Emergency Department Management of Dental Trauma: Recommendations for Improved Outcomes in Pediatric Patients -Trauma EXTRA Supplement - (Trauma CME)

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Delivery Method:	Online
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Publication Date: December 2024 (Volume 22, Number 1)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-B Credits. CME expires 12/15/2027.

Specialty CME Credits:Included as part of the 4 credits, this CME activity is eligible for 4 Trauma credits, subject to your state and institutional approval.

Authors

Joyce Li, MD, MPH

Physician in Medicine, Boston Children’s Hospital, Division of Emergency Medicine; Assistant Professor, Harvard Medical School, Division of Pediatrics and Emergency Medicine, Boston, MA

Peer Reviewers

Michael Gorn, MD

Clinical Assistant Professor of Pediatrics, University of Texas at Austin, Dell Medical School, Dell Children’s Medical Center, Austin, TX

Tali Tehrani, DDS

Certified Pediatric Dentist, Toothbuds Pediatric Dentistry, Los Angeles, CA

Abstract

Over 40% of children will experience dental trauma by the age of 4 years. Timely and effective care is important in the management of dental injuries, as several studies have shown poor outcomes with delayed treatment. The current evidence in the management of dental injuries is primarily from a dentist’s perspective, with limited evidence specific to management in the emergency department. The goal of pediatric dental injury management is dictated largely by whether the dentition is primary or permanent. This issue provides a systematic emergency medicine-based approach to address pediatric dental injuries, along with a review of basic dental procedures that will lead to improved dental outcomes.

Case Presentations

A 2-year-old girl is brought to the ED by her parents after she tripped and fell while walking, hitting her mouth on the concrete sidewalk…

• On examination, her left central incisor tooth appears to be fractured, with a yellow dot visible inside the tooth.
• The tooth is nontender and nonmobile.
• The parents don’t have the other part of the tooth and think it fell onto the street.
• You start to consider: How do you determine what kind of fracture this is and how serious it is? How does management differ between primary teeth versus permanent teeth, and how can you tell if this is a primary tooth or a permanent tooth? Do you need to do anything regarding the missing fragment?

A 15-year-old boy comes in with a tooth avulsion...

• He was at basketball practice when another player accidentally elbowed him in the mouth.
• He did not lose consciousness and has pain only in his mouth. He was immediately brought to your ED, which is about 15 minutes away from where the accident happened.
• His coach arrives with the boy’s tooth in a container of milk.
• On physical examination, the patient has lost his right lateral incisor, and a clot remains where his tooth had been.
• How much time do you have to replace the tooth to have the best success of replantation? What do you need to consider while handling, storing, and cleaning the tooth?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.