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

Points and Pearls Excerpt

• The first step in assessing dentition is to determine whether the patient has primary or permanent dentition, or both. Primary teeth are more milky-white in color with a smooth incisor edge. It is very uncommon for children aged < 5 years to have permanent teeth.
• Assess each tooth for: (1) fracture, (2) pulp exposure, (3) an empty socket, (4) displacement, (5) mobility, and (6) percussion tenderness.
• If there are missing teeth or tooth fragments, consider ordering radiographs to rule out aspiration or foreign body displacement. 
• If there is clinical concern for an alveolar bone fracture (mobility and dislocation of multiple continuous teeth), order dental radiographs. If panoramic x-ray is unavailable, consider a maxillofacial CT scan.

• King C, Henretig FM, King BR, et al. Textbook of Pediatric Emergency Procedures. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2008. (Textbook) https:// shop.lww.com/Textbook-of-Pediatric-Emergency- Procedures/p/9780781753869
• 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) http://www.ingentaconnect.com/contentone/ aapd/pd/2016/00000038/00000006/art00084
• 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) http://www.ingentaconnect. com/content/aapd/pd/2016/00000038/00000006/art00082
• 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) https://www.ncbi.nlm.nih.gov/pubmed/19216418
• 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) http://www.ingentaconnect.com/contentone/aapd/ pd/2016/00000038/00000006/art00083