Avulsed Tooth

Losing a tooth can be physically and emotionally trying, as the resulting empty site is not aesthetically pleasing and is difficult to fill and difficult to replace. Long-term sequelae include shifting of remaining teeth with resulting misalignment and periodontal disease.

As early as 400 BCE, Hippocrates suggested that displaced teeth should be replaced and fastened to adjacent teeth with wire. Modern emergency departments focus on reimplanting teeth as soon as possible, minimizing periodontal damage, and preventing infection of the pulp tissue.

The usual cause is a directed force sufficient to overcome the bond between the affected tooth and the periodontal ligament within the cradling alveolar socket. Avulsion results in hypoxia and eventual necrosis of the pulp. The primary goal of rapid reimplantation is to preserve the periodontal ligament, not the tooth. The avulsed tooth inevitably requires a root canal; however, if the periodontal ligament survives, the degree and timeliness of root resorption is improved and ankylosis is decreased.

Causes of tooth avulsion include the following:

• Unknown (17%)

• Altercations (17%)

• Contact sports (15.9%)

• Motor vehicle collision (10.8%)

• Motorcycle accident (10.4%)

• Ice hockey (2.3%)

United States statistics

The prevalence of avulsion from traumatic injury of primary dentition is 7-13%. In permanent teeth, the prevalence is 1-16%.

International statistics

A study conducted in Sweden showed approximately 7% of all physical injuries involved the oral cavity. In patients aged 0-19 years, 9% of all injuries involved the oral cavity. In the same study, more than 50% of physical trauma in child abuse cases occurred in the head and neck region.

Facial injuries are common during war. During the Korean War, maxillofacial injuries numbered 3,000.

Sex- and age-related demographics

The male-to-female ratio is 2-3:1.

The average age of injury varies. A study from Beijing, China, noted that most dental trauma occurs in children aged 7-15 years. ^[1] In youths, falls and sporting activities account for most injuries. In later teenaged years, motor vehicle collisions (MVCs) and assaults account for most injuries.

Immature permanent teeth have a higher chance of survival than older permanent teeth.

Root canal is necessary when necrotic tooth pulp becomes infected. Infection can pass from the pulp through the dentin tubules and stimulate an inflammatory response, resulting in inflammatory root resorption.

The chance of a successful reimplantation is dependent upon the amount of time the tooth has been out of the socket. Education of patients toward self-reimplantation may help to decrease the out-of-socket time.

Morbidity/mortality

Trauma to the teeth is not life threatening; however, associated maxillofacial injuries and fractures can compromise the airway. Morbidity to the teeth may be individualized to primary or permanent teeth. Teeth with avulsion actually continue deteriorating, even at the 36-month follow-up appointment.

Primary teeth

• Failure to continue eruption

• Color changes

• Infection

• Abscess

• Loss of space in the dental arch

• Ankylosis

• Injury to the permanent teeth

• Abnormal exfoliation

Permanent teeth

• Color changes

• Infection

• Abscess

• Loss of space in the dental arch

• Ankylosis

• Resorption of root structure

• Abnormal root development

Complications

Complications of tooth avulsion include the following:

• Loss of tooth

• Cosmetic deformity

• Infection

A dental mouth guard is an effective device for preventing dental injuries, and patients should be advised to wear them during activities where dental injuries are possible. ^[2]

For excellent patient education resources, visit WebMD's Oral Care Center. Also, see WebMD's patient education article Handling Dental Emergencies.