Injury | Dental referral | Dental management* |
Avulsion | Routine¶ |
|
Extrusion | Urgent◊ |
|
Intrusion | Urgent |
|
Lateral luxation (malocclusion) | Urgent |
|
Lateral luxation (normal bite) | Routine |
|
Subluxation/concussion | Routine |
|
Uncomplicated crown fracture (pulp not exposed) | Routine |
|
Complicated crown fracture (pulp exposed) | Urgent |
|
Root fracture (rare) | Urgent (emergency if poses aspiration risk) |
|
* Tetanus prophylaxis, as needed, is necessary for patients with tooth avulsion, contaminated wounds, or deep intraoral lacerations. Provide antibiotic prophylaxis for bacterial endocarditis in susceptible patients for dental injuries that induce bacteremia (eg, intrusions, extrusions, lateral luxations, and avulsions). Refer to UpToDate content on tetanus and bacterial endocarditis prophylaxis.
¶ If the tooth is not found, then a foreign body plain radiograph (AP view, mouth to anus) may be necessary to locate the tooth. Urgent referral for dental films to evaluate for deep intrusion may also be needed.
Δ All teeth are primary for most children ≤5 years old. Permanent incisors usually erupt around the age of 6 to 7 years. If uncertain, whether the tooth is primary or permanent, gently replant it and obtain emergency dental evaluation.
◊ If the tooth is dangling and poses a risk of aspiration, grasp it with dry gauze and remove it. If the tooth is intact, then routine referral to the dentist as for avulsion of a primary tooth is sufficient.