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

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

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  About this Issue

Timely and effective care is important in the management of dental trauma, as delayed treatment can have life-long detrimental effects on the patient’s dentition. This issue provides a review of the anatomy of pediatric dentition, the proper assessment methods for dental injuries, the types of injuries that need emergent intervention, and the different management approaches for primary versus permanent dentition. You will learn:

•  Tooth characteristics that differentiate primary dentition from permanent dentition
•  Appropriate prehospital management of dental injuries including replantation of permanent dental avulsions
•  Management strategies for injuries to primary versus permanent dentition, including a fractured tooth, a luxated tooth, and an avulsed tooth
•  Basic procedures for administering anesthetic via a supraperiosteal nerve block and for applying a dental splint using sutures or Coe PakTM

  Issue Information

Authors: Joyce Li, MD, MPH

Peer Reviewers: Michael Gorn, MD; Tali Tehrani, DDS

Publication Date: August 1, 2018

CME Expiration Date: August 1, 2021

CME Credits: AMA PRA Category 1 CreditsTM, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2A or 2B Credits. Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credits.

PubMed ID: 30020737

  Issue Features
  Table of Contents
  1. Abstract
  2. Case Presentations
  3. Introduction
  4. Critical Appraisal of the Literature
  5. Dental Anatomy
  6. Etiology and Pathophysiology
    1. Mechanisms of Injury and Anatomic Risk Factors
    2. Traumatic Dental Injuries
      1. Fractures
      2. Luxation Injuries
      3. Avulsion Injuries
  7. Prehospital Care
  8. Emergency Department Evaluation
    1. Physical Examination
      1. Extraoral Examination
        • Recognizing Signs of Nonaccidental Trauma
      2. Intraoral Examination
        • Recognizing Signs of Nonaccidental Trauma
    2. Differentiation of Dental Injuries
      1. Fractures
        • Ellis Classification of Dental Fractures
      2. Luxation and Avulsion Injuries
  9. Diagnostic Studies
  10. Treatment
    1. Anesthesia
      1. General Cautions
      2. Infiltration Techniques
    2. Intraoral Lacerations
    3. Injuries to Primary Dentition
      1. Primary Dentition Fractures
      2. Primary Dentition Luxation and Avulsion Injuries
    4. Injuries to Permanent Dentition
      1. Splinting
        • Coe PakTM Splinting
        • Suture Splinting
      2. Permanent Dentition Fractures
      3. Permanent Dentition Luxation Injuries
      4. Permanent Dentition Avulsion Injuries
  11. Special Considerations
  12. Controversies and Cutting Edge
  13. Disposition
  14. Summary
  15. Risk Management Pitfalls in the Management of Pediatric Patients With Dental Trauma
  16. Case Conclusions
  17. Time- and Cost-Effective Strategies
  18. Clinical Pathway for the Management of Pediatric Patients With Dental Injuries
  19. Tables and Figures
    1. Table 1. Guidelines for the Management of Dental Trauma
    2. Table 2. Differentiation of Primary Versus Permanent Teeth
    3. Table 3. Physical Examination Findings for Various Types of Dental Injuries
    4. Table 4. Antibiotic Recommendations to Prevent Infective Endocarditis
    5. Figure 1. Basic Tooth Anatomy
    6. Figure 2. Primary Tooth Development
    7. Figure 3. Permanent Tooth Development
    8. Figure 4. Permanent and Primary Dentition Classification Systems
    9. Figure 5. Fractures Through Layers of the Tooth
    10. Figure 6. Ellis Dental Fracture Classification
    11. Figure 7. Supraperiosteal Nerve Block
    12. Figure 8. Procedure for Splinting Teeth Using Coe PakTM
    13. Figure 9. Suture Splint to Stabilize a Tooth
  20. References



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.


Case Presentations

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?

You are then asked to see a 15-year-old adolescent boy who has come 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?



