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  • Avulsed primary teeth should not be replaced. Avulsed permanent teeth should be reimplanted as soon as possible.
  • Always consider aspiration when a tooth/tooth fragment cannot be located.
  • Fractures of primary teeth may be a sign of child abuse. The presence of Neisseria gonorrhoeae pharyngitis in a child suggests sexual abuse.
  • Physicians should maintain a high index of suspicion for carotid injury in a patient with trauma to the oropharynx.
  • Uncomplicated dental infections are treated on an outpatient basis. Deep fascial space infections often require hospitalization, IV antibiotics, and surgical drainage.
  • Suppurative complications of pharyngitis include peritonsillar abscess, Lemierre's postanginal sepsis, and Ludwig's angina.
  • Needle aspiration may be employed diagnostically to differentiate between peritonsillar cellulitis and peritonsillar abscess. Definitive treatment may be achieved via aspiration, incision and drainage, or tonsillectomy in selected cases.
  • Airway assessment is important in suspected cases of peritonsillar abscess, retropharyngeal abscess (RPA), and Ludwig's angina. Definitive management of unstable airways is best achieved in the operating room with the assistance of an anesthesiologist or an ENT specialist. Emergency airway equipment should be available at the bedside.


Emergencies pertaining to the oral cavity and neck can be broadly divided into four categories: dental trauma, oropharyngeal trauma, dentoalveolar infections, and soft tissue infections. Facial and neck trauma are covered in Chapters 34 and 19, respectively.


Tooth development begins in utero, with completion of mineralization of all primary (deciduous) teeth prior to birth. Eruption of the primary teeth begins with the lower central incisors between 6 and 10 months of age. The primary dentition consists of 20 teeth with eruption usually completed by 33 months. Eruption of the secondary (permanent) teeth begins with the lower central incisors at approximately 6 years of age. Full secondary teeth eruption is usually completed by 21 years of age and consists of 32 permanent teeth.


A tooth is composed of a neurovascular center, or pulp, which is surrounded by dentin (Fig. 91–1). The exterior surface of the tooth, or crown, is covered by enamel. The root of the tooth is protected by cementum and is attached to alveolar bone by the periodontal ligament (PDL).


The oral cavity is lined by mucosa composed of stratified squamous epithelium. The superior portion is formed by the hard and soft palates, while the inferior portion is formed by the tongue and its supportive structures. The oral cavity is bordered laterally by the cheeks which are supported by buccinator muscles. The vestibule is the space between the cheeks/lips and teeth. Gingiva covers the alveolar surfaces of the maxilla and mandible.1


Approximately 30% of preschool-aged children suffer injuries of the primary dentition, equally distributed between males and females.2 Among school-aged children, trauma to permanent incisors occurs in approximately 23% of boys and 13% of girls.3 Falls ...

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