Why won't dentist reimplant baby teeth?

My five year old son fell on our wooden stairs this weekend and knocked out two front teeth. Both teeth appear to have been extracted roots and all. I placed the teeth in a damp towel and rushed him to a pediatric dentist. The dentist examined him and told me baby teeth are never re-inserted. He placed my son on antibiotics and will re-examine him in 4 days.

My questions:

  1. I've read teeth can be re-inserted after an accident. Could this have been done?
  2. What is the prognosis for his adult teeth coming in normally? When?
  3. How should I care for him in the next week?

Dear David,

Your dentist is correct. Reimplantation of completely avulsed primary teeth is generally not recommended. This is mainly due to concern for the developing permanent teeth which are underneath the primary teeth. Certain complications can arise if primary teeth are reimplanted. For example, reimplantation of the primary tooth can lead to ankylosis. This is a condition in which the primary tooth fuses with the bone. If this is allowed to happen, it will interfere with the eruption of the permanent tooth. Necrosis of the pulp tissue in the primary tooth can also cause an infection which might affect the development of the permanent tooth. Reimplantation of primary teeth is rarely successful.

It is possible that some complications with the permanent teeth may still develop. If the roots of the primary teeth happened to intrude on the crowns of the permanent teeth before avulsion, a defect in the enamel in the crown of the permanent tooth may occur. This may be an actual spot of missing enamel or the enamel may be present but discolored. Depending on the severity of the trauma, the developing roots of the permanent teeth may be affected. This effect may include a change in direction of the root, incomplete root formation, or development of a bifid root (two apices instead of one).

Premature loss of primary teeth can delay the eruption of the permanent incisor by about 1-2 years. The average age of eruption of lower incisors is 6-7 years old and upper incisors is 7-8 years old. This is partly dependent upon the development of the root. If the root of the permanent incisor is less than 1/2 developed, this delay may be more likely. The delay can also be related to abnormal changes in the connective tissue or the tooth follicle. Deposition of scar tissue in the path of eruption may also contribute to a delay in eruption. Occasionally, surgical and/or orthodontic intervention may be necessary to aid eruption of the permanent tooth. Given your son's age and the stage of development of his permanent incisors, he may be less likely to develop some of these complications than a younger child would; however, you should be aware that complications are possible.

I advise you to administer the antibiotics as prescribed. The area of trauma and the surrounding teeth should be kept clean. You might help your son brush and floss the surrounding teeth gently so as not to disturb the healing process. Warm salt water rinses, especially after meals and snacks, for several days will help keep the injured area clean and promote healing. If your son is experiencing any discomfort, a mild analgesic such as Children's Motrin should be helpful. It might be helpful to avoid hard, crusty or spicy foods for a few days as healing begins. Definitely keep follow up visits with your dentist so he or she can monitor the healing or possible complications in the future. I hope, by now, that everyone is feeling better!

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