Dental trauma during intubation

Q: 52 years old male has an accidental tooth avulsion during intubation in a small rural town where no emergency dental help is available on short notice. An attempt should be made to reimplant. 

A) Yes

B) No

Answer: A

Although it is true that, ideally, a dentist, oral-maxillofacial surgeon, or trauma surgeon should perform tooth reimplantation, dentists are generally unavailable in acute ICU/ER/trauma-field situations. In minor, partial, or lateral avulsion (not major facial trauma), where reimplantation seems easy, it should be attempted. A tooth reimplanted within one hour has a better chance of healing and becoming functional over a period of time. This advantage is lost once the three-hour markup is over. A few precautions that need to be taken care of are:

• Try not to disturb the socket 
• Handle the tooth by the crown 
• Root should not be wiped or even handled
• Rinse the tooth and socket with tap water or saline
• Attempt to replace the tooth in the socket (it may "click" into place!)

If an operator seems uncomfortable or reimplantation seems complicated, the tooth should be preserved preferably in a culture medium (Hank's Balanced Salt Solution) or in milk if the culture medium is not available. 

If a tooth is intruded, reimplantation should not be attempted; instead, it should not be manipulated, as this may lead to significant trauma. Reimplantation can be painful, so 1% lidocaine WITHOUT epinephrine should be applied to the region. If doable, a regional dental block is preferred.

If an avulsed tooth cannot be located, a CXR should be performed. It should be retrieved via scope if it's found in the bronchus or esophagus. The probability of salvaging is low if it is below the diaphragm.

In any case, a dentist, trauma surgeon, or oral-maxillofacial surgeon should be called as soon as possible.

#trauma

#procedures

#dental-medicine

References:

1. Belmonte FM, Macedo CR, Day PF, et al. Interventions for treating traumatised permanent front teeth: luxated (dislodged) teeth. Cochrane Database Syst Rev 2013; :CD006203.

2. Jones LC. Dental Trauma. Oral Maxillofac Surg Clin North Am 2020; 32:631.

3. Schatz JP, Hausherr C, Joho JP. A retrospective clinical and radiologic study of teeth re-implanted following traumatic avulsion. Endod Dent Traumatol 1995; 11:235.

4. Petrovic B, Marković D, Peric T, Blagojevic D. Factors related to treatment and outcomes of avulsed teeth. Dent Traumatol 2010; 26:52.