Referral & Clinical

Avulsion or Subluxation

Avulsion of teeth – particularly upper canines – is a relatively common occurrence. The two most common reason are fights between dogs and catching frisbees. The forces produced by a flying frisbee are considerable. Think about the centrifugal forces produced by a hard disc rotating at high speed. Teeth are often pushed sideways by these activities and, as the bone plate there is thin, can be relatively easily displaced - see below. Note the laceration in the gums at the front of the empty socket.

On these occasions, the best advice to your client is to find the tooth as soon as possible, hold it by the crown and gently rinse it clean of any debris with water, milk or saline. If possible, re-insert it into the socket until they get to the practice. Alternatively, store it in milk or saline (or the mouth of the client!) until they reach the practice. Once there, the tooth needs to be inserted into the socket and splinted with figure of 8 wire and composite or acrylic for around six weeks. The tooth below was excessively cleaned by the owner before they arrived at us. The root (lower 70%) should be covered with a nice pink ligament for successful implantation.

Since the blood supply has been lost irreversibly, the tooth needs root canal therapy between three and six weeks post-op. This involves removal of all the pulp inside the tooth that no longer has a blood supply and replacing it with a mixture of gutta percha rubber and cement. This "mummifies" the tooth whilst still allowing it normal function.

Long term studies do indicate that these teeth that are re-implanted to deteriorate within a few years. so long term prognosis needs to be guarded. Problems such as external root resorption and ankylosis are common.