A 5-year-old child is hit in the face with a baseball bat and presents with avulsed primary maxillary incisors. What is the recommended initial management?

• A. Prescribe tetracycline 4.4 mg/kg twice daily for 7 to 10 days.
• B. Refer the child to a dentist for reimplantation of the avulsed teeth.
• C. Refer the child to a dentist immediately for further examination.
• D. Remove the teeth, place them in saline, and refer the child to a dentist.

Answer: (C)

In primary dentition trauma, avulsed primary teeth are not replanted because doing so can damage the developing permanent tooth buds and lead to eruption problems or ankylosis. The safest and most appropriate first step is to have the child seen by a dentist immediately for a thorough examination and radiographs if needed. This allows the dentist to assess for other injuries, evaluate the soft tissues, and determine the best plan of care, which typically does not involve reimplanting the avulsed primary teeth.

Antibiotic therapy with tetracycline isn’t indicated, and attempting to “remove” and store the primary teeth or replant them is not advised. The emphasis is on urgent dental evaluation to guide appropriate ongoing management.