Tooth Replantation

Tooth replantation

Definition

Tooth replantation is the reinsertion and splinting of a tooth that has been avulsed (knocked or torn out) of its socket.

Purpose

Teeth are replanted to prevent permanent loss of the tooth, and to restore the landscape of the mouth so that the patient can eat and speak normally.

Demographics

According to the National Center for Health Statistics, about 5 million teeth are accidentally avulsed in the United States each year. Most teeth that are replanted are lost through trauma, usually falls and other types of accidents. The most common traumata resulting in tooth avulsion are sports accidents that result in falls or blows to the head. The mandatory use of mouthguards, which are plastic devices that protect the upper teeth, has prevented approximately 200,000 oral injuries each year in football alone. The American Dental Association recommends the use of mouthguards for any sport that involves speed, contact, or the potential for falls. These categories include not only contact sports like football, wrestling, and boxing, but also gymnastics, baseball, hockey, bicycling, skateboarding, and skiing. Without a mouthguard, a person is 60 times more likely to experience dental trauma if he or she participates in these sports.

Other common causes of trauma to the mouth resulting in avulsed teeth include motor vehicle accidents, criminal assaults, and fist fights. Domestic violence is the most common cause of avulsed teeth in women over the age of 21.

Description

In most cases, only permanent teeth are replanted. Primary teeth (baby teeth) do not usually have long enough roots for successful replantation. The only exception may be the canine teeth, which have longer roots and therefore a better chance of staying in place. In some cases, however, the dentist may choose to replant a child's primary tooth because there is risk to the permanent tooth that has not yet emerged.

To replant a tooth, the dentist or oral surgeon will first administer a local anesthetic to numb the patient's gums. He or she will then reinsert the avulsed tooth in its socket and anchor it within the mouth by installing a splint made of wire and composite resin. Some dentists remove the root canal nerve of the tooth and replace it with a plastic material before reinserting the tooth. The splint holds the tooth in place for two to six weeks. At that time, the splint can be removed and the tooth examined for stability.

Diagnosis/Preparation

When a tooth is dislodged, it is critical to recover the tooth, preserve it under proper conditions, and get the patient to a dentist immediately. The tooth should be handled carefully; it should be picked up or touched by its crown (the top part of the tooth), not by its root. The tooth should be rinsed and kept moist, but not cleaned or brushed. The use of toothpaste, soap, mouthwash, or other chemicals can remove the fibroblasts clinging to the root of the tooth. Fibroblasts are connective tissue cells that act as a glue between teeth and the underlying bone.

The avulsed tooth can be placed in milk or a Save-a-Tooth (R) kit, which is a tooth-preserving cup that contains a medium for preserving the fibroblasts around the tooth. The tooth and the patient should go to the dentist within 30 minutes of the accident since fibroblasts begin to die within that time. Rapid treatment improves the chances for successful replantation. In some cases, artificial fibroblasts can be substituted for the patient's own connective tissue cells.

If the tooth is a primary tooth, it should be rinsed and kept moist also. The dentist should be consulted to determine whether the tooth should be replanted by examining the gums and the emergent tooth. The dentist will take a set of x rays to determine how soon the permanent tooth is likely to emerge. Sometimes an artificial spacer is placed where the primary tooth was lost until the permanent tooth comes in.

Any injury to the gum is treated before the tooth is replanted. The dentist may give the patient an antibiotic medication to reduce the risk of infection. Cold compresses can reduce swelling. Stitches may be necessary if the gum is lacerated. The dentist may also take x rays of the mouth to see if there are other injuries to the jawbone or nearby teeth.

Aftercare

The patient may take aspirin or acetaminophen for pain. Antibiotics may also be given for infection. The patient should avoid rinsing the mouth, spitting, or smoking for the first 24 hours after surgery. He or she should limit food to a soft diet for the next few days.

Beginning 24 hours after surgery, the patient should rinse the mouth gently with a solution of salt and lukewarm water every one to two hours. The salt helps to reduce swelling in the tissues around the tooth.

Any kind of traumatic injury always carries the risk of infection. Patients with heart disease or disorders of the immune system should be monitored following tooth replantation. Dentists recommend consulting a physician within 48 hours of the dental surgery to determine the risk of tetanus, particularly if the patient has not received a tetanus booster within the past five years.

Adults with replanted teeth should have periodic checkups. According to the American Association of Endodontists, it takes about two to three years after replantation before the dentist can fully evaluate the outcome of treatment.

Risks

In addition to infection, tooth replantation carries the risks of excessive bleeding and rejection of the tooth. Rejection is a rare complication. An additional risk is that the root of the tooth may become fused to the underlying bone.

Normal results

Most permanent tooth replantations are successful when the patient acts quickly (within 2 hours). If the tooth is rejected, the dentist may attach the tooth to the bone with tissue glue.

Morbidity and mortality rates

Mortality following tooth replantation is almost unheard of. The rate of complications varies according to the circumstances of the injury, the patient's age, and his or her general health. A history of smoking increases the risk of rejection of the tooth as well as infection.

Alternatives

There are no effective medical alternatives to oral surgery for replanting an avulsed tooth. Over-the-counter analgesics (pain relievers), prescription antibiotics, and some herbal preparations may be useful in relieving pain, reducing swelling, or preventing infection.

Herbal preparations that have been found useful as mouthwashes following oral surgery include calendula Calendula officinalis and clove (Eugenia caryophyllata ).

Resources

books

"Dental Emergencies: Fractured and Avulsed Teeth." Section 9, Chapter 107 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.

periodicals

Douglass, Alan B., MD, and Joanna M. Douglass, DDS. "Common Dental Emergencies." American Family Physician 67 (February 1, 2003): 511-516.

Franklin, Deeanna. "How to Save a Tooth, Save a Smile." Pediatric News 36 (February 2002): 1-2.

Pavek, D. I., and P. K. Radtke. "Postreplantation Management of Avulsed Teeth: An Endodontic Literature Review." General Dentistry 48 (March-April 2000): 176-181.

"Pedia Trick: Handle with Care." Pediatrics for Parents 20 (February 2002): 12.

organizations

American Academy of Pediatric Dentistry. 211 East Chicago Avenue, Ste. 700, Chicago, IL 60611-2616. (312) 337-2169. <www.aapd.org>.

American Association of Endodontists. 211 East Chicago Avenues, Ste. 1100, Chicago, IL 60611-2691. (312) 266-7255. <www.aae.org>.

American Association of Oral and Maxillofacial Surgeons. 9700 West Bryn Mawr Avenue, Rosemont, IL 60018-5701. (847) 678-6200. <www.aaoms.org>.

American Dental Association. 211 East Chicago Avenue, Chicago, IL 60611. (312) 440-2500. <www.ada.org>.

Janie Franz

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

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Tooth replantations are performed by general dentists, endodontists, and oral surgeons, usually as office or outpatient procedures. In some cases the patient may be treated in the emergency room of a hospital.

QUESTIONS TO ASK THE DOCTOR

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• How should I take care of the replanted tooth?
• How long will it take to assess the results of treatment?
• What can be done if the tooth cannot be replanted?
• Where can I be fitted for a mouthguard?