Dental injuries are a common pediatric complaint, and they often occur outside of the typical dentists' office hours.1,2 The incidence of dental trauma to primary teeth has been reported to be as high as 50% in children aged 2 to 3 years,3-6 due to their developing mobility.7 Another peak in dental injuries is seen in adolescents, with an incidence of 20%, as reported in a United States national survey;8 these injuries are most commonly associated with falls, sports, motor vehicle crashes, and violent altercations.6,9-11

Due to insurance issues and lack of dental healthcare access, pediatric dental complaints to the emergency department (ED) continue to increase.12-14 There are several reasons it is important for emergency clinicians to have a good understanding of pediatric dental development and trauma. First, the care of dental injuries is time-sensitive, and delayed treatment can have life-long detrimental effects on the patient’s dentition. Retrospective and prospective cohort studies have shown complications including tooth discoloration, ectopic or delayed eruption, or ankylosis (fusion of the tooth to the bone).7,11,15-18 Second, the management of injuries to primary dentition is different from that of injuries to permanent dentition, due to the developing dental buds that may be damaged by trauma.6 Finally, surveys have shown that emergency clinicians lack confidence in their management of pediatric dental injuries.19,20 Emergency clinicians must have a good understanding of: (1) the anatomy of pediatric dentition, (2) the proper assessment methods for dental injuries, (3) the types of injuries that need emergent intervention, and (4) the different management approaches for primary versus permanent dentition. This issue of Pediatric Emergency Medicine Practice provides a review of various types of dental injuries as well as a systematic approach to their evaluation and management in pediatric patients.


Critical Appraisal of the Literature

A search was performed using PubMed, with limits for articles published in the past 10 years, written in the English language, and with patients aged < 18 years as subjects. The search terms included: dental trauma, oral trauma, emergency dental care, dental injury, dental fracture, dental intrusion, dental extrusion, dental luxation, dental avulsion, crown fracture, and root fracture. The Cochrane Database of Systematic Reviews, National Guideline Clearinghouse, American Academy of Pediatrics (AAP), American Association of Pediatric Dentistry (AAPD), and International Association of Dental Traumatology (IADT) guidelines were searched and reviewed. A total of 101 articles were identified. Textbooks on dentistry and pediatric emergency medicine were also reviewed.

There are no guidelines specifically for emergency clinicians; most of the guidelines were written for dentists. (See Table 1 for a list of current guidelines for the management of dental trauma.) There are no prospective studies specifically addressing the efficacy of temporizing measures for use by emergency clinicians in managing pediatric patients; this topic is currently guided by expert opinion and limited data from adult studies. The majority of studies in both pediatric dentistry and pediatric ED populations are retrospective or observational, with case reports to supplement information on complications of dental injury.



Risk Management Pitfalls in the Management of Pediatric Patients With Dental Trauma

2. “I replanted the primary tooth that was avulsed, because avulsion is a dental emergency.”

An avulsed primary tooth should not be replanted. Preservation of the permanent dentition is the priority with primary tooth injuries, and most management is focused on pain control and urgent referral to a dentist.

4. “The family said they couldn’t find the girl’s tooth fragment. It was probably just lost at the scene.”

Unaccounted-for teeth or dental fragments should not be assumed to be lost. Foreign body aspiration or retained foreign bodies should be ruled out by radiography.

8. “The family brought in an avulsed tooth; I made sure to clean it well, because it had fallen in the dirt.”

Avulsed teeth can be rinsed with cold water for a maximum of 10 seconds, but should be held by the crown only, not the root, to help preserve the periodontal ligaments. The tooth should be kept moist to preserve the periodontal ligaments.

Tables and Figures

Table 3. Physical Examination Findings for Various Types of Dental Injuries6,21,23,26,27,29,109

Type of Injury
Apparent on Visual Examination?
Percussion Tenderness
Gingival Bleeding
May be visible only by transillumination
Crown fracture
Crown-root fracture
Root fracture
May not be apparent on visual examination alone
May not be apparent on visual examination alone
Lateral luxation
Intrusive luxation
Extrusive luxation
+ (empty socket)
Abbreviation: N/A, not applicable.




Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of patients. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study is included in bold type following the reference, where available. In addition, the most informative references cited in this paper, as determined by the author, are highlighted.

  1. Lewis C, Lynch H, Johnston B. Dental complaints in emergency departments: a national perspective. Ann Emerg Med. 2003;42(1):93-99. (Retrospective national database study; 738,000 patients)
  2. Wagle E, Allred EN, Needleman HL. Time delays in treating dental trauma at a children’s hospital and private pediatric dental practice. Pediatr Dent. 2014;36(3):216-221. (Retrospective chart review; 210 patients)
  3. Jorge KO, Moyses SJ, Ferreira e Ferreira E, et al. Prevalence and factors associated to dental trauma in infants 1-3 years of age. Dent Traumatol. 2009;25(2):185-189. (Prospective cross-sectional study; 510 patients)
  4. Kramer PF, Zembruski C, Ferreira SH, et al. Traumatic dental injuries in Brazilian preschool children. Dent Traumatol. 2003;19(6):299-303. (Prospective cross-sectional study; 1545 patients)
  5. Andreasen JO, Ravn JJ. Epidemiology of traumatic dental injuries to primary and permanent teeth in a Danish population sample. Int J Oral Surg. 1972;1(5):235-239. (Prospective cross-sectional study; 487 patients)
  6. Casamassimo PS, Fields HW Jr, McTigue DJ, et al. Pediatric Dentistry: Infancy Through Adolesence. 5th ed. St. Louis: Elsevier Saunders; 2012. (Textbook)
  7. Flores MT. Traumatic injuries in the primary dentition. Dent Traumatol. 2002;18(6):287-298. (Systematic review; 75 studies)
  8. Dye BA, Tan S, Smith V, et al. Trends in oral health status: United States, 1988-1994 and 1999-2004. Vital Health Stat 11. 2007;Apr(248):1-92. (Retrospective database study; 30,548 patients)
  9. Bruns T, Perinpanayagam H. Dental trauma that require fixation in a children’s hospital. Dent Traumatol. 2008;24(1):59-64. (Retrospective chart review: 79 patients)
  10. Mitchell J, Sheller B, Velan E, et al. Managing pediatric dental trauma in a hospital emergency department. Pediatr Dent. 2014;36(3):205-210. (Retrospective chart review; 265 patients)
  11. McTigue DJ. Overview of trauma management for primary and young permanent teeth. Dent Clin North Am. 2013;57(1):39-57. (Review)
  12. Bisgaier J, Cutts DB, Edelstein BL, et al. Disparities in child access to emergency care for acute oral injury. Pediatrics. 2011;127(6):e1428-e1435. (Prospective one-way blinded cross-sectional study; 170 calls to 85 dental practices)
  13. Ladrillo TE, Hobdell MH, Caviness AC. Increasing prevalence of emergency department visits for pediatric dental care, 1997-2001. J Am Dent Assoc. 2006;137(3):379-385. (Retrospective chart review; 1102 patients)
  14. Smith RG, Lewis CW. Availability of dental appointments for young children in King County, Washington: implications for access to care. Pediatr Dent. 2005;27(3):207-211. (Prospective one-way blinded study; 508 phone calls to 508 dental practices)
  15. Bardellini E, Amadori F, Pasini S, et al. Dental anomalies in permanent teeth after trauma in primary dentition. J Clin Pediatr Dent. 2017;41(1):5-9. (Retrospective chart review; 241 patients)
  16. Costa VP, Goettems ML, Baldissera EZ, et al. Clinical and radiographic sequelae to primary teeth affected by dental trauma: a 9-year retrospective study. Braz Oral Res. 2016;30(1). (Retrospective chart review; 576 children, 774 teeth)
  17. Gungor HC, Pusman E, Uysal S. Eruption delay and sequelae in permanent incisors following intrusive luxation in primary dentition: a case report. Dent Traumatol. 2011;27(2):156-158. (Case report)
