Save a Tooth Today: Dental Trauma Management

by
|
Reading Time: 3 minutes
Picture of Amar Jain DS3
Amar Jain DS3

Columbia University College of Dental Medicine

The Pre-brief

A 19 year old male comes in the ED after being assaulted,  he was punched in the face a few times. While his jaw is intact, you notice a few broken teeth and a few loose ones, one even seems like it is on the brink of falling out. Which of these injuries warrant emergent dental trauma vs which can wait?

Emergency vs Non-emergency dental trauma

Dental trauma is not uncommon. Although the oral cavity only comprises a small area of total body area, 5% of all bodily injuries occur in the mouth and up almost 20% of all bodily injuries in children ages1.

Most dental traumas occur from falls, sports injuries (specifically contact sports), and most notably, siblings. Trauma can vary from simple tongue lacerations to tooth displacement and even avulsion.

Emergency UrgencyWhat to do in the meantime
Tooth avulsionHIGH

Replace ASAP (if possible)

The faster the tooth is re-implanted, the better the prognosis for the tooth’s reintegration. 

Gently rinse the tooth and socket with saline solution and proceed to place the tooth back in. Try to handle the tooth by the crown only. Local anesthesia can be administered to numb the patient in the affected area. (Lidocaine 2% with 1:100,100 epinephrine via local infiltration injection is preferred, unless the patient has underlying comorbidities contraindicating the use of this local anesthesia.). Once set, splint with composite (dental filling) if possible. 

Advise the patient to avoid any occlusive forces on this tooth (like eating, chewing, biting, etc.) and proceed to see their dental professional as soon as possible. 

If the tooth is replaced:

  • In less than five minutes of being avulsed, it is likely the tooth can survive. 
  • Between 5 and 60 minutes, the tooth still has a good chance of survival, IF it is stored correctly. (See storage options below).
  • Beyond 1 hour, the tooth’s prognosis is less favorable2.

If the patient cannot put the tooth back in, advise the patient to store the tooth in:

  • Hank’s solution
  • Milk
  • Saline solution
  • If you do not have access to any of that, use the patient’s saliva3.

Patient should visit ER and/or dental provider ASAP.

Tooth intrusion/extrusionHIGH 

Reposition the tooth and stabilize with a composite splint if available. 

Refer to dental provider within the next 24 hours

If >3mm of intrusion and/or underlying alveolar bone fracture, needs emergency dental repositioning and stabilization

Patient should visit ER and/or dental provider ASAP.

Severe dental pain after physical trauma to mouthHIGH

Dental pain that presents after physical trauma but shows no signs of visual damage could be due to root fracture. However, further diagnostic tools are needed to adequately assess the etiology of the pain (radiographs, oral evaluation, etc); therefore, refer the patient to their dental provider. 

The patient should see the dentist as soon as possible. 

Tooth fracture MEDIUM

Tooth fractures can occur at different levels in the tooth: in the outer enamel layer, in the inner dentin layer, or even deep in the root, which can  affect the pulp chamber and nerve. Advise patient to avoid occlusal forces on that tooth. 

Refer to the dentist as soon as possible, especially if the fracture is large and there is heme exuding from the tooth. 

Loose tooth LOW

Advise the patient to avoid occlusal forces on this tooth. Further diagnostic tools are needed to adequately assess the etiology of the pain (radiographs, oral evaluation, etc); therefore, refer the patient to their dental provider. 

The patient should see the dentist as soon as possible, especially if the tooth is symptomatic. 

The Debrief

  • Emergency management including dental consults should occur if a tooth has completely avulsed, severely pushed in or there is a fracture with visible blood/root
  • Just about everything else can wait until the morning.

References

  1. Anderson L. Epidemiology of Traumatic Dental Injuries. Journal of Endodontics. 2013;39(3). doi: https://doi.org/10.1016/j.joen.2012.11.021 
  2. Flores, M.T., Andersson, L., Andreasen, J.O., Bakland, .L.K., Malmgren, B., Barnett, F., Bourguignon, C., DiAngelis, A., Hicks, L., Sigurdsson, A., Trope, M., Tsukiboshi, M. and Von Arx, T. (2007), Guidelines for the management of traumatic dental injuries. II. Avulsion of permanent teeth. Dental Traumatology, 23: 130-136. doi:10.1111/j.1600-9657.2007.00605.x
  3. Adnan, SLone, MMKhan, FRHussain, SMNagi, SE. Which is the most recommended medium for the storage and transport of avulsed teeth? A systematic review. Dent Traumatol. 2018; 34: 59– 70. https://doi.org/10.1111/edt.12382

Share:

More Posts

Related Posts

0
Would love your thoughts, please comment.x
()
x