From the Guidelines
Immediate care for oral trauma involves controlling bleeding, managing pain, and preventing infection, with the most critical step being to handle a knocked-out tooth by the crown, rinse it gently, and try to reinsert it in its socket or store it in milk or saliva while seeking immediate dental care, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The first step in managing oral trauma is to rinse the mouth gently with warm salt water to clean the area.
- Apply direct pressure with clean gauze or cloth to bleeding areas for 15-20 minutes to control bleeding.
- For pain relief, take over-the-counter medications like acetaminophen (Tylenol) 500-1000mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours as needed, not exceeding maximum daily doses.
- Apply cold compresses to the outside of the face for 20 minutes on, 20 minutes off to reduce swelling. If a tooth is knocked out,
- handle it by the crown (not the root)
- rinse it gently without scrubbing
- try to reinsert it in its socket, or
- store it in milk or saliva while seeking immediate dental care, as supported by the 2010 American Heart Association and American Red Cross guidelines for first aid 1 and the management of dental trauma in a primary care setting 1. For cuts inside the mouth,
- avoid spicy, hot, or hard foods that could irritate the wound. Seek professional dental or medical attention within 24 hours for significant trauma, especially with tooth displacement, severe pain, or facial fractures, as emphasized in the management of dental trauma in a primary care setting 1 and the 2015 American Heart Association and American Red Cross guidelines update for first aid 1. These immediate measures help preserve dental structures and prevent complications while professional care is being arranged, with the importance of proper handling and storage of an avulsed tooth highlighted in the 2024 American Heart Association and American Red Cross guidelines for first aid 1.
From the Research
Immediate Care for Oral Trauma
The immediate care for oral trauma involves several key steps to ensure proper treatment and management of the injury. Some of the key considerations include:
- Recognition and assessment of the injury 2
- Proper treatment and referral to a specialist if necessary 2, 3
- Management of tooth luxations and avulsion, tooth fracture, mandible dislocation, jaw fracture, intraoral bleeding, and dental pain 4
Assessment and Treatment Protocol
A sound understanding of assessment and treatment protocol is important for the immediate care of oral trauma 2. This includes:
- Evaluation of the injury to determine the best course of treatment
- Stabilization of the injury to prevent further damage
- Referral to a specialist if necessary, such as an oral and maxillofacial surgeon 5, 3
Management of Specific Injuries
The management of specific injuries, such as tooth avulsion, tooth fracture, and mandible dislocation, requires specialized knowledge and training 4, 3. Some key considerations include:
- Storage media for avulsed teeth to increase the chances of successful replantation
- Quick referral to a dental surgery for proper treatment and management
- Importance of proper diagnosis and treatment to prevent long-term complications
Pain Management
Pain management is an important aspect of oral trauma care, and may involve the use of analgesic agents such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids 6. However, opioid monotherapy is rarely used in dentistry, and combination therapy or nonopioid analgesic monotherapy is often preferred.