| Evaluation |
| When did the injury occur? |
| Any loss of consciousness or altered mental status suggesting significant head trauma? |
| Does the child have tooth pain or dental pain with touch, eating, or exposure to hot or cold? |
| Is malocclusion present? |
| Which teeth are injured? Are they primary or secondary teeth?Δ |
| Is tooth avulsion present (see "Emergency treatment of dental avulsion" below)? |
| Are there signs of child abuse (eg, torn upper labial frenula or labial sulcus in a nonambulatory child, bruising behind the ear, bruising in the shape of a hand, pinchmarks, bruising in various stages of development)?¶ |
| Is there tenderness over the jaw or temporomandibular joint? |
| Emergency treatment of dental avulsion |
| Replant any avulsed permanent teeth as soon as possibleΔ |
- Handle the tooth by the crown
|
- Gently rinse the tooth with tap water or saline. Do NOT scrub or sterilize the tooth!
|
- Insert the tooth into the empty socket
|
- Keep the tooth in place through finger pressure or by having the child bite on a gauze pad or clean towel
|
- Obtain urgent pediatric dental consultation
|
| If unable to replant immediately, store the tooth in Hank's balanced salt solution, cold milk, or a container of the child's saliva (NOT the child's mouth and not in water) |
| Do NOT replant primary (baby) teethΔ. If uncertain if the tooth is primary or permanent, gently replant. |
| Other dental injuries |
| Remove very loose or dangling primary (baby) teethΔ |
| Urgently refer the following children to a dentist with pediatric expertise: |
- Extruded >3 mm or interfering with bite
|
- Laterally luxated (displaced) teeth that interfere with bite
|
| |
- Fractured teeth when dental pulp is exposed (bleeding from central core of the tooth)
|
- Fractured permanent teeth. If available, tooth fragments may be reattached (store in tap water to prevent discoloration)
|
- Suspected dental root or alveolar fracture
|
- Suspected jaw fracture (jaw tenderness and/or malocclusion) to obtain panorex radiograph
|
| Other considerations |
| Provide tetanus prophylaxis, as needed, for patients with contaminated wounds, deep intraoral lacerations, or avulsed teeth |
| Provide antibiotic prophylaxis for bacterial endocarditis in susceptible patients |
