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Tooth AvulsionAka: Avulsed Teeth, Knocked-Out Tooth, Knocked-Out Teeth

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  1. Definition
    1. Most severe of Tooth Luxation injuries
    2. Tooth is completely displaced from alveolar bone
  2. Management: General
    1. Avulsed primary teeth need not be reimplanted
    2. Avulsed permanent teeth are a dental emergency
      1. Reimplantation within 5 minutes: 85-97% healing rate
      2. Reimplantation after 60 minutes: Tooth rarely heals
  3. Management: Technique for tooth reimplantation
    1. Avoid periodontal ligament (root) injury
      1. Hold tooth gently by crown
      2. Do not touch, rub or clean root
    2. Gently remove debris if present
      1. Rinse tooth with saline or cool Running tap water
    3. Immediately reimplant tooth
    4. Transport tooth to dentist if reimplant not possible
      1. Hank's Balanced Salt Solution (e.g. Save-A-Tooth)
        1. Considered best option by some dentists
      2. Milk packed in ice (not evaporated or condensed)
      3. Normal saline
      4. Avoid harmful storage media
        1. Do not store in Saliva due to cell lysis, infection
        2. Do not store tooth in other person's mouth
        3. Do not store tooth in dry tissue or cloth
    5. Immediate dental evaluation for splinting of tooth
    6. Antibiotic prophylaxis with Penicillin
    7. Tetanus Vaccine if not given in last 5 years
  4. References
    1. (2006) Correspondence from Dr. Paul Krasner, DDS
    2. McTigue (2000) Pediatr Clin North Am 47(5):1067

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