Replanting and splinting an avulsed tooth

Do not replant or reposition a primary tooth because this will damage the secondary tooth that is developing in the bone.

Note: Primary (baby) teeth should not be replanted or repositioned.

Hold an avulsed secondary tooth carefully by the crown so the root is not damaged—do not hold the root. Survival of the cells of the periodontal ligament, which is attached to the root, is essential for healing of the ligament following replantation. If the ligament heals, the tooth has a reduced risk of replacement root resorption and can remain in the mouth for many years.

If the tooth is dirty, rinse it briefly with milk or saline—do not scrub or rub the tooth. Replant an avulsed secondary tooth into its socket as soon as possible. Teeth replanted within 15 minutes are more likely to heal without complications.

Note: If the tooth cannot be replanted immediately, arrange urgent transfer to a dentist or emergency department. Prognosis is worse the longer the delay in treatment.

If the tooth cannot be replanted immediately, arrange urgent transfer to a dentist or emergency department. Submerge the tooth in cool or room temperature dairy milk until it can be replanted. The cells of the periodontal ligament can survive in milk for up to 6 hours. All first-aid kits, especially those for sporting clubs and schools, should stock a small container of long-life milk.

If milk is not available, saliva, saline or plastic wrap can be used, but the periodontal ligament cells will survive for up to 1 hour at most under these conditions. If plastic wrap is used, ask the patient to spit some saliva into the plastic before wrapping the tooth. Avoid using water for cleaning or storing an avulsed tooth because the osmotic effect of water causes cell death in the periodontal ligament.

Note: Do not use water to rinse or store the avulsed tooth.

After replanting the tooth, place a temporary splint to hold the tooth in position. Use a small piece of aluminium foil or malleable material (eg Blu Tack), then ask the patient to bite down to hold it in position. Refer the patient to a dentist urgently for further treatment and splinting. If a delay in dental treatment is expected, skin glue or another adhesive material may be appropriate to bond the replanted tooth to the adjacent teeth. The temporary splint needs to be easily removed by the dentist without damaging the adjacent teeth.