About Hans Rosenberg, MD

ALiEM Contributor
Assistant Professor, Emergency Medicine
Ottawa Hospital

Trick of the Trade: Dental Avulsion and Subluxation

ToothAvulsionIt’s a Friday evening shift in the “minor area” of your ED and a young woman who had imbibed a little too much alcohol comes in with an avulsion of her first left upper incisor after falling and striking her face against the ground.  She’s crying because of the event but is otherwise unscathed.  At this point it’s time to take care of the avulsion.  What to do?


Close up repair 4

Trick of the Trade

Dermabond (2-octyl cyanoacrylate) and N95 Nasal Bridge Technique

Although originally described for dental avulsions, I have also used this technique to stabilize subluxations. This is temporizing fix until the patient can get to the dentist for a definitive repair. Below is a description of the technique.

  1. Lightly rinse tooth with saline solution.
  2. Rinse socket with 20-40 mL of saline solution and then pat dry with a surgical sponge.
  3. Gently reimplant tooth into a satisfactory anatomic position.
  4. Pat tooth dry and apply 2-octyl cyanoacrylate (2-OCA) to the mesial and distal edges of the tooth, thereby adhering it to the adjacent teeth. In this case of a left central incisor avulsion, “mesial” means right edge and “distal” means left edge in dental speak.
  5. Use the pliable metal nasal bridge from an N95 respirator mask as a splint. Cut it to the appropriate size. Be sure to round the edges to avoid injury.
  6. Secure the replanted tooth by applying 2-OCA to the inner aspect of the splint and buccal surface of the target and one/both adjacent teeth.
  7. Hold the splint under pressure for about 1 minute.
  8. Confirm stability.

In addition, remember to start the patient on prophylactic antibiotics. Penicillin is a reasonable choice. Keep a liquid diet and see a dentist, as soon as possible.


  • Children: Avulsed primary teeth should not be replanted. Also ensure they will not be at aspiration risk.
  • Warn the patient that if they feel that the dental splint is loosening, simply remove it.

Special thanks to our amazing residents Dr. Mike Hickey for his assistance with the case report and Dr. Warren Cheung for providing one of the images.

Below are other images where we have successfully used this technique in our ED.
Close up repair 3
Close up repair 2
  • Rosenberg H, Rosenberg H, Hickey M. Emergency management of a traumatic tooth avulsion. Ann Emerg Med. 2011 Apr;57(4):375–7.


By |2021-09-04T09:55:04-07:00Jan 17, 2012|Dental, Tricks of the Trade|

Article review: Evaluating your written evaluation of a learner

EvaluationChecklist3dAs a new faculty, one of the first challenges that I encountered was completing evaluation forms for medical students and residents. In our department, a Daily Evaluation Card (DEC) is to be completed at the end of every shift for each learner. These DEC’s are then collated by the program directors to yield a summative final rotation evaluation.

What I wondered was: how can I best use these DEC’s to help learners progress as medical professionals and at the same time provide critical information for the PD’s?


By |2016-11-15T22:24:53-08:00Nov 7, 2011|Education Articles, Medical Education|

Paucis Verbis: Fibrinolytics for Acute Pulmonary Embolism

Pulmonary embolism fibrinolytics

When would you give fibrinolytics for a Pulmonary Embolism?

This Paucis Verbis card summarizes recommendations found in Circulation’s recently published Scientific Statement from the American Heart Association. Although it is rare to give fibrinolytics for a pulmonary embolism (PE) in the Emergency Department, it is important to remember when lytics are indicated.

PV Card: Fibrinolysis for Acute Pulmonary Embolism

Adapted from [1]
Go to ALiEM (PV) Cards for more resources.


  1. Jaff M, McMurtry M, Archer S, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011;123(16):1788-1830. [PubMed]
By |2021-10-12T16:21:19-07:00Jul 29, 2011|ALiEM Cards, Cardiovascular, Pulmonary|
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