Dental Trauma or Infection Clinical Pathway — Emergency Department

History and Physical Exam

Obtain full history, including potential for infection vs. trauma and if tooth involved is primary or permanent.

When performing a dental exam on children:

Position child at a 45 degree angle or in caregiver's arms depending on age
Have tongue blade, 2x2 gauze, suction and adequate lighting available
Consider doing exam with supervising physicians to minimize trauma or if behavior is a concern

History and Assessment	Dental infection, toothache Pain but no signs of diffuse inflammation/cellulitis Localized inflammation surrounding mucosa of one or two teeth Diffuse facial swelling and systemic infection History of trauma/obvious tooth fracture Mechanism Time of injury Associated symptoms First aid, wound care, analgesia Tooth avulsion Confirm tooth was recovered or consider chest X-ray Examine laceration for foreign body History of dental caries or previous dental treatment Last PO intake solids, liquids Ability to eat Tetanus status Any other trauma PMH Medications Allergies Medical co-morbidities
Physical Exam	General VS, Pain Score, concern for systemic infection Dental Assessment (primary dentition vs. permanent dentition) Eruption Charts Potential Trauma Neurologic exam Concern for jaw, TMJ fracture Swelling, deformity, pain to palpation Trismus Deviation of the jaw upon opening Injury to teeth Ellis fractures, avulsions, luxations Lacerations Gingiva or other soft tissues Extra-oral tissue Potential infection Cervical lymphadenopathy Jaw mobility Tooth percussion tenderness Gingival swelling, draining fistula Facial swelling, cellulitis Airway – deviation of uvula or displacement of the tongue

History and Assessment

Dental infection, toothache
- Pain but no signs of diffuse inflammation/cellulitis
- Localized inflammation surrounding mucosa of one or two teeth
- Diffuse facial swelling and systemic infection
History of trauma/obvious tooth fracture
- Mechanism
- Time of injury
- Associated symptoms
- First aid, wound care, analgesia
- Tooth avulsion
  - Confirm tooth was recovered or consider chest X-ray
  - Examine laceration for foreign body
History of dental caries or previous dental treatment
Last PO intake solids, liquids
Ability to eat
Tetanus status
Any other trauma
PMH
- Medications
- Allergies
- Medical co-morbidities

Physical Exam

General
- VS, Pain Score, concern for systemic infection
Dental Assessment (primary dentition vs. permanent dentition)
- Eruption Charts
Potential Trauma
- Neurologic exam
- Concern for jaw, TMJ fracture
  - Swelling, deformity, pain to palpation
  - Trismus
  - Deviation of the jaw upon opening
- Injury to teeth
  - Ellis fractures, avulsions, luxations
- Lacerations
  - Gingiva or other soft tissues
  - Extra-oral tissue
Potential infection
- Cervical lymphadenopathy
- Jaw mobility
  - Tooth percussion tenderness
- Gingival swelling, draining fistula
- Facial swelling, cellulitis
- Airway – deviation of uvula or displacement of the tongue

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Dental Trauma or Infection Clinical Pathway — Emergency Department

History and Physical Exam

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Dental Trauma or Infection Clinical Pathway, Emergency Department – History and Physical

Dental Trauma or Infection Clinical Pathway — Emergency Department

History and Physical Exam