What should NOT be done when managing an avulsed permanent tooth?

The key to successful replantation of an avulsed tooth is preservation of the periodontal ligament (PDL) cells on the root surface. Scrubbing or vigorous cleaning of the root surface (with chlorhexidine, soap, or antiseptics) destroys these vital PDL cells, dramatically reducing the chance of successful healing and increasing the risk of replacement resorption/ankylosis. Gentle rinsing with saline or milk is acceptable. The root should be handled by the crown only. If replantation is delayed, the tooth should be stored in milk, Hank's Balanced Salt Solution, physiological saline, or saliva (buccal vestibule) - NOT tap water (hypotonic, rapidly kills PDL cells).