Pediatric dental trauma: Rapid overview*

Evaluation

When did the injury occur?

Any loss of consciousness or altered mental status suggesting significant head trauma?

Does the child have tooth pain or dental pain with touch, eating, or exposure to hot or cold?

Is malocclusion present?

Which teeth are injured? Are they primary or secondary teeth?^¶

Is tooth avulsion present (refer to "Emergency treatment of dental avulsion" below)?

Are there signs of child abuse (eg, torn upper labial frenula or labial sulcus in a nonambulatory child, bruising behind the ear, bruising in the shape of a hand, pinchmarks, bruising in various stages of development)?^Δ

Is there tenderness over the jaw or temporomandibular joint?

Emergency treatment of dental avulsion

Replant any avulsed permanent teeth as soon as possible^¶

Handle the tooth by the crown
Gently rinse the tooth with milk, saline, or the child's saliva. Do not scrub or sterilize the tooth
Insert the tooth into the empty socket
Keep the tooth in place through finger pressure or by having the child bite on a gauze pad or clean towel
Obtain urgent pediatric dental consultation

If unable to replant immediately, store the tooth in cold milk, Hank's balanced salt solution, or a container of the child's saliva (not the child's mouth or in tap water)^¶

Do NOT replant primary (baby) teeth^¶. If uncertain if the tooth is primary or permanent, gently replant.

Other dental injuries

Remove very loose or dangling primary (baby) teeth^¶

Urgently refer the following children to a dentist with pediatric expertise:

Extruded >3 mm or interfering with bite
Laterally luxated (displaced) teeth that interfere with bite
Intruded primary teeth
Fractured teeth when dental pulp is exposed (bleeding from central core of the tooth)
Fractured permanent teeth. If available, tooth fragments may be reattached (store in tap water to prevent discoloration)
Suspected dental root or alveolar fracture
Suspected jaw fracture (jaw tenderness and/or malocclusion) to obtain panorex radiograph

Other considerations

Provide tetanus prophylaxis, as needed, for patients with contaminated wounds, deep intraoral lacerations, or avulsed teeth

Provide antibiotic prophylaxis for bacterial endocarditis in susceptible patients

* Refer to UpToDate topics on pediatric dental injuries.

¶ Permanent teeth do not typically erupt before six years of age.

Δ Refer to UpToDate topics on diagnosis and management of physical abuse in children.

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Pediatric dental trauma: Rapid overview*