ON SITE TX:
Immediately rinse/gently remove foreign objects. If unable to replant tooth at site of injury then use a transport media to get to dentist – milk, saline or saliva.
If the tooth is not reimplanted, and a transport media is not used, the emergency treatment by the doctor must be done within 1 hour. (If the tooth is dry for greater than an hour, reimplantation by the dentist is generally not indicated)
AT DR’S OFFICE:
Clean off affected area (water, saline or chlorhexidine) – don’t extract tooth if it has been re-implanted.
If the tooth is out of the mouth, prepare it for reimplantation by: cleaning with saline, soak in 1mg/20ml doxycycline, remove coagulum from socket with saline, reposition the socket wall if fractured, gently replant the tooth with finger pressure.
Take radiograph to verify position
Flexible splint (fishing line, mild steel wire)
Antibiotic Rx: Doxycyline 2x/day for 7 days or Penicillin 4x/day for 7 days
Tetnus booster
7-10 DAYS LATER:
Remove splint
Begin to monitor for re-vascularization (thermal testing baselines)
3-6 MONTHS:
Continue to monitor – avoid endodontic treatment unless obvious signs of non-healing are present (pain, swelling, increasing radiolucency). It may take 3 months for the tooth to respond to thermal testing again.
If endodontic treatment is necessary, follow guidelines for Apexification.
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