Dento-alveolar trauma represents that class of injuries involving external impacts to teeth and their supporting structures, which vary from simple contusions to complete avulsion of teeth. This is a relatively rare form of dental injury that involves a heavy amount of force and could often be linked to other sorts of injuries around the structures. Replantation represents the treatment of choice, where timelymanagement and proper storage are crucial for its favorable outcome.
One of the newer techniques, anti-resorption therapy, may be performed to prevent inflammation in avulsed teeth after replantation. Treatment includes systemic antibioticsand splinting. Follow-up consultations are essential to ensure clinical and radiographic evaluation for vitality of teeth and to monitor sign of ankylosis or root resorption.
Epidemiology
Peak incidence for dental trauma takes place in the age group of 7 to 11 years. The female to male ratio is 1:2, while permanent tooth is damaged higher than temporary teeth. Studies on 800 children aged 11 to 13 years noticed that just 10% did not remember a past incident of trauma. In a survey of 1298 patients who encountered trauma and managed in an emergency care, 24% involved dental injuries, while two-thirds of these were tooth avulsions.
Falls are considered the most common reasons for dental trauma, followed by assaults, full-contact sports, and cycling accidents. Bemelmans studied and reported that a minimum of 32% of athletes who took place in full- contact sports suffered few kinds of injury to dentition. The sports posing highest risk for dental injury include rugby, lacrosse, skating, martial arts, football, and ice hockey. Helmets did not reduce the incidence of dental damage, but the use of a mouth guard does. Dental accidents in children of young age must prompt consideration of potential abuse.
Anatomy
Pathophysiology
The periodontal ligament, also known as PDL, is a soft tissue that links up with the cementum which coats the tooth roots to the alveolar bone. Trauma may cause detachment of teeth if there is force applied on it from outside and periodontal fibers might be torn in this case. This traumatic event can interfere with blood vessels and nerves leading to pulp necrosis. The most frequent teeth involved are maxillary central incisors, followed by maxillary lateral incisors. Sometimes several teeth are avulsed simultaneously. Once exposed to open air, periodontal ligament fibers can cause resorption of the root leading to loss of bony substance. Resorption of roots will result in crown fracture and subsequent loss of the tooth.
Etiology
The majority of dentoalveolar trauma injuries are due to falls, particularly in full-contact sports, assaults, traffic accidents, cycling, and children. Dental injuries prevail mostly in a home setting, at school, and during sports at sports centers.
Dento-alveolar trauma is predisposed to features such as protuberant upper teeth, malocclusion class II, mouth breathing, overjet more than 3mm, incompetent lips, and anterior open bite.
Genetics
Prognostic Factors
A study by Karayilmazet al., on the long-term prognosis of teeth following avulsion concluded that replantation of the avulsed teeth is a rather highly successful procedure. However, the dry time strongly affects the prognosis both in the short and long term. Another study by Andreasen reported only 20% long-term survival of replanted avulsed teeth due to the lack of follow-up treatment.
Clinical History
The following must be considered in patients suffering from this disease:
Age of patient: Till the age of 6 to 7 years, primary anterior teeth can be usually seen.
To examine the contamination, location of the recovered tooth is important
Check whether the tooth was kept in solution or dry environment.
The mode of transport of tooth is to be checked as carrying it by root may worsen the condition
Concomitant injuries should be ruled out
Primary teeth should not be replaced as early tooth loss does not compromise the growth of succedaneous teeth. Replacement may foment tardiness of the eruption of permanent successors. Primary teeth may be fused, directly with the underlying alveolar bones giving rise to dentoalveolar ankylosis besides facial deformities.
Physical Examination
Inspection: Examine the surrounding soft tissue for embedded foreign particles like chipped teeth, ecchymosis, lacerations, and discoloration. Evaluate the teeth for chips, other deformities and fractures, as embedded fragments of tooth can cause fibrosis or chronic infection.
Palpation: Determine whether the entire segment or tooth is moving. If the patient can tolerate it, the patient can be asked to bite down to localize further in the suspected area.
Sensitivity and percussion: This test should be carried out using a tongue blade to assess general sensitivity. Note the sensitivity of air, cold, and heat.
Missing tooth: In case the tooth is not visualized, consider total intrusion into the underlying alveolar bone.
