Emergency Department Management of Dental Trauma: Recommendations for Improved Outcomes in Pediatric Patients -

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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?