A 21-year-old woman comes to the emergency department after she slipped and fell at work, landing on her mouth 30 minutes ago. She brought a tooth with her that got avulsed secondary to the injury. The patient did not lose consciousness and has no other injuries. Vital signs are within normal limits. On examination, the patient has an avulsed left central incisor with a small amount of dry blood in the socket. The remainder of the teeth are stable without fractures. There is no injury to the gum or palate. There is no mandibular or maxillary tenderness or instability, and neurologic examination is normal. The patient has the avulsed tooth with her in a tissue, and it appears intact. Which of the following is the best next step in management of this patient?

Question

A 21-year-old woman comes to the emergency department after she slipped and fell at work, landing on her mouth 30 minutes ago.  She brought a tooth with her that got avulsed secondary to the injury.  The patient did not lose consciousness and has no other injuries.  Vital signs are within normal limits.  On examination, the patient has an avulsed left central incisor with a small amount of dry blood in the socket.  The remainder of the teeth are stable without fractures.  There is no injury to the gum or palate.  There is no mandibular or maxillary tenderness or instability, and neurologic examination is normal.  The patient has the avulsed tooth with her in a tissue, and it appears intact.  Which of the following is the best next step in management of this patient?

Quizplus · Accepted Answer

This patient has had a traumatic avulsion of a permanent tooth, and the tooth is present. The tooth and the socket should be rinsed gently with normal saline and then reimplanted. After evaluation to ensure there are no concurrent life-threatening injuries, avulsed permanent teeth should be reimplanted. Ideally, this should be done within 15 minutes to 1 hour to increase the likelihood of tooth survival (Choice B). Until reimplantation takes place, the avulsed tooth can be stored in cold milk, saliva, or tooth culture media (eg, Hank's balanced salt solution). Prior to reimplantation, dental block can be performed to minimize pain. The tooth and socket should be rinsed gently with normal saline or tap water. Sterilizing agents (eg, hydrogen peroxide) or forceful scrubbing should be avoided to prevent damage to the tooth and/or socket (Choice C). The tooth should be handled by the crown, placed in the socket, and splinted to the adjacent teeth. Patients are discharged with prophylactic antibiotics (eg, doxycycline) and advised to follow-up with a dentist as soon as possible for definitive care. (Choice A) An avulsed primary tooth should not be reimplanted because it could injure the developing tooth bud. However, an avulsed permanent tooth should be reimplanted as soon as possible; disposal is not appropriate. Educational objective: An avulsed permanent tooth should be reimplanted as soon as possible. The tooth can be briefly stored in cold milk or saliva and manually reimplanted after gentle rinsing of the tooth and socket with normal saline.

A 21-Year-Old Woman Comes to the Emergency Department After She