International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth

Abstract – Avulsion of permanent teeth is one of the most serious dental injuries, and a prompt and correct emergency management is very important for the prognosis. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the task group. The guidelines represent the current best evidence and practice based on literature research and professionals’ opinion. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of avulsed permanent teeth.

If a tooth is avulsed, make sure it is a permanent tooth (primary teeth should not be replanted).
• Keep the patient calm.
• Find the tooth and pick it up by the crown (the white part). Avoid touching the root.
• If the tooth is dirty, wash it briefly (max 10 s) under cold running water and reposition it. Try to encourage the patient/guardian to replant the tooth. Once the tooth is back in place, bite on a handkerchief to hold it in position.
• If this is not possible, or for other reasons when replantation of the avulsed tooth is not possible (e.g., an unconscious patient), place the tooth in a glass of milk or another suitable storage medium and bring with the patient to the emergency clinic. The tooth can also be transported in the mouth, keeping it inside the lip or cheek if the patient is conscious. If the patient is very young, he/she could swallow the tooth – therefore it is advisable to get the patient to spit in a container and place the tooth in it. Avoid storage in water!
• If there is access at the place of accident to special storage or transport media (e.g., tissue culture/trans- port medium, Hanks balanced storage medium (HBSS or saline) such media can preferably be used.
• Seek emergency dental treatment immediately.

The poster ‘Save a Tooth’ is written for the public and is available in several languages: English, Spanish, Portuguese, French, Icelandic, Italian, Arabic, and Turkish and can be obtained at the IADT website:

Lars Andersson*1, Jens O. Andreasen*2, Peter Day*3, Geoffrey Heithersay*4, Martin Trope*5, Anthony J. DiAngelis6, David J. Kenny7, Asgeir Sigurdsson8, Cecilia Bourguignon9, Marie Therese Flores10, Morris Lamar Hicks11, Antonio R. Lenzi12, Barbro Malmgren13, Alex J. Moule14, Mitsuhiro Tsukiboshi15  International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth Dental Traumatology 2012; 28: 88–96; doi: 10.1111/j.1600-9657.2012.01125.x