Traumatically Displaced Tooth
(Adopted 1995, Revised 1997)
The key element in the design of this set of parameters for the traumatically displaced tooth is the professional judgment of the attending dentist, for a specific patient, at a specific time.
The patient's chief complaint, concerns and expectations should be considered by the dentist.
When possible, the dentist should instruct the patient on the protocol for managing the traumatically displaced tooth prior to oral evaluation and/or dental treatment.
Following oral evaluation (see limited, comprehensive, periodic, detailed and extensive evaluation parameters) and consideration of the patient's needs, the dentist should provide the patient with information about the traumatically displaced tooth prior to obtaining consent for treatment.
The dental and medical histories should be considered by the dentist to identify medications and predisposing conditions that may affect the prognosis, progression and management of the traumatically displaced tooth.
Following oral evaluation (see limited, comprehensive, periodic, and detailed and extensive evaluation parameters) and consideration of the patient's needs, the dentist is responsible for providing the patient with information about the nature of his or her traumatically displaced tooth prior to obtaining consent for treatment.
The dentist should attempt to manage the patient's pain, anxiety and behavior during treatment to facilitate safety, efficiency and patient cooperation. (See: ADA Policy Statement: The Use of Sedation and General Anesthesia by Dentists and Guidelines for the Use of Sedation and General Anesthesia by Dentists.)
Factors affecting the patient's speech, function and orofacial aesthetics should be considered by the dentist in developing a treatment plan.
The behavioral, psychological, anatomical, developmental and physiological limitations of the patient should be considered by the dentist in developing the treatment plan.
Restorative implications, carious lesions, pulpal/endodontic status, tooth position, and periodontal status and prognosis should be considered in developing a treatment plan.
When the dentist considers it necessary, (an)other health care professional(s) should be consulted to acquire additional information.
The dentist may counsel the patient concerning the potential effects of the patient's health condition, medication use, and behaviors and/or habits on his or her oral health.
The dentist should consider the possibility that the patient may be the victim of physical abuse and/or neglect.
Medications should be prescribed, modified and/or administered for dental patients whose known conditions would affect or be affected by dental treatment provided without the medication or its modification. The dentist should consult with the prescribing health care professional(s) before modifying medications being taken by the patient for known conditions. (See: ADA Statement on Antibiotic Prophylaxis, Prevention of Bacterial Endocarditis: A Statement for the Dental Profession (PDF), and A-Z Topic: Antibiotic Prophylaxis.)
After consideration of the individual circumstances, the dentist should decide whether the traumatically displaced tooth should be monitored or treated.
The dentist should recommend treatment; present treatment options, if any; and discuss the probable benefits, prognosis, limitations and risks associated with treatment, and the probable consequences of no treatment.
Any treatment performed should be with the concurrence of the patient and the dentist. If the patient insists upon treatment not considered by the dentist to be beneficial for the patient, the dentist may decline to provide treatment. If the patient insists upon treatment considered by the dentist to be harmful to the patient, the dentist should decline to provide treatment.
The dentist should refer the patient to (an)other health professional(s) when the dentist determines that it is in the best interest of the patient.
Relevant and appropriate information about the patient and any coordinated treatment should be communicated and coordinated between the referring dentist and the health professional(s) accepting the referral.
The dentist should consider the characteristics and requirements of each patient in selecting the material(s) and treatment(s) to be utilized.
The dentist may take this opportunity to emphasize the prevention and early detection of oral diseases through patient education in preventive oral health practices, which may include oral protective appliances.
The patient should be informed that the success of the treatment is often dependent upon patient compliance with the prescribed treatment and recommendations for behavioral modifications. Lack of compliance should be recorded.
Alteration of tooth morphology and/or position; placement of restorations; modification or replacement of restorations; and treatment of carious lesions may be performed to facilitate treatment or reduce symptoms.
Pulpal tissue should be protected by the dentist when indicated.
Endodontic therapy may be performed by the dentist.
Transitional or provisional restorations may be utilized by the dentist to facilitate treatment.
Chemotherapeutic agents may be used by the dentists to facilitate treatment.
Foreign matter on the traumatically displaced tooth may be removed.
Reimplantation or repositioning may be accomplished by the dentist.
The dentist may utilize stabilization techniques to facilitate treatment.
The dentist may modify occluding and articulating tooth/teeth to facilitate treatment.
Fixed, removable and/or implant-supported restorations (prostheses) may be repaired, modified or replaced as determined by the dentist.
Teeth may be removed, as determined by the dentist. When appropriate, the patient should be informed of the necessity to replace any removed or lost teeth.
The dentist should inform the patient that he or she should participate in a prescribed program of continuing care to allow the dentist to evaluate the effectiveness of the treatment provided and the status of the traumatically displaced tooth.
Documentation of treatment provided, counseling and recommended preventive measures, as well as consultations with and referrals to other health care professionals should be included in the patient's dental record.