  18. Ritwik P, Massey C, Hagan J. Epidemiology and outcomes of dental trauma cases from an urban pediatric emergency department. Dent Traumatol. 2015;31(2):97-102. (Retrospective chart review; 548 teeth)
  19. Trivedy C, Kodate N, Ross A, et al. The attitudes and awareness of emergency department (ED) physicians towards the management of common dentofacial emergencies. Dent Traumatol. 2012;28(2):121-126. (Prospective survey; 102 physicians)
  20. Needleman HL, Stucenski K, Forbes PW, et al. Massachusetts emergency departments’ resources and physicians’ knowledge of management of traumatic dental injuries. Dent Traumatol. 2013;29(4):272-279. (Prospective survey; 72 surveys, 16 medical directors, 56 physicians)
  21. King C, Henretig FM, King BR, et al. Textbook of Pediatric Emergency Procedures. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2008. (Textbook)
  22. Wright JT. Anatomy and development of the teeth. UpToDate. (Review)
  23. Bachur RG, Shaw KN. Fleisher & Ludwig’s Textbook of Pediatric Emergency Medicine. 7th edition ed. Philadelphia: Lippincott Williams & Wilkins; 2016. (Textbook)
  24. American Dental Association. Baby Tooth Eruption Charts. Available at:
    . Accessed July 15, 2018.
  25. Sabuncuoglu O. Traumatic dental injuries and attention-deficit/hyperactivity disorder: is there a link? Dent Traumatol. 2007;23(3):137-142. (Review)
  26. Malmgren B, Andreasen JO, Flores MT, et al. Guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Pediatr Dent. 2016;38(6):377-385. (Guideline)
  27. DiAngelis AJ, Andreasen JO, Ebeleseder KA, et al. Guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Pediatr Dent. 2016;38(6):358-368. (Guideline)
  28. MacLeod SP, Rudd TC. Update on the management of dentoalveolar trauma. Curr Opin Otolaryngol Head Neck Surg. 2012;20(4):318-324. (Review)
  29. American Academy on Pediatric Dentistry Council on Clinical Affairs. Guideline on management of acute dental trauma. Pediatr Dent. 2008;30(7 Suppl):175-183. (Guideline)
  30. Antunes AA, Santos TS, Carvalho de Melo AU, et al. Tooth embedded in lower lip following dentoalveolar trauma: case report and literature review. Gen Dent. 2012;60(6):544-547. (Case report)
  31. Radhakrishnan S, Chopra A, Waraich G, et al. Embedded tooth fragment masquerading as keloid for 11 months. Dermatol Online J. 2015;21(6). (Case report)
  32. Leith R, Fleming P, Redahan S, et al. Aspiration of an avulsed primary incisor: a case report. Dent Traumatol. 2008;24(5):e24-e26. (Case report)
  33. Andersson L, Andreasen JO, Day P, et al. Guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Pediatr Dent. 2016;38(6):369-376. (Guideline)
  34. Andreasen JO, Kristerson L. The effect of limited drying or removal of the periodontal ligament. Periodontal healing after replantation of mature permanent incisors in monkeys. Acta Odontol Scand. 1981;39(1):1-13. (Methods comparison; 66 teeth)
  35. Dewhurst SN, Mason C, Roberts GJ. Emergency treatment of orodental injuries: a review. Br J Oral Maxillofac Surg. 1998;36(3):165-175. (Review)
  36. Andreasen JO, Borum MK, Jacobsen HL, et al. Replantation of 400 avulsed permanent incisors. 1. Diagnosis of healing complications. Endod Dent Traumatol. 1995;11(2):51-58. (Cohort study; 400 teeth)
  37. Andreasen JO, Borum MK, Jacobsen HL, et al. Replantation of 400 avulsed permanent incisors. 2. Factors related to pulpal healing. Endod Dent Traumatol. 1995;11(2):59-68. (Cohort study; 400 teeth)
  38. Andreasen JO, Borum MK, Jacobsen HL, et al. Replantation of 400 avulsed permanent incisors. 4. Factors related to periodontal ligament healing. Endod Dent Traumatol. 1995;11(2):76-89. (Cohort study; 400 teeth)
