Title: Facial soft tissue injuries associated with dental trauma: A decision making framework for dental practitioners
Abstract:
Background: Facial soft-tissue injuries frequently accompany dental trauma and may involve the lips, cheeks, peri-oral tissues, or extra-oral skin. While dental practitioners routinely assess dento-alveolar injuries, confidence in the assessment and management of associated facial lacerations is variable. Inappropriate referral increases pressure on secondary care; conversely, inappropriate primary closure risks infection, poor aesthetic outcomes, neurovascular injury, or missed co-existing head injury.
Objective: To develop a practical, safety-focused decision-making framework to support dental practitioners in assessing, initially managing, and appropriately escalating facial soft-tissue injuries associated with dental trauma to oral and maxillofacial surgery (OMFS) services.
Methods: A narrative clinical review was undertaken using current guidance and published literature relating to facial laceration assessment, wound biology, referral criteria, and closure techniques. Findings were synthesised into a structured clinical pathway for dental settings, supported by illustrative cases of facial soft-tissue trauma managed in secondary care.
Results: Key decision points identified include: injury mechanism and timing; wound contamination; tetanus status; medical risk factors; safeguarding concerns; head injury red flags; anatomical site; wound depth; tissue loss; neurovascular involvement; and patient cooperation. The proposed pathway distinguishes wounds suitable for primary dental care management from those requiring urgent hospital referral. Practical principles include early assessment, thorough wound irrigation, tension-free tissue approximation, appropriate suture selection, structured safety-netting advice, and recognition of high-risk anatomical and systemic features.
Conclusion: Facial soft-tissue injuries should be considered an integral part of dental trauma assessment, not an adjunct to it. A structured decision-making framework can support dental practitioners in confidently identifying minor wounds suitable for local management while ensuring timely and appropriate referral of complex or high-risk injuries to OMFS. This approach has the potential to improve patient safety, optimise aesthetic outcomes, and support more appropriate use of secondary care services.
