Pediatric Dentistry · patient case question
A tooth is avulsed at school and cannot be replanted immediately. What is the best storage medium?
Patient case: A Seven-Year-Old with Two Painful Primary Molars
Patient: 7-year-old female
Chief Complaint: “Both bottom back baby teeth on the left hurt when she eats.”
Background: First dental visit. No medical history. Cooperative but apprehensive — she will sit and open, but keeps asking what will happen next and needs frequent reassurance.
Medications: None
Vital Signs: BP 100/64 mmHg · HR 90 bpm · RR 20 · T 98.4°F
Findings: Deep occlusal caries in teeth #S and #T with pain on eating that stops when the food is removed. Both teeth are RESTORABLE with substantial remaining structure. No swelling, no sinus tract, no mobility. Radiographs show no furcation or periapical radiolucency and no pathological root resorption.
Show answer and explanation
Correct answer: A. Hank's Balanced Salt Solution
- A. CORRECT. HANK'S BALANCED SALT SOLUTION is the ideal medium. It is pH-balanced and osmolality-matched to physiological conditions and supplies glucose, calcium, magnesium and phosphate — it maintains periodontal ligament cell viability for up to 24 hours, far longer than any alternative. It is the medium in commercial tooth-preservation kits.
- B. TAP WATER is the WORST option. It is hypotonic, so PDL cells swell and lyse osmotically within minutes. It is worse than dry storage in some comparisons.
- C. Alcohol-based mouthwash is cytotoxic and destroys the ligament immediately.
- D. Dry storage kills PDL cells rapidly. Beyond about 60 minutes dry, the ligament is not salvageable and ankylosis with replacement resorption becomes the expected outcome.
Note: Practical hierarchy when Hank's is unavailable: milk (readily available, roughly physiological osmolality, good for up to about 6 hours) > saliva in the buccal vestibule or a container of the patient's saliva (about 2 hours) > saline > never water. Best of all: replant at the scene within 15 minutes and go straight to the dentist.
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