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IADT Guidelines 2012-Avulsions.Pdf Dental Traumatology 2012; 28: 88–96; doi: 10.1111/j.1600-9657.2012.01125.x International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth Lars Andersson*1, Jens O. Abstract – Avulsion of permanent teeth is one of the most serious dental Andreasen*2, Peter Day*3, Geoffrey injuries, and a prompt and correct emergency management is very important Heithersay*4, Martin Trope*5, for the prognosis. The International Association of Dental Traumatology Anthony J. DiAngelis6, David J. (IADT) has developed a consensus statement after a review of the dental Kenny7, Asgeir Sigurdsson8, literature and group discussions. Experienced researchers and clinicians from Cecilia Bourguignon9, Marie various specialties were included in the task group. The guidelines represent the Therese Flores10, Morris Lamar current best evidence and practice based on literature research and professionals’ Hicks11, Antonio R. Lenzi12, Barbro opinion. In cases where the data did not appear conclusive, recommendations Malmgren13, Alex J. Moule14, were based on the consensus opinion or majority decision of the task group. Mitsuhiro Tsukiboshi15 Finally, the IADT board members were giving their opinion and approval. The 1Department of Surgical Sciences, Faculty of Dentistry, primary goal of these guidelines is to delineate an approach for the immediate or Health Sciences Center, Kuwait University, Kuwait City, urgent care of avulsed permanent teeth. Kuwait; 2Department of Oral and Maxillofacial Surgery, Center of Rare Oral Diseases, Copenhagen University Hospital, Rigshopitalet, Copenhagen, Denmark; 3Pae- driatic Dentistry, Leeds Dental Institute and Bradford District Care Trust Salaried Dental Service, Leeds, UK; 4Faculty of Health Sciences, School of Dentistry, Endodontology, The University of Adelaide, Adelaide, SA, Australia; 5Department of Endodontics, School of Dentistry, University of Pennsylvania, Philadelphia, PA; 6Department of Dentistry, Hennepin County Medical Center and University of Minnesota School of Dentistry, Minneapolis, MN, USA; 7Hospital for Sick Children and University of Toronto, Toronto, ON, Canada; 8Depart- ment of Endodontics, UNC School of Dentistry, Chapel Hill, NC, USA; 9Private Practice, Paris, France; 10Department of Pediatric Dentistry, Faculty of Den- tistry, Universidad de Valparaiso, Valparaiso, Chile; 11Department of Endodontics, University of Maryland School of Dentistry, Baltimore, MD, USA; 12Private Practice, Rio de Janeiro, Brazil; 13Division of Pediatrics, Department of Clinical Sciences Intervention and Technology, Karolinska University Hospital, Stockholm, Sweden; 14Private Practice, University of Queensland, Brisbane, Qld, Australia; 15Private Practice, Amagun, Aichi, Japan Key words: avulsion; exarticulation; con- sensus; review; trauma; tooth Correspondence to: Lars Andersson, DDS, PhD, DrOdont, Oral & Maxillofacial Surgery, Department of Surgical Sciences, Health Sciences Center, P.O. Box 24923, Safat 13110, Kuwait Tel.: +965 24986695 Fax: +965 24986732 e-mail: [email protected] Accepted 30 January, 2012 *Members of the Task Group. 88 Ó 2012 John Wiley & Sons A/S IADT guidelines for avulsed permanent teeth 89 Medline and Scopus databases using the search words: avulsion, exarticulation, and replantation. The task group has then discussed the emergency treatment in detail and reached consensus of what to recommend today as best practice for the emergency management. This text is aiming at giving the concise, short necessary advice for treatment in the emergency situation. More detailed description of protocols, methods, and docu- mentation for clinical assessment and diagnosis of Avulsion of permanent teeth is seen in 0.5–3% of all different dental injuries can be found in articles, dental injuries (1, 2). Numerous studies show that this textbooks, and manuals (2, 24) and in the interactive injury is one of the most serious dental injuries, and the web site Dental Trauma Guide http://dentaltrauma prognosis is very much dependent on the actions taken at guide.org. the place of accident and promptly after the avulsion The final decision regarding patient care remains (2–27). Replantation is in most situations the treatment primarily in the hand of the treating dentist. For ethical of choice, but cannot always be carried out immediately. reasons, it is important that the dentist provides the An appropriate emergency management and treatment patient and guardian with pertinent information relating plan are important for a good prognosis. There are also to treatment so also the patient and guardian has as much individual situations when replantation is not indicated influence in the decision-making process as possible. (e.g., severe caries or periodontal