What does this alert you to?

The possibility of legal action against the school. It is especially important to make drawings of any external injuries on the face and keep accurate records of intraoral injuries and subsequent treatment. A photographic record will be an advantage.

What specific questions would you ask and why?

Was there any loss of consciousness? If there was, then Andrea should be referred to an accident and emergency department.

Is there any pain or discomfort while opening and closing the jaw? Absence of symptoms should rule out any condylar injury/fracture. When the force that produces an injury is significant then it should raise suspicion of a deeper underlying bony injury. Bony injury would be more likely in Andrea’s case compared to the scenario of root fractures on teeth that had been produced by less force.

What questions and examination would you complete regarding the swelling and bruising under the right eye?

Is there any double vision? Palpate the infraorbital margin for ‘stepping’ and then check for altered sensation over the distribution of the infraorbital nerve. Check that there is a full range of eye movements – especially upward gaze. Fracture of the infraorbital margin and infraorbital floor could lead to entrapment of the inferior oblique extraocular muscle preventing upward and outward movement of the globe of the eye.

Is there any altered sensation on the cheek? Oedema surrounding the infraorbital nerve or entrapment of the nerve in a fracture can result in paraesthesia.

If there is any doubt about a fracture then posteroanterior and occipitomental views will detect displacement of the infraorbital margin, and tomograms will detect orbital floor ‘blow-out’ fractures.

What tests would you do prior to repositioning of the teeth?

Radiographs. Intraoral periapicals (Fig. 31.1) or an anterior occlusal view are needed to diagnose root fractures compared to luxation injuries. The upper lateral incisors should also be checked for injury. Consideration should also be given to taking radiographs of the lower incisors, which may also have received either direct or indirect trauma. Where there is no significant displacement of the coronal portion of a tooth with a root fracture, then an anterior occlusal radiograph will often detect root fractures that may not be so evident on periapical views. These radiographs will serve as baseline views prior to repositioning.

Vitality tests of all upper and lower incisors.

What design of splint would you use for

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