From the Guidelines
The most effective approach to managing dental trauma involves immediate assessment and intervention, with a focus on preserving the tooth and preventing infection, as outlined in the 2014 guidelines for management of dental trauma in a primary care setting 1.
Key Principles
- For avulsed teeth, handle the tooth by the crown, rinse it gently without scrubbing, and attempt reimplantation within 30 minutes for best outcomes, or place it in a recommended transport medium such as cold milk or a balanced salt solution 1.
- For fractured teeth, collect any fragments and seek immediate dental care, with restoration of the tooth and smoothing of sharp edges as necessary 1.
- Luxated teeth require professional repositioning and possible splinting, with observation and follow-up care to monitor for complications such as pulp necrosis or root resorption 1.
Pain Management and Antibiotics
- Pain management can include acetaminophen (500-1000mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours) for adults, with antibiotics like amoxicillin (500mg three times daily for 7 days) prescribed for contaminated injuries or immunocompromised patients 1.
Follow-up Care
- Follow-up care is essential, with regular dental radiographs and monitoring for complications such as pulp necrosis, root resorption, or infection, which may develop weeks or months after injury 1.
Prevention and Education
- Counseling parents and caregivers on injury-prevention strategies, such as proper mouthguard use and fall prevention, can help reduce the risk of dental trauma 1.
Important Considerations
- The American Academy of Pediatrics guidelines emphasize the importance of collaborative relationships between pediatricians and dentists to facilitate referral and management of traumatic dental injuries 1.
- The guidelines also highlight the need for prompt treatment to improve prognosis, as dental tissues have limited healing capacity and bacterial contamination can quickly lead to infection and further damage 1.
From the Research
Guidelines for Managing Dental Trauma
The management of dental trauma requires timely and well-informed intervention to improve the clinical outcome for the patient 2. The International Association of Dental Traumatology (IADT) has developed guidelines for the management of traumatic dental injuries, including fractures and luxations of permanent teeth 3, 4, 5 and avulsion of permanent teeth 6.
Key Principles
- Proper diagnosis, treatment planning, and follow-up are important for improving a favorable outcome 3, 4, 5
- Guidelines should assist dentists and patients in decision-making and provide the best care effectively and efficiently 3, 4, 5
- The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of traumatic dental injuries 3, 4
Management of Specific Injuries
- Avulsion of permanent teeth: replantation is the treatment of choice, but cannot always be carried out immediately 6
- Fractures and luxations of permanent teeth: proper diagnosis, treatment planning, and follow-up are important for improving a favorable outcome 3, 4, 5