Pediatric Dentistry · patient case question
What is the MOST appropriate management of the luxated primary incisor?
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: C. Extract it
- A. Splinting a tooth with almost no remaining root support achieves nothing and risks damaging the erupting successor.
- B. Pulp therapy is for a restorable primary tooth with years of service left, not one about to exfoliate.
- C. CORRECT. A grade 3 mobile primary tooth at the point of exfoliation, with the successor nearly erupted, offers nothing worth preserving and carries a real aspiration risk. Extract it; the permanent tooth will erupt into the space.
- D. Watchful waiting is reasonable for a mildly mobile primary tooth, not for one that is grade 3 mobile and loose in a child's mouth.
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