From the Guidelines
Management of a 9-year-old male with a tooth laceration through the lip requires prompt medical attention, with the initial approach including gentle cleaning of the wound and dental consultation to evaluate tooth damage and determine the need for extraction or repair. The laceration typically requires suturing with absorbable material like 5-0 or 6-0 Vicryl, particularly if it crosses the vermilion border, to ensure proper cosmetic alignment 1. Antibiotic prophylaxis with amoxicillin-clavulanate (45 mg/kg/day divided twice daily for 5-7 days) is recommended due to the high risk of infection from oral flora contamination. Pain management should include acetaminophen (15 mg/kg every 4-6 hours as needed) or ibuprofen (10 mg/kg every 6-8 hours as needed) 1. The child should maintain good oral hygiene with gentle brushing and antiseptic mouthwash like chlorhexidine 0.12% twice daily. A soft diet is advised for several days to minimize trauma during healing. Parents should monitor for signs of infection such as increasing pain, swelling, or purulent discharge.
Key considerations in the management of dental trauma include:
- Gentle repositioning of the tooth if displacement is minor, or acceptance of the position as spontaneous repositioning will take place 1
- Ensuring the tooth position does not interfere with the occlusion (bite) 1
- Immediate referral to a dentist for evaluation and treatment 1
- Advocating for dental injury–preventive measures, such as proper mouthguards during sports activities 1
It is essential to prioritize the child's comfort and prevent complications, while also supporting proper healing of both dental and soft tissue injuries. The American Academy of Pediatrics provides guidance on the management of dental trauma in children, emphasizing the importance of prompt and proper care to ensure the best possible outcome 1.
From the Research
Management of Dental Trauma with Laceration
- The primary goal is to achieve hemostasis and optimal cosmetic results without increasing the risk of infection 2.
- Gentle irrigation of the wound helps to remove microscopic infectious agents and larger debris 3.
- Consider the mechanism and severity of the injury, as well as the location and type of wound, to guide decisions about technique, anesthetic, suture material, and the interval period before nonabsorbable equipment can be removed 3, 2.
Assessment and Repair
- Clinical assessment of each wound is important to determine the best approach for repair 3.
- The use of nonsterile gloves during laceration repair does not increase the risk of wound infection compared with sterile gloves 2.
- Irrigation with potable tap water rather than sterile saline also does not increase the risk of wound infection 2.
- Tissue adhesives and wound adhesive strips can be used effectively in low-tension skin areas 2.
Prevention of Infection
- Prophylaxis against tetanus, rabies, and/or bacterial infection should be considered 3.
- Tetanus prophylaxis should be provided if indicated 2.
- The presence of a foreign body, laceration width, and patient characteristics such as age and history of diabetes mellitus can increase the likelihood of wound infection 4.
- Laceration location on the head/neck may be associated with a decreased risk of infection 4.
Follow-up Care
- The wound should be examined a couple of days after suture placement for signs of infection 5.
- Timing of suture removal depends on location and is based on expert opinion and experience 2.
- Wounds heal faster in a moist environment, and therefore occlusive and semiocclusive dressings should be considered when available 2.