Trauma due to physical injury, e.g., a fall, sports, road traffic accident
MANAGEMENT
General measures
- Give tetanus booster if needed
- Check for facial fractures and/or lacerations
- If evidence of head injury (amnesia, loss of consciousness, neurological signs), transfer
patient to hospital immediately - Intra-oral check: for soft-tissue lacerations, dento-alveolar fractures, and damage to teeth
- Check for the whereabouts of tooth fragments, which are commonly embedded in the lip
- Examine traumatized teeth for mobility
- Check occlusion, especially if any teeth have been displaced
- Refer for radiographs of affected teeth to check for root fracture
- Avulsed permanent teeth should be re-planted immediately. Prognosis is good with immediate
treatment, therefore refer the patient to a dentist as soon as possible - Suture soft tissue lacerations in 3/0 resorbable suture
- Refer to an oral surgeon for reduction and immobilization of mobile teeth and alveolar
fragments
Medicines
- Wash mouth with warm salt solution (dissolve a 5 ml spoonful of salt in 200 ml of warm water)
Or hydrogen peroxide solution 6% (add 15 ml to a cup 200 ml of warm water) - Repeat mouth wash 3 times daily
- Paracetamol 1 g every 8 hours
- Or ibuprofen 400 mg every 8 hours
Give prophylactic antibiotics if indicated
- Amoxicillin 500 mg every 8 hours for 5-7 days
- Refer to a dentist for orthodontics, endodontic (root canal) treatment, or protection of pulp
Prevention
- Early orthodontic treatment in children with large overjets that are susceptible to trauma
- Provision of a mouth guard (made of vacuum formed thermoplastic vinyl) for sports
- Be alert for evidence of child abuse and notify relevant authorities if any.