Dental avulsion. Causes, therapeutic approach
Particularly unpleasant for the patient, avulsion is the loss of the tooth, the removal from the socket.
Often referred to as a total dislocation, avulsion is a medical emergency and the time from accident to treatment is critical to the healing and subsequent prognosis of the tooth.
This article is intended to inform the patient about the steps to follow in the event of a dental avulsion as well as to present the treatment methods currently used.
Dental avulsion frequency
In the trauma category, avulsion accounts for up to 30% of accidents involving the dental arches. It more often affects the temporary dentition, as the roots are weaker and shorter and can be more easily mobilized.
Causes of dental avulsion
As mentioned above, dental avulsion most often occurs in a brutal manner, following a severe trauma. Dysmorphic teeth or teeth with hard substance dystrophies are more likely to be affected in case of an accident. The most common causes of total dislocation are:
domestic accidents – medical literature mentions this type of accident as being responsible for avulsion of dental units in 50% of cases;
Patient attitude immediately after the trauma
Following an accident resulting in the avulsion of a dental unit, the patient must find the tooth and avoid manipulating the roots in order not to further endanger the periodontal ligaments. The tooth is rinsed with water, without using any antiseptic agent and under low pressure. It is indicated to keep the tooth in cold milk, water or saline solution.
The patient should go to the dentist’s surgery within 60 minutes of the accident. Research to date has concluded that for an increased success rate of reimplantation, the operation should be performed within the first 15-20 minutes after the trauma.
The treatment that is required is replantation of the avulsed tooth unit and the success rate depends primarily on the speed with which therapy is instituted.
The healing capacity of the periodontal ligaments to strengthen the tooth in the socket also influences success. Complications such as necrosis or resorption slow down or jeopardize the healing process.
As a first step, an attempt is made to re-implant the tooth in the socket, followed by endodontic root canal treatment. However, this therapy is likely to fail if:
the patient has a systemic infection;
the tooth socket is fractured;
the avulsed tooth is affected by carious processes or even fractures.
Complications following re-implantation
The more adverse the conditions found in the oral cavity are to dental replantation, the further the treatment will be from the desired outcome. Complications that may arise include:
root resorption of the replanted tooth;
pulp necrosis, which is accompanied by loss of substance;
ankylosis: fusion of the root with the alveolar wall, with loss of physiological mobility of the tooth.
Accidents leading to tooth avulsion can occur both during recreational activities and in a brutal manner.
Whatever the situation, tooth recovery and emergency referral to the dentist’s office exponentially increase the chances of therapeutic success.