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Dental Trauma, continued
6. Avulsion
With this type of injury, the tooth is completely out of the socket. Management of avulsion injuries depends on the 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.
 
Re-implant an avulsed permanent tooth immediately, ensuring correct orientation. The tooth should be re-implanted within 20 minutes, but the best outcome is with teeth replaced within 5 minutes.
 
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.
 
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.
 
Never suggest a child hold the damaged tooth in his or her mouth because of the risk of aspiration or bacterial contamination.
 
 
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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