Miscellaneous Handling of Dislodged Teeth
First aid measures in the field immediately after a tooth has fallen out include:
- Find the loose tooth, hold it against the tooth crown. Avoid holding the teeth by the roots as this can cause damage.
- If possible, return the tooth to its original position, then let the patient press it with the tongue. Immediately to the dentist for further treatment.
- If the tooth cannot be returned to its original position, put the tooth in the milk.
1. First Handling
It is important to know how long it has taken the tooth to come out (dry time). After more than 30-60 minutes, the periodontal ligament is permanently damaged. These damaged cells cause inflammation and ultimately lead to ankylosis, which is a joint that becomes stiff due to the fusion of two bones.
2. Dry Time Less than 30 Minutes
If it is less than 30 minutes since the tooth is dislodged, the periodontal ligament is most likely still alive and will grow back. Currently the tooth is susceptible to resorption, which is absorption of the dentin layer and tooth cementum due to inflammation. To prevent inflammation, the teeth are immersed in special media that has been given antibiotics and steroids for 20 minutes. Meanwhile, the mouth and gums are cleaned. After 20 minutes, the tooth can be replanted and given a tool to maintain the stability of the tooth that was placed for 10 days.
3. After 10 Days
After the splint is removed, the dentist will check whether the implanted tooth is loose and if the tooth is still alive (vitality test). If the vitality test shows that the tooth has survived, the implant is considered successful. Evaluation in the form of dental X-rays can be done, ideally in the first, third, and sixth months. If signs of resorption are found, the inflammatory process can be stopped with root canal treatment (PSA). If it turns out that the tooth does not survive after 10 days, new blood vessel formation is almost impossible to occur so root canal treatment is required, followed by photo evaluation. X-rays.
4. Dry Time> 30 Minutes
If the tooth is out of the mouth for more than 30 minutes, periodontal ligament damage is almost certain, and resorption is likely to occur. If this occurs in children, it can affect alveolar bone growth. The best course is to temporarily replant the tooth until the alveolar bone growth is complete. Only then did the dentures be installed.
5. Apical foramen> 1.3 mm
The apical foramen is a small hole at the end of the tooth root, which is where the pulp tissue enters the pulp cavity inside the tooth. In children <9 years with a wide apical foramen, the teeth can be attempted to retain. Fluoride is given to slow down the resorption process. Within 1 week after the incident, root canal treatment should be started.
6. Apical foramen <1.3 mm
If the dry time is more than 30 minutes, plus the size of the apical foramen that is less than 1.3 mm, the result is usually not optimal and often causes ankylosis. Often it is in these cases that the teeth cannot be preserved.
7. No Tooth Found
If the tooth is not found after being dislodged, therapy will be carried out to maintain the integrity of the tooth socket. Dental implants in children are not recommended because they can interfere with the growth of the upper jaw, mandible and teeth.