Evaluation |
When did the injury occur? |
Any loss of consciousness or altered mental status suggesting significant head trauma? |
Does the child have tooth pain or dental pain with touch, eating, or exposure to hot or cold? |
Is malocclusion present? |
Which teeth are injured? Are they primary or secondary teeth?¶ |
Is tooth avulsion present (refer to "Emergency treatment of dental avulsion" below)? |
Are there signs of child abuse (eg, torn upper labial frenula or labial sulcus in a nonambulatory child, bruising behind the ear, bruising in the shape of a hand, pinchmarks, bruising in various stages of development)?Δ |
Is there tenderness over the jaw or temporomandibular joint? |
Emergency treatment of dental avulsion |
Replant any avulsed permanent teeth as soon as possible¶
|
If unable to replant immediately, store the tooth in cold milk, Hank's balanced salt solution, or a container of the child's saliva (not the child's mouth or in tap water)¶ |
Do NOT replant primary (baby) teeth¶. If uncertain if the tooth is primary or permanent, gently replant. |
Other dental injuries |
Remove very loose or dangling primary (baby) teeth¶ |
Urgently refer the following children to a dentist with pediatric expertise:
|
Other considerations |
Provide tetanus prophylaxis, as needed, for patients with contaminated wounds, deep intraoral lacerations, or avulsed teeth |
Provide antibiotic prophylaxis for bacterial endocarditis in susceptible patients |
* Refer to UpToDate topics on pediatric dental injuries.
¶ Permanent teeth do not typically erupt before six years of age.
Δ Refer to UpToDate topics on diagnosis and management of physical abuse in children.Do you want to add Medilib to your home screen?