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Dental Trauma, continued
6. Avulsion
Tooth is completely out of the socket. Management depends on tooth type.

Avulsion of a Primary Tooth
DO NOT re-implant, as this may damage the underlying permanent tooth. Instead, refer to a dentist within 24 hours.

Avulsion of a Permanent Tooth
This is a dental emergency! The most common teeth avulsed are the central maxillary incisors.

Avulsion should be managed as follows:

Gently rinse off debris with saline or milk. Hold tooth by crown only.
Avoid touching the root. Do not clean or rub it. It is important to preserve the periodontal ligament for tooth survival.
For a permanent tooth, re-implant immediately, ensuring correct orientation. Time is of the essence! The tooth should be re-implanted within 20 minutes, but the best outcome is with teeth replaced within 5 minutes. Re-implantation must occur within 2 hours for hope of survival.
Instruct patient to bite on gauze or a handkerchief or to hold the tooth in place.
Send to a dentist or maxillofacial surgeon immediately for radiographs, splinting, and antibiotic prophylaxis. The tooth will be splinted for 7 to 10 days, during which time a soft diet is recommended. Pain is usually controlled with NSAIDs.
If tooth cannot be re-implanted on scene, it should be transported (in order of preference): a tooth storage solution (Hank’s Balance Salt Solution, Viaspan®), warm milk, saline, or saliva. A tooth should not be transported dry or in plain water, as this significantly decreases the chance of ligament survival.
Never suggest a child hold the damaged tooth in his or her mouth because of the risk of aspiration or bacterial contamination.
If a tooth cannot be located, do not assume it is lost at the scene. (See Examination Following Oral Injury for more information.)
Primary avulsed teeth should not be re-implanted.
It is paramount to reinsert avulsed permanent teeth as soon as possible.
Avulsed teeth should be transported in a tooth storage solution, warm milk, saline, or saliva (in descending order of preference).

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