06 Jul 2014

The Super Dental Emergency

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In dental practice there are emergencies and there are what the Americans call “super emergencies”. Emergencies need to be seen on the same day while there is one super emergency – the knocking out of a permanent tooth – this needs to be managed immediately!

The permanent teeth most likely to be knocked out are the top front teeth. Sporting injuries, falls, fights, cycling accidents account for the commonest cause. Teeth that are knocked out can be replanted successfully if they have been stored properly (kept moist) and if the time out of the mouth is short (less than 1 hour).

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The cells on the surface of the root start to die within 15 minutes of the tooth being knocked out. These cells are responsible for the tooth reattaching to the bone, so our aim is to keep as many of the bone, so our aim is to keep as many of them healthy as possible.

The options are as follows:

1. To reduce the risk of cell death the best approach is for the individual or a family member to put the tooth back in and come to the Dental Surgery. This gives the tooth the best chance of survival as more cells on the root survive.

2. If unable to put the tooth back in then store the tooth in milk while coming to the Dental Surgery. Milk is readily available and is kind to the cells on the root surface. Milk is a better storage medium than water. Milk gives a better outcome for teeth that are out for longer.

The Dentist will replant the tooth, best results are for teeth that have been out for less than 1 hour and have been stored well. Once replanted the tooth is splinted to hold it in place while it reattaches. Most teeth need root canal treatment in the following few weeks to avoid root resorption and abscess formation. Following this format gives a 5 year survival of 50%.

For sports clubs and dental centres dealing with frequent traumatic dental injuries there is a superior method of storing teeth that have been knocked out. It is called the Save A Tooth. It is a storage container specially designed for storage of avulsed teeth. It contains Balanced Hanks Solution that keeps the cells on the root surface alive for up to 24 hours. It can be purchased online.

If a primary or baby tooth is knocked out it should not be replanted as it increases the risk of damage to the permanent successor; put it under the pillow!

By Dr William Fenlon