ADC Practice Question — Traumatic Dental Injuries — Permanent Teeth

For which patient is 'no treatment at the emergency visit' explicitly listed as an acceptable management option?

OMS questions focus on surgical decision-making with medical comorbidities that change the surgical plan. This exam-level vignette tests your ability to work through clinical details and arrive at the correct management.

Two children present with complicated crown fractures (pulp exposure). Patient A is a 10-year-old boy with a fractured permanent upper central incisor (tooth 11, open apex). Patient B is a 3-year-old girl with a fractured primary upper central incisor (tooth 51). Both children are distressed. A paediatric dental team is available for referral within 2 days. For which patient is 'no treatment at the emergency visit' explicitly listed as an acceptable management option?

A. Neither patient — pulp exposure always requires immediate treatment
B. Patient A (permanent tooth) only — immature permanent teeth can safely wait for specialist treatment
C. Both patients — emergency deferral is acceptable for any complicated crown fracture
D. Patient B (primary tooth) only — no treatment is acceptable at the emergency visit when rapid referral to a child-oriented team is available

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Sources cited

Therapeutic Guidelines v4 Odell's 3rd & 4th Ed IADT 2020 Code of Conduct CMS (Evans) Infection Control + more

Show the answer and cited explanation

Correct answer: D

This captures the fundamentally different emergency management philosophy between primary and permanent teeth: Permanent teeth: treat at the emergency visit. Partial pulpotomy is recommended for both immature and mature teeth. Primary teeth: 'no treatment may be the most appropriate option in the emergency situation, but only when there is the potential for rapid referral (within several days) to the child-oriented team.' The reasoning: each treatment option for primary teeth is invasive and has the potential to cause long-term dental anxiety. A TDI is often the child's first dental encounter. Minimising the trauma of the dental visit itself is a legitimate clinical priority. SOURCE — IADT Guidelines 2020, Fractures and Luxations Table 4; Primary Dentition Table 3

Source: IADT Guidelines 2020 — Fractures and Luxations Table 4; Primary Dentition Table 3

Remy's study tip — Check the patient’s medical history first — anticoagulants, bisphosphonates, immunosuppression change management.

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