An avulsed permanent tooth should be replanted if the tooth is intact and alveolar socket is uninjured. Even if replantation later fails, it improves the outcome of a later implantation and postpones the need of prosthetic replacement of the tooth.
An avulsed primary tooth should never be replanted so as not to damage the developing permanent tooth underneath.
Replantation of an avulsed tooth must take place within 3 hours from the avulsion. Urgency in other dental traumas depends on whether the patient has intense pains, heavy bleeding or other problems requiring urgent treatment.
The tooth is gently cleaned from dirt but the membrane covering the root should not be rubbed nor unnecessarily touched.
The tooth should be preserved in milk, in the mouth under the tongue or in any moist environment until it is replanted.
Replantation can sometimes be performed without local anaesthesia in a general practitioner's office. The alveolar socket can be cleaned of dirt and blood clot by rinsing with physiological saline before the tooth is pressed gently in place.
The positions of the neighbouring teeth help to align the tooth correctly. After replantation the tooth should be fixed to the neighbouring teeth by a dentist. According to current understanding, one-week fixation may be sufficient.
A systemic course of an antimicrobial drug administered right after replantation decreases the risk of late inflammatory complications. Immunization status for tetanus must always be checked, and a tetanus booster is given in unclear cases.
Crown fractures and injuries to primary teeth
Urgency: if there is no bleeding or severe pain, the patient can visit a dentist the next working day. Otherwise, the patient should go to a dental emergency deparment.
Exposed dentin surfaces in crown fractures can be covered with an isolating varnish as first aid. This can be done out of the dental chair.
All crown fractures can be treated with conventional fillings or artificial crowns, but the treatment requires conditions and equipment of a dentist's practice.
Sharp edges on the crowns of fractured primary teeth can be rounded, but luxated primary teeth should be extracted in order to avoid damage to the growing permanent tooth underneath.
Intrusively luxated permanent teeth sometimes erupt spontaneously, but primary teeth may require surgical extraction.
Root fractures
The diagnosis is made by dental radiography.
Depending on the location of the fracture line root fractures may go unnoticed and heal spontaneously or they may require long-term (up to 3 months) arch bar fixation, or result in the loss of the tooth.
If the fracture line is located in the middle third of the longitudinal axis of the root or lower, the duration of arch bar fixation may be limited to only 4 weeks.
If the fracture line is close to the crown but still completely inside the bony part of the tooth extraction fossa, the duration of arch bar fixation is 3 months.
Luxations
Urgency: severe bleeding and pain may justify a visit to a dental emergency department. It would be good to reposition a badly luxated tooth soon, even as an emergency procedure. Otherwise, it is sufficient to visit a dentist the next working day.
Do not attempt to press luxated teeth back to their sockets in a general practitioner's office as they require local anaesthesia and immediate fixation.
During transportation to the dentist the patient can bite a gauze dressing that stabilized the luxated teeth and reduces bleeding.
Mild forms of luxation include concussion and subluxation, in which the tooth is loose, but not dislocated. The dislocation may be palatinal, buccal, extrusive or intrusive, or the tooth may be totally avulsed.
Usually more than one tooth is injured even if clinical signs of injury are visible in only one tooth. Late complications reveal damage to neighbouring teeth.
Fracture of the alveolar process is diagnosed by the observation that moving the displaced tooth causes the neighbouring teeth to move.