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 or parent/carer if a tooth fragment or avulsed tooth was located. Fragments can embed in soft tissue or be inhaled.
• Confirm with the patient or parent/carer any dentures, crowns or braces.
• Assess for additional facial or oral injuries.
• Confirm the patient's last tetanus immunisation.

Face

• Assess facial symmetry.
• Ask the patient or parent/carer 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

• Positioning young children for a dental examination is often difficult.
• Ensure adequate positioning to reduce the number of examinations and complete a full inspection.
• Position the parent/carer on a chair with the child cuddling them on their lap. Sit knee to knee with the parent. Lay the patient backward so their head rests on the clinician's knees.
• If the patient cooperates, ask them to keep their teeth together, as this allows thorough inspection of the lips and gums. Assess for gingival and/or lip lacerations.
• Inspect inside the mouth, including the tongue and palate.
• Account for all lost teeth and fragments, and examine the chest and soft tissues of the mouth for any missing teeth, as they may have been aspirated or embedded.
• Inspect for dental trauma:
  • primary or secondary teeth
  • type of injury
  • gently assess for movement of the injured teeth
  • ask the patient to bite together and assess for malocclusion and pain.

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

Primary teeth

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.