Pediatric emergency medicine trisk 3235 3235

ED Pathway for Dental Trauma or Infection
URL: />Authors: E. Szydlowski, MD; M. Herring, MD; K. Castelo, CRNP; B.
Pagliaro, RN; H. Giannakopoulos, DDS, MD; E. Hajishengallis, DDS,
PhD
Posted: August 2019

ASSESSMENT OF TRAUMATIC DENTAL EMERGENCIES
CLINICAL PEARLS AND PITFALLS
In patients with TDIs, carefully assess for associated injuries to the
CNS, cervical spine, orbits, and jaw.
Airway obstruction in the setting of facial trauma may be the result of an
aspirated tooth or blood in the oral cavity and pharynx.
Mucosal ecchymoses at the floor of the mouth or vestibular area are
highly suggestive of mandibular fractures.
Primary teeth in the process of exfoliation may be confused with TDI.
Be alert to the possibility of nonaccidental trauma (child abuse) if the
history is not consistent with the observed injuries.

Current Evidence
The most emergent concern in a child with dental trauma is to evaluate for
associated facial injuries and airway obstruction. Obstruction can result from
accumulation of blood in the oral cavity and pharynx. Alternatively, the etiology
may be a tooth aspirated by a child, or a fractured mandible causing the tongue to
fall backward against the posterior pharynx.
Beyond airway obstruction and life-threatening injuries, trauma to the jaw,
dentition, or soft tissues requires careful evaluation and treatment. Inadequate
recognition and management of these injuries can lead to suboptimal cosmetic
and functional outcomes.

Goals of Treatment
The care of pediatric patients with maxillofacial and dental trauma should follow

the basic tenets of emergency medicine, starting with evaluation and management