Age group
Associated comorbidity
Fistulas
Apical periodontitis
Pulp necrosis
Tooth discoloration
Alveolus root ankylosis
Pulp canal obliteration
Loss of vitality in case of complete formation of apex
Periapical periodontitis
Associated activity
Acuity of presentation
Differential Diagnoses
Fractured tooth (Dental)
Displaced tooth (Dental)
Lateral luxation
Subluxation
Total tooth intrusion
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Prehospital care: Military dental Professionals have updated guidelines for handling avulsed teeth. Avoid cleaning the tooth or touching the root, only using the crown. If reimplantation is not possible, a carrier media like saliva, water, Hanks solution or milk can be used. Hanks solution is pH-preserving and ideal for suspension apparatus that is trauma-reducing. Milk maintains periodontal ligament cell vitality for up to three hours, while saline is isotonic and sterile. Saliva is moist but it is not ideal because it is not osmotically and pH compatible, besides containing bacteria.
Emergency department care: Tooth preparation: To clean a tooth, rinse it with normal saline, reimplant if extraoral time is less than 20 minutes, use a bathing solution for 5 minutes to inhibit pathogens, or soak the tooth in fluoride and citric acid for longer periods.
Socket preparation:In order to avoid complications, leave the socket alone, soak in Hanks solution for half an hour before reimplantation, perform light aspiration if a blood clot remains, and gently irrigate for foreign bodies.
Tooth stabilization:To provide rapid tooth stabilization without prior training, use a Coe-Pak zinc oxide preparation, molded over the gingival area and between teeth, for rapid support. Adequate pain management should be provided along with tetanus vaccination.
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
Use of antibiotics
Penicillin VK: It inhibits the biosynthesis of mucopeptides in the cell wall and is effective in case of active multiplication.
Erythromycin: It is used as an alternative treatment in patients who are allergic to penicillin. This acts by inhibiting protein synthesis that is RNA-dependent by stimulating the breakdown of peptidyl tRNA which inhibits the growth of bacteria.
Amoxicillin: It is known to interfere with the cell wall mucopeptide in the active multiplication which results in bactericidal activity.
Use of analgesics
Acetaminophen and oxycodone: It is employed in relieving moderate to intense pain. It is indicated in treating patients who are sensitive to aspirin.
Codeine and acetaminophen: It is indicated to treat mild to medium pain.
Acetaminophen: It is used for relieving pain in people suffering with NSAIDS or aspirin.
intervention-with-a-procedure
Pre-replantation procedures
Storage media Storing an avulsed tooth in an isotonic solution like milk, saliva, or saline can lower the cell death in the roots of PDL (periodontal ligament), providing temporary, effective healing before replantation. Milk is the most recommended due to its availability, pH, and nutrient content.
Anti-resorption therapy: This involves soaking of an avulsed tooth into a solution that contains antibiotics to overcome inflammation from microbial contamination and necrotic cells. It involves a 20-minute storage solution consisting of 640µg dexamethasone and 800 µg doxycycline, while the alveolus is lightly irrigated and aspirated.
Tooth replantation
Tooth must be oriented physiologically and replanted, pressing firmly into the socket. Many teeth may be replanted successfully in case of dry time (extraoral) less than thirty minutes. The probability of survival of a tooth drastically goes down beyond this time. The ligament cells pertaining to periodontal region are damaged irreversibly beyond 30-60minutes.
Post-replantation procedures
Splinting The replanted tooth has to be disabled using a semi-rigid splint. An example of such splint is Titanium trauma. The replanted teeth seem to allow splinting for stabilization while the traumatized fibers of periodontal ligament are reattaching themselves to cementum from alveolus. According to the IADT (International Association of Dental Traumatology), suggested guidelines recommend splinting for different types of dental wounds. On the other hand, these guidelines suggested that the avulsed tooth needs to be splinted for a period of two weeks and four weeks when the tooth has been dried for more than 60minutes. As far as alveolar fractures are concerned, there is no mention of any type of splint, however they have suggested to immobilize the segment of alveolar region for a four-week period.
Systemic antibiotics
This is good to prescribe doxycycline to the patient for 5 days or using amoxicillin when intolerance is noted. In children weighing less than 50kg, the treatment consists of 100mg doxycycline as the first dose during the first day followed by 50mg for 4 consecutive days.
An avulsion is an uncommon form of dental injury. Professionals therefore have to familiarize themselves with the treatment protocols in order toenhance a successful outcome by remembering the purpose of treatment to retain the bone and tooth until the face reaches full growth. The requirement of early replantation and proper storage medium is recognized by parents lately. In this regard, a lead role needs to be taken by the primary care providers, and general dentist by educating the public on prognosis and success of replantation with regards to how early treatment is necessary and pointing out balanced salt solution or milk as being the best storage medium.
