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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -22 مورد

Management of primary tooth injuries in children

Management of primary tooth injuries in children
Injury Dental referral Dental management*
Avulsion Routine
  • No replantationΔ
Extrusion Urgent◊
  • Dental radiographs to exclude root fracture:
    • >3 mm extrusion – Extract
    • ≤3 mm extrusion – Gently reposition but do not splint
Intrusion Urgent
  • Dental radiographs to determine if permanent tooth bud affected:
    • Permanent bud involved – Extract
    • Permanent bud not involved – Leave in place with dental follow-up to ensure spontaneous re-eruption and shedding
Lateral luxation (malocclusion) Urgent
  • Not shedding tooth soon – Reposition, but do not splint
  • Shedding tooth soon – Extract
Lateral luxation (normal bite) Routine
  • Reassurance: The tooth will usually undergo spontaneous repositioning
Subluxation/concussion Routine
  • Soft diet until the child can chew without pain (typically 1 week).
  • Dental radiograph to assess for root fracture (see below). If normal, follow-up to watch for signs of pulpal necrosis (tooth discoloration or localized gum abscess).
Uncomplicated crown fracture (pulp not exposed) Routine
  • Dental radiograph to exclude root fracture
  • Tooth restoration and smoothing of rough edges
Complicated crown fracture (pulp exposed) Urgent
  • Dental radiograph to exclude root fracture
  • Pulpotomy or pulpectomy with tooth restoration
  • or
  • Extraction
Root fracture (rare) Urgent (emergency if poses aspiration risk)
  • Dental radiograph
  • Extract if roots fractured in middle or coronal 1/3rd (towards the crown)
  • Leave to resorb if fracture is at apical 1/3rd (near the dental root)
This table provides suggested timing and definitive dental management of specific dental injuries to primary teeth in children. It is intended to be used with other UpToDate content. Refer to UpToDate content on evaluation and management of dental injuries in children.

* 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.
Adapted from: Keels MA, Section on Oral Health, American Academy of Pediatrics. Management of dental trauma in a primary care setting. Pediatrics 2014; 133:e466.
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