Pediatric Dental Emergencies: How to Face an Urgent Consultation

✅ Abstract
Pediatric dental emergencies are critical situations requiring prompt diagnosis, calm communication, and effective intervention to relieve pain, prevent complications, and protect developing teeth.

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This article reviews the most common emergencies, including trauma, infections, and soft tissue injuries, offering an evidence-based guide for clinical management.

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✅ Introduction
In pediatric dentistry, emergencies are among the most stressful encounters for both practitioners and parents. Children often present with fear, pain, and anxiety, making communication and behavior management essential. The primary goals in these cases are alleviating pain, controlling infection, and preserving tooth structure and function. Proper training and a structured protocol allow clinicians to act efficiently while reassuring parents.

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✅ Development

1. Classification of Pediatric Dental Emergencies
Emergencies can be classified into:

▪️ Traumatic dental injuries (fractures, luxations, avulsions)
▪️ Acute infections (pulpitis, abscesses, cellulitis)
▪️ Soft tissue injuries (lacerations, hematomas)
▪️ Postoperative complications (pain, bleeding, or swelling)

Understanding these categories allows the clinician to prioritize care and implement an appropriate treatment sequence.

2. Initial Clinical Approach
A systematic approach is key:

1. Calm the child and caregiver to reduce emotional stress.
2. Take a brief medical history, including allergies and previous reactions to medications.
3. Perform a quick extraoral and intraoral assessment to identify trauma, bleeding, or infection.
4. Apply immediate measures, such as hemostasis, cold compresses, or analgesics.
5. Plan definitive treatment, or refer to a specialist if necessary.

3. Management of Common Pediatric Dental Emergencies
Below is a comparative table summarizing the most frequent pediatric dental emergencies, their advantages of early management, and limitations if treatment is delayed.

📊 Comparative Table: Common Pediatric Dental Emergencies and Their Management

Emergency Type	Early Management Benefits	Consequences of Delayed Care
Dental Trauma (fracture, avulsion)	Preserves tooth vitality; reduces risk of infection and resorption	Loss of tooth, ankylosis, or root resorption
Acute Pulpal or Periapical Infection	Rapid pain control and prevention of systemic spread	Cellulitis, fever, and possible airway compromise
Soft Tissue Injury	Promotes healing and prevents scarring	Infection or poor esthetic outcome
Postoperative Complications	Maintains child comfort and parental trust	Prolonged pain, bleeding, or loss of cooperation

💬 Discussion
Pediatric dental emergencies require both technical skill and emotional intelligence. The practitioner must act swiftly while maintaining a child-centered approach. Evidence shows that early management of trauma and infection significantly improves outcomes (Andreasen et al., 2022). Moreover, parental education is fundamental—teaching them to store an avulsed tooth in milk, recognize infection signs, and seek immediate dental care can prevent severe complications.

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✍️ Conclusion
Pediatric dental emergencies demand preparedness, empathy, and clear communication. A calm approach, combined with structured clinical decision-making, ensures optimal outcomes. Establishing emergency protocols and educating parents can reduce anxiety and improve long-term oral health.

🔎 Recommendations

▪️ Keep an emergency kit with topical anesthetics, hemostatic agents, and splinting materials.
▪️ Train the dental team in pediatric behavior management and first aid.
▪️ Provide parents with educational materials on common emergencies and when to seek help.
▪️ Collaborate with pediatricians and emergency physicians for systemic cases.

📚 References

✔ Andreasen, J. O., Andreasen, F. M., & Lauridsen, E. (2022). Textbook and Color Atlas of Traumatic Injuries to the Teeth (6th ed.). Wiley-Blackwell.
✔ American Academy of Pediatric Dentistry (AAPD). (2023). Best Practices: Management of Acute Dental Trauma. https://www.aapd.org/research/oral-health-policies--recommendations/
✔ Malhotra, N., Kundabala, M., & Acharaya, S. (2021). Dental emergencies in children: Clinical management guidelines. Journal of Clinical Pediatric Dentistry, 45(2), 85–93. https://doi.org/10.17796/1053-4628-45.2.3

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Dental Splinting (Ferulization) in Primary and Young Permanent Teeth: Indications and Materials

✅ Abstract
Dental splinting (ferulization) stabilizes mobile or traumatised teeth to promote healing of periodontal and pulpal tissues.

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This review summarizes indications in primary and immature permanent dentitions, compares available splinting materials, and provides practical recommendations for clinicians based on current guidelines and evidence.

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✅ Introduction
Ferulization (tooth splinting) is the clinical procedure of joining mobile or displaced teeth to adjacent teeth to provide temporary stability during healing. The goals are to reduce pain, protect healing periodontal ligament (PDL), enable reattachment or root development, and facilitate endodontic or restorative therapy when needed. Recommendations for splint type and duration differ for primary teeth and young permanent teeth, and should follow contemporary trauma guidelines.

