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Alec  Such
Posted May 18, 2018 by Alec Such
Also, the period for finding a suitable vehicle and biologic fluid is severely limited to 15 to 60 minutes.11,12,13 After 60 minutes, the cells, exposed to the air and having depleted their stored metabolites, begin to die. The observer stands there holding the enamel of the teeth while the cells of the ligament die. Placing the teeth in milk after 60 minutes does very little good to replace the lost cell metabolites.What Is Continuing Education? for more information.

So, unless the teeth are replanted immediately where they were avulsed or unless there is an emergency optimal storage device that can safely transport teeth at the scene of the accident, they are more likely to resorb following replantation. They are especially likely to fail in specific situations. For instance, when a patient in an automobile accident has more serious injuries that require prior attention, avulsed teeth will be ignored unless there’s a storage device at the scene to put them into.

The lack of education among all first aid caregivers and other professionals about the methodology for storing and preserving avulsed teeth has been shown to be a big factor in the large failure rate.11,12,13,14,15 But while this lack of education is a major factor, the lack of supportive armamentarium at the scene of the accident is equally as important. Knowing what to do is useless without the right tools to do it.

The transportation of avulsed teeth to the dentist requires a device that is constructed specifically to preserve, protect, and renew the metabolites and sugars that are necessary for them to continue to metabolize until they are successfully replanted. Teeth that are protected this way can demonstrate more than 90% success in reattachment without significant resorption following replantation.16

Yet there are many potential problems at each step on the path from the accident scene to the dentist. At the accident scene, teeth may be mishandled. There might not be a biologic fluid environment or an atraumatic transport system dental vibrator. People on the scene might not know what to do, or they may be unwilling to help. More serious injuries may need to be treated first. Or, unsafe transportation vessels such as handkerchiefs, tissues, an open glass, plastic wrap, or even the mouth may be used.

What to Do

When teeth fall on the ground (Figure 12), debris lodges in the wet ligament. Since the ligament can’t be touched, care must be taken in cleaning it. Rinsing the tooth in water can damage it because the osmolality is so low. And, because the tooth is slippery, the tooth may be hard to hold when doing so. Instead, avulsed teeth need to be gently washed with a biologic solution.

The process of removing avulsed teeth from the transport vehicle also is more difficult than it seems. Teeth that are carried in a glass of milk, water, or even sterile saline are difficult to see because the debris cloudies the fluid (Figure 13). Getting the teeth out of this solution without crushing the ligament, then, can be difficult and may cause more damage.

In these cases, dentists must grab the teeth blindly with their forceps. Or, if the solution is suctioned out to leave the teeth behind, there may be potential problems with reinsertion tooth scaler australia. Spilling the fluid carefully while hoping that the teeth won’t slide out from between slippery fingers and onto the floor is challenging as well.

Reinsertion problems may follow, too. If the tooth doesn’t fit in the socket, it will need to be put back into a biologic solution. HBSS would be the best option. But if the transport fluid has been spilled or suctioned out, there would be no medium left for storing the tooth while the socket is modified. Even with a clear solution, dentists still need to grasp the tooth with their forceps, thus, increasing the chance of crushing the PDL.
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