In tooth avulsion management, which storage medium is appropriate when the tooth cannot be replanted immediately?

• A. Milk or saline or saliva.
• B. Tap water.
• C. Alcohol.
• D. Dry storage.

Answer: (A)

Maintaining periodontal ligament cell viability is the central idea when an avulsed tooth cannot be replanted right away. The best storage media are milk, saline, or saliva because they are compatible with the cells outside the mouth: they are relatively isotonic, help prevent dehydration, and provide a supportive environment that slows cell death during the extra-alveolar period. Milk is especially favored because it is widely available, has a near-neutral pH, and osmolality similar to body fluids, reducing cellular stress. Saline is another good option as a sterile isotonic solution. Saliva can be used if those aren’t available, though it may carry bacteria and enzymes, it’s still better than leaving the tooth dry. In contrast, tap water is hypotonic and can cause cell swelling and rupture, while dry storage fully desiccates the cells and alcohol is cytotoxic. So, storing the tooth in milk, saline, or saliva best preserves the cells and improves the chance of a favorable outcome if replantation is delayed.