  39. Andreasen JO, Borum MK, Andreasen FM. Replantation of 400 avulsed permanent incisors. 3. Factors related to root growth. Endod Dent Traumatol. 1995;11(2):69-75. (Cohort study; 400 teeth)
  40. Andersson L, Bodin I. Avulsed human teeth replanted within 15 minutes--a long-term clinical follow-up study. Endod Dent Traumatol. 1990;6(1):37-42. (Prospective cohort; 21 teeth)
  41. de Souza BD, Bortoluzzi EA, da Silveira Teixeira C, et al. Effect of HBSS storage time on human periodontal ligament fibroblast viability. Dent Traumatol. 2010;26(6):481-483. (Methods comparison study)
  42. Hiltz J, Trope M. Vitality of human lip fibroblasts in milk, Hanks balanced salt solution and Viaspan storage media. Endod Dent Traumatol. 1991;7(2):69-72. (Laboratory comparison)
  43. Trope M, Friedman S. Periodontal healing of replanted dog teeth stored in Viaspan, milk and Hank’s balanced salt solution. Endod Dent Traumatol. 1992;8(5):183-188. (Methods comparison; 72 teeth)
  44. Blomlof L, Lindskog S, Andersson L, et al. Storage of experimentally avulsed teeth in milk prior to replantation. J Dent Res. 1983;62(8):912-916. (Methods comparison; 10 monkeys)
  45. Nelson LP. Pediatric emergencies in the office setting: oral trauma. Pediatr Emerg Care. 1990;6(1):62-64. (Review)
  46. Goswami M, Chaitra T, Chaudhary S, et al. Strategies for periodontal ligament cell viability: an overview. J Conserv Dent. 2011;14(3):215-220. (Review)
  47. Schwartz O, Andreasen FM, Andreasen JO. Effects of temperature, storage time and media on periodontal and pulpal healing after replantation of incisors in monkeys. Dent Traumatol. 2002;18(4):190-195. (Methods comparison; 16 teeth)
  48. Blomlof L, Lindskog S, Hammarstrom L. Periodontal healing of exarticulated monkey teeth stored in milk or saliva. Scand J Dent Res. 1981;89(3):251-259. (Methods comparison; 9 monkeys, 18 teeth)
  49. Sigalas E, Regan JD, Kramer PR, et al. Survival of human periodontal ligament cells in media proposed for transport of avulsed teeth. Dent Traumatol. 2004;20(1):21-28. (Laboratory comparison)
  50. Souza BD, Luckemeyer DD, Felippe WT, et al. Effect of temperature and storage media on human periodontal ligament fibroblast viability. Dent Traumatol. 2010;26(3):271-275. (Laboratory comparison)
  51. Poi WR, Sonoda CK, Martins CM, et al. Storage media for avulsed teeth: a literature review. Braz Dent J. 2013;24(5):437-445. (Systematic review; 39 articles)
  52. No authors listed. Guideline on behavior guidance for the pediatric dental patient. Pediatr Dent. 2016;38(6):185-198. (Guideline)
  53. Caputo ND, Raja A, Shields C, et al. Re-evaluating the diagnostic accuracy of the tongue blade test: still useful as a screening tool for mandibular fractures? J Emerg Med. 2013;45(1):8-12. (Prospective controlled clinical trial)
  54. Malhotra R, Dunning J. The utility of the tongue blade test for the diagnosis of mandibular fracture. Emerg Med J. 2003;20(6):552-553. (Systematic review)
  55. Jessee SA. Orofacial manifestations of child abuse and neglect. Am Fam Physician. 1995;52(6):1829-1834. (Review)
  56. Naidoo S. A profile of the oro-facial injuries in child physical abuse at a children’s hospital. Child Abuse Negl. 2000;24(4):521-534. (Retrospective chart review; 300 patients)
  57. Fisher-Owens SA, Lukefahr JL, Tate AR, et al. Oral and dental aspects of child abuse and neglect. Pediatrics. 2017;140(2). (Clinical guideline)
  58. da Fonseca MA, Feigal RJ, ten Bensel RW. Dental aspects of 1248 cases of child maltreatment on file at a major county hospital. Pediatr Dent. 1992;14(3):152-157. (Retrospective chart review; 1248 patients)
