Pediatric emergency medicine trisk 3243 3243
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FIGURE 105.3 The anatomy of a tooth should be considered during a traumatic injury: enamel
and dentin fractures are considered uncomplicated, and require dental care within 48 hours.
Fractures into the pulp require emergency treatment as soon as possible.
Displaced Teeth
Teeth are attached to their socket by elastic collagen fibers collectively known as
the periodontal ligament (PDL). These fibers are easily injured or severed with
trauma. Clinically, the emergency physician may note an increase in mobility
depending on the extent of the cortical plate fracture and/or displacement of the
affected teeth. TDIs that involve the PDL are classified as (i) concussion, (ii)
subluxation, (iii) intrusion, (iv) extrusion/lateral luxation, or (v) avulsion ( Fig.
105.4 ).
When a traumatic blow to a tooth results in only minor damage and edema to
the PDL and the tooth is sensitive to percussion, but not mobile, a concussion is
diagnosed. No emergency treatment is needed although a baseline radiograph
should be obtained since pulpal necrosis is possible.
Subluxation is defined as mobility of a tooth without displacement and is a
result of increasing edema within the PDL. The tooth is clinically sensitive to
