MANAGEMENT OF DENTAL TRAUMAEvery week I am asked about how to handle dental trauma in children. Below are some highlights of the latest thought on how to handle these situations. At the bottom of the post is a link to a Trauma Flow chart provided by the AAE. If you have any questions please contact my office at 810-235-0100 or email me at
dkinra@gmail.comInjuries to children’s teeth can be very distressing for children as well as their parents. Dental trauma may occur as a result of a sports mishap, an altercation, a fall inside of the home, or other causes. Prompt treatment is essential for the long-term health of an injured tooth. Obtaining dental care within 30 minutes can make the difference between saving or loosing a tooth.
Approximately 30% of children have experienced dental injuries. Injuries to the mouth include teeth that are: knocked out, fractured, forced out of position, pushed up, or loosened. Root fracture and dental bone fractures can also occur. The peak period for trauma to the primary teeth is 18 to 40 months of age, because this is a time of increased mobility for the relatively uncoordinated toddler. Injuries to primary teeth usually result from falls and collisions as the child learns to walk and run.With the permanent teeth: school-aged boys suffer trauma almost twice as frequently as girls. Sports accidents and fights are the most common cause of dental trauma in teenagers. The upper (maxillary) central incisors are the most commonly injured teeth. Maxillary teeth protruding more than 4 mm are two to three times as likely to suffer dental trauma than normally aligned teeth.
Types of dental traumaDentoalveolar trauma may be classified into categories based on treatment protocols. These categories include: dental avulsion, dental luxation and extrusion, enamel and crown fracture, dental intrusion, dental concussion and subluxation, root fracture, and alveolar bone fracture.
Medical historyTake a complete medical history. Assess the need for SBE prophylaxis. Determine if the child has a bleeding disorder, or is immunocompromised. Record any current medications. Question the parent about allergies to medications. Obtain a history of any prior surgeries. Determine if the child’s tetanus immunization is up-to-date. Determine if the child lost consciousness due to the injury.
Dental historyThe clinician should determine how, when, and where the injury occurred. “How” is important because it provides information on the severity of the injury. “When” is important, because the prognosis for the injured tooth worsens with every minute of delay in treatment. “Where” is important, because it may determine whether or not tetanus prophylaxis is warranted.
Physical examinationA thorough examination is necessary to assess the full extent of all injuries. Important information to be gathered for each patient includes: vital signs, review of all systems, head and neck exam, and accident information. It is important to rule out head injury, ocular damage, and cervical spine injury. An evaluation of pupil size and reaction to light may establish the presence of head injury.
Extraoral examinationThe location and size of all extraoral and intraoral injuries must be recorded. Palpate the mandible, zygoma, TMJ, and mastoid region. Ensure that no mandibular or maxillary fractures are present. Find any mandibular fractures by palpating the lower border of the mandible for a “step-down” fracture. Record any extraoral lacerations, bruises, or swelling. If a laceration is present in the upper or lower lip, the area must be inspected for foreign bodies such as gravel or tooth fragments. Any foreign bodies must be debrided from the soft tissue.The mandibular condyles and maxilla should be carefully palpated. Check jaw movements for normal range of movements. Chin lacerations require careful evaluation of the cervical spine and mandibular condyles. Indications of condylar fractures include: an anterior open bite, a malocclusion, or limited mandibular opening. Confirmation of condylar fractures requires a panoramic radiograph with closed – and open – mouth views.
Intraoral examinationAll extraoral and intraoral clots and debris must be removed prior to examining the oral soft and hard tissue. Palpate the alveolus to detect any fractures. Have the patient clench the teeth so that the dental occlusion can be evaluated. Each tooth should be examined for damage or mobility.The labial mucosa, maxillary frenum, gingival tissues, and tongue should be examined for bruising or lacerations. All intraoral lacerations must be cleaned and explored, looking for any foreign bodies. The oral frenum, when torn, will heal without long-term consequences. A tongue laceration should be sutured if the tissue edges are not self-approximating. Most intraoral impalement injuries will heal on their own – except for soft tissue avulsion injuries.
Radiographic examinationFor evaluating injuries to the maxillary or mandibular teeth, an occlusal radiograph is the film of choice. If a root fracture is suspected, radiographs at two different angles are required for a definite diagnosis. For intruded teeth, a lateral anterior radiograph provides additional useful information. A panoramic radiograph helps to evaluate suspected mandibular or condylar fractures.
Trauma Flow ChartThanks,
Diwakar Kinra, DDS MS
On the 29th of September, the Genesee District Dental Society Committee on the New Dentist had its first Study Club. We had a great turnout of 22 dentist! The first lecture was given by me on the topic of Clean/Shape/Pack using the ProTaper Technique. The lecture and hands-on course was free and provided 3 CEs. This is a great adjunct to the traditional local society meetings and allows some of the newer dentist to socialize and create a community, in which they will be practicing for years to come. Our goal is to provide these types of events at least 3 times a year. This course was sponsored by Tulsa Dental Specialities, which made this event very cost effective. In the future we are planning courses involving all aspects of dentistry and practice management. If you have any ideas or suggestions please feel free to call me at 810-235-0100.
My office is very interested in keeping education a part of our focus for referring dentist. If you are interested in a very unique opportunity please join me at 4 PM on October 20th for a Webinar. This webinar will provide 2 Free CE via a web cast by Cliff Ruddle. This is a once in a lifetime opportunity and I am glad to offer it to you at no cost.
As promised, I have posted the link below to my presentation. Thank you so much for all the hospitality I received in Seattle. I had a great time at the social and educational events. I hope to be invited back again to the next APICES!! Any feedback would be appreciated very much. If you have any question please free feel to email me at 
