Dental trauma is a common occurrence that can happen to anyone, regardless of age or gender. The causes of dental trauma can vary from a simple trip or fall to sports-related injuries, car accidents, or physical violence. Regardless of the cause, it’s important to seek immediate dental attention in order to prevent further damage to your teeth and gums.

An up to date understanding of current recommended guidelines will help not only with the INBDE exam, but will be of benefit to all your patients within clinical practice.

 In recent years, the American Dental Association (ADA) has updated its guidelines for dental professionals regarding treating dental trauma. One of the most notable updates is related to the use of prophylactic antibiotics in patients with dental trauma.

Prophylactic Antibiotics and Dental Trauma

 Prophylactic antibiotics are antibiotics that are prescribed to prevent an infection from developing in a patient with an injury or undergoing a surgical procedure. In the past, prophylactic antibiotics were routinely prescribed to patients with dental trauma, even if there was no evidence of infection. However, recent studies have shown that the overuse of antibiotics can lead to antibiotic resistance, which can be a serious public health issue.

 The ADA’s updated guidelines recommend that prophylactic antibiotics should only be prescribed in certain situations, such as:

• Patients with systemic signs of infection, such as fever or swollen lymph nodes

• Patients with avulsed teeth (teeth that have been completely knocked out of the socket)

• Patients with fractures that extend into the pulp (the innermost part of the tooth that contains nerves and blood vessels)

• In other cases, such as uncomplicated dental fractures or tooth luxation (displacement of a tooth from its normal position), prophylactic antibiotics are not necessary.

The American Heart Association (AHA) issued a novel scientific statement in 2021, negating the prescription of clindamycin for antibiotic prophylaxis due to its substantial susceptibility to Clostridium difficile infection, and the consequential elevated morbidity and mortality rates.

Timely Treatment

 One of the most important aspects of treating dental trauma is seeking prompt dental attention. Delaying treatment can increase the risk of complications, such as infection or permanent damage to the teeth and gums.

 If you or someone you know has experienced dental trauma, it’s important to seek dental care as soon as possible. In some cases, such as a knocked-out tooth, it may be possible to re-implant the tooth if it’s treated within the first 30 minutes to an hour after the injury.

 In addition to seeking prompt dental attention, there are a few steps you can take to care for your teeth and gums before you’re able to see a dentist:

• Rinse your mouth with warm water to help clean any debris or blood from the area.

• If a tooth is knocked out, handle it carefully by the crown (the part of the tooth that’s normally visible in the mouth) and rinse it gently with water. Try to re-implant the tooth if possible, or place it in a container of milk or saline solution until you’re able to see a dentist.

• If a tooth is fractured or chipped, try to save any pieces that you can and bring them with you to your dental appointment. If the fracture is severe, you may need a temporary filling or crown to protect the tooth until a permanent restoration can be placed.

In a small change from previous guidelines, the preferred order of preference of storage mediums are milk, HBSS, saliva, or saline.

Preventing Dental Trauma

 While dental trauma can happen unexpectedly, there are steps you can take to reduce your risk of injury:

• Wear a mouthguard during sports activities that involve contact or risk of injury. Custom-fitted mouthguards provide the best protection, but even a basic, boil-and-bite mouthguard is better than no protection at all.

• Avoid chewing on hard objects such as ice, hard candy, or pens, which can cause fractures or chips in your teeth.

• Practice safe driving habits and always wear a seatbelt to reduce your risk of car accidents.

• Use caution when walking or running on uneven surfaces, especially in wet or slippery conditions.

 By taking these steps to prevent dental trauma and seeking prompt dental attention if an injury does occur, you can help protect your teeth and gums and minimize the risk.