Pediatric Dentistry · patient case question
If Hank’s Balanced Salt Solution had not been available, which of the following would have been the best alternative storage medium?
Patient case: Avulsed Central Incisor on the Soccer Field
Patient: 8-year-old male
Chief Complaint: “His tooth got knocked out at soccer practice.”
Background: Healthy, immunizations current, no allergies. Tooth #8 was avulsed 35 minutes ago. The coach placed it directly into a container of Hank’s Balanced Salt Solution from the sideline kit. No loss of consciousness, no other injuries.
Medications: None
Vital Signs: BP 100/64 mmHg · HR 98 bpm · RR 20 · T 98.6°F
Findings: Empty socket at #8 with no alveolar fracture. The avulsed tooth is intact with a wide open apex and short root (approximately two-thirds formed). Adjacent teeth #7 and #9 are firm and respond within normal limits.
Show answer and explanation
Correct answer: D. Cold milk
- A. Incorrect. Tap water is hypotonic. Osmotic influx causes PDL cells to swell and lyse rapidly, and it is the single worst common storage medium — markedly worse than dry storage for short intervals.
- B. Incorrect. Dry storage kills PDL cells quickly. After 60 minutes dry, the ligament is considered non-viable and the tooth is managed as a delayed replantation with an expected ankylotic outcome.
- C. Incorrect. Chlorhexidine is cytotoxic to periodontal ligament cells. It has no role as a storage medium.
- D. Correct. Milk is the best widely available medium. It is roughly isotonic, has a physiologic pH, contains growth factors, and is relatively free of bacteria, so it preserves periodontal ligament cell viability for several hours. Saliva and saline are acceptable but inferior.
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