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✅ Indications: importance and clinical situations

➤ Primary teeth (deciduous dentition)
° Splinting is considered for selected luxation injuries or root fractures when repositioning is attempted and where stabilization will improve function or comfort. However, the decision is conservative because of risks to the developing successor tooth; therefore, non-invasive management is often preferred. Evidence supports flexible, short-term splinting in some primary tooth root fractures to improve outcomes.

➤ Young permanent teeth (immature permanent dentition)
° Splinting is important in extrusive, lateral luxation, root fractures, and avulsions to allow PDL healing and continued root development (apexogenesis). The IADT recommends passive, flexible splints (eg. 0.016" stainless steel or comparable flexible wire/fiber) for most traumatized permanent teeth, typically for 2 weeks (longer—4 weeks—if alveolar fracture or root fracture is present). Early stabilization preserves vascular and PDL healing and can improve pulpal survival in immature teeth.

➤ Why splinting matters
° Proper splinting reduces micromovement, lessens further tissue damage, and facilitates clot stabilization in replanted avulsed teeth and luxation injuries—thereby improving prognosis for both periodontal and pulpal healing.

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✅ Types of splints and choice rationale
Clinicians should prefer flexible and passive splints that allow physiologic tooth movement while providing stabilization. Rigid splints are generally avoided because they may cause ankylosis or inhibit PDL healing. Modern options include:

▪️ Wire-composite splints (stainless steel wire + composite) — traditional, widely available.
▪️ Fiber-reinforced composite (FRC) splints — superior aesthetics, less plaque retention, good strength.
▪️ Direct composite splints (wire-free) — quick application but technique-sensitive; some materials demonstrated good short-term retention in training studies.
▪️ Glass ionomer-based connectors — easier removal in some settings, but lower flexural strength.
▪️ Emerging options: 3D-printed or CAD/CAM fabricated removable splints for specific cases, an expanding field with promising early data.

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✅ Clinical protocol (practical points)

▪️ Reposition tooth carefully, then place a passive, flexible splint. Follow IADT timing recommendations (commonly 2 weeks; 4 weeks for root/alveolar fractures). Document occlusion and ensure splint does not cause premature contacts.
▪️ Combine splinting with appropriate endodontic management when indicated (eg. immature teeth with necrotic pulp require apexification/regenerative approaches).
▪️ Provide oral hygiene instructions, soft diet, and follow-up radiographs to monitor healing and detect complications (resorption, ankylosis).

💬 Discussion
Current evidence and guidelines emphasize flexibility, passivity, and short duration of splints to maximize periodontal healing and minimize adverse sequelae such as ankylosis or root resorption. Comparative studies show that fiber-reinforced composite splints may offer improved aesthetics and comparable mechanical performance to wire-composite splints, while new technologies (CAD/CAM, 3D printing) can produce customized appliances for special cases. However, heterogeneity in study designs and limited high-quality randomized trials mean clinical judgment and guideline adherence remain essential.

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✍️ Conclusion
Ferulization is a key tool in the management of dental trauma and mobility in both primary and young permanent teeth when appropriately indicated. Choosing a passive, flexible splint and limiting duration according to injury type optimizes healing while minimizing complications. Ongoing advances in materials (FRC, CAD/CAM splints) broaden clinicians’ options but should be adopted guided by evidence and practicality.

🔎 Recommendations

1. Prefer passive, flexible splints (eg. 0.016" stainless wire or FRC) and avoid rigid fixation.
2. Duration: generally 2 weeks for most luxations and avulsions; extend to 4 weeks for root or alveolar fractures as per IADT.
3. Primary teeth: be conservative—splint selectively and weigh risks to successors.
4. Combine splinting with appropriate endodontic, restorative, and follow-up care; monitor radiographically for resorption and ankylosis.
5. When available and indicated, consider fiber-reinforced or CAD/CAM solutions for improved patient comfort and aesthetics, while recognizing cost and accessibility limitations.

