Dental assessment

Dental injury assessment

• Confirm details of first aid received, including first aid to avulsed tooth or fragment, e.g. rinsing or storage.
• Confirm with the patient if a tooth fragment or avulsed tooth was located. Fragments can be embedded in soft tissue or inhaled.
• Ask the patient if there are dentures, crowns or braces.
• Look for other facial or oral injuries.
• Confirm the patient's last tetanus immunisation.

Face

• Look for facial symmetry.
• Ask the patient if they notice any swelling, deformity or unusual features.
• Note any bruising, swelling or injuries.
• Assess for decreased sensation in the face.
• Palpate facial bones, assessing for tenderness. Consider facial fractures.
• Assess for movement of the temporomandibular joint (TMJ).

Dental

• Look inside the mouth, including the tongue and palate.
• Assess for gingival and/or lip lacerations by asking the patient to keep their teeth together while maintaining loose lips. Gently fold the lips, checking the gums and inside of the lips for injury
• Account for all lost teeth and fragments. If there are missing fragments or teeth, look at the soft tissues of the mouth and complete a respiratory examination. Missing teeth may have been aspirated or embedded. Feel for movement of the injured teeth.
• Ask the patient to bite together. Check for malocclusion and pain.
• Use the table below to document the type of injury.

Injury type

Injury type	Description
Concussion	Tender but firm in the socket
Subluxation	Tender, loose, and blood around the gum
Lateral luxation	Anteriorly or posteriorly displaced
Extrusion	Partially out of the socket
Intrusion	Pushed into the socket, complete or partial intrusion
Avulsion	Complete displacement (may be mistaken for complete intrusion)
Fracture	Broken tooth

Dental pain assessment

• Look for facial symmetry.
• Ask the patient if they notice any swelling, deformity or unusual features.
• Assess for gingival and/or lip lacerations by asking the patient to keep their teeth together while maintaining loose lips. Gently fold the lips, checking the gums and inside of the lips for injury
• Check for:
  • loose or tender teeth
  • gingival swelling, erythema, cellulitis or pain
  • trismus
  • fever and systemic features (may not always be present).
• Assess for lymphadenopathy in the head and neck.