Traumatic injuries to teeth are more common than ever before and they are the most serious of dental conditions. Excluding motor-vehicle injuries, most data document a relatively consistent increase in injuries to teeth in recent years.
Advice to parents and team coaches used to be fairly straightforward and easy to remember. First, find the tooth and keep it moist while transporting the injured child to the dental office. Distilled water, contact lens solutions and milk were considered acceptable liquids for the purpose. Second, the predominant treatment philosophy followinan accident involving tooth loss called for replacing the tooth immediately or within 30 to 60 minutes if possible.
But after years of study, researchers have found that the long-term clinical rate of replanted avulsed teeth has been low, ranging from 4 to 50 percent. For this reason, attention is now being focused on keeping the soft tissue around the root healthy rather than on the speed of tooth replacement.
The best outcome in the case of a tooth being knocked out can be expected when the tooth is replaced within a few minutes of the traumatic event. According to Endodontics: Colleagues for Excellence, if teeth can be replaced within 15 minutes of being knocked out, the periodontal ligament (soft tissue surrounding root of tooth) will be restored within a few weeks in a very high percent of teeth. However, the pulp cannot be expected to survive; therefore root canal therapy is an important part of successful treatment. The sole exception to performing root canal treatment of teeth that have been replanted is in the case of a very immature tooth, where revascularization of the pulp is possible and desired. Ideally, root canal treatment should be performed on a tooth during the second week after replantation. Calcium hydroxide placed for up to 1 month prior to filling the root canal will aid in disinfection of the root canal system, and stabilization of the tooth with a functional, nonrigid splint for 2 to 3 weeks will help re-establish the periodontal ligaments.
If the avulsed (knocked out) tooth has been left dry for more than 1 hour, chances for restoration of the periodontal ligament are very poor. However, replantation of such a tooth may be worthwhile because the patient may benefit from several years of use.
Parents and coaches can take preventative measures to protect the children from facial injuries when playing sports. Approved mouth guards are the first step. But somehow, accidents will happen. Consequently, you should purchase the commercially available balanced salt solution (HBSS or ETPS) from the local drug stores and have one or two of the kits available at every game and practice session. Because a team will use only one or two of the kits in a season, the cost should not be prohibitive. Simply having one of these balanced salt solution kits available will provide a significant head start when dealing with an avulsed tooth. If commercially prepared balanced salt solutions kits are not available in your area, consider informing the various sports leagues, local schools and pharmacies that there is a market for these kits, and their promotion should be encouraged.
(Sources: Endodontics: Colleagues for Excellence, Spring 2006, and American Journal of Orthodontics and Dentofacial Orthopedics)
Dr. S. Jovovic received his dental degree from the University of Belgrade in 1981. He is registered with the Royal College of Dental Surgeons as a general practitioner and was practicing dentistry in the west end of Toronto until 2002. From 2000 he runs the Flemingdon Park Dental Centre with his wife. http://www.flemingdondental.com