Where is the Tooth? Diagnosing and Managing Dentoalveolar Injuries During Infancy - Abstract
Pediatric traumatic injuries involving the oral cavity are common, and can have
serious functional, esthetic, and developmental sequelae. The peak incidence for primary tooth trauma occurs between the ages of 18 and 30 months – a time when parents have established a medical home for their child, but may have yet to establish a dental home. As a result, such acute injuries commonly present to the pediatrician or family practitioner for initial evaluation. We present the case of a 10-month-old male who sustained avulsion (complete tooth displacement out of the socket) of both maxillary primary central incisors after falling onto a table at day care. Initial assessment was performed by the child’s pediatrician, who referred the family to the pediatric dentist for further evaluation. The
diagnosis of tooth avulsion was confirmed clinically and radiographically. However, the teeth could not be located at the scene of the fall, raising the question of whether the teeth had been aspirated or ingested. The child’s parents and their pediatrician chose to follow a conservative protocol, consisting of monitoring the stool for passage of the avulsed teeth or signs of pulmonary involvement. The teeth were recovered in the stool the following day. This case serves as an example of collaborative care between the pediatrician and pediatric dentist, working together to arrive at an accurate diagnosis, deliver appropriate case management, and provide emotional support to concerned parents.