Dental Trauma or Infection Clinical Pathway — Emergency Department

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Goals and Metrics

Triage

Frontline Ordering Clinician (FLOC)/RN Team Assessment
- History and Physical Exam
  - Assess VS, Mental Status
  - ADA Dental Eruption Chart
  - Analgesia, NPO
  - Child Life

Dental Trauma

Primary Teeth
Luxation Injury, Primary Teeth	Minor injury May not require treatment Severe injury May require tooth extraction and dental consult
Fractures	Dental consult for exposed nerve/pulp

Permanent Teeth
Avulsion	Place tooth in Save-a-Tooth Dental consult to replant tooth Review tetanus status Antibiotics
Luxation Injury, Permanent Teeth	Minor injury May not require treatment Severe injury Dental consult required
Fractures	Dental consult for exposed nerve/pulp

Dental Infection

Pain/Local Inflammation

Consider Antibiotics
Prompt outpatient dental follow-up

Facial Cellulitis/Abscess

Consult OMFS for Abscess I&D
Antibiotics
PO antibiotics vs. IV antibiotics and admission depending on severity of infection

Discharge Instructions

Posted: August 2019
Last Revised: October 2024
Authors: E. Szydlowski, MD; K. Castelo, CRNP; B. Pagliaro, RN; H. Giannakopoulos, MD; E. Hajishengallis, PhD

Evidence

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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.

Emergency Department Clinical Pathway for Evaluation/Treatmentof Children with Emergent Dental Pathology and/or Trauma

Evidence

Emergency Department Clinical Pathway for Evaluation/Treatment
of Children with Emergent Dental Pathology and/or Trauma