obtained to exclude inhalation.
- Concussion, headache, vomiting or amnesia? Brain damage must be excluded and
referral to a hospital for further investigation organized. - Previous dental history? Previous trauma can affect pulpal sensibility tests and the
recuperative capacity of the pulp and/or periodontium. Alternatively are there
suspicions of physical abuse? Previous treatment experience, age, and parental/child
attitude will affect the choice of treatment.
12.4.2 Medical history
- Congenital heart disease, a history of rheumatic fever or severe
immunosuppression? These may be contra-indications to any procedure that is likely
to require prolonged endodontic treatment with a persistent necrotic/infected focus.
All congenital heart defects do not carry the same risks of bacterial endocarditis and
the child's paediatrician/cardiologist should be consulted before a decision regarding
endodontic treatment is made. - Bleeding disorders? Very important if soft tissues are lacerated or teeth are to be
extracted. - Allergies? Penicillin allergy requires alternative antibiotics.
- Tetanus immunization status? Referral for tetanus toxoid injection is necessary if
there is soil contamination of the wound and the child has not had a 'booster' injection
within the last 5 years.
12.4.3 Extraoral examination
When there are associated severe injuries a general examination is made with respect
to signs of shock (pallor, cold skin, irregular pulse, hypotension), symptoms of head
injury suggesting brain concussion, or maxillofacial fractures.
Facial swelling, bruises, or lacerations may indicate underlying bony and tooth injury.
Lacerations will require careful debridement to remove all foreign material and
suturing. Antibiotics and/or tetanus toxoid may be required if wounds are
contaminated. Limitation of mandibular movement or mandibular deviation on
opening or closing the mouth indicate either jaw fracture or dislocation.
Crown fracture with associated swollen lip and evidence of a penetrating wound
suggests retention of tooth fragments within the lip. Clinical and radiographic
examination should be undertaken (666HFig. 12.5 (a)-(d)).
667H