  59. Ellis RG, Davey KW. The Classification and Treatment of Injuries to the Teeth of Children; a Reference Manual for the Dental Student and the General Practitioner. 5th ed. Chicago: Year Book Medical Publishers; 1970. (Reference manual)
  60. Luna AH, Moreira RW, de Moraes M. Traumatic intrusion of maxillary permanent incisors into the nasal cavity: report of a case. Dent Traumatol. 2008;24(2):244-247. (Case report)
  61. Bertolami CN, Kaban LB. Chin trauma: a clue to associated mandibular and cervical spine injury. Oral Surg Oral Med Oral Pathol. 1982;53(2):122-126. (Case report)
  62. Hurt TL, Fisher B, Peterson BM, et al. Mandibular fractures in association with chin trauma in pediatric patients. Pediatr Emerg Care. 1988;4(2):121-123. (Case report)
  63. Lee CY, McCullom C 3rd, Blaustein DI. Pediatric chin injury: occult condylar fractures of the mandible. Pediatr Emerg Care. 1991;7(3):160-162. (Case report)
  64. Van Dyke T, Litkowski LJ, Kiersch TA, et al. Combination oxycodone 5 mg/ibuprofen 400 mg for the treatment of postoperative pain: a double-blind, placebo- and active-controlled parallel-group study. Clin Ther. 2004;26(12):2003-2014. (Double-blind randomized controlled trial; 498 subjects)
  65. Forbes JA, Kehm CJ, Grodin CD, et al. Evaluation of ketorolac, ibuprofen, acetaminophen, and an acetaminophen-codeine combination in postoperative oral surgery pain. Pharmacotherapy. 1990;10(6 ( Pt 2)):94S-105S. (Double-blind randomized controlled trial; 206 subjects)
  66. Forbes JA, Butterworth GA, Burchfield WH, et al. Evaluation of ketorolac, aspirin, and an acetaminophen-codeine combination in postoperative oral surgery pain. Pharmacotherapy. 1990;10(6 ( Pt 2)):77S-93S. (Double-blind randomized controlled trial; 128 subjects)
  67. Barden J, Edwards JE, McQuay HJ, et al. Relative efficacy of oral analgesics after third molar extraction. Br Dent J. 2004;197(7):407-411. (Systematic review; 73 studies)
  68. Guideline on use of local anesthesia for pediatric dental patients. Pediatr Dent. 2016;38(6):204-210. (Guideline)
  69. Becker DE, Reed KL. Essentials of local anesthetic pharmacology. Anesth Prog. 2006;53(3):98-108. (Review)
  70. Evers H, Haegerstam, G. Introduction to Dental Local Anaesthesia. Fribourg, Switzerland: Mediglobe; 1990. (Textbook)
  71. Hollander J, Weinberger Conlon LN. Assessment and management of intra-oral lacerations. UpToDate. Accessed July 15, 2018. (Review)
  72. Harper M. Clinical manifestations and initial management of animal and human bites. UpToDate, Accessed July 15, 2018. (Review)
  73. Borum MK, Andreasen JO. Sequelae of trauma to primary maxillary incisors. I. Complications in the primary dentition. Endod Dent Traumatol. 1998;14(1):31-44. (Prospective cohort; 278 children, 545 teeth)
  74. Holan G, Ram D. Sequelae and prognosis of intruded primary incisors: a retrospective study. Pediatr Dent. 1999;21(4):242-247. (Prospective cohort; 110 children, 172 teeth)
  75. Lauridsen E, Blanche P, Yousaf N, et al. The risk of healing complications in primary teeth with intrusive luxation: a retrospective cohort study. Dent Traumatol. 2017;33(5):329-336. (Retrospective cohort; 149 patients, 194 teeth)
  76. Lauridsen E, Blanche P, Yousaf N, et al. The risk of healing complications in primary teeth with extrusive or lateral luxation-a retrospective cohort study. Dent Traumatol. 2017;33(4):307-316. (Retrospective cohort; 266 patients, 357 teeth)
  77. Hermann NV, Lauridsen E, Ahrensburg SS, et al. Periodontal healing complications following extrusive and lateral luxation in the permanent dentition: a longitudinal cohort study. Dent Traumatol. 2012;28(5):394-402. (Longitudinal cohort; 82 teeth)
