A healthy 24-year-old man presents 2 hours after a bicycle accident in which he went over the handlebars and onto a paved surface. He takes no medications, was helmeted, and sustained no loss of consciousness. There are no complaints of neck, back, chest, or abdominal pain. His vital signs are normal, but there are abrasions to his right palm and elbow. A complete physical exam raises no concern for thoraco-abdominal injuries, neck or back injury, or extremity fractures. The facial exam reveals a fractured right central incisor with yellowish dentin exposed, but no bleeding from the tooth. There is a 1 cm intraoral laceration of the upper lip adjacent to the fractured tooth. Which of the following choices represents the best course of action?
a. The patient has sustained multisystem trauma. Activate EMS and place the patient in full spinal protocol in preparation for transport to the ED. Have him bite a piece of rolled, saline-soaked gauze during transport.
b. Ensure tetanus status is current and cleanse the abrasions. Consider facial and chest x-rays to ensure that the tooth fragment has not been aspirated or embedded in the wound. Anesthetize, irrigate, and repair the intraoral laceration, then perform a dental block and cover the exposed dentin with calcium hydroxide paste. Ensure the patient has dental follow up in the next 24 to 48 hours.
c. Cleanse and dress the abrasions and ensure tetanus status is current. Send the patient’s family member back to the scene of the accident to search for the missing tooth fragment, then have them call a dentist.
d. Obtain x-rays of the elbow and hand, cleanse and dress the abrasions, and ensure that tetanus status is current. The intraoral injuries can be managed expectantly with one week dental follow up.
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Answer: B. Tooth fractures with exposed dentin can result in pulp infection. The exposed dentin should be covered with calcium hydroxide paste and prompt dental follow up should be arranged.
Last Updated on May 8, 2023