The final stop on my CME Adventure proved to be the most exotic.  Lazarote, a desolate volcanic land nestled in the Canary Islands chain is home to few humans albeit an abnormally high population of camels.  Following a morning camel ride and tour of the local volcano (which included cooking chicken on a grate above an active volcanic steam vent) I was treated to informative emergency medicine lectures.  The most interesting thing I learned today?  Management and treatment of tooth avulsion.

What should you do if a patient presents to your clinic or hospital after traumatically losing a tooth? Until this week, I did not know the answer to this important question.  First, you must ask “Where is the tooth?!”.  Many times, patients will accidentally swallow an avulsed tooth in the chaos of the traumatic injury resulting in aspiration.  If the tooth in question has not been found, consider a chest X-Ray to ensure the tooth is not located in the patient’s lungs.  Second, if the patient has the tooth, do not attempt to clean the tooth, especially the root.    Third, place the affected tooth in a glass of milk if available.  Saline or Save-A-Tooth solution are also acceptable mediums (but who has Save-A-Tooth when they need it?).  Milk will maintain viability of the periodontal ligament for up to three hours and has a pH comparable with that of the human body making it the perfect tooth preservative.  Finally, you must place the tooth back in the socket.

How do you go about placing the tooth back into the socket?  Rinse the socket gently with normal saline to check for foreign bodies.  Then, holding the tooth by the crown, gently rinse with saline as well.  Finally, return the tooth to its original position in the socket by applying firm pressure.  Stabilize the tooth by applying a dental splint such as a zinc oxide preparation.  Simply mold the mixture over the gingival area and between teeth to provide support to the damaged tooth.  Replacing an avulsed tooth is very painful so numbing the area using a nerve block prior to the procedure is ideal.  Replacing the tooth in a timely manner protects the periodontal ligament preventing further dental damage.  Antibiotics must be initiated and the patient’s tetanus vaccine should be updated if necessary.  The patient must follow up with a dentist for continued care as a root canal will be required.  

I will let you know when I have a chance to try my new technique (under supervision the first few times, of course).  This concludes my Continuing Medical Education adventure.  No more camel riding; back to real life for now.  Are you attending a CME conference?  I would love to hear what you are learning!  Please share with us by commenting. 

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