The first step in any diagnostic process should be to secure an accurate history. A comprehensive history of the injury should be obtained from the patient.Tncorporating information on who, when, where, and how. The
dentist must ask the following questions to the patient, parent, or a reliable respondent.
1. Who is the patient? Included here should be the patient’s name, age, address, phone number, and other pertinent demographic data. It is imperative that this data be obtained quickly and time not be wasted .
2. When did the injury occur? This is one of- the most important questions to ask, because studies have shown that the sooner an avulsed tooth can be repositioned, the better the prognosis.s Similarly rthe results of treating displaced teeth, crown fractures (with and without exposed dentalpulps), and alveolar fractures may be influenced by a delay in treatment.
3. Where did the injury occur? This question may beimportant, because the possibility and degree of bacterial or chemical contamination should be ascertained. For example, if a child falls on the playground and gets
dirt in the wound, a tetanus prophylaxis history should be carefully established. On the other hand, if an injury occurs from a clean object held in the mouth, gross bacterial contamination from external sources is not expected.
4. How did the injury occur? The nature of the trauma provides valuable insight into what the resultant tissue injury is likely to be. For example, an unrestrained car passenger who is thrown forward into the dashboard
with sufficient force to damage several teeth may also  have sustained occult injuries to the neck. The manner in which the injury occurred is valuable information . and should make the clinician investigate the possibility of further injuries. Additional information that can
be gained f om this question may relate to the cause of
the injury. If a patient cannot remember what happened, a preexisting medical condition, such as a seizure disorder, may have caused the accident producing the injury. Injuries caused by possible negligence
by others are open for litigation. These considerations should caution the clinician to do.cument the findings . carefully and word’ any discussions with the patient thoughtfully. One other thought that must be kept. in
the clinician’s mind when examining children whose  injuries do not seem to be a likely result of the injury described by the parent is child abuse.

5. What treatment has been provided since the injury (if any) This question elicits important information regarding the original condition of the injured area. Did the patient or parent replant a partially avulsed tooth?
How was the avulsed tooth stored before presentation to the dentist.
6. Did anyone note teeth or pieces of teeth at the site of the accident? Before an accurate diagnosis and treatment plan are made, it is imperative that each tooth the

FIG. 23-5 Teeth displaced into abnormal locations. A, Chest radiograph showing maxillary canine tooth in. right main st~m bronchus after traumatic displacement. 8, Incisor tooth in line of fracture after reduction
FIG. 23-5 Teeth displaced into abnormal locations. A, Chest radiograph showing maxillary
canine tooth in. right main st~m bronchus after traumatic displacement. 8, Incisor tooth in line
of fracture after reduction

patient had before the accident be accounted for. If, during the clinical examination a tooth or crown .is found missing and no history suggests that it was lost at the scene, radiographic examination of the perioral soft tissues, the chest, and the abdominal region is necessary to rule out the presence of the missing piece within the tissues or other body cavities (Fig. 23-5).
7. What is the general health of the patient? It is essential that a succinct medical history be taken; it should not be ignored in the dentist’s haste to replant an avulsed tooth. It can, however, be performed concomitantly
with treatment or immediately thereafter. A history that touches on drug allergy, heart murmur, bleeding disorder, other systemic disease, and’ current medications should be taken before .treatment, because their
existence affects the treatment the dentist will provide.
B. Did the patient have nausea, vomiting, unconsciousness, amnesia, headache, visual disturbances, or confusion after the accident? An affirmative answer to any of these questions may indicate intracranial injury and direct the dentist to obtain medical consultation immediately
after completing treatment. Immediate referral should be made if the patient is still having any of the symptoms or if the patient does not feel or look well. The patient’s life should not be jeopardized to save an
avulsed tooth.
9. Is there a disturbance in the bite? An affirmative answer to this question may indicate tooth dentoalveolar or jaw fracture.



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