disease, non-cooperat- ing patient, severe medical conditions (e.g., immunosup- First aid for avulsed teeth at the place of accident (2, 10, pression and severe cardiac conditions) which must be 24, 25, 31–55) dealt with individually. Replantation may successfully save the tooth, but it is important to realize that some of Dentists should always be prepared to give appropriate the replanted teeth have lower chances of long-term advice to the public about first aid for avulsed teeth. survival and may even be lost or extracted at a later stage. An avulsed permanent tooth is one of the few real Guidelines for the emergency management are useful emergency situations in dentistry. In addition to for delivering the best care possible in an efficient increasing the public awareness by, for example, mass manner. The International Association of Dental Trau- media campaigns, healthcare professionals, guardians matology (IADT) has developed a consensus statement and teachers should receive information on how to after an update of the dental literature and discussions in proceed following these severe unexpected injuries. expert groups. Experienced international researchers and Also, instructions may be given by telephone to people clinicians from various specialties and general dentistry at the emergency site. Immediate replantation is the were included in the groups. In cases in which the data best treatment at the place of accident. If for some did not appear conclusive, recommendations were based reasons this cannot be carried out, there are alterna- on the consensus opinion and in some situations on tives such as using various storage media. majority decision among the IADT board members. All If a tooth is avulsed, make sure it is a permanent tooth recommendations are not evidence based on a high level. (primary teeth should not be replanted). The guidelines should therefore be seen as the current • Keep the patient calm. best evidence and practice based on literature research • Find the tooth and pick it up by the crown (the white and professionals’ opinion. part). Avoid touching the root. Guidelines should assist dentists, other healthcare • If the tooth is dirty, wash it briefly (max 10 s) under professionals, and patients in decision making. Also, cold running water and reposition it. Try to encourage they should be credible, readily understandable, and the patient/guardian to replant the tooth. Once the practical with the aim of delivering appropriate care as tooth is back in place, bite on a handkerchief to hold it effectively and efficiently as possible. in position. It is understood that guidelines are to be applied with • If this is not possible, or for other reasons when judgment of the specific clinical circumstances, clinicians’ replantation of the avulsed tooth is not possible (e.g., judgments, and patients’ characteristics, including, but an unconscious patient), place the tooth in a glass of not limited to compliance, finances and understanding of milk or another suitable storage medium and bring the immediate and long-term outcomes of treatment with the patient to the emergency clinic. The tooth alternatives vs non-treatment. The IADT cannot and can also be transported in the mouth, keeping it does not guarantee favorable outcomes from strict inside the lip or cheek if the patient is conscious. If adherence to the Guidelines, but believe that their the patient is very young, he/she could swallow the application can maximize the chances of a favorable tooth – therefore it is advisable to get the patient to outcome. Guidelines undergo periodic updates. The spit in a container and place the tooth in it. Avoid following guidelines by the IADT represent an updated storage in water! set of guidelines based on the original guidelines • If there is access at the place of accident to special published in 2007 (28–30). storage or transport media (e.g., tissue culture/trans- In this article, one of a series of three articles, the port medium, Hanks balanced storage medium (HBSS IADT Guidelines for management of avulsed permanent or saline) such media can preferably be used. teeth are presented. Literature has been searched using • Seek emergency dental treatment immediately. Ó 2012 John Wiley & Sons A/S 90 Andersson et al. The poster ‘Save a Tooth’ is written for the public and • Initiate root canal treatment 7–10 days after replanta- is available in several languages: English, Spanish, tion and before splint removal. (see Endodontic consid- Portuguese, French, Icelandic, Italian, Arabic, and erations). Turkish and can be obtained at the IADT website: http://www.iadt-dentaltrauma.org. Follow-up See: Follow-up procedures. Treatment guidelines for avulsed permanent teeth (56–95) 1b. The tooth has
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