  78. Hermann NV, Lauridsen E, Ahrensburg SS, et al. Periodontal healing complications following concussion and subluxation injuries in the permanent dentition: a longitudinal cohort study. Dent Traumatol. 2012;28(5):386-393. (Longitudinal cohort; 469 teeth)
  79. Andreasen JO, Bakland LK, Andreasen FM. Traumatic intrusion of permanent teeth. Part 3. A clinical study of the effect of treatment variables such as treatment delay, method of repositioning, type of splint, length of splinting and antibiotics on 140 teeth. Dent Traumatol. 2006;22(2):99-111. (Prospective study; 140 teeth)
  80. Andreasen JO, StorgÅRd Jensen S, Sae-Lim V. The role of antibiotics in preventing healing complications after traumatic dental injuries: a literature review. Endodontic Topics. 2006;14(1):80-92. (Review)
  81. Srivastava A, Gupta N, Marleau A, et al. How do I manage a patient with intrusion of a permanent incisor? J Can Dent Assoc. 2014;80:e50. (Review)
  82. McIntosh MS, Konzelmann J, Smith J, et al. Stabilization and treatment of dental avulsions and fractures by emergency physicians using just-in-time training. Ann Emerg Med. 2009;54(4):585-592. (Randomized controlled trial; 25 physicians)
  83. Hile LM, Linklater DR. Use of 2-octyl cyanoacrylate for the repair of a fractured molar tooth. Ann Emerg Med. 2006;47(5):424-426. (Case report)
  84. McCabe MJ. Use of histoacryl tissue adhesive to manage an avulsed tooth. BMJ. 1990;301(6742):20-21. (Case report)
  85. Rosenberg H, Rosenberg H, Hickey M. Emergency management of a traumatic tooth avulsion. Ann Emerg Med. 2011;57(4):375-377. (Case report)
  86. No authors listed. Guideline on use of nitrous oxide for pediatric dental patients. Pediatr Dent. 2016;38(6):211-215. (Guideline)
  87. No authors listed. Guideline for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures: update 2016. Pediatr Dent. 2016;38(6):216-245. (Guideline)
  88. Nelson T, Nelson G. The role of sedation in contemporary pediatric dentistry. Dent Clin North Am. 2013;57(1):145-161. (Guideline)
  89. Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007;116(15):1736-1754. (Guideline)
  90. Guideline on antibiotic prophylaxis for dental patients at risk for infection. Pediatr Dent. 2016;38(6):328-333. (Guideline)
  91. Baltimore RS, Gewitz M, Baddour LM, et al. Infective endocarditis in childhood: 2015 update: a scientific statement from the American Heart Association. Circulation. 2015;132(15):1487-1515. (Guideline)
  92. Committee on Infectious Diseases; American Academy of Pediatrics; Kimberlin DW, et al. Red Book Online. 2018. Available at: Accessed July 15, 2018. (Textbook)
  93. Guideline on oral and dental aspects of child abuse and neglect. Pediatr Dent. 2016;38(6):177-180. (Guideline)
  94. Zachrison KS, Hayden EM, Schwamm LH, et al. Characterizing New England emergency departments by telemedicine use. West J Emerg Med. 2017;18(6):1055-1060. (Retrospective survey; 169 ED directors)
  95. Marcin JP. Telemedicine in the pediatric intensive care unit. Pediatr Clin North Am. 2013;60(3):581-592. (Review)
  96. du Toit M, Malau-Aduli B, Vangaveti V, et al. Use of telehealth in the management of non-critical emergencies in rural or remote emergency departments: a systematic review. J Telemed Telecare. 2017:1357633X17734239. (Systematic review; 15 studies)
  97. Heath B, Salerno R, Hopkins A, et al. Pediatric critical care telemedicine in rural underserved emergency departments. Pediatr Crit Care Med. 2009;10(5):588-591. (Prospective study; 63 telemedicine consultations, 10 rural EDs)
  98. Ward MM, Jaana M, Natafgi N. Systematic review of telemedicine applications in emergency rooms. Int J Med Inform. 2015;84(9):601-616. (Systematic review; 38 studies)
