location of developing permanent tooth bud) (C ); extrusion (D ); and avulsion (E ) Refer emergencies (B ) through (E ) to the dental staff as soon as possible Teeth luxated in an extrusion or lateral direction must be realigned and splinted as soon as possible Palatally displaced teeth often prevent the child from biting properly As with intrusions, endodontic treatment is usually needed since the periapical pulpal tissues that have been severed are unlikely to reanastomose in the long term Extrusive/lateral luxations of the primary dentition usually necessitate extraction This avoids complex treatment to a young child who will eventually lose the tooth and avoids potential injury to the succedaneous permanent tooth during realignment or as a result of eventual pulpal necrosis Avulsion is defined as a tooth that has been completely displaced from its alveolar socket If the tooth was not found, radiographs are needed to confirm that the tooth was actually avulsed rather than intruded Chest films can be obtained to assess for ingestion or aspiration of the missing tooth The best prognosis exists when the avulsed permanent tooth is reimplanted within 15 to 30 minutes The emergency physician or the parent needs to determine whether it is a primary or permanent tooth If a child has missing teeth in an area of trauma, it is important to determine if any primary teeth were in the process of exfoliation The eruption/exfoliation timetables ( Tables 105.1 and 105.2 ) can be helpful in determining whether the loss was imminent In addition, intra- and/or extraoral dental radiographs such as a panoramic view can be diagnostic