Dental injuries in the pediatric emergency department: A retrospective analysis and literature review

This retrospective cohort study included all patients aged 0-18 years who presented to our pediatric emergency department (PED) between 2017 and 2021 following injuries of primary and permanent teeth. We explored risk factors for the need for dental intervention that required urgent consultation with an oral and maxillofacial specialist and included: tooth repositioning, splinting, extraction, replantation, intraoral soft tissue laceration repair, and surgical intervention. Of the total of 830 patients (mean age 7.1±3.9 years, 589 males [71.0%]), 237 (28.5%) required dental intervention. All patients with alveolar fractures and those with involvement of permanent teeth with extrusive luxation mandated urgent dental consultation. Additional independent predictors for dental intervention for primary tooth injury were: root fracture (aOR 38.4 [95%CI: 3.95–373.22, p = 0.002), facial bone involvement (aOR 12.40 [95%CI: 2.33–65.93], p = 0.003), lateral luxation (aOR 6.9 [95%CI: 4.27–11.27], p < 0.001), extrusive luxation (aOR 6.44 [95%CI: 2.74-15.14, p < 0.001), and avulsion (aOR 2.06 [95%CI: 1.23–3.45], p = 0.006). Additional independent predictors for permanent tooth injury were: lateral luxation (aOR 27.8 [95%CI: 6.1–126.6], p < 0.001) and avulsion (aOR 6.8 [95%CI: 2.9-15.9], p < 0.001). Conclusion: : Alveolar fracture is the most severe pediatric dental injury, requiring immediate dental intervention for injuries of both primary and permanent teeth. Tooth luxation with significant mobility or malocclusion, incomplete avulsion, a suspected root involvement, or facial bone injury in the primary teeth, and tooth luxation (extrusive/lateral) and avulsion in the permanent teeth dictate urgent dental consultation and intervention. Clinical algorithms for dental injuries management are suggested.