Oral Surgery · patient case question
Beyond managing the teeth and the lip laceration, what additional step does this injury require?
Patient case: Basketball injury in a mixed dentition
Patient: 7-year-old boy brought in by his father one hour after an accident.
Chief complaint: Broke his front teeth playing basketball.
History: Struck in the mouth by an elbow. No loss of consciousness, no vomiting, no headache. Immunizations reportedly up to date but the father is unsure about the last tetanus booster.
Findings: Bleeding from the gingival margin and a lacerated lower lip. Fractures of two permanent maxillary incisors involving enamel and dentin with no pulp exposure; both respond within normal limits. A primary maxillary central incisor is luxated and grade 3 mobile. Radiographs show the tooth close to exfoliation with the permanent successor nearly erupted.
Show answer and explanation
Correct answer: A. Verify his tetanus immunization status and refer for a booster if it is not current
- A. CORRECT. Any contaminated or soil-exposed wound raises tetanus risk. When the immunization history is uncertain or the last booster was more than five years ago for a dirty wound, refer for tetanus prophylaxis. Clean the wound thoroughly and check for embedded debris.
- B. Imaging of the head is reserved for red flags — loss of consciousness, vomiting, amnesia, headache, or altered consciousness — none of which are present here.
- C. Routine systemic antibiotics are not indicated for a simple intraoral laceration in a healthy child; thorough irrigation and debridement matter more.
- D. Blood tests are not indicated — there is no history of a bleeding disorder and the bleeding described is ordinary soft tissue bleeding.