Pediatric emergency medicine trisk 3240 3240
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is very painful. A common site for this is the lower lip ( e-Fig. 105.1 ). Rarely
is this type of injury associated with infection. Standard over-the-counter pain
medications and keeping a soft, bland diet are sufficient until the wound heals,
typically in 1 to 2 weeks.
Electrical Burns
Electrical burns occur when children bite on electrical cords. The saliva in the
mouth acts as a conductor to complete the circuit. Although the commissure of
the mouth is most likely affected, the tongue, alveolar ridge, and floor of the
mouth are occasionally involved. Most children with these injuries can be
managed as an outpatient. A bland, soft, cold diet is initially recommended. If a
child refuses oral intake, dehydration may ensue and the administration of
intravenous fluids may be required. Meticulous oral hygiene using a toothbrush
with or without toothpaste should be performed three to four times per day, as
well as hydrogen peroxide and water (1:1) rinses in a cooperative child. With
severe burns of the lips and mouth, labial artery bleeding may occur 5 to 8 days
after the injury. Although admission to the hospital for wound management has
been utilized, the delayed presentation of this late complication makes this
impractical. The clinician should instruct the parent on the method for digitally
compressing the artery if bleeding were to occur. To prevent scarring down of the
commissure, electrical burns of this area require the fabrication of an intra- or
extraoral device to separate the upper and lower segments during healing ( eFig. 105.2A,B ).
TRAUMATIC DENTAL INJURIES
CLINICAL PEARLS AND PITFALLS
Avulsed permanent teeth must be reimplanted immediately while
primary teeth are generally not reimplanted.
Displaced teeth should be repositioned as soon as possible.
Teeth with exposed pulpal tissue require urgent dental treatment.
Fractured posterior teeth may have an associated mandibular fracture.
Current Evidence
The International Association of Dental Traumatology has detailed, evidencebased guidelines for the management of dental trauma which are updated
periodically and can be found online (see References). Focused recommendations
