Follow-Up for Dental Trauma Presenting to a Hospital Emergency Department

Abstract

Purpose: This study describes ED presentation/management, subsequent follow-up visits and family experience for a cohort of patients initially presenting to a hospital with dental trauma.

Methods: Patients presented with dental trauma between March 2021 and February 2022. Data was collected from the ED visit notes and follow-up appointment visit notes. All families were invited to participate in a telephone survey about their experience.

Results: 168 patients (mean age 6.2 years) were included. Insurance status was private insurance 54.2%, Medicaid 45.2%, and no dental insurance 0.6%. Primary tooth injuries (N=100) were isolated luxation N=51, combination injuries N=33, isolated crown fractures N=14, and isolated avulsion N=2. Permanent tooth injuries (N=68) were combination injuries N=33, isolated crown fracture N=18, and isolated avulsion N=5. Most frequent treatments were extraction for injured primary teeth 46% and baseline exams for injured permanent teeth 63%. Follow-up visit details were available for 40 patients: 20 with primary tooth injuries and 20 with permanent tooth trauma. At the follow-up visit the most frequent management of primary teeth was monitoring for re-eruption (95%) and monitoring/vitality testing for permanent teeth (57.9%). Thirty-six parents completed surveys: 22 for primary injuries and 14 for permanent tooth injuries. Of the surveyed parents 47.2% had private insurance. All reported that the ED experience was intense. All but one patient had follow-up within the recommended time frames. Three families reported barriers to obtaining follow-up: available appointments (N=3) and restricted insurance network (N=2). Conclusions:Guidelines recommend timely dental clinic follow-up for dental injuries that are initially treated in an ED. Given the stress of an ED encounter, families may best be supported by development of clear multimodal roadmaps specific to their child's dental trauma.