Immediate management of avulsion injuries in children

Avulsion, whereby a tooth is completely displaced from the socket, is one of the most severe dental injuries.¹ The pulp is severed from the neurovascular supply apically and the periodontal ligament is ruptured or torn.² As soon as the tooth is avulsed the pulp and periodontal ligament begin to undergo ischaemia, with damage also sustained to the surrounding tissues, including cementum, alveolar bone and gingiva.³ Expedient management of avulsion injuries is required as the prognosis of the tooth diminishes with each minute the tooth is out of the socket. As such, an avulsion is a true dental emergency.

However, there is evidence that only 10% of children in the UK receive adequate emergency care following avulsion injuries.⁴ This can lead to unfavourable outcomes and premature loss of the tooth, which may negatively impact quality of life.⁵ The ultimate aim of treatment for an avulsed tooth is to achieve periodontal healing and consequently have a similar longevity to an adjacent uninjured tooth. Studies show that the majority of traumatic dental injuries occur during normal working hours and therefore many children will initially present to the primary care setting.⁶ Therefore, it is imperative that all dentists have sound knowledge of the emergency management of this injury.