If a tooth has been avulsed due to trauma and is out of the mouth, minimizing damage to the periodontal ligament while the tooth is out of the mouth is a critical part of managing these teeth. According to an article by Loushine, Weller, and Kimbrough, the most important factor in terms of successful replantation of an avulsed tooth is replanting the tooth as quickly as possible. Drying of PDL cells must be prevented by replanting the tooth within 15 to 20 minutes from the time of avulsion. If this is not possible, the tooth should be stored in an appropriate transport medium until the tooth can be replanted into the socket in the dental office. The most ideal storage and transport medium is Hank’s Balanced Salt Solution, which is available as Save-A-Tooth. This fluid preserves and reconstitutes PDL cells. If this solution is not available, milk has the pH and osmolarity that is compatible with vital cells, and is free of bacteria. Saliva and tap water are less desirable as a transport medium, but are preferable to allowing the root of the tooth to dry. Replanted teeth should be stabilized with a semi-rigid splint for 7 to 10 days, and within 1 to 2 weeks pulp canal irritants should be removed to prevent inflammatory root resorption. Long-term recall appointments for more than 5 years are recommended because an avulsed tooth has a guarded long-term prognosis.
(Source: GDA Action, The Journal of the Georgia Dental Association, October 2005)
