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Dental emergencies

Tooth avulsion: does the milk matter?

Sir, a recent study found that almost a quarter of the UK population now use dairy free milks such as soy, oat, almond, coconut.1 Avulsion injuries are one of the most serious dental emergencies, accounting for 0.5-16% of dental injuries and the actions undertaken after this injury are key to tooth prognosis.2 The International Association of Dental Traumatology consider immediate reimplantation of the avulsed tooth to be the best treatment. If not possible, the tooth should be placed in a physiologic storage medium. Cow's milk is advocated as this medium because of its physiological pH, lack of added sugar and the assumption that it's readily available, cheap and convenient.2

A suitable storage medium can increase the viability time of an avulsed tooth and its survival and this may be especially important during the pandemic where patients may face delays seeking emergency dental care. It is difficult to know if these dairy-free alternatives provide the tooth with such ideal storage conditions. Some contain added sugar for taste and the pH can be variable.3

This has led to the question of whether the type of milk used as a storage medium has an impact on outcomes to the avulsed tooth and can be recommended as an alternative. A literature search revealed minimal research with the majority of studies investigating pasteurised dairy milk. Limited studies, including a systematic review, demonstrate conflicting results around the suitability of soy and almond milks as storage media.4,5 One paper revealed soy milk to show significantly higher ankylosis than the control group.4 Should the situation occur that people refuse to use dairy milk for storage, it would be prudent for dentists to be able to advise whether storage in other media could be recommended, or whether it would be unsafe, incur damage to the tissues and impact outcomes. Further research, expert advice or open discussion would be welcome to ensure safe dental care.

References

  1. Horton H. Vegan milk no longer just a trend with millennials as third of Britons buy non-dairy alternatives. The Telegraph, 21 August 2020. Available at: https://www.telegraph.co.uk/news/2020/08/21/vegan-milk-no-longer-just-trend-millennials-third-britons-buy/ (accessed March 2021).

  2. Fouad A F, Abbott P V, Tsilingaridis G et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol 2020; 36: 331-342.

  3. Aydar E F, Tutuncu S, Ozcelik B. Plant-based milk substitutes: Bioactive compounds, conventional and novel processes, bioavailability studies, and health effects. J Functional Foods 2020; 70: 103975. 10.1016/j.jff.2020.103975.

  4. de Paula Reis M V, Gomes Moura C C, Ferreira Soares P B et al. Histologic and micro-computed tomographic analyses of replanted teeth stored in different kind of media. J Endod 2014; 40: 665-669.

  5. Adnan S, Lone M M, Khan F R, Hussain S M, Nagi S E. Which is the most recommended medium for the storage and transport of avulsed teeth? A systematic review. Dent Traumatol 2018; 34: 59-70.

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Hamid, A., Carter, A. Tooth avulsion: does the milk matter?. Br Dent J 230, 326 (2021). https://doi.org/10.1038/s41415-021-2859-5

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  • DOI: https://doi.org/10.1038/s41415-021-2859-5

Further reading

  • Coconut water

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    British Dental Journal (2021)

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