Dental trauma and avulsed teeth

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Target exams

Red flags

• An avulsed permanent tooth is a time-critical emergency — every minute of dry extra-alveolar time reduces the chance of periodontal-ligament healing; replant immediately at the scene or store in milk, HBSS, saline or saliva and get to a dentist within minutes. Do not store the tooth in water, and do not scrub or touch the root.
• An avulsed primary (baby) tooth must never be replanted — doing so can damage the developing permanent successor; seek dental review and reassurance.
• Facial or gum laceration with a missing tooth fragment and no tooth found raises the possibility of intrusion, aspiration, swallowing or embedding of the tooth or fragment — image and review the airway, and consider child safeguarding when the history and injury are inconsistent.
• Repeated, unexplained or age-inconsistent oral and dental injury, torn frenulum in a non-mobile infant, or delayed presentation of a painful injury raises the possibility of non-accidental injury — assess the whole child and follow safeguarding procedures.

Life stages

Care settings

Clinical exam formats

Board mappings

• General Paediatrics and Oral Health: recognition of traumatic dental injury as a time-critical emergency, the first-aid for an avulsed permanent tooth, and the rule that primary teeth are never replanted.
• Injury, poisoning and toxicology: the immediate management of an avulsed tooth, analgesia, tetanus assessment, and safeguarding consideration for oral injury.
• Renewed curriculum — Oral Health and Acute Care: the periodontal-ligament cell-viability pathophysiology, the dominant prognostic role of extra-alveolar dry time, and the IADT 2020 protocol for replantation, storage media, flexible splinting and systemic antibiotics.
• Regional practice: the role of school and sporting mouthguard programmes and the disproportionate trauma burden in remote communities with limited urgent dental access.
• General Paediatrics: the scene first-aid for a knocked-out permanent tooth — find it, hold it by the crown, rinse a dirty root for about ten seconds, replant it or store it in milk, and the reasons water and scrubbing harm the root.
• Emergency care: analgesia, tetanus prophylaxis assessment, and the safety-net and urgent dental or maxillofacial referral for replanted, luxated and fractured teeth.
• Long Case / Structured discussion: a child with a knocked-out permanent incisor — the Andreasen classification, the IADT 2020 management by extra-alveolar dry time and apex status, complications of root resorption, and the prognosis.
• Communication station: explaining to a parent, coach or teacher what to do with a knocked-out tooth in the first minutes, and why milk and immediate replantation matter.
• Level 2 / 3 — Oral Health and Injury: traumatic dental injury, the first-aid for an avulsed permanent tooth, and the never-replant-a-primary-tooth rule.
• Child protection: recognition that oral injury can be a sign of non-accidental injury, and the importance of consistent history and safeguarding referral.
• Foundation of Practice (FOP): the classification and epidemiology of traumatic dental injury, and the emergency first-aid for an avulsed permanent tooth.
• Applied Knowledge in Practice (AKP): the IADT 2020 management protocol, storage media, the distinction between primary and permanent teeth, and the complications of root resorption.
• History-taking and management: the child with a dental injury, the timing and mechanism, the first-aid given, and the immediate management and analgesia plan.
• Communication: coaching a family or teacher on what to do with a knocked-out tooth, and the safety-net advice for facial swelling, infection or uncontrolled pain.
• General Pediatrics Content Outline: traumatic dental injury, the avulsed permanent tooth as an emergency, storage media and immediate replantation, and the primary-tooth rule.
• Injury, Emergency Care and Child Abuse: tetanus prophylaxis, the safeguarding consideration in oral injury, and sporting mouthguard prevention.
• Patient Care: the time-critical first-aid and management of an avulsed permanent tooth, and the stepwise care of luxation and crown-fracture injuries.
• Medical Knowledge: the periodontal-ligament pathophysiology, the dominant prognostic role of extra-alveolar dry time, and the complications of inflammatory and replacement root resorption.
• Systems-Based Practice and Population Health: sporting and playground mouthguard programmes, first-aid education for teachers and coaches, and reduction of oral-injury inequality.
• Medical Expert: traumatic dental injury diagnosis and management, the IADT 2020 protocol, and the complications of root resorption.
• Health Advocate and Collaborator: mouthguard and first-aid programmes, and urgent access to dental and maxillofacial care in remote communities.
• Communicator: explaining first-aid for a knocked-out tooth, the safety-net for infection, and the safeguarding consideration when oral injury is unexplained.