Pediatric emergency medicine trisk 3241 3241
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within this chapter reflect current standards of care regarding management of
dental injuries.
Goals of Treatment
Advocating for mouthguards, protective gear, and safe practices can help reduce
the incidence of TDI. The emergency physician needs to know which injuries can
be managed without dental consultation, which need follow-up care with a
dentist, and which need immediate attention.
Clinical Considerations
Teeth are labeled according to their position in the mouth. For older children with
permanent dentition, the examiner begins on the upper right with the third molar
as no. 1, proceeding across the upper arch to no. 16, and then continues on the
lower left with the third molar from no. 17 across the right to no. 32. Primary
dentition are labeled using letters rather than numbers, starting with letter A in the
upper right proceeding across the upper arch to J then continuing on the lower left
from K across to T ( Fig. 105.2A,B ).
Injuries to Hard Dental Tissues and Pulp
With any injury resulting in fragmentation of teeth, the emergency physician
should attempt to account for all the fragments. The fragments may be embedded
in a soft tissue laceration of the lip or tongue which may become infected if not
debrided (see section on Soft Tissue Injury). Next, accessing the depth of the
fracture is important. Fractures of the enamel or dentin are considered
uncomplicated, while those extended into the pulp are complicated ( Fig. 105.3 ).
Uncomplicated tooth fractures are confined to the enamel and the underlying
dentin without pulp exposure ( e-Fig. 105.3 ). The child may complain of
sensitivity, especially to cold air and fluids. Emergency treatment is aimed at
decreasing sensitivity of the involved tooth and protecting the pulp even if no
frank pulp exposure is noted. The child should be seen within 48 hours by a
dentist to place an insulating dressing over the exposed dentin which decreases
sensitivity and minimizes the chance of pulpal necrosis. The prognosis for
uncomplicated tooth fracture is good.
