed in a storage medium (such as Hanks Balanced Salt Solution, Save-a-Tooth solution, or milk) within 60 mins of the tooth leaving the mouth, prognosis of saving the tooth is increased. | If tooth is placed in a solution (such as water) that is not a recommended storage solution or is dry for greater than an hour, the cells on the surface of the root die and the long-term prognosis of the tooth is guarded/poor. |
| Despite differences in long-term prognosis, teeth will be reimplanted to either save the natural tooth or to act as bone preservation for the developing alveolar ridge. | |
- If tooth is in a storage medium other than Hanks Balanced Salt Solution or Save-a-Tooth, call the pharmacy to provide Save-a-Tooth solution and place tooth in it.
- Handle tooth from the crown, do not touch the root and do not rinse with water.
- Page dental to replant and splint tooth.
- Review tetanus vaccination status of child. Provide tetanus booster if child is overdue.
- Antibiotic Recommendations
- Prescribe Peridex mouthwash (0.12% chlorhexidine gluconate rinse) for improved hygiene.
- Splint will remain on teeth for at least 2 wks — soft food diet for the duration of the splint.
- Refer to Penn Dental Medicine for follow-up and possible root canal treatment of tooth.