Avulsion Systemic Antibiotics — ORE Part 1 MCQ

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ModerateOral SurgeryAvulsion Systemic AntibioticsORE Part 1

A 16-year-old patient presents with an avulsion of the upper left central incisor. The tooth was stored in milk and the extra-alveolar time was 30 minutes. The apex is closed. What systemic medication should be prescribed after replantation?

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Correct answer: B — Systemic antibiotics (doxycycline for patients ≥12 years, or amoxicillin if <12) for 7 days

Explanation lettering: D = shown as A · A = shown as B · B = shown as C · C = shown as D

The correct answer is A. Current UK and international guidelines recommend systemic antibiotic prophylaxis for replanted avulsed teeth despite inconclusive evidence for periodontal healing benefit. The operative principle is: pending future research, follow established guidelines. For this 16-year-old with a closed-apex, freshly replanted incisor (30-minute extra-alveolar time in milk—an excellent scenario), doxycycline 7 days is appropriate and aligns with UK prescribing practice. Corticosteroids (B) are not routinely indicated; NSAIDs alone (C) do not address infection risk; no medication (D) contradicts guideline consensus; antifungals (E) have no role. The closed apex increases pulp necrosis risk, reinforcing the rationale for antimicrobial cover.

Reference: Cochrane systematic review (Hinckfuss & Messer, 2009) & SDCEP clinical guidelines; NHS Clyde ED Tooth Avulsion Protocol; International Association of Dental Traumatology consensus practice, https://pubmed.ncbi.nlm.nih.gov/19290893/