Loss of a Permanent tooth- What to do as First Aid?

 To facilitate early replanation of the avulsed permanent teeth, 

PARENTS, SCHOOL TEACHERS  and care givers should have quick access to the FIRST AID advice in those cases. 

This can be provided through telephone calls, or through instructions provided in schools.

 First aid advice include the following:

· Calm down the child

· Don't allow the child to eat. If there is extensive trauma, general anesthesia or sedation might be needed and accordingly the child must be fasting.

· Locate the avulsed tooth. Always look for the tooth in the child's clothes if it was thought to be lost.

· Hold the tooth from the crown and not from the root.

· Replant the tooth immediately if it was clean. However if it was contaminated clean it under cold water for 10 seconds only, or by milk if available.

· After replantation of the tooth, let the child bite on a folded handkerchief or clean cloth or on a piece of aluminum foil.

· If it's difficult to replant the tooth, store it in a suitable medium. The best medium available is milk. Milk is readily available, cold and pasteurized containing little amount of bacteria.
( It preserves the vitality of periodontal ligament cell up to 6 hours. If milk is not available store in the mouth of the child close to the molars. Saliva can maintain the vitality of periodontal ligament cells up to two hours. Otherwise, it can be stored in saline (optic lens solution) or wrapped in plastic cling film; both can preserve the vitality of PDL cells up to 1 hour. Any way, the storage medium must be isotonic. Water is hypotonic.) 

Storage in water will cause lysis of the PDL cells. Don't store the tooth in water.

· Take the child immediately to a dental clinic.

In case of an already replanted the tooth, leave the tooth as it is and follow up regularly.

In case of an avulsed tooth which has been stored in a suitable medium or which has not been avulsed for more than an hour, the tooth should be managed according to the following:

  

REMEMBER

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     * Hold the tooth carefully by the crown, and wash the root in saline, or (if not available) in milk, and replant it in its socket! *

Don't store the tooth in water.

Water is hypotonic. Storage in water will cause lysis of the PDL cells.