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Dental Trauma, Emergency Medicine

Brian N. Corwell Reviewed 06/2017
 


Basics

Description

  • Primary teeth:

    • Eruption begins between 6–10 mo of age and concludes by 30 mo

    • Eruption is bilaterally symmetric

    • 20 total teeth

  • Permanent teeth:

    • Begin to erupt at age 6

    • 32 total (4 central a...

Diagnosis

Signs and Symptoms

History

  • Tooth mobility, avulsion or laxity

  • Bite malocclusion or trismus

  • Exacerbating factors (may indicate pulp exposure or PDL damage):

    • Chewing or drinking

    • Extremes of temperat...

Treatment

Pre-Hospital

  • Avulsed teeth:

    • Only replace avulsed secondary teeth

    • Rinse tooth with cold running water

    • Immediate attempt to reimplant permanent tooth into socket by 1st capable person:

      • Time is toot...

Follow-Up

Disposition

Admission Criteria

  • Admission for other associated injuries

  • Suspected child or elder abuse and those with no available safe environment

Discharge Criteria

All hemodynamically stable pa...

Pearls and Pitfalls

  • Avulsed teeth should never be transported in a dry medium or in tap water

  • Occlusion is the best guide to proper tooth position after reimplantation

  • Warn patients with dental trauma o...

Additional Reading

  • Andreasen  JO, Lauridsen  E, Gerds  TA, et al. Dental Trauma Guide: A source of evidence-based treatment guidelines for dental trauma. Dent Traumatol.  2012;28:345–350.

  • Diangeli...

Codes

ICD9

  • 525.8 Other specified disorders of the teeth and supporting structures

  • 525.11 Loss of teeth due to trauma

  • 873.63 Open wound of tooth (broken) (fractured) (due to trauma), without mention of co...

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