The assessment of the injury begins by asking questions that aid in diagnosis and treatment planning of the injuries. The questions include the following:
Does the patient have any medical issues?
A medical history can reveal medical conditions, allergies and other information that may influence treatment. Information relevant to dental injuries includes:
Cardiac disease, which may necessitate subacute bacterial endocarditis antibiotic prophylaxis. (The reader is referred to the American Heart Association’s latest guidelines for infective endocarditis published in its journal Circulation: Journal of the American Heart Association in April 2007).
Allergies to medications
Tetanus prophylaxis status, especially if the child suffered a dirty wound. If the injured child has not received tetanus toxoid within the last five years, a booster is indicated.
As forces that are strong enough to fracture, intrude or avulse a tooth can also result in cervical spine or intracranial injuries, the dentist should perform a neurological assessment and make the proper medical referral even before commencing with dental treatment, if necessary.
The patient should be assessed for nausea, vomiting, drowsiness or possible cerebrospinal fluid leakage from the nose which would be indicative of a skull fracture. The dentist should conduct a cranial nerve evaluation in the following four areas:
The patient can track a finger moving vertically and horizontally through the visual field with the eyes in tandem to evaluate whether the extraocular muscles are intact and functioning.
Pupils are equal, round and reactive to light.
Light contact with various areas of the face measures normal sensory function.
Have the patient frown, smile, move the tongue and perform several voluntary muscular movements to determine symmetry of motor function.
When did the injury occur?
The answer will provide a timeframe that will influence the type of treatment rendered. A delay in seeking treatment should raise suspicions of child abuse.
Where did the injury occur?
The answer may suggest legal issues and financial responsibility for the injuries as well as degree of contamination of the wound.
How did the injury occur?
The answer to this question suggests the possible areas of injury, i.e., a blow to the chin may suggest root/crown fracture in the posterior area or jaw fracture. Inconsistencies between the injuries exhibited by the child and the provided history should raise suspicions of child abuse.
Was there a period of unconsciousness?
If yes, how long? Is/was there a headache? Amnesia? Nausea? Vomiting? If so, these are signs of a brain concussion and require medical attention and observation. Once the patient is deemed stable, there is no contradiction for treatment of the dental injury.
Have there been previous injuries to the teeth?
Positive answers may explain chronic conditions to the teeth unrelated to the acute injuries, i.e., obliterated pulp canal, shortened roots, or abscesses.
Is there a disturbance in the bite?
A positive answer may indicate alveolar, jaw or condylar fracture.
Is there any reaction in the teeth to cold/heat?
A positive answer indicates dentin exposure and the need for treatment.6