Management of Partially Avulsed Tooth
Immediate Assessment and Action
- The American Academy of Pediatrics recommends confirming whether the tooth is permanent or primary before any intervention, as management differs completely between the two 1, 2
- For a partially avulsed permanent tooth, gentle repositioning is indicated immediately for minor extrusion (<3mm) 1, 2
- Severe extrusion (>3mm) may require extraction, and immediate dental referral is critical 1, 2
On-Site Management Steps
- The American Academy of Pediatrics recommends handling the tooth only by the crown, never touching the root surface, as it contains fragile periodontal ligament fibroblasts essential for successful reattachment 3
- Gentle repositioning of the tooth back into its normal anatomic position in the socket is recommended 1, 2
- Having the patient bite down on clean gauze or cloth to hold the tooth in position is advised 3
Urgent Dental Referral
- Immediate referral to a dentist is mandatory for all partially avulsed permanent teeth, regardless of whether repositioning was successful 1, 2, 3
- The likelihood of successful outcome decreases rapidly with time, as periodontal ligament cells die quickly 4, 3
Expected Dental Treatment
- A flexible splint will be placed by the dentist for up to 2 weeks after repositioning 3
- Most partially avulsed teeth will require root canal therapy within 7-10 days after the injury 3
- Radiographic examination will be performed to assess for root fracture or alveolar bone involvement 1, 2
Antibiotic Prophylaxis
- For patients over 12 years old, Doxycycline is the recommended systemic antibiotic after repositioning 3
- For patients under 12 years old, Penicillin is recommended, or clindamycin if penicillin-allergic 3
Critical Pitfalls to Avoid
- Delaying repositioning can reduce tooth survival, and immediate action maximizes tooth survival 4, 3
- Never scrub or handle the root surface, as this damages periodontal ligament cells 3