Let's talk about dental avulsion

Dr Ningthoujam Sharna *

Smile is an important asset for every individual. The front tooth plays a major role on aesthetic for each one of us. WHEN WE LOSE A FRONT TOOTH, it has a great adverse effect on our self confidence and social life.

Traumatic injuries to teeth and their supporting structures during childhood are one of the major problems faced by the dentist. Children usually encounter many minor accidents during their day to day play activities which can result in complete avulsion of teeth. Tooth avulsion in layman term can be expressed as the whole tooth getting "knocked out" of the mouth from its socket without getting broken or fractured.

Boys tend to engage more in play activities and hence it has been reported to occur more among boys than in girls. However not only children, it also occurs in adults due to road traffic accidents and other reasons.

Let's discuss on what can be done to save the tooth...before that some questions to ponder upon:
o Do you feel that we can put the tooth back into the socket?
o Or will you just leave the tooth at the site of the trauma?
o Will you go to a Dentist ASAP or leave it and wait for another day.. .month.. .or forget about it? And don't be surprised as the first question a dentist would ask you is where is the tooth???!

Various treatment modalities are available for management of dental avulsion which includes prosthetic replacement of the avulsed tooth, minor orthodontic movements, functional appliances, and immediate re-implantation of the avulsed tooth followed by endodontic treatment. However immediate re-implantation of the avulsed teeth is considered to be ideal treatment as it has shown to have more psychological benefits than wearing a denture or fixed partial denture.

Re-implantation means putting back the tooth into its socket. Retrieval of the avulsed tooth and its transportation to the dentists is a crucial factor to carry out re-implantation. Therefore let us discuss on what simple steps can be done by near and dear ones especially parents, school teachers and health care professionals from a very young age when tooth avulsion is encountered. These steps also apply for adults.

A proper medical history of any present/past illness, drug allergies, current medications if any, history of surgeries and hospitalisations should be informed to the dentist (before any dental procedures).

What will you do when a tooth is knocked out?

> If a tooth is knocked out without getting broken/fractured, the good news is yes we can put it back.
> Milk/primary (Baby) teeth cannot be reimplanted, only permanent teeth can be reimplanted.
> Never throw or leave an avulsed tooth at the site of the injury.
> Do take it to the dentist. How will you bring it to the dentist?
> If a tooth is avulsed make sure it is permanent teeth, milk/baby or primary teeth should not be replanted.
> Keep the patient calm.
> Find the tooth and pick it up by the crown (the white part). Avoid touching the root.
> If the tooth is dirty wash it briefly under cold running water for 1 Os maximum and reposition it and make the patient bite firmly on a handkerchief once the teeth is in place.
> If the guardian is reluctant to do this, the avulsed tooth can be brought by placing it under the tongue or between the cheeks of the child's mouth (Please note that if he/she is not co-operative/ very young child / child in the state of shock or unconscious than don't try this as they may end up swallowing the tooth)
> If that cannot be done you can make your child spit saliva in a clean container and place the tooth inside the container.
> Some accessible medium for transport you can use is milk and saline.
> The tooth should be brought as soon as possible.
> Never use water as a storage medium.
> Never leave the tooth dry.

The prognosis of the re-implantation procedure entirely depend on the knowledge of transporting the teeth to the dentist as delayed and unphysiological transportation of the avulsed teeth has been reported with low survival rate of reimplanted tooth. The anterior permanent teeth play a major role in aesthetics and dental avulsion can hugely disrupts the aesthetic harmony in children lowering their self esteem. It brings aesthetic, functional, and psychological consequences, both on the child and the parents.

Hope this article by and large spreads a little knowledge about tooth avulsion and help everyone save their smile.

(We are currently working on a research work here in Imphal – on "knowledge and attitudes of parents towards avulsed teeth". And our pilot study has revealed a very low number of parents have knowledge with regard to avulsed teeth. This article is part of the study and attempts to spread knowledge on the concerned topic)