Field Care of the Injured Tooth
abstract &commentary
Synopsis: Avulsed teeth should be kept viable and reimplanted within 30 minutes for the best outcome.
Source: Roberts WO. Field care of the injured tooth. Physician and Sportsmedicine 2000;28(1):101-102.
The article, "field care of the injured tooth," by William Roberts, MD, is a well-organized, inclusive presentation on the emergency management of the injured tooth. Not only does the article briefly review the pertinent anatomy of the tooth, including a helpful diagram, but it also presents a concise but thorough review of the most common injuries to the tooth. Emergency measures that can be taken at the trauma scene to salvage the tooth are highlighted. What injuries do and do not require immediate dental evaluation are clearly defined. If a tooth is avulsed, Roberts recommends that, if the athlete is alert, the avulsed tooth should immediately be repositioned in its socket with care taken to position the tooth proper side forward. The tooth can be temporarily held in place by aluminum foil, chewing gum, or Silly Putty. One should rinse off obvious dirt before repositioning.
If the tooth cannot be replaced, it should be placed in cold milk (preferably skim), cold saline, or, if the athlete is alert, under the athlete’s cheek or tongue. The athlete should be transported immediately to a dentist. Roberts recommends reimplantation of the tooth within 30 minutes in order to have a favorable outcome. Therefore, it is advisable to call the dentist as soon as the injury is diagnosed so that the dentist will be available to see the athlete as soon as the athlete arrives at the dental facility. Furthermore, the athlete should be transported immediately following the injury rather than waiting for transport after completion of practice or the game.
While it is advisable prior to transport to attempt to reposition a tooth that is laterally displaced or extruded (i.e., one that appears longer than surrounding teeth), an intruded tooth (one that is pushed into the gum and is shorter than the surrounding teeth) should not be repositioned prior to transport to the dental facility.
Comment by Letha Y. Griffin, MD, PhD
Roberts has done an excellent job of simplifying into a "cookbook-like" presentation the suggested care for an injured tooth. Dental injuries are frequent in contact sports. While it is imperative for all those involved in athletic care to be knowledgeable regarding their treatment, it is also equally important that we all be advocates of oral protective equipment. Athletes involved in sports such as football, ice hockey, field hockey, rugby, lacrosse, basketball, soccer, and infielders in baseball and softball should be encouraged to wear mouth guards in practice as well as competition. Face masks for hockey, football, and men’s lacrosse are also suggested and mandatory in high school and collegiate competition.
An avulsed tooth ideally:
a. should be reimplanted within 30 minutes.
b. should not be reimplanted if contaminated.
c. should only be reimplanted by a dentist or dental assistant.
d. should be soaked in antibiotic solution prior to reimplantation.
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