A patient attends after a road traffic accident with a fractured tooth. She reports a headache and seems mildly confused about the sequence of events. What should the dentist do?

Correct answer: B. Refer immediately for emergency medical evaluation

• A. Analgesics could mask a deteriorating neurological picture, and NSAIDs are relatively contraindicated where intracranial bleeding is possible.
• B. Correct. Headache with CONFUSION or altered mental status after head trauma are RED FLAGS for intracranial injury — concussion at minimum, and possibly an evolving extradural or subdural haematoma with a lucid interval. The dental problem is entirely secondary. Refer for emergency medical evaluation and imaging FIRST. Other red flags: vomiting, unequal pupils, amnesia, deteriorating consciousness, seizure, CSF rhinorrhoea or otorrhoea, and any loss of consciousness.
• C. Radiographic assessment of the tooth does not address the neurological risk.
• D. Treating the tooth ignores a potentially life-threatening intracranial injury.