Dento-alveolar trauma represents that class of injuries involving external impacts to teeth and their supporting structures, which vary from simple contusions to complete avulsion of teeth. This is a relatively rare form of dental injury that involves a heavy amount of force and could often be linked to other sorts of injuries around the structures. Replantation represents the treatment of choice, where timelymanagement and proper storage are crucial for its favorable outcome.
One of the newer techniques, anti-resorption therapy, may be performed to prevent inflammation in avulsed teeth after replantation. Treatment includes systemic antibioticsand splinting. Follow-up consultations are essential to ensure clinical and radiographic evaluation for vitality of teeth and to monitor sign of ankylosis or root resorption.
Peak incidence for dental trauma takes place in the age group of 7 to 11 years. The female to male ratio is 1:2, while permanent tooth is damaged higher than temporary teeth. Studies on 800 children aged 11 to 13 years noticed that just 10% did not remember a past incident of trauma. In a survey of 1298 patients who encountered trauma and managed in an emergency care, 24% involved dental injuries, while two-thirds of these were tooth avulsions.
Falls are considered the most common reasons for dental trauma, followed by assaults, full-contact sports, and cycling accidents. Bemelmans studied and reported that a minimum of 32% of athletes who took place in full- contact sports suffered few kinds of injury to dentition. The sports posing highest risk for dental injury include rugby, lacrosse, skating, martial arts, football, and ice hockey. Helmets did not reduce the incidence of dental damage, but the use of a mouth guard does. Dental accidents in children of young age must prompt consideration of potential abuse.
The periodontal ligament, also known as PDL, is a soft tissue that links up with the cementum which coats the tooth roots to the alveolar bone. Trauma may cause detachment of teeth if there is force applied on it from outside and periodontal fibers might be torn in this case. This traumatic event can interfere with blood vessels and nerves leading to pulp necrosis. The most frequent teeth involved are maxillary central incisors, followed by maxillary lateral incisors. Sometimes several teeth are avulsed simultaneously. Once exposed to open air, periodontal ligament fibers can cause resorption of the root leading to loss of bony substance. Resorption of roots will result in crown fracture and subsequent loss of the tooth.
The majority of dentoalveolar trauma injuries are due to falls, particularly in full-contact sports, assaults, traffic accidents, cycling, and children. Dental injuries prevail mostly in a home setting, at school, and during sports at sports centers.
Dento-alveolar trauma is predisposed to features such as protuberant upper teeth, malocclusion class II, mouth breathing, overjet more than 3mm, incompetent lips, and anterior open bite.
A study by Karayilmazet al., on the long-term prognosis of teeth following avulsion concluded that replantation of the avulsed teeth is a rather highly successful procedure. However, the dry time strongly affects the prognosis both in the short and long term. Another study by Andreasen reported only 20% long-term survival of replanted avulsed teeth due to the lack of follow-up treatment.
The following must be considered in patients suffering from this disease:
Age of patient: Till the age of 6 to 7 years, primary anterior teeth can be usually seen.
To examine the contamination, location of the recovered tooth is important
Check whether the tooth was kept in solution or dry environment.
The mode of transport of tooth is to be checked as carrying it by root may worsen the condition
Concomitant injuries should be ruled out
Primary teeth should not be replaced as early tooth loss does not compromise the growth of succedaneous teeth. Replacement may foment tardiness of the eruption of permanent successors. Primary teeth may be fused, directly with the underlying alveolar bones giving rise to dentoalveolar ankylosis besides facial deformities.
Inspection: Examine the surrounding soft tissue for embedded foreign particles like chipped teeth, ecchymosis, lacerations, and discoloration. Evaluate the teeth for chips, other deformities and fractures, as embedded fragments of tooth can cause fibrosis or chronic infection.
Palpation: Determine whether the entire segment or tooth is moving. If the patient can tolerate it, the patient can be asked to bite down to localize further in the suspected area.
Sensitivity and percussion: This test should be carried out using a tongue blade to assess general sensitivity. Note the sensitivity of air, cold, and heat.
Missing tooth: In case the tooth is not visualized, consider total intrusion into the underlying alveolar bone.