📊 Symptoms: Mild - Severe: Splinting Materials — Pros and Cons

Aspect	Advantages	Limitations
Wire-composite (stainless steel wire + composite)	Widely available; reliable stabilization; cost-effective; good clinical familiarity	Aesthetic concerns; plaque retention if excess resin; technique sensitivity for passive placement
Fiber-reinforced composite (FRC)	Better aesthetics; low profile; good flexural strength; reduced metal visibility	Higher material cost; requires precise technique; may need special fiber handling
Direct composite splint (wire-free)	Fast application; no metal components; comfortable for patients	May have lower long-term retention; increases polymerization shrinkage risk if bulky
Glass ionomer connectors	Easy to remove; fluoride release may benefit caries-prone patients	Lower mechanical strength; higher wear; less suitable for high-load stabilization
CAD/CAM or 3D-printed removable splints	Custom-designed fit; predictable passive support; minimal chair time for placement	Requires lab workflow or in-clinic 3D printing; higher cost; limited data in pediatric trauma

📚 References

✔ Bourguignon, C., et al. (2020). International Association of Dental Traumatology (IADT) guidelines for the management of traumatic dental injuries. Dental Traumatology. (IADT guidelines).
✔ Deery, C., et al. (2023). Should we splint traumatised primary teeth? British Dental Journal Open / Systematic Review. Retrieved from PubMed Central.
✔ Goswami, M., et al. (2020). Management of traumatic dental injuries using different splinting methods. Journal of Clinical and Experimental Dentistry.
✔ Sobczak-Zagalska, H., et al. (2020). Best splinting methods in case of dental injury. Journal of the American Academy of Pediatric Dentistry / JOCPD (article discussing splint types and techniques).
✔ Šimunović, L., et al. (2025). Three-dimensionally printed splints in dentistry: review and applications. Journal of Clinical Dentistry / MDPI Reviews.
✔ Moon, W., et al. (2022). Mechanical evaluation of dental trauma splints fabricated with various materials. Dental Materials Journal.

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What Are the Most Common Dental Emergencies and How Can You Manage Them?

Dental emergencies are frequent in both pediatric and adult populations and often require immediate intervention to prevent pain, infection, and functional impairment.

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This article reviews the most common dental emergencies, including their definitions, clinical management, and evidence-based treatment guidelines.

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✅ Introduction
Dental emergencies are defined as urgent conditions involving teeth, gums, or surrounding tissues that cause acute pain, swelling, or trauma requiring immediate attention. They represent a significant portion of dental visits worldwide and have direct implications for both oral and systemic health (Andersson, 2013). Understanding their management is essential for ensuring patient comfort, preventing complications, and preserving dental structures.

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1. Dental Trauma
➤ Definition: Physical injury to teeth and supporting structures caused by accidents or sports.
➤ Management:
° Avulsed permanent teeth should be replanted immediately or stored in milk/saline until dental care is available (Flores et al., 2012).
° Fractured teeth may require composite restoration, pulp therapy, or endodontic treatment depending on pulp involvement.

2. Acute Pulpitis and Irreversible Pulpitis
➤ Definition: Inflammation of the pulp leading to severe toothache, often due to caries or trauma.
➤ Management:
° Immediate pulpotomy or pulpectomy in children.
° Endodontic treatment or extraction in adults, combined with analgesics.

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3. Dental Abscess
➤ Definition: Localized pus accumulation due to bacterial infection of the pulp or periodontal tissues.
➤ Management:
° Drainage of abscess and elimination of infection source.
° Antibiotics when systemic involvement is present (Fouad, 2017).

4. Pericoronitis
➤ Definition: Inflammation and infection of the soft tissue around a partially erupted tooth, usually a mandibular third molar.
➤ Management:
° Irrigation and debridement.
° Analgesics and antibiotics in severe cases.
° Extraction of the involved tooth if recurrent.

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5. Orthodontic Emergencies
➤ Definition: Complications related to orthodontic appliances such as broken brackets, protruding wires, or soft tissue irritation.
➤ Management:
° Temporary relief with orthodontic wax.
° Cutting or repositioning wires as needed.
° Follow-up with orthodontist for definitive repair.

6. Soft Tissue Injuries
➤ Definition: Lacerations or contusions affecting oral mucosa, tongue, or gingiva.
➤ Management:
° Control bleeding with pressure.
° Suturing in deep lacerations.
° Antiseptic rinses and analgesics.

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💬 Discussion
Dental emergencies vary widely in etiology, from traumatic injuries to infections. Timely management is crucial to reduce morbidity, prevent tooth loss, and avoid systemic complications. Evidence-based protocols, such as those from the International Association of Dental Traumatology (IADT), highlight the importance of immediate care and appropriate referral (Andersson, 2013). The role of antibiotics should be restricted to systemic involvement to avoid resistance (Fouad, 2017). Patient education on prevention, including mouthguard use and caries control, remains vital.

✍️ Conclusion
The most common dental emergencies include trauma, pulpitis, abscesses, pericoronitis, orthodontic issues, and soft tissue injuries. Their effective management depends on prompt diagnosis, evidence-based intervention, and preventive strategies. Dental professionals should stay updated on current guidelines to optimize outcomes and reduce complications.

