TRAUMATIC LESIONS THREE

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.