Fistulas
Apical periodontitis
Pulp necrosis
Tooth discoloration
Alveolus root ankylosis
Pulp canal obliteration
Loss of vitality in case of complete formation of apex
Periapical periodontitis
Fractured tooth (Dental)
Displaced tooth (Dental)
Lateral luxation
Subluxation
Total tooth intrusion
Prehospital care: Military dental Professionals have updated guidelines for handling avulsed teeth. Avoid cleaning the tooth or touching the root, only using the crown. If reimplantation is not possible, a carrier media like saliva, water, Hanks solution or milk can be used. Hanks solution is pH-preserving and ideal for suspension apparatus that is trauma-reducing. Milk maintains periodontal ligament cell vitality for up to three hours, while saline is isotonic and sterile. Saliva is moist but it is not ideal because it is not osmotically and pH compatible, besides containing bacteria.
Emergency department care: Tooth preparation: To clean a tooth, rinse it with normal saline, reimplant if extraoral time is less than 20 minutes, use a bathing solution for 5 minutes to inhibit pathogens, or soak the tooth in fluoride and citric acid for longer periods.
Socket preparation:In order to avoid complications, leave the socket alone, soak in Hanks solution for half an hour before reimplantation, perform light aspiration if a blood clot remains, and gently irrigate for foreign bodies.
Tooth stabilization:To provide rapid tooth stabilization without prior training, use a Coe-Pak zinc oxide preparation, molded over the gingival area and between teeth, for rapid support. Adequate pain management should be provided along with tetanus vaccination.
Penicillin VK: It inhibits the biosynthesis of mucopeptides in the cell wall and is effective in case of active multiplication.
Erythromycin: It is used as an alternative treatment in patients who are allergic to penicillin. This acts by inhibiting protein synthesis that is RNA-dependent by stimulating the breakdown of peptidyl tRNA which inhibits the growth of bacteria.
Amoxicillin: It is known to interfere with the cell wall mucopeptide in the active multiplication which results in bactericidal activity.
Acetaminophen and oxycodone: It is employed in relieving moderate to intense pain. It is indicated in treating patients who are sensitive to aspirin.
Codeine and acetaminophen: It is indicated to treat mild to medium pain.
Acetaminophen: It is used for relieving pain in people suffering with NSAIDS or aspirin.
Pre-replantation procedures
Storage media Storing an avulsed tooth in an isotonic solution like milk, saliva, or saline can lower the cell death in the roots of PDL (periodontal ligament), providing temporary, effective healing before replantation. Milk is the most recommended due to its availability, pH, and nutrient content.
Anti-resorption therapy: This involves soaking of an avulsed tooth into a solution that contains antibiotics to overcome inflammation from microbial contamination and necrotic cells. It involves a 20-minute storage solution consisting of 640µg dexamethasone and 800 µg doxycycline, while the alveolus is lightly irrigated and aspirated.
Tooth replantation
Tooth must be oriented physiologically and replanted, pressing firmly into the socket. Many teeth may be replanted successfully in case of dry time (extraoral) less than thirty minutes. The probability of survival of a tooth drastically goes down beyond this time. The ligament cells pertaining to periodontal region are damaged irreversibly beyond 30-60minutes.
Post-replantation procedures
Splinting The replanted tooth has to be disabled using a semi-rigid splint. An example of such splint is Titanium trauma. The replanted teeth seem to allow splinting for stabilization while the traumatized fibers of periodontal ligament are reattaching themselves to cementum from alveolus. According to the IADT (International Association of Dental Traumatology), suggested guidelines recommend splinting for different types of dental wounds. On the other hand, these guidelines suggested that the avulsed tooth needs to be splinted for a period of two weeks and four weeks when the tooth has been dried for more than 60minutes. As far as alveolar fractures are concerned, there is no mention of any type of splint, however they have suggested to immobilize the segment of alveolar region for a four-week period.
Systemic antibiotics
This is good to prescribe doxycycline to the patient for 5 days or using amoxicillin when intolerance is noted. In children weighing less than 50kg, the treatment consists of 100mg doxycycline as the first dose during the first day followed by 50mg for 4 consecutive days.
An avulsion is an uncommon form of dental injury. Professionals therefore have to familiarize themselves with the treatment protocols in order toenhance a successful outcome by remembering the purpose of treatment to retain the bone and tooth until the face reaches full growth. The requirement of early replantation and proper storage medium is recognized by parents lately. In this regard, a lead role needs to be taken by the primary care providers, and general dentist by educating the public on prognosis and success of replantation with regards to how early treatment is necessary and pointing out balanced salt solution or milk as being the best storage medium.
