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August 2012, Volume 42 Number 8 , p 72 - 72


  • Ellen Pfadt MSN, RN
  • Dorothy S. Carlson DEd, RN


NL, 9, IS BROUGHT to the school nurse's office by the physical education teacher. NL is crying and her mouth is bloody. She's holding her tooth in her hand.When NL opens her mouth, one of her upper front teeth is missing. The teacher says that NL was elbowed in the mouth about 3 minutes earlier by another child during an outdoor soccer game. NL is awake, alert, and oriented times three. She denies a headache and she has no neurologic deficits. Her gum is bleeding where the tooth is missing. Her upper lip is edematous, but intact.NL's airway is adequate and her breathing is within normal limits. Assessing her oral cavity, you find that all other teeth are intact and see no tooth fragments or lacerations. Based on NL's clinical presentation, the avulsed tooth is an immature permanent tooth that should be immediately reimplanted for the best outcome. Immature permanent teeth have a better chance than mature permanent teeth for regeneration of the tooth's pulp.An avulsion is a complete separation

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