Management of an avulsed tooth after replanting and splinting

For all patients with tooth avulsion, ensure that tetanus immunisation is up-to-date (see Requirement for tetanus prophylaxis).

Antibiotic therapy is indicated after replanting the tooth; however, there is limited evidence that it reduces healing complications (eg inflammatory root resorption, which is associated with the presence of bacteria in the root canal system). Doxycycline is preferred because of widespread clinical experience with its use in this setting, and there is some evidence that it has direct antiresorptive activity; use:

doxycycline orally, once daily for 7 days¹. tooth avulsion doxycycline

adult: 100 mg

child less than 21 kg: 2.2 mg/kg²

child 21 to less than 26 kg: 50 mg

child 26 to 35 kg: 75 mg

child more than 35 kg: 100 mg.

If doxycycline is contraindicated or a suitable formulation is not available, use:

amoxicillin 500 mg (child: 15 mg/kg up to 500 mg) orally, 8-hourly for 7 days. tooth avulsion amoxicillin

Recommend the use of chlorhexidine mouthwash after replantation while the tooth is splinted; use:

1 chlorhexidine 0.2% mouthwash 10 mL rinsed in the mouth for 1 minute, 8- to 12-hourly³ tooth avulsion chlorhexidine

OR

1 chlorhexidine 0.12% mouthwash 15 mL rinsed in the mouth for 1 minute, 8- to 12-hourly³. chlorhexidine

¹ An oral liquid formulation of doxycycline is not marketed in Australia but is available via the Special Access Scheme. For formulation options for children or people with swallowing difficulties, see Don't Rush to Crush, which is available for purchase from the Advanced Pharmacy Australia website or through a subscription to eMIMSplus.Return

² When used short term (eg less than 21 days), doxycycline has not been associated with tooth discolouration, enamel hypoplasia or bone deposition so can be used in children of all ages.Return

³ When used for more than a few days, chlorhexidine may cause a superficial discolouration of the teeth and fillings (see Chlorhexidine for more information).Return