  99. Fugok K, Slamon NB. The effect of telemedicine on resource utilization and hospital disposition in critically ill pediatric transport patients. Telemed J E Health. 2017. (Cohort study; 212 telemedicine patients)
  100. Kofos D, Pitetti R, Orr R, et al. Telemedicine in pediatric transport: a feasibility study. Pediatrics. 1998;102(5):E58. (Prospective study; 15 patients)
  101. Yoo BK, Kim M, Sasaki T, et al. Economic evaluation of telemedicine for patients in ICUs. Crit Care Med. 2016;44(2):265-274. (Cost analysis)
  102. Boye U, Pretty IA, Tickle M, et al. Comparison of caries detection methods using varying numbers of intra-oral digital photographs with visual examination for epidemiology in children. BMC Oral Health. 2013;13:6. (Methods comparison; 490 patients)
  103. Boye U, Walsh T, Pretty IA, et al. Comparison of photographic and visual assessment of occlusal caries with histology as the reference standard. BMC Oral Health. 2012;12:10. (Methods comparison; 50 teeth)
  104. Wong HM, McGrath C, Lo EC, et al. Photographs as a means of assessing developmental defects of enamel. Community Dent Oral Epidemiol. 2005;33(6):438-446. (Methods comparison; 257 patients)
  105. Golkari A, Sabokseir A, Pakshir HR, et al. A comparison of photographic, replication and direct clinical examination methods for detecting developmental defects of enamel. BMC Oral Health. 2011;11:16. (Methods comparison; 110 patients)
  106. Cochran JA, Ketley CE, Sanches L, et al. A standardized photographic method for evaluating enamel opacities including fluorosis. Community Dent Oral Epidemiol. 2004;32 Suppl 1:19-27. (Methods comparison; 2063 patients)
  107. Gustafson D, McTigue D, Thikkurissy S, et al. Continued care of children seen in an emergency department for dental trauma. Pediatr Dent. 2011;33(5):426-430. (Retrospective study; 856 patients)
  108. Pinto Gdos S, Goettems ML, Brancher LC, et al. Validation of the digital photographic assessment to diagnose traumatic dental injuries. Dent Traumatol. 2016;32(1):37-42. (Methods comparison; 412 patients, 3296 teeth)
  109. Dental Trauma Guide - evidence-based treatment guide. Available at: Accessed July 15, 2018. (Website)


  CME Information

Accreditation: EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the ACCME.

Credit Designation: EB Medicine designates this enduring material for a maximum of 4 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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

Faculty Disclosures: It is the policy of EB Medicine to ensure objectivity, balance, independence, transparency, and scientific rigor in all CME-sponsored educational activities. All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. Presenters must also make a meaningful disclosure to the audience of their discussions of unlabeled or unapproved drugs or devices. In compliance with all ACCME Essentials, Standards, and Guidelines, all faculty for this CME activity were asked to complete a full disclosure statement. The information received is as follows: Dr. Li, Dr. Tehrani, Dr. Claudius, Dr. Horeczko, Dr. Mishler, and their related parties report no significant financial interest or other relationship with the manufacturer(s) of any commercial product(s) discussed in this educational presentation. Dr. Gorn made the following disclosure: co-founder, majority holder, and CMO of EM Device Lab (www. Dr. Jagoda made the following disclosures: Consultant, Daiichi Sankyo Inc; Consultant, Pfizer Inc; Consultant, Banyan Biomarkers Inc; Consulting fees, EB Medicine.

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