Catching a baseball with your teeth

This youngster tried to catch a baseball with his teeth. Tooth #9 was partially avulsed. Luckily his neighbor is a dental hygenist and knew to re-implant the tooth immediately. They called the general dentist and were at his office within 30 minutes of the accident. I got the call from the doctor to review the guidelines for treatment. As you can see, this is an immature root. Here are the guidelines for treatment of a tooth like this.

ON SITE TX:

• Immediately rinse/gently remove foreign objects. If unable to replant tooth at site of injury then use a transport media to get to dentist - milk, saline or saliva.


• If the tooth is not reimplanted, and a transport media is not used, the emergency treatment by the doctor must be done within 1 hour. (If the tooth is dry for greater than an hour, reimplantation by the dentist is generally not indicated)

AT DR'S OFFICE:

• Clean off affected area (water, saline or chlorhexidine) - don't extract tooth if it has been re-implanted.


• If the tooth is out of the mouth, prepare it for reimplantation by: cleaning with saline, soak in 1mg/20ml doxycycline, remove coagulum from socket with saline, reposition the socket wall if fractured, gently replant the tooth with finger pressure.


• Take radiograph to verify position


• Flexible splint (fishing line, mild steel wire)


• Antibiotic Rx: Doxycyline 2x/day for 7 days or Penicillin 4x/day for 7 days


• Tetnus booster

7-10 DAYS LATER:

• Remove splint


• Begin to monitor for re-vascularization (thermal testing baselines)

3-6 MONTHS:

• Continue to monitor - avoid endodontic treatment unless obvious signs of non-healing are present (pain, swelling, increasing radiolucency). It may take 3 months for the tooth to respond to thermal testing again.


• If endodontic treatment is necessary, follow guidelines for Apexification.

For more information regarding treatment of traumatic injuries: click here