Emergency Cases Northwest Group

015 Dental disaster

Situation

A 10 year old boy had two permanent teeth knocked out; reimplanted in ED

Background

By chance it was over heard that a child had two teeth knocked out. It turned out that the accident only happened 20 minutes earlier and dad had brought the teeth with him. Child crying but both upper central and lateral incisors re-implanted. Patient and dad holding them in place with gauze then went to max-fax at another hospital to stent properly.

Assessment

This emergency wasn’t flagged up, only by chance was prompt action taken.

Recommendation

1 Dental avulsion of permanent teeth is a real emergency and you should drop what you’re doing to deal with it [don’t reimplant baby teeth however]

2 Reimplant at scene of accident but if transfer to hospital needed put the teeth in milk [or saline which is second best]

3 Don’t touch the root but gently clean off any dirt

4 Use local anaesthetic at the periosteum of the socket [or proper nerve block if possible] and gently clear debris, clots from it

5 Reimplant tooth, correct tooth correct socket and not back to front

6 Temporarily splint with the foil from suture pack or steristrips, wound glue. In this case crying child meant dad had to hold.

7 Send to max fax ASAP to stent properly

8 Successful reimplantation is possible <60 minutes post avulsion but sooner is definitely better. Even >60 minutes is worth attempting in correct circumstances


PLEASE DO NOT INCLUDE ANY PATIENT IDENTIFIABLE DATA OR GEO-LOCATION DATA IN THE SUBMISSION OR IN ANY ATTACHED IMAGES

Emergency Cases Northwest Group