Definition

Dental avulsion refers to the total dislodgement of a tooth from its socket. This condition typically develops due to a forceful hit, whether during sporting activities or as a consequence of an accident. Dental avulsions primarily impact pediatric populations, but this does not exclude the potential occurrence of dental avulsions in adults.

To avoid irreversible tooth loss, the knocked-out teeth must be immediately reattached. Teeth should be reinserted 30 to 60 minutes after removal.

Causes

Dental avulsion primarily results from physical trauma caused by disease or damage during sports activities and accidents.

Dental avulsion may result from the following situations:

• Dropping with the mouth impacts the ground or a rigid surface
• Traffic accident
• Mouth injuries resulting from sporting activities such as football and mixed martial arts (MMA)
• Acts of violence

Risk Factors

Children are the primary risk factor for avulsed teeth.

Symptoms

The dental avulsion symptom is the tooth's expulsion from the oral cavity. This condition results in the absence of attachments where the teeth were formerly positioned.

Several additional symptoms may manifest in addition to the aforementioned:

• Swelling and bleeding
• The occurrence of symptoms such as sores on the cheekbones and lips is indicative of an impact-induced avulsion.
• Angioedema surrounding the dislodged tooth
• Experiencing bleeding in the area of the dislodged tooth
• Oral pain
• Pain in the area surrounding the teeth and mandible; pain may be induced by chewing or a change in temperature.
• Headache due to head injury

Diagnosis 

The dentist will ask about your medical history and symptoms to diagnose a dental avulsion. After that, the doctor will examine the oral cavity, socket, and missing tooth.

Next, the dentist will evaluate the best treatment for your condition. If feasible, missing teeth are reattached quickly.

Management

Teeth will reattach more easily if treated early. You should immediately administer first aid after this incident.

Follow these instructions when a hard impact knocks out one of the teeth.

1. Take the tooth and clean it immediately after removal.
2. Just hold the crown when taking it. Avoid touching the tooth root because it removes healing-promoting periodontal connective tissue.
3. Remove dental debris by rinsing the teeth with milk without rubbing, then dry them or apply soap.
4. Put the tooth back in the socket after cleaning.
5. Bite the gauze or handkerchief for 15–20 minutes to keep it in place.
6. Get dental treatment immediately. After the tooth falls out, visit the dentist within an hour.

Typically, the dentist examines the proper positioning of the teeth. If accurate, the missing tooth's impacted side is affixed to the adjacent teeth through a splinting technique.

The dentist will assess in two weeks. If the bone surrounding the tooth is also fractured, the splinting may remain in effect for at least six weeks.

Splinting involves attaching a loose tooth to strong teeth with Blu-tac or aluminum foil. This step stabilizes the fallen tooth during recovery.

Complications

Without immediate treatment, dental avulsions can cause irreversible tooth loss. Reattached teeth are susceptible to complications.

The following complications could happen:

• Pulp necrosis refers to the demise of tissue in the deepest layer of the tooth (pulp)
• Ankylosis refers to the occurrence when a tooth that has been reattached becomes embedded in the gingival tissue.
• Apical periodontitis refers to the inflammation of the tissue surrounding the tooth.
• Periodontitis refers to the deterioration of the tooth root structure, resulting in a sensation of looseness or mobility.
• Pulp canal obliteration (PCO) refers to the presence of calcified tissue formations along the inner walls of the root canal.

Prevention

Avulsions frequently result from sports injuries or accidents. To prevent the risk, it is advisable to minimize injuries and accidents and use head and facial safeguards during exercise.

An alternative option is using a mouth guard. It is advisable to get a custom mouth guard from a dentist, as this will ensure that the shape of the guard fits perfectly with the specific condition and structure of the teeth.

Patients should be provided with detailed instructions regarding the management of tooth avulsions during replantation, which include:

• Complete recovery is not guaranteed, particularly for teeth that have not been immersed in the medium for more than an hour.
• Providing information about the potential for infection and the necessity of using antibiotics throughout the body
• Reimplanted teeth are more susceptible to dislodging or loosening than natural teeth.
• Following replantation, the patient requires periodic dental check-ups for additional intervention and assessment.
• Patients are advised to refrain from participating in contact sports.
• The patient must eat a soft diet for 2 weeks.
• Clean the teeth softly after every meal.
• Use 0.1% chlorhexidine twice a day for a week.

When to see a doctor?

Consult a dentist for more information on what to do if you suspect a dental avulsion. Please let them know if you have any additional symptoms or issues not listed or if you have any further inquiries.

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