Emergencies

Before the accident the tooth was held in place by fibres and cells called the periodontal
ligament. These fibres were torn apart and many of the cells were damaged either by the
accident or by the length of time out of the mouth. If the tooth has been out of the
mouth more than 5 minutes it will never be the same again. This means that if it is
put back in, it will have to be extracted sooner or later.

Things that can cause a tooth to fail:

• Infection can cause the tooth root to rapidly dissolve (months to a year).
• The tooth root can become part of the bone and dissolve slowly (year(s)).
• The tooth may become attached to bone and remain in the same location as the child
grows. During adolescent growth the tooth will appear ‘shorter’ and may later be
extracted (year(s)).
• The tooth root can dissolve just below the crown and snap off (years).

What do we know?

• After 5 minutes the damaged periodontal ligament (the tissue that attaches the tooth to
bone) will not produce new periodontal ligament but will heal by alternate means.
• Teeth that are so young the root has not fully formed have very poor survival prospects
(months to a year).
• Dentists can prevent infection by completing root canal treatment before re-plantation.
• Adults over 18 have better prospects for extended tooth survival than pre-adolescents
or adolescents (years).

Responsibilities of the dentist

• Determine the extra-alveolar duration and storage conditions
• Inform patient/parent of the prospects/outcomes of replacing the tooth
• Attempt to replant the tooth if the patient/parent/caregiver requests
• Prevent/control infection
• Splint the tooth and remove the splint at the appropriate time
• Begin/complete root canal treatment

Responsibilities of the patient/parent/caregiver

• Allow radiographs for diagnosis of damage
• Decide whether the tooth should be replanted or left out of the mouth
• Cooperate for replantation/splinting/root canal treatment
• Comply with instructions if antibiotic coverage is required
• Return for post-operative splint removal and radiographs at the times described by the
dentist before replantation (splint removal at less than 2 weeks or at 2 months
depending upon treatment objectives and radiographs at that time, 6 months, 12 months
and then yearly)

Time out of the mouth is the most important reason for eventual tooth removal.
Immature roots and adolescent growth (that produces submerging teeth) reduce
chances for long-term survival of replanted teeth. Fully-grown youths and adults
have the best prognosis for survival of replanted teeth.

What do we know?

• When displaced teeth are repositioned they are quite likely to be retained for a
lifetime.
• The longer the tooth has been displaced without repositioning, the more difficult
repositioning becomes because a blood clot forms that makes repositioning less
successful. By 48 hours it is unlikely the tooth can be repositioned to its original
location.
• About 40% of displaced teeth require root canal treatment, usually within the
first year.
• The dental pulps (‘nerves’) of about 40% of displaced teeth will show evidence
of ‘scarring’ but will remain vital and not require any treatment.
• The crown might become darker with time as the ’scarring’ process continues.

Responsibilities of the dentist

• Inform patient/parent/caregiver of the prospects/outcomes of repositioning the
tooth
• Attempt to reposition the tooth if the patient/parent/caregiver wishes
• Prevent/control infection
• Splint the tooth and remove the splint at the appropriate time
• Begin/complete root canal treatment if required

Responsibilities of the patient/parent/caregiver

• Allow radiographs for diagnosis of damage
• Cooperate for repositioning/splinting
• Comply with instructions if antibiotic coverage is required
• Return for post-operative splint removal/radiographs at the appropriate times as
described by the dentist. (Usually splint removal at 6-8 weeks and radiographs at
that time, 6 months and then yearly)

What do we know?

• When extruded teeth are repositioned they are quite likely to be retained for a
lifetime.
• The longer the tooth has been extruded without repositioning, the more difficult
repositioning becomes because a blood clot forms that makes repositioning less
successful. By 48 hours it is unlikely the tooth can be repositioned to its original
location.
• About 40% of extruded teeth require root canal treatment, usually within the first
year (chance of dental pulp death increases with increased extrusion).
• The dental pulps (‘nerves’) of about 40% of extruded teeth become smaller with
time but remain alive and do not require any treatment.
• The crown might become darker with time as the dental pulp (‘nerve’) becomes
smaller.

Responsibilities of the dentist

• Inform patient/parent/caregiver of the prospects/outcomes of repositioning the
tooth
• Attempt to reposition the tooth if the patient/parent/caregiver wishes
• Prevent/control infection
• Splint the tooth and remove the splint at the appropriate time
• Begin/complete root canal treatment if required

Responsibilities of the patient/parent/caregiver

• Allow radiographs for diagnosis of damage
• Cooperate for repositioning/splinting
• Comply with instructions if antibiotic coverage is required
• Return for post-operative splint removal/radiographs at the appropriate times as
described by the dentist. (Usually splint removal at less than 2 weeks and
radiographs at that time, 3 months, 6 months and then yearly)

Things that can cause this tooth to fail are:

• The depth the tooth has been pushed into the bone
• Infection leads to rapid resorption of the root (months to a year)
• The tooth can become part of the bone and simply dissolve over time (year(s))
• As children grow, pushed-up teeth may remain in the same position. Tooth will appear
‘short’ and have to be removed (year(s))
• Tooth can dissolve just below the crown and snap off…root must be extracted (years)

What do we know?

• Teeth pushed up less than 3mm will likely come back to place by themselves and
survive.
• Teeth pushed up between 3-6mm will likely need help to return to their location and
may need root canal treatment within the next year. Teeth pushed up more than 6mm
will need to be repositioned and will need immediate root canal treatment.
• Dentists can prevent infection by completing root canal treatment on the intruded tooth
before repositioning it.

Responsibilities of the dentist

• Inform patient/parent/caregiver of the prospects/outcomes of this injury
• Attempt to reposition the tooth if the patient/parent/caregiver wishes
• Prevent/control infection
• Splint the tooth and remove splint at the appropriate time
• Begin and/or complete root canal treatment

Responsibilities of the patient/parent/caregiver

• Allow radiographs for diagnosis of damage
• Approve treatment plan: surgical, active or passive repositioning
• Cooperate for repositioning/splinting/root canal treatment
• Comply with instructions if antibiotic coverage is required
• Return for post-operative splint removal/radiographs at the appropriate times as
described by the dentist before replantation. (Usually splint removal at 8 weeks and
radiographs at that time then 8 weeks, 3 months, 6 months and then yearly)
In the case of severe intrusions patients/parents should expect several visits during the
first year.