within this chapter reflect current standards of care regarding management of dental injuries Goals of Treatment Advocating for mouthguards, protective gear, and safe practices can help reduce the incidence of TDI The emergency physician needs to know which injuries can be managed without dental consultation, which need follow-up care with a dentist, and which need immediate attention Clinical Considerations Teeth are labeled according to their position in the mouth For older children with permanent dentition, the examiner begins on the upper right with the third molar as no 1, proceeding across the upper arch to no 16, and then continues on the lower left with the third molar from no 17 across the right to no 32 Primary dentition are labeled using letters rather than numbers, starting with letter A in the upper right proceeding across the upper arch to J then continuing on the lower left from K across to T ( Fig 105.2A,B ) Injuries to Hard Dental Tissues and Pulp With any injury resulting in fragmentation of teeth, the emergency physician should attempt to account for all the fragments The fragments may be embedded in a soft tissue laceration of the lip or tongue which may become infected if not debrided (see section on Soft Tissue Injury) Next, accessing the depth of the fracture is important Fractures of the enamel or dentin are considered uncomplicated, while those extended into the pulp are complicated ( Fig 105.3 ) Uncomplicated tooth fractures are confined to the enamel and the underlying dentin without pulp exposure ( e-Fig 105.3 ) The child may complain of sensitivity, especially to cold air and fluids Emergency treatment is aimed at decreasing sensitivity of the involved tooth and protecting the pulp even if no frank pulp exposure is noted The child should be seen within 48 hours by a dentist to place an insulating dressing over the exposed dentin which decreases sensitivity and minimizes the chance of pulpal necrosis The prognosis for uncomplicated tooth fracture is good