Avulsion Scene Management — ORE Part 1 MCQ

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EasyDental Public Health & EpidemiologyAvulsion Scene ManagementORE Part 1

At the scene of an accident, a conscious cooperative patient has avulsed a permanent incisor. The tooth is intact but visibly dirty. What is the most appropriate immediate management?

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Correct answer: D — Gently rinse, replant, then bite on clean gauze

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

A is correct. For an avulsed permanent tooth, the priority is immediate reimplantation where feasible. The tooth should be handled by the crown, gently rinsed only to remove contamination, replanted in its original position and retained by gentle biting on clean gauze or a handkerchief. This minimises extra-alveolar time and protects periodontal-ligament viability. Antiseptic solution is inappropriate because it may damage periodontal-ligament cells. Scrubbing the root mechanically damages these cells. Dry storage in tissue allows desiccation, while foil provides no suitable storage environment. If reimplantation cannot be achieved, the tooth should instead be kept moist in milk, saline or saliva and urgent dental care sought. Primary teeth are not replanted.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP). Management of Acute Dental Problems: Injuries to the mouth, face and jaws — Dento-alveolar injuries: avulsed teeth. https://www.acutedentalproblems.sdcep.org.uk/guidance/management-of-oral-conditions/less-common-oral-conditions/injuries-to-the-mouth-face-and-jaws/