Dental Trauma Management
Overview
Dental injuries are common in the ED and early decisions determine long‑term tooth survival and function. The ED role is to secure the airway, control bleeding and pain, preserve tooth and periodontal tissues where appropriate, assess tetanus risk, give interim wound care and arrange urgent dental/maxillofacial follow‑up.
Definitive procedural detail (replantation technique, splint design/duration, antibiotic choice and timing of endodontic therapy) is provided by specialist dental guidance (e.g. IADT, BSPD) or local trust SOPs; this section gives practical, exam‑relevant ED actions and priorities.
Immediate priorities
- Airway first: manage any suspected airway compromise from loose or avulsed teeth/fragments using national first‑aid choking algorithms (encourage coughing; back blows and abdominal/chest thrusts as age‑appropriate; escalate to advanced airway/CPR if unresponsive). Do not perform blind digital sweeps (Resuscitation Council UK).
- Primary survey: treat life‑threatening injuries per major‑trauma principles (NICE NG39). Control haemorrhage with direct pressure, give prompt analgesia and consider anxiolysis or procedural sedation when required.
- Triage and imaging: assess for associated facial fractures; obtain dental periapical or panoramic radiographs, or CT for complex injuries as indicated (NICE/RCEM guidance).
- Documentation: record mechanism, time of injury, time tooth became extra‑oral, storage medium, photographs, and all treatments given.
Key principles for avulsed teeth
- Handle the avulsed tooth only by the crown; avoid touching or scraping the root to preserve periodontal ligament cells.