Dento-alveolar trauma represents that class of injuries involving external impacts to teeth and their supporting structures, which vary from simple contusions to complete avulsion of teeth. This is a relatively rare form of dental injury that involves a heavy amount of force and could often be linked to other sorts of injuries around the structures. Replantation represents the treatment of choice, where timelymanagement and proper storage are crucial for its favorable outcome.
One of the newer techniques, anti-resorption therapy, may be performed to prevent inflammation in avulsed teeth after replantation. Treatment includes systemic antibioticsand splinting. Follow-up consultations are essential to ensure clinical and radiographic evaluation for vitality of teeth and to monitor sign of ankylosis or root resorption.
Peak incidence for dental trauma takes place in the age group of 7 to 11 years. The female to male ratio is 1:2, while permanent tooth is damaged higher than temporary teeth. Studies on 800 children aged 11 to 13 years noticed that just 10% did not remember a past incident of trauma. In a survey of 1298 patients who encountered trauma and managed in an emergency care, 24% involved dental injuries, while two-thirds of these were tooth avulsions.
Falls are considered the most common reasons for dental trauma, followed by assaults, full-contact sports, and cycling accidents. Bemelmans studied and reported that a minimum of 32% of athletes who took place in full- contact sports suffered few kinds of injury to dentition. The sports posing highest risk for dental injury include rugby, lacrosse, skating, martial arts, football, and ice hockey. Helmets did not reduce the incidence of dental damage, but the use of a mouth guard does. Dental accidents in children of young age must prompt consideration of potential abuse.
The periodontal ligament, also known as PDL, is a soft tissue that links up with the cementum which coats the tooth roots to the alveolar bone. Trauma may cause detachment of teeth if there is force applied on it from outside and periodontal fibers might be torn in this case. This traumatic event can interfere with blood vessels and nerves leading to pulp necrosis. The most frequent teeth involved are maxillary central incisors, followed by maxillary lateral incisors. Sometimes several teeth are avulsed simultaneously. Once exposed to open air, periodontal ligament fibers can cause resorption of the root leading to loss of bony substance. Resorption of roots will result in crown fracture and subsequent loss of the tooth.
The majority of dentoalveolar trauma injuries are due to falls, particularly in full-contact sports, assaults, traffic accidents, cycling, and children. Dental injuries prevail mostly in a home setting, at school, and during sports at sports centers.
Dento-alveolar trauma is predisposed to features such as protuberant upper teeth, malocclusion class II, mouth breathing, overjet more than 3mm, incompetent lips, and anterior open bite.
A study by Karayilmazet al., on the long-term prognosis of teeth following avulsion concluded that replantation of the avulsed teeth is a rather highly successful procedure. However, the dry time strongly affects the prognosis both in the short and long term. Another study by Andreasen reported only 20% long-term survival of replanted avulsed teeth due to the lack of follow-up treatment.
The following must be considered in patients suffering from this disease:
Age of patient: Till the age of 6 to 7 years, primary anterior teeth can be usually seen.
To examine the contamination, location of the recovered tooth is important
Check whether the tooth was kept in solution or dry environment.
The mode of transport of tooth is to be checked as carrying it by root may worsen the condition
Concomitant injuries should be ruled out
Primary teeth should not be replaced as early tooth loss does not compromise the growth of succedaneous teeth. Replacement may foment tardiness of the eruption of permanent successors. Primary teeth may be fused, directly with the underlying alveolar bones giving rise to dentoalveolar ankylosis besides facial deformities.
Inspection: Examine the surrounding soft tissue for embedded foreign particles like chipped teeth, ecchymosis, lacerations, and discoloration. Evaluate the teeth for chips, other deformities and fractures, as embedded fragments of tooth can cause fibrosis or chronic infection.
Palpation: Determine whether the entire segment or tooth is moving. If the patient can tolerate it, the patient can be asked to bite down to localize further in the suspected area.
Sensitivity and percussion: This test should be carried out using a tongue blade to assess general sensitivity. Note the sensitivity of air, cold, and heat.
Missing tooth: In case the tooth is not visualized, consider total intrusion into the underlying alveolar bone.
