multitude of teeth are knocked out every year in the United States.
The main causes in the permanent dentition are fights and sports injuries.
including Dr. Paul Krasner, have developed methods of saving over 90%
of these teeth. These knocked out teeth can often be re-implanted under
favorable conditions. If the tooth can be replanted within 15-30 minutes
after the accident, there is a greater than 90% chance the tooth will
be retained for life. However, practical life experience shows us that
may be unrealistic.
The critical determining factors for success of replantation are the condition
of the alveolar socket (bone) which should be free from periodontal (gum)
disease and be reasonably intact, the time the tooth is out of the bone
socket, the storage and transport medium used to deliver the tooth to
the dentist, and how the tooth is handled between the accident and arrival
at the dentist.
After the accident, the tooth should be located and picked up by the crown
or enamel portion and NOT the root. If the tooth is dirty or contaminated,
it should gently be placed in a transport solution of Hank's Balanced
Salt Solution. If HBSS is not available, the next best alternatives are
whole cold milk, saline, or saliva. However it should be noted that milk,
saline, and saliva have their limitations.
Saline solution may be damaging if it is allowed to soak in it for more
than one or two hours. Saliva may be damaging as the tooth ligament cells
may become infected. Cold whole milk is acceptable for short periods of
time however it sours quickly, and milk is usually not available at a
sporting event. Never transport the tooth to the dentist in tissue or
gauze. If none of the above are readily available, use water.
The HBSS is biocompatible with the tooth periodontal ligament cells and
can keep these cells viable for 24 hours because of its ideal pH and osmolality.
Research has shown that this fluid can rejuvenate degenerated ligament
cells and maintain a success rate of over 90% if an avulsed tooth is soaked
in it for 30 minutes prior to replantation. This solution does not need
refrigeration and is preserved in a break resistant, sterilized container.
It is now obvious that a proper transport medium for tooth avulsion should
be part of the first aid kit at schools and most definitely be part of
the sports medicine medical kit of the athletic trainers and coaches available
at all sporting events. It would be beneficial for parents to keep a container
of HBSS in the home medicine cabinet.
Once the dentist receives the tooth preserved in this system he/she may
precede to implant the tooth and do the proper splinting procedures with
a favorable prognosis.
It should be noted that if a primary (baby) tooth is knocked out, it should
NOT be replanted as it could damage the permanent tooth bud in formation.
Parents should NOT try to place the baby tooth back into the socket, and
should immediately seek the advise and treatment of their dentist.
It is advised that if the accident victim shows any signs of head injury,
unconsciousness, nausea, or persistent headaches, they should be first
evaluated for their head injury by proper medical personnel. Once a head
injury is ruled out, they may precede to the dentist for treatment of
the avulsed (knocked out) tooth. This is another reason why a proper storage
medium for the tooth is critical.
Therefore the treatment of choice is HBSS followed by whole cold milk.
Hanks Balanced Salt Solution can be purchased by the trade name Save-a-Tooth at www.save-a-tooth.com or 1-888-788-6684.