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dental injuries

FDI Two-digit tooth numbering system

Permanent teeth
upper right upper left
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
lower right lower left
Deciduous teeth (baby teeth)
upper right upper left
55 54 53 52 51 61 62 63 64 65
85 84 83 82 81 71 72 73 74 75
lower right lower left

dental injuries

  • all pts with significant dental trauma should be advised that any teeth involved may later die & require root canal Rx

concussed tooth

  • tender but firm
  • review by local dentist


  • tender and loose, blood around gum
  • if very loose then attempt to splint in place if secondary tooth

lateral luxation

  • tooth displaced laterally
  • Mx as for extrusion


  • tooth displaced, partly out of socket
  • if primary tooth:
    • usually extracted or expectant Mx
    • not re-positioned as risk of damage to underlying secondary tooth
  • if secondary tooth:
    • reposition and splint (see under avulsion) under LA or GA


  • tooth pushed into socket
  • Mx as for extrusion but will usually require LA and forceps or needle holders to forcibly reposition the tooth


  • complete displacement of tooth from socket
  • if tooth not found:
    • consider CXR to exclude aspiration into lungs
    • consider dental XRay to exclude a fully intruded tooth into the socket
  • transportation of avulsed tooth:
    • place tooth in milk
    • do not handle or wipe root of tooth
    • needs to be re-implanted within 2 hours for any reasonable likelihood of success
    • best prognosis is if dry time < 60 minutes
    • never re-implant primary teeth
  • re-implantation of permanent teeth:
    • consider LA
    • irrigate socket with normal saline to remove any blood clot
    • check socket for any loose alveolar bone fragments which would restrict the tooth being replaced
    • hold by crown not the roots and insert into socket - convex to front
    • splint tooth in place, either by:
      • Blu-Tac (this is non-toxic) rolled into a sausage shape and placed over the repositioned teeth, then several layers of aluminium foil is moulded over the Blu-Tac to resemble a mouth guard, or,
      • Histoacryl glue applied to external surfaces of gum and tooth, or,
      • dental kit (see below)
        • place a horizontal roll of GC across adjacent teeth which will harden and splint tooth, or,
        • use dabs of GC on the front of each tooth and use a piece of fishing line placed horizontally across each dab of GC as a splint.
  • tetanus prophylaxis

fractured tooth

primary teeth
  • if exposed pulp (pink and painful) then usually needs extraction
  • otherwise see dentist within next few weeks
permanent teeth
  • if exposed pulp (pink and painful):
    • keep any tooth fragments in milk as they may be suitable for re-attachment
    • if dental registrar or dentist available, refer, otherwise:
      • protect tooth with dental kit (see below)
        • cover with a small amount of Dycal to try and preserve pulp vitality
  • if enamel (white) or dentine (yellow) only involved, see local dentist within a few weeks

de-gloving injury

  • gum is stripped from tooth to expose the roots
  • requires operative cleaning and repair to minimise risk of osteomyelitis of exposed bone

persistent heavy bleeding from tooth sockets

  • interrupted sutures (take care as gingival tissue is more delicate than skin and tears easily)
    • 3/0 or 4/0 absorbable material such as plain catgut, chromic or vicryl sutures

Emergency Dental Kit for doctors

  • available from Dr Tony Skapetis email:
  • contents (as at 2008):
    • emergency dental handbook for medical practitioners
    • GC Fuji IX kit powder + liquid
      • radio-opaque posterior glass ionomer restorative cement
      • primarily used by doctors as a bonding agent to splint loose teeth by creating a roll
      • follow instructions to mix the powder and liquid
    • Dycal Ca(OH)2 base + catalyst
      • used to protect pulp in dental fractures with exposed pulp (pink and painful)
    • SS cement spatula
    • SS double ended spatula
    • microbrush applicators

Dental Emergency Service

  • ContempoDentcare - appointment only basis
  • Dental Practices in Bundoora, Broadmeadows & Preston
  • 24 hour 7 day a week dental emergency service by appointment only
  • 24 hour number 0421 983 283
  • Patient should be advise that may be an after hour callout charge in addition to treatment costs
  • Operations Manager of ContempoDentcare - (03) 9357 7050
dental_injuries.txt · Last modified: 2014/07/06 16:14 (external edit)