Avulsion is defined as complete displacement of a tooth out of its socket. The periodontal ligament is severed and fracture of the alveolus may occur. Clinical examination and radiographic examinations reveal that the tooth is not present in the socket. Radiographic examination is necessary to rule out intrusion, if the avulsed tooth is not found. Treatment consists of:
Permanent teeth: The sooner avulsed permanent teeth are replanted the greater chance for a favorable outcome. However, before attempting replantation:
Assess the patient's medical status. Replantation is contraindicated in patients that are immunocompromised or suffer from severe congenital cardiac anomalies, severe uncontrolled seizure disorders, severe mental disability and severe uncontrolled diabetes.
Assess the integrity of the tooth and the supporting structures. Compromised integrity of the tooth (extensive decay) or supporting structures (alveolar fracture, bone recession due to periodontal disease) will reduce replantation success.
Replantation of an avulsed tooth is preferably done at the injury site to minimize extra-alveolar time. The tooth is rinsed with cold tap water for ten seconds to remove any gross contaminants and then immediately replanted in its socket. The patient is referred to the dental care facility for stabilization and antibiotic prophylaxis.