📚 References

✔ Andersson, L. (2013). Epidemiology of traumatic dental injuries. Journal of Endodontics, 39(3 Suppl), S2–S5. https://doi.org/10.1016/j.joen.2012.11.021
✔ Flores, M. T., Andersson, L., Andreasen, J. O., Bakland, L. K., Malmgren, B., Barnett, F., Bourguignon, C., DiAngelis, A., Hicks, M. L., Sigurdsson, A., Trope, M., & Kenny, D. J. (2012). Guidelines for the management of traumatic dental injuries II: Avulsion of permanent teeth. Dental Traumatology, 28(2), 88–96. https://doi.org/10.1111/j.1600-9657.2012.01125.x
✔ Fouad, A. F. (2017). Endodontic Microbiology and Treatment of Infections. In Hargreaves, K. M., & Berman, L. H. (Eds.), Cohen’s Pathways of the Pulp (11th ed., pp. 599–638). St. Louis: Elsevier.

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Webinar: Pediatric Dental Trauma and Odontogenic Infections - Dr. Kelly A. Kirtland DDS

Pediatric dental trauma and odontogenic infections remain among the most frequent and challenging conditions faced in children’s oral health. These events can compromise not only the integrity of the teeth but also the function, aesthetics, and overall well-being of young patients.

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Understanding how to recognize, diagnose, and manage trauma early is crucial for preserving tooth vitality and preventing long-term complications in both primary and permanent dentition.

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Likewise, odontogenic infections demand prompt and accurate intervention, as they may progress rapidly and affect adjacent tissues or even systemic health. Modern pediatric dentistry emphasizes evidence-based protocols, the use of minimally invasive techniques when possible, and a patient-centered approach that reduces anxiety and improves cooperation.

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By combining preventive strategies, clinical expertise, and multidisciplinary collaboration, dental professionals can ensure safer, more predictable outcomes. This video explores the current knowledge and best practices that empower clinicians to provide effective and compassionate care when facing dental trauma and infections in children.

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Youtube/ South Asian Association of Pediatric Dentistry

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Management of acute orofacial infection of odontogenic origin in children - Diagnosis, clinic and pharmacology

Infections of odontogenic origin are those that are generated and evolve from a tooth, either by a process of pulpal or periodontal infection. These infections spread to other tissues and put the patient's life at risk.

The abscess and cellulitis are the manifestations of the progressive phases of the infectious process. It is important to know their differences, and the clinical and pharmacological management.

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We share a clinical and pharmacological management manual for orofacial infections (abscess and cellulitis) of odontogenic origin in children.

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Ludwig's Angina. Presentation of a pediatric case

👉 READ AND DOWNLOAD "Management acute orofacial infection of odontogenic origin in children" IN FULL IN PDF👈

Management acute orofacial infection of odontogenic origin in children 1° Edition. 2016. Oral Health Division Ministry of Health Malaysia.

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Odontogenic facial cellulitis in a pediatric patient - Diagnosis, treatment and multidisciplinary management

Facial cellulitis is an infectious process, usually odontogenic, that puts the life of the pediatric patient at serious risk if it does not have the appropriate treatment. The immune system of the child patient is not developed enough to deal with this type of infection.

Facial cellulite spreads to other anatomical regions, aponeurotic plane and tissue spaces. Clinically, facial cellulite is of a soft consistency and with inflammatory signs. Early diagnosis and treatment prevents serious consequences of cellulite.

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Treatment of facial cellulite in an infant must be immediate, and multidisciplinary management is necessary in many cases. We share an article that teaches us how to identify, diagnose and treat facial cellulite in pediatric patients.

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Ludwig's Angina. Presentation of a pediatric case

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Giunta Crescente C, Soto de Facchin M, Acevedo Rodríguez AM. Medical-dental considerations in the care of children with facial cellulitis of odontogenic origin. A disease of interest for pediatricians and pediatric dentists. Arch Argent Pediatr 2018;116(4):e548-e553.

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Guidelines for the management of traumatic dental injuries in the primary dentition

Dental traumas in pediatric patients represent 18% of all injuries and that is due to the activities of children, and they occur more frequently when they learn to crawl, walk or run.

The lesions can compromise dental tissue (enamel, dentin, root), dental pulp, alveolar bone, and periodontal ligaments. Soft tissues such as lips and cheeks are also included.

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We share an article that does not offer different recommendations for the diagnosis and treatment of traumatic injuries in the primary dentition.

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How to handle dental trauma?

👉 READ AND DOWNLOAD "Guidelines for the management of traumatic dental injuries in the primary dentition" IN FULL IN PDF👈

Day PF, Flores MT, O’Connell AC, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Dent Traumatol 2020;36(4):343-359. https://doi.org/10.1111/edt.12576

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