TRAUMATIC CONDITIONS OF THE FACE AND MOUTH

Maxillofacial and Dental Emergencies 429

3 Avulsed permanent incisor tooth
The best chance of successful re-implantation is by reposition of an avulsed
tooth within 30 min outside its socket, or up to 2 h if stored in milk or saliva,
which help preserve the delicate periodontal ligament cells.
(i) Transport the tooth in milk or saline if immediate re-
implantation is not possible
(a) the patient’s own buccal sulcus is not ideal due to the
presence of bacteria and incompatible osmolarity and pH.
(ii) Handle the tooth only by the crown on arrival in the emergency
department (ED), rinse it in saline, and replace back into the
socket with firm pressure. No analgesia is necessary.
(iii) Splint the tooth with aluminium foil, give the patient an
antibiotic such as amoxycillin 500 mg orally t.d.s., and give
tetanus prophylaxis
(a) an avulsed tooth is considered a ‘tetanus-prone’ wound (see
p. 321).
(iv) Refer the patient to a dental surgeon as soon as possible.

4 Avulsed primary (deciduous) incisor tooth
Do not replace these, but refer the patient to a dental surgeon for follow-up.

5 Bleeding tooth socket
(i) This can be post-traumatic or post-extraction.
(ii) Clear out clots and arrest haemorrhage using a calcium alginate

(Kaltostat™) dressing or gauze roll. Ask the patient to bite on it

for 15–30 min.

(iii) Infiltrate with 1% lignocaine (lidocaine) with 1 in 200 000

adrenaline (epinephrine) if the bleeding persists, and close the

mucosa over the socket using 3/0 absorbable polydioxanone or

polyglactin sutures.

(iv) Refer the patient to the oral surgery team if this fails.

6 Broken denture
(i) Always save a broken denture as it will be invaluable to the
maxillofacial surgeon to aid in the fixation of any jaw fracture, or
if a splint is needed.

Warning: whenever a tooth or denture is found to be missing following

trauma, perform an anteroposterior (AP) and lateral chest radiograph (CXR)

to exclude inhalation into the lung, or AP and lateral neck X-rays to exclude

lodgement in the upper oesophagus (see p. 406).

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