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Examination Following Oral Injury
History and mechanism of injury are extremely important in predicting the likely type of oral injury. Airway, breathing, and circulation (ABC’s) are paramount, and life-threatening injuries should be addressed immediately.
A complete neurologic examination is necessary, as oral injuries are often accompanied by more generalized head trauma.

Once the patient has been stabilized, a thorough examination of the mouth is mandatory and should encompass the following steps:

Irrigate to remove blood and debris and improve visualization.
Examine soft tissues for edema, tenderness, and lacerations.
Examine bony structures for pain or
Malocclusion: An abnormality in the coming together of teeth.
Assess the patient’s ability to open the mouth and laterally deviate the jaw. Be especially concerned about fracture in a patient unable to perform this maneuver.
Examine the tooth ridge for “step-offs”, which can indicate a fracture of the underlying alveolar bone.
Examine the teeth for tenderness and mobility.
Account for all teeth and determine if injury has occurred to the primary or permanent dentition, as this will affect management.

Missing teeth should be accounted for. Do not assume they were lost at the scene of the accident, as they may be imbedded in soft tissues, intruded into the alveolar bone or sinus cavity, aspirated, or swallowed. Radiographs (soft tissue and chest X-rays) should be done to look for missing teeth. Consider tetanus prophylaxis for wounds or lacerations if the primary tetanus series was not completed or the patient has not received a booster within 5 years.
Inability to open and laterally deviate the jaw following trauma is concerning for fracture.
Physicians should attempt to locate missing teeth following an accident.

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