108 - Management of Pediatric Dental Emergency Based on Location, Provider Background and Training

Background
The most common pediatric dental emergencies are from trauma and toothaches from untreated dental caries. This study aims to see if there are differences in how pediatric dental emergencies are managed within a teaching hospital across healthcare providers of different training backgrounds within various clinical settings.

Method
This study was conducted via retrospective chart review. Inclusion criteria for charts were pediatric patients seen for chief complaints of dental pain between July 2021 and June 2023 at the Emergency Department (ED) of St. Joseph's University Medical Center (SJHMC) and Family Health Center Dental Clinic (FHC). The study population was pediatric patients who were under the age of 15 years old. Eligible charts were reviewed in the ED for the following variables of interest: Encounter type, provider type, dental consult, treatment provided, behavior management aid, prescriptions, recommendations, and hospital stay. The analyzed variables for the FHC dental clinic include encounter type, dental resident type, attending type, procedures, and behavior management aids.

Results
In every case in the ED where there was swelling associated with dental caries, the dental department was consulted as compared to dental pain without swelling and trauma, in which the dental department was much less likely to be consulted with a p-value of <1.247. In the case that the dental department was consulted, there was a difference in management depending on which dental residents were involved in care, with the p-value shown to be <1.118; the data showed surgery and medicine or surgery alone mainly was done under a dental consult when compared to the patient was only seen by medical. There was also a difference within the dental department in management with the P value of <3.374; surgery or surgery with medication was done mainly by oral surgery residents, followed by pediatric residents, followed by GPR residents. Medication and no treatment were seldom done by all dental residents. In the dental clinic, there was no difference between the treatment and provider, but there was a difference in behavior management, with the p-value shown to be 0.003732. Pediatric residents and pediatrics attending when paired together tend to use more behavior management aids, and GPR residents and GPR attending when paired together tend not to do any behavior management such as physical or pharmacological aids such as papoose or nitrous oxide.

Conclusion
The differences in treatment depending on the encounter setting can be attributed to the scope of practice of attending doctors within the emergency department versus the dental clinic and the equipment available. Additionally, there was a statistically significant difference in presentation. Emergencies that presented to the emergency department were more likely to have facial swelling. Emergencies seen at the clinic were more likely to be trauma or dental pain without noticeable facial swelling. This difference is expected from families with an established dental home, knowing to bring their child to the dentist when the child reports pain, compared to families without a dental home who may wait until significant swelling before seeking medical attention. The primary area in which AAPD recommendations were followed when dental emergencies were seen at the pediatric emergency department, and many patients were lost to follow-up, maybe because instructions were not explicitly provided when patients were discharged. It could be an oversight in the documentation rather than a lack of knowledge, given that the hospital clinicians consistently know to call the dental department when facial swelling occurs. The patient just went to another dental clinic that was not located at the hospital. Dental emergency at the dental clinic, pediatric residents were more likely to perform behavior management.