What is the next step in evaluating a 17-month-old child who has fallen and injured her teeth?

Evaluation of Dental Trauma in a 17-Month-Old Child

Immediate referral to a dentist or oral surgeon is recommended for proper assessment and management of dental trauma in a 17-month-old child who has fallen and injured her teeth. 1

Initial Assessment

When evaluating a 17-month-old with dental trauma, the following should be assessed:

1. Type of dental injury:

   • Visual examination for:
     • Crown fractures (cracks, chips, or complete fractures)
     • Tooth displacement (intrusion, extrusion, or lateral luxation)
     • Complete avulsion (tooth knocked out)
     • Mobility of teeth
     • Bleeding from gingival sulcus

2. Soft tissue assessment:

   • Check for lacerations of lips, gums, tongue, or oral mucosa
   • Assess for swelling or hematoma formation

3. Determine if there's risk of aspiration:

   • If a tooth or tooth fragment is missing and not found
   • If the child shows respiratory symptoms
   • Consider chest radiograph if breathing difficulties are present 1

Management Based on Injury Type

For Primary Tooth Fractures:

• Infractions (cracks): Generally no immediate treatment needed unless there's a marked crack that may stain 1
• Enamel-only fractures: No immediate treatment required unless there's a sharp edge causing soft tissue injury 1
• Enamel and dentin fractures: Referral to dentist within a few days 1
• Fractures with pulp exposure: Immediate dental referral for pulpotomy/pulpectomy or extraction 1

For Tooth Displacement:

• Extrusion: If minor, gentle digital pressure to reposition; immediate dental referral for splinting if mobility persists 1
• Intrusion: Observation for natural re-eruption; dental referral for monitoring 1
• Lateral luxation: Gentle repositioning for minor displacement; immediate dental referral for more significant displacement 1

For Root Fractures:

• Dental referral for radiographic examination
• Timing depends on crown mobility - immediate referral if aspiration risk exists 1

For Avulsed Primary Teeth:

• Do not replant avulsed primary teeth to avoid damage to developing permanent tooth buds 1
• If tooth not found, confirm it's not intruded through clinical and radiographic examination

Important Considerations

1. Post-trauma care instructions:

   • Soft diet for 10 days
   • Limit pacifier or digit sucking if possible
   • Maintain good oral hygiene 1

2. Monitor for complications:

   • Signs of pulpal necrosis: gingival swelling, increased mobility, parulis (gum boil)
   • Crown discoloration
   • Pulp canal obliteration 1, 2

3. Child abuse consideration:

   • Evaluate if injury pattern is consistent with reported mechanism
   • Assess for other signs of trauma or neglect 1

Follow-up Care

• Establish a "Dental Home" if not already in place (recommended within 6 months of first tooth eruption but no later than 12 months of age) 2
• Regular monitoring by dentist until tooth exfoliation 1
• Preventive dental care to maintain overall oral health 2

Common Pitfalls to Avoid

1. Delaying referral for complicated fractures or significant displacement
2. Attempting to replant avulsed primary teeth (contraindicated)
3. Dismissing parental concerns without proper evaluation 2
4. Failing to consider aspiration when tooth fragments are missing
5. Overlooking signs of child abuse in cases of unexplained or unusual oral trauma 2

The management of dental injuries in preschool children focuses primarily on minimizing potential damage to developing permanent teeth rather than heroic measures to save primary teeth 3. Prompt dental referral ensures proper assessment and treatment to prevent complications that could affect both primary dentition and developing permanent teeth.