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Initial Assessment and Management of Pediatric Dental Emergencies - $30.00
This issue includes 4 AMA PRA Category 1 CreditsTM; 4 ACEP category
1 credits; and 4 AAP Prescribed credits.
Derya Caglar, MD
Assistant Professor, University of Washington School of Medicine; Attending Physician, Division of Emergency Medicine, Seattle Children’s Hospital, Seattle, Washington
Richard Kwun, MD
Attending Physician, Department of Emergency Medicine, Swedish Medical Center, Issaquah, Washington
Alan B. Douglass, MD, FAAFP
Associate Director, Family Medicine Residency Program, Middlesex Hospital, Middletown, CT
Joanna Douglass, BDS, DDS
Associate Professor, Division of Pediatric Dentistry, University of Connecticut School of Dental Medicine, Farmington, CT
Martin I. Herman, MD, FAAP, FACEP
Professor of Pediatrics, UT College of Medicine; Assistant Director of Emergency Services, Lebonheur Children’s Medical Center, Memphis, TN
Publication Date: June 2010; Volume 7, Number 6
Excerpt from the issue...
In the middle of a busy shift in the ED, a nurse tells you she has just placed a 5-year-old boy with a mouth injury in an examining room. The boy reports that less than an hour ago he was playing basketball and lost a tooth when he was accidentally “elbowed” by his older brother. His mother reports that an adolescent nephew had a similar incident last year, and the dentist recommended that they place the tooth in milk, and she produces a small jar of milk containing the lost tooth. On physical examination, the child denies having any jaw pain or swelling, but the socket where the left central maxillary incisor should be is empty and oozing blood. Can this tooth be saved? What sort of dental injuries might this child have suffered in addition to the lost tooth? How does the management of dental trauma change in light of a patient’s age or the location of the traumatized tooth? Is there something else a parent should have done prior to arrival in the ED to help save the tooth?
Meanwhile, one of your patients has just been taken to the cardiac catheterization laboratory since you diagnosed his myocardial infarction. After intubating a woman with lung cancer and respiratory failure secondary to acute H1N1 influenza, her condition has finally stabilized. You have even managed to administer moderate sedation to reduce the shoulder dislocation of a young skateboarder who fell on his outstretched hand. You are hoping for an easy case when the nurse tells you there’s a 6-year-old girl with dental pain in the next room. You think you’ve caught a break until your review of this patient’s previous visits to the ED for several episodes of dental pain. Her record contains several notes from emergency clinicians as well as from social workers instructing the parents to follow-up with the dental clinic. The reports also document transport assistance provided to the family as well as their need for financial aid. Before you enter the examining room, you ask yourself several questions. Are this child’s primary or permanent (secondary) teeth affected? What is the likely cause of her dental pain? If there is an infection, what are the indications for antibiotics? Given the repeated history of visits to the ED without appropriate follow-up, should you report her parents to Child Protective Services?
This review of available evidence in the literature will equip the emergency clinician with the information needed to provide the most up-to-date care.