An anaphylactic replantation: milk allergy, tooth avulsion and appropriate storage media

There are many recommended media for the immediate storage and transportation of avulsed permanent teeth following dental trauma.¹ Cow's milk is considered one of the gold standard storage media, and is readily available.^1,2 However, there is a high prevalence of allergy to cow's milk in children, which is estimated to be 0.25-4.9% worldwide, with approximately 1 in 40 children affected within the UK.³ This article highlights the potential danger with regard to cow's milk as a storage medium for avulsed permanent teeth and discusses alternative storage media.

A 7-year-old male was referred to the Community Dental Service for urgent trauma review and prosthodontic management. Medically, the patient had a dairy allergy, but was otherwise fit and well. History taking revealed that he had suffered a facial and dental injury while playing football, which resulted in avulsion of a permanent maxillary central incisor. The avulsed tooth was not replanted at the scene of injury, but was placed in milk for circa 90 minutes while seeking emergency care. At the local accident and emergency department, the tooth was rinsed with saline and then replanted. However, the tooth was promptly removed when the patient began to experience wheezing, urticaria, pruritus and significant distress. He was immediately transferred to the resuscitation department and treated for anaphylaxis.⁴ The source of anaphylaxis was attributed to trace amounts of milk on the tooth. No further attempts to replant this tooth were made.