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Dental Emergencies Pediatric Dentistry Supporting Your Practice

Improving the Quality of Dental Trauma Care: Two Cases


Dr. Raymond Lee, Chief of Dentistry at the London Health Sciences Centre, spoke with Dr. John O’Keefe about some common mishaps occurring when treating children with traumatic dental injuries.


Dr. Lee has learned from experience that assumptions can sometimes lead to increased pain and less desirable outcomes for young patients.

Dental trauma, including fractured teeth, are frequent in young children that have not gained their balance when learning to walk for example. As such, these young children will present frequently with injuries ranging from slight extrusion to complete avulsion of the teeth as the primary teeth have short roots and the bones are still soft. In contrast, older children with permanent teeth presenting with dental trauma will usually suffer from fractured teeth. The permanent teeth have longer roots and the bone surrounding them is stronger and as such, the forces sustained during injury results in coronal fractures.

What to look for

  • Do not assume that teeth or pieces of teeth are not present because they are not visible.
  • Radiographs are useful to help rule out intrusion, displacement of pieces of teeth in the soft tissue.
  • If young children present with avulsed teeth and they cannot be found and conventional dental radiographs do not show they are intruded or displaced in the hard or soft tissue of the oral cavity, a chest X-ray may be indicated to rule out aspiration.
  • Oral lacerations should be carefully examined to ensure fractured pieces of teeth are not embedded in them.

Remember, the overall goal of our treatment is to improve the quality of life and the outcome of treatment in our patients.



Dr. Lee is from Waterloo, Ontario.  He received a Bachelor of Mathematics (BMath, 1988) from the University of Waterloo, earned his Doctor of Dental Surgery (DDS, 1991) from the University of Western Ontario, and then completed an internship/residency at the Hospital for Sick Children in Toronto (1991).  His paediatric specialty training included a Diploma in Paediatric Dentistry (DipPaed, 1995) from the University of Toronto, a Masters in Science (MSc, 1996) completed at the Hospital for Sick Children through the University of Toronto, and a Fellowship in Paediatric Dentistry (FRCD(C), 2003) from the Royal College of Dentists of Canada. 

Dr. Lee has been in private practice since returning to London in 1995.  He has also been an Adjunct Professor at the Schulich School of Medicine and Dentistry, Western University since then.  Dr. Lee became the Staff Paediatric Dentist at Children’s Hospital, London Health Sciences Centre in 1997, and has been Site Chief, Paediatric Dentistry at Victoria Hospital since 2008.  He remains cross-appointed with the Division of Paediatric Surgery, Department of Surgery, since its inception in 2004.  In Toronto, Dr. Lee has been a staff member of the Program for Persons with Disabilities at Mount Sinai Hospital, Toronto since 2003.  He has also been cross-appointed at the University of Toronto as an Associate-In-Dentistry since then, and served as an Assistant Professor from 2012 to 2016. 

In general, Dr. Lee continues to be heavily involved in undergraduate and post-graduate teaching programs in Paediatric Dentistry at both dental schools in Ontario, while maintaining a private, hospital-based clinical practice.

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