Dental Trauma: Guidelines for Pediatricians Updated

Nondentists can play a key role in preventing and treating dental trauma, according to a new report by the American Academy of Pediatrics.

In guidelines published online January 27 in Pediatrics, the academy lays out the basics of prevention, diagnosis, and treatment for injured teeth.

In children 6 years of age and younger, oral injuries are the second most common injury, accounting for almost 20% of their injuries, writes Martha Ann Keels, DDS, PhD, chief of pediatric dentistry at Duke University in Durham, North Carolina, and her colleagues.

Anyone who sees kids in urgent care settings needs to be prepared to treat dental trauma because often no dentist is available and time may be of the essence, they write.

But even before considering treatment, the authors write, physicians who care for children should try to prevent injuries to their patients' teeth. Physicians can do this by recommending safety measures, such as stairway gates and the removal of trip hazards.

They should also counsel their patients to wear mouth guards during sports, the authors write. Recommendations vary, with the US National Collegiate Athletic Association recommending mouth guards for ice hockey, lacrosse, field hockey, and football, while the American Dental Association recommends them for 29 sports.

When injuries do occur, Dr. Keels and colleagues offer recommendations that include the following:

Before treatment, take an abbreviated medical and dental history.
Thoroughly examine the patient's face, lips, and oral musculature for soft tissue lesions.
Check the traumatized region for fractures, abnormal tooth position, and tooth mobility.
Complete an age-appropriate neurologic assessment.
Inquire about sensitivity to heat or cold.
Image an injured tooth with intraoral dental radiography rather than computed tomography.
Recognize the dental trauma classifications and urgent care for concussion, subluxation, lateral luxation, extrusive luxation, intrusive luxation, avulsion, infraction, enamel-only (uncomplicated) crown fracture, enamel and dentin (uncomplicated) crown fracture, crown fracture with exposed pulp (complicated), root fracture, and alveolar fracture.
Instruct caregivers that the child should eat a soft diet and avoid digit-sucking for 10 days following an injury to a permanent tooth.
Make caregivers aware of the potential for root resorption, ankylosis, or pulpal necrosis; they should be vigilant for crown discoloration, periodontal abnormalities, gingival swelling, increased mobility, and a sinus tract (parulis).
Know the difference between treatments recommended for primary vs permanent teeth.
Establish relationships with local dentists to facilitate referrals.
Know when dental trauma requires immediate referral to a dentist.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online January 27, 2014. 2014;133:e466-e476. Abstract

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