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11 yo patient presents with avulsed #6 at 10:30. Pts parents state that it happened around 7:30. What would you do? Reimplant the tooth even though the prognosis of the tooth is poor?
avulsed tooth
- Thread starter 3rdmolarslayer
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3rdmolarslayer said:
On an 11 year old I would probably re-implant it and tell the parents he should see a dentist the next day for close follow up. Explain it probably will not work and if it does he will need endo. If you're getting hammered, then just trash it.
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3 hrs is pretty long. What was it stored in when they brought it into you?
If it was in something like the socket, saliva or saline I would at least try but tell them it has a very poor prognosis. Followup with GP.
If it was in milk and they came in within 90 mins I would consider it but after 3 hrs??
If they stored it in something like water or nothing - I wouldn't bother.
Based on time - poor prognosis
Based on age - open apex = good prognosis
My deciding factor would be what it's stored in.....
If it was in something like the socket, saliva or saline I would at least try but tell them it has a very poor prognosis. Followup with GP.
If it was in milk and they came in within 90 mins I would consider it but after 3 hrs??
If they stored it in something like water or nothing - I wouldn't bother.
Based on time - poor prognosis
Based on age - open apex = good prognosis
My deciding factor would be what it's stored in.....
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since the tooth was not stored in anything i decided to just trash the tooth (PDL cells arent going to survive)...now i think that i should have at least tried to reimplant the tooth and see what happens.
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I've seen this situation several times. My decision is often based on the patient's individual "dental IQ". If they have made an effort to store the tooth in some kind of medium, I will often replant the tooth even if it's over an hour or 2. I make sure they understand that it probably won't work, but there's nothing wrong with giving it a try...you can drop it in the trash now, or you can drop it in the trash in a a couple of weeks...you're not losing anything to try.
On the other hand, I've had this situation where the kid is just sitting there and mom is rummaging through her purse looking for the tooth. And another dad who just told the kid to put it in his pocket until the baseball game was over. 6 hours later, I wondered what they expected me to do. Those people I basically told they were wasting their time unless they can get to a dentist within an hour of the injury.
On the other hand, I've had this situation where the kid is just sitting there and mom is rummaging through her purse looking for the tooth. And another dad who just told the kid to put it in his pocket until the baseball game was over. 6 hours later, I wondered what they expected me to do. Those people I basically told they were wasting their time unless they can get to a dentist within an hour of the injury.
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what's tooth #6? is that the permanent right maxillary canine? i'm a dental student from canada and the american numbering system still confuses me. 
this question piqued my interest b/c i know i learned how to deal with this last year, but it's funny how you forget if you never get to apply it.
any way, you guys should check out the 2004 AAE guidelines for treatment of avulsed teeth.
basically, for an avulsed tooth with open (divergent) apex and extraoral dry time of >1 hr, the tooth has poor prognosis and replantation is not indicated.
but if you really wanted to try, you could soak the tooth in a fluoride soltuion for 20 mins, rinse with saline, clean and fill the canal with CaOH (for apexification), replant and recall in 6-8w. i might be inclined to do this--what's the worse that could happen? the patient becomes symptomatic, root fails to develop and you lose the tooth any way. but at least you tried.
this question piqued my interest b/c i know i learned how to deal with this last year, but it's funny how you forget if you never get to apply it.any way, you guys should check out the 2004 AAE guidelines for treatment of avulsed teeth.
basically, for an avulsed tooth with open (divergent) apex and extraoral dry time of >1 hr, the tooth has poor prognosis and replantation is not indicated.
but if you really wanted to try, you could soak the tooth in a fluoride soltuion for 20 mins, rinse with saline, clean and fill the canal with CaOH (for apexification), replant and recall in 6-8w. i might be inclined to do this--what's the worse that could happen? the patient becomes symptomatic, root fails to develop and you lose the tooth any way. but at least you tried.
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As a side note, I saw a study that compared different storage mediums with regard to PDL viability. Water was not much better than air. They also used gatorade because there's usually plenty to go around when a kid loses a tooth at a sporting event. Gatorade was worse than water or air. I just thought thata was interesting. Now I will return you to your regularly scheduled program.
