Managing avulsed teeth...

A few students and I were discussing management of avulsed teeth today. Wanting to find the best evidence of what to do when an adult walks in with their tooth in their hand we searched TRIP Database using the term avulsed tooth, which led us to a couple of systematic reviews looking at management of avulsed teeth and how long to splint them. Try it yourself if you're interested and see what you learn.

Later on I wanted to find some evidence based guidelines on trauma generally so popped 'Dental Trauma' into TRIP instead. This resulted in the following paper: Clinical guideline on management of acute dental trauma at the National Guideline Clearinghouse.

This guideline from 2007 has a succinct summary of what to do for the different types of trauma. It's not perfect in its methodology but appears to be pretty thorough.

The National Guideline Clearinghouse can be a useful site to visit if you're trying to find evidence about interventions. It's one of many online aids now available to help us make more informed decisions about healthcare.

One other paper I came across was a structured search to answer the PICO: How long should we wait for a pulp extirpation after a replantation of an avulsed permanent tooth? (If you're unsure what a PICO is let me know and I'll blog on it...and if you're not in the library you will need to log into Athens to read the paper). The basic take home messages were:

1. for replanted teeth with closed apices (i.e. very low chance of the pulp being revascularised) elective extirpation of the pulps should be performed within 14 days. 
2. for teeth with open apices, pulps should be extirpated when there is evidence of pulpal necrosis. 
3. pulpal extirpation is beneficial in the control of inflammatory resorption but has no proven benefit in control of replacement resorption or other aspects of healing.

Cheers.