Guidelines for Emergency Management of the Traumatic Dental Injuries of the Chilean Ministry of Health

Abstract

Background

Traumatic dental injuries (TDIs) are the fifth most prevalent condition worldwide. Proper diagnosis and emergency management are essential for ensuring a favourable outcome and prognosis. Although other international guidelines provide recommendations for the emergency management of TDI, specific clinical situations are not always addressed.

Objective

To provide the dental health team and patients with recommendations based on the best scientific evidence available for the outpatient emergency management of people suffering from TDI.

Methods

The Chilean Ministry of Health formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Universidad de La Frontera, supported the guideline-development process, including evidence synthesis. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including GRADE Evidence-to-Decision frameworks.

Recommendation

The panel agreed on 15 recommendations for outpatient management of TDIs, such as fractures, luxations and avulsions in primary and permanent dentition. Conditional recommendations for permanent teeth included performing partial pulpotomy with calcium hydroxide or bioceramic in complicated crown fractures, stabilizing with a rigid splint in cervical root fracture, performing digital repositioning and splinting in lateral and extrusive luxation for more than 48 h, performing dental reimplantation in avulsed teeth with extended extra-oral time > 1 h, not treating the root surface and prescribe antibiotics in avulsed teeth. Conditional recommendations for primary teeth included performing just the extraction of the mobile fragment in complicated crown-root fractures and not splint in teeth with subluxation, lateral or extrusive luxation. Conditional recommendations for the use of mouthwash with 0.12% chlorhexidine twice a day for a period of 7–14 days in people with TDIs and against prescribing antibiotics in people with crown fracture, intra-alveolar root fracture or tooth luxation associated with trauma.