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Emergency Department Management of Dental Trauma: Recommendations for Improved Outcomes in Pediatric Patients (Trauma CME and Pharmacology CME)
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Emergency Department Management of Dental Trauma: Recommendations for Improved Outcomes in Pediatric Patients (Trauma CME and Pharmacology CME) - $49.00

Publication Date: August 2018 (Volume 15, Number 8)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 8/1/2021

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME and 0.5 Pharmacology CME 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

Nearly 50% 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.

Excerpt From This Issue

Your first patient of the day is a 2-year-old girl who tripped and fell while walking, hitting her mouth on the concrete sidewalk. On your 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?

 

Product Reviews
Dr. Li - 04/09/2019
Several reminders and evidence updates were given here. Indications for antibiotics were reviewed, and having evidence against its use in many dental emergencies helps make decisions. Approaches to the oral trauma patient were reviewed adequately in my opinion and the article helps to review the ways to determine the age of teeth, especially in situations where the parents aren't available. Excellent diagrams.
Dr. Li - 04/04/2019
Great insight to emergent dental episodes in ER and the management. We see these so often, and often refer to dentists instead, when we could do some interventions first to help save the tooth.
Dr. Li - 04/01/2019
I was weak on dental emergencies. Great review!
Dr. Li - 03/29/2019
I feel more comfortable with the basic management of teeth that will need splinting, calcium hydroxide past, and other management such as films.
Dr. Li - 03/22/2019
I will be able to give a more detailed & accurate physical exam for both primary & permanent teeth. I will be more confident in using supraperiosteal nerve blocks.
Dr. Li - 03/21/2019
Great overview, much more comfortable dealing with these injuries.
Dr. Li - 03/19/2019
Now I’m ready for splints!
Dr. Li - 03/16/2019
Great article with excellent images, and thanks for the information on Coe Pak.
Dr. Li - 03/13/2019
I will give the Coe Pak a try. And Calcium Hydroxide patches. Little experience with these, but your article bolsters my confidence levels. Also, I have been shy about urgent f/u within 24 hours and will encourage dentists on call to see pt next morning even if it's a weekend.
Dr. Li - 03/08/2019
I now have better methods to stabilize a tooth.
Dr. Li - 03/06/2019
I will feel much more comfortable with the lingo involved in dental trauma in pediatric patients and will be able to much more effectively communicate to patients and dentists.
Dr. Li - 03/04/2019
I now have a much better understanding of the classification of dental injuries and am better able to determine primary vs permanent tooth.
- 02/18/2019
Excellent diagrams. Also, several reminders and evidence updates were given here. Indications for antibiotics were reviewed, and having evidence against its use in many dental emergencies helps make decisions. Approaches to the oral trauma patient were reviewed adequately in my opinion and the article helps to review the ways to determine the age of teeth, especially in situations where the parents aren't available.
Heather B, MD - 09/19/2018
This was a very helpful issue. Dental injuries often come in after hours and no dentist is available. I feel much better about managing these childre after reading this.
Erin T, PA-C - 09/12/2018
After reading this, I'll have better splinting/management of teeth and better charting/description of injuries in chart
Erin T, PA-C - 09/11/2018
After reading this, I'll have better splinting/management of teeth and better charting/description of injuries in chart
Teri B, MD - 09/10/2018
This gave me better knowledge of pediatric management for teeth
Michael B, DO - 09/07/2018
I will now have better documentation of tooth injuries
Matthew D., MD - 09/04/2018
Thanks! I will have more confidence in dx dental injuries.
Jennifer W. W - 09/03/2018
I now have a much better understanding of classification of dental injuries and am better able to determine primary vs permanent tooth
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