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 following an 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)