Let’s face it—traumatic dental injuries are one of those things that we barely learn about during our medical training. And yet, every now and then, a patient waltzes (or winces) into your urgent care with a dental injury, expecting your dental skills to be as sharp as their broken molar. Lucky for us, Dr. Samuel Goldman and Dr. Brett Murray recorded a segment on Urgent Care Rap to help us sink our teeth into the essentials. Whether you’re looking for a quick dental trauma guide or a refresher on how to fix fractured teeth, here’s a breakdown of what to do when a traumatic dental injury shows up on your shift.
Look, Feel, and Function—The Oral Exam
Inspect: Missing teeth? Mucosal lacerations? Active bleeding?
Palpate: Any loose teeth or tenderness?
Function: Are bite mechanics off? Trismus? Midface instability? (Be alert—where there’s a tooth injury, there’s often a facial fracture to go along with it).
Avulsion: The Ultimate Dental Emergency
Tooth completely gone? Time is of the essence!
Best-case scenario: Reimplant within 5 minutes → 90% tooth survival rate.
Second-best: Store in cold milk if immediate reimplantation isn’t possible (yep, dairy saves the day).
Handle like fine china: Pick it up by the crown, rinse gently with milk, saline, or the patient’s saliva (no scrubbing!), and gently plop it back into the socket.
Stabilize with gauze and splint
Start antibiotics
Refer for immediate dental follow-up
For kids: Do NOT reimplant avulsed baby teeth! Dispo → tooth fairy
Luxation Injuries: When a Tooth is Hanging On for Dear Life
Subluxation: Loose tooth? → Monitor and follow up.
Extrusion: Dangling out of socket? → Reposition it, splint, refer to dentist.
Lateral Luxation: Displaced sideways? → Reposition it, splint, refer to dentist.
Intrusion: Impacted into the socket?
- > 3 mm displacement or alveolar fracture → Call in the emergency dental cavalry.
- < 3 mm → Urgent outpatient dental follow-up is fine.
Concussion injury → Still in place but painful after trauma? → Refer to dentist to monitor for pulpal necrosis and send for non-emergent dental radiographs.
Imaging: See the Bigger Picture
CXR if aspiration of the missing tooth is a concern.
CT if there are signs of associated facial fractures.
Panorex (if available) may be helpful for dental colleagues, but if there is a high degree of suspicion for associated bony injury (i.e., alveolar ridge fracture), consider transferring for CT imaging.
Tooth Fractures: The Ellis Classification System
Ellis I: Enamel of tooth crown only → No pain, no problem. Non-emergent dental follow-up.
Ellis II: Dentin exposed → Painful! Cover with calcium hydroxide or Dermabond and then apply dental foil to form a barrier. Soft foods only! Prompt dental follow-up.
Ellis III: Pulp exposed (red dot = bad news) → Dental emergency! Send them to a hospital with dental services or their dentist immediately.
Prophylactic Antibiotics: Who, What and When
Penicillin/Amoxicillin or Doxycycline
Penicillin or clindamycin for kids.
Consider in patients with:
- Complete avulsions that need to be reimplanted (to help the periodontal ligaments heal)
- Open dental alveolar fractures
- Secondary infection risks
- Immunosuppression or high endocarditis risk
Final Bite: Confidence is Key
Traumatic dental injuries don’t have to be a nightmare. With a systematic approach, a steady hand, and a little bit of dental know-how, you can help your patients keep their pearly whites intact. And if all else fails? Just remember—grab the milk.
Learn more by tuning into our Urgent Care RAP episode, “Dental Fracture Management.” Or watch our Urgent Care Bootcamp videos demonstrating Dental Fracture Repair and Dental Splinting if you are a subscriber!