If a permanent (second) tooth is knocked out (i.e. in an accident or fight) but is intact, it can be saved by the following, immediate procedure. The tooth should not be out of the mouth for longer than 20 to 30 minutes from the time of injury.
Using a sterile glove hold the tooth by its crown and replace it in its original position, preferably immediately (Fig. 12.1); if dirty, put it in milk before replacement or, better still, place it under the tongue and ‘wash’ it in saliva. Alternatively, it can be placed in contact lens saline or the solution in the ‘Dentist in a Box’ kit (www.dentistinabox.com.au). Note: Do not use water, and do not rub (it removes dentine) or wipe it or touch the root.
Fix the tooth by moulding strong silver foil (e.g. a milk bottle top or cooking foil) over it and the adjacent teeth. Moulding foil can be difficult: an alternative is to suture with a figure-of-eight silk suture to encompass the tooth. It can also be secured to the two adjoining teeth with a strip of tape cut from a disc in the ‘Dentist in a Box’ kit.
Refer the patient to his or her dentist or dental hospital as soon as possible. Tell the patient to avoid exerting any direct biting force on the tooth.
Replacement of a knocked-out tooth
Note: If a blood clot is present, remove it after a nerve block. Teeth replaced within 20 to 30 minutes have a 90% chance of successful reimplantation.
Loosening is excessive movement of a permanent tooth with no displacement.
Splint the mobile tooth to a neighbouring tooth with the splinting material from the kit (see above). Alternatively, use chewing gum or Blu-Tack. Refer the patient to a dentist.
Cover the exposed area, which is usually painful, with dental tape. Recover and store the tooth fragment for use by the dentist. If possible, secure the broken fragment with splinting material from the kit. Refer the patient to a dentist.
First aid treatment method
Instruct the patient to bite very firmly on a rolled-up handkerchief over the bleeding socket. This simple measure is sufficient to achieve haemostasis in most instances. Biting on a recently used tea bag is another suggestion.
Surgical treatment for persistent bleeding
Remove excess blood clot, using a piece of sterile gauze.
Bite on a firm gauze pack.
If still bleeding, insert a suture. (Chromic or plain catgut is suitable.)
Using a reverse suture, approximate ...
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