Presentations 2020: Restorative

369 - The challenges of managing a patient who has sustained complex dental trauma injuries in an emergency setting

M Bassilious M Collard
Presented by: Mena Bassilious
Cardiff Dental Hospital

Introduction This case describes a 22-year-old male who sustained multiple dental and medical injuries after falling off an electric bike at 25mph. He presented on the Exam and Emergency (E&E) department at Cardiff Dental Hospital after being seen by OMFS in A&E the night before. Examination On examination, the patient had a laceration on his lower lip and chin, which was sutured by the on call OMFS. The patient sustained a complicated crown fracture, two avulsions, two subluxations and a combination injury of extrusive/lateral luxation on his upper and lower anterior teeth. He could not bear weight on his right foot and had a right scaphoid fracture. Management The initial management was to get the patient out of pain and commence treatment that would lead to a good prognosis for the traumatised teeth. Radiographs and photographs were taken to aid treatment along with sensibility and vitality testing. Over three visits, the patient had emergency dental treatment and was advised to see a GDP for more definitive treatment such as RCT and either fixed or removal prosthesis for the avulsed teeth. Discussion and summary The challenges that were faced can be split up into three categories: patient factors; clinic factors and dental/operator factors. The patient had spent all night in A&E so was extremely tired when he presented to E&E. He also had certain aesthetic concerns which could not be met in an emergency setting. On a busy department like E&E, time management can be an issue especially if the patient has multiple injuries. From an operator point of view, it can be quite overwhelming when faced with such a case. Repositioning and splinting the upper canine proved to be difficult and this can be attributed in part to the delay in treatment. Ideally, this should have been carried out much sooner however dental trauma can be difficult to manage in an A&E environment.
Consent Statement: Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient/parent/guardian. A copy of the consent form is available for review by the the meeting organisers..

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