See also

Key Points

1. Management of dental trauma depends on whether primary or permanent teeth are involved
2. Injuries to primary teeth are generally managed by observation or extraction
3. Successful replantation of permanent teeth or teeth fragments requires urgent management to improve long term tooth viability

Background

• Dental trauma is very common, and often occurs alongside other injuries, especially facial and head injuries. Where required, perform a primary and secondary survey prior to instituting dental management
• Management of dental trauma is different for primary (baby) teeth compared to permanent teeth, as primary teeth are never repositioned, splinted or replanted
• Severe injuries to primary teeth can cause later problems in the formation and eruption of permanent teeth. Treatment of injuries to primary teeth is aimed at minimising additional risks to the developing permanent teeth and preventing complications such as aspiration of tooth fragments
• Crown discolouration is a common complication after dental injury. This may resolve with time. Extraction is only required where there is associated infection of the dental pulp or abscess formation
• Appropriate use of a mouthguard during sports can minimise dental trauma
• In young children and infants with oral trauma, consider child abuse

Assessment

Reviewing tooth anatomy, tooth numbering and eruption dates will assist when referring to dentist

History

• Mechanism of injury and associated injuries
• Time since injury - avulsion of a permanent tooth is a dental emergency
• First aid rendered - tooth rinsing, wet or dry storage
• Sensitivity to hot and/or cold
• Previous dental history including injuries, crowns or prostheses
• Tetanus immunisation status

Examination

• Use the "lap-to-lap" position for toddlers
• Check symmetry in the mouth and alignment of teeth
• Lift the lips to look for gingival or oral mucosal injury
• Type of tooth and whether permanent or primary
• Type of dental injury: loose or displaced tooth, fractured tooth, injury to supporting bone, injury to oral mucosa or gingivae
• Bite for even occlusion, subjective or objective; steps in bite or bone border
• Temporomandibular joint movement and tenderness
• Numbness, intra or extraoral bruising
• Account for all lost teeth and fragments, examine chest and soft tissues of the mouth if any missing as they may have been aspirated or embedded

Management

Investigations

• Orthopantogram (OPG) for children >3 years who can cooperate if considering fractured mandible, temporomandibular joint (TMJ) injury or concern for fully intruded tooth
• Chest x-ray if suspicion of aspiration of missing tooth or fragments
• Occlusal (bite-down) views can only be done by dental service

Treatment

• Discuss with emergency dental service and provide an intraoral photograph of the injury, where possible.  They will assess the injury and determine whether emergency specialist management or referral to a community dental clinic for non-urgent assessment is required
• Prophylactic antibiotics recommended after replantation of avulsed tooth, soft tissue injuries with debris or operative management required. Provide tetanus booster if required
• Healing after a dental injury requires good oral hygiene. Swabbing the area with 0.12% chlorhexidine mouth wash twice a day for 10-14 days reduces the infection risk. A soft diet will also allow loose teeth to become firmer

Loose or displaced teeth

Fractured teeth
Enamel is white, dentine is yellow, pulp is pink

Injuries to the supporting bone

• Check that the child's bite is normal
• Get an OPG and other views as required
• Refer to both dental and maxillofacial (obvious jaw fractures)
• Dental and maxillofacial follow-up is recommended for all patients with mandibular or maxillary fractures, even when undisplaced

Injuries to the gingivae or oral mucosa

• Oral mucosa degloving injuries (gingivae stripped from underlying bone) can be missed if the lips are not firmly lifted away from the gum as part of the examination
• The chin is often swollen and tender in mandibular degloving injuries
• Degloving injuries and deep lacerations or tears require operative cleaning, debridement and suturing to reduce the risk of osteomyelitis
• Refer to emergency dental service
• Manage intra and extraoral lacerations as required

              Oral mucosal degloving injuries

Consider consultation with local paediatric dental team when

Dental trauma requiring surgical input and assessment

Consider transfer when

Specialist dental or maxillofacial assessment and management is required and is not locally available

For emergency advice and paediatric or neonatal ICU transfers, see Retrieval Services

Consider discharge when

Intervention is complete and follow up plans are in place

Parent information

Broken or dislodged tooth
Dental care

Additional notes

International Association of Dental Traumatology Dental Trauma Guide

Access to dental services 
Each state has eligibility criteria for access to public dental services 

• New South Wales 
• Queensland 
• South Australia 
• Victoria 
• Western Australia 

 
Some children will also be eligible for the Child Dental Benefits Schedule which subsidises dental treatment through public or private dental services

Last updated July 2024