Fistulas
Apical periodontitis
Pulp necrosis
Tooth discoloration
Alveolus root ankylosis
Pulp canal obliteration
Loss of vitality in case of complete formation of apex
Periapical periodontitis
Fractured tooth (Dental)
Displaced tooth (Dental)
Lateral luxation
Subluxation
Total tooth intrusion
Prehospital care: Military dental Professionals have updated guidelines for handling avulsed teeth. Avoid cleaning the tooth or touching the root, only using the crown. If reimplantation is not possible, a carrier media like saliva, water, Hanks solution or milk can be used. Hanks solution is pH-preserving and ideal for suspension apparatus that is trauma-reducing. Milk maintains periodontal ligament cell vitality for up to three hours, while saline is isotonic and sterile. Saliva is moist but it is not ideal because it is not osmotically and pH compatible, besides containing bacteria.
Emergency department care: Tooth preparation: To clean a tooth, rinse it with normal saline, reimplant if extraoral time is less than 20 minutes, use a bathing solution for 5 minutes to inhibit pathogens, or soak the tooth in fluoride and citric acid for longer periods.
Socket preparation:In order to avoid complications, leave the socket alone, soak in Hanks solution for half an hour before reimplantation, perform light aspiration if a blood clot remains, and gently irrigate for foreign bodies.
Tooth stabilization:To provide rapid tooth stabilization without prior training, use a Coe-Pak zinc oxide preparation, molded over the gingival area and between teeth, for rapid support. Adequate pain management should be provided along with tetanus vaccination.
Penicillin VK: It inhibits the biosynthesis of mucopeptides in the cell wall and is effective in case of active multiplication.
Erythromycin: It is used as an alternative treatment in patients who are allergic to penicillin. This acts by inhibiting protein synthesis that is RNA-dependent by stimulating the breakdown of peptidyl tRNA which inhibits the growth of bacteria.
Amoxicillin: It is known to interfere with the cell wall mucopeptide in the active multiplication which results in bactericidal activity.
Acetaminophen and oxycodone: It is employed in relieving moderate to intense pain. It is indicated in treating patients who are sensitive to aspirin.
Codeine and acetaminophen: It is indicated to treat mild to medium pain.
Acetaminophen: It is used for relieving pain in people suffering with NSAIDS or aspirin.
Pre-replantation procedures
Storage media Storing an avulsed tooth in an isotonic solution like milk, saliva, or saline can lower the cell death in the roots of PDL (periodontal ligament), providing temporary, effective healing before replantation. Milk is the most recommended due to its availability, pH, and nutrient content.
Anti-resorption therapy: This involves soaking of an avulsed tooth into a solution that contains antibiotics to overcome inflammation from microbial contamination and necrotic cells. It involves a 20-minute storage solution consisting of 640µg dexamethasone and 800 µg doxycycline, while the alveolus is lightly irrigated and aspirated.
Tooth replantation
Tooth must be oriented physiologically and replanted, pressing firmly into the socket. Many teeth may be replanted successfully in case of dry time (extraoral) less than thirty minutes. The probability of survival of a tooth drastically goes down beyond this time. The ligament cells pertaining to periodontal region are damaged irreversibly beyond 30-60minutes.
Post-replantation procedures
Splinting The replanted tooth has to be disabled using a semi-rigid splint. An example of such splint is Titanium trauma. The replanted teeth seem to allow splinting for stabilization while the traumatized fibers of periodontal ligament are reattaching themselves to cementum from alveolus. According to the IADT (International Association of Dental Traumatology), suggested guidelines recommend splinting for different types of dental wounds. On the other hand, these guidelines suggested that the avulsed tooth needs to be splinted for a period of two weeks and four weeks when the tooth has been dried for more than 60minutes. As far as alveolar fractures are concerned, there is no mention of any type of splint, however they have suggested to immobilize the segment of alveolar region for a four-week period.
Systemic antibiotics
This is good to prescribe doxycycline to the patient for 5 days or using amoxicillin when intolerance is noted. In children weighing less than 50kg, the treatment consists of 100mg doxycycline as the first dose during the first day followed by 50mg for 4 consecutive days.
An avulsion is an uncommon form of dental injury. Professionals therefore have to familiarize themselves with the treatment protocols in order toenhance a successful outcome by remembering the purpose of treatment to retain the bone and tooth until the face reaches full growth. The requirement of early replantation and proper storage medium is recognized by parents lately. In this regard, a lead role needs to be taken by the primary care providers, and general dentist by educating the public on prognosis and success of replantation with regards to how early treatment is necessary and pointing out balanced salt solution or milk as being the best storage medium.
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