Given the alveolar fracture AND the penicillin allergy, what is the correct combined splint + antibiotic protocol?
Dental trauma questions test protocol-level decisions — splint type, duration, follow-up timing — where one wrong detail means a wrong answer. This high-difficulty vignette tests your ability to work through clinical details and arrive at the correct management.
A 9-year-old with penicillin allergy (anaphylaxis) has an avulsed upper left central incisor with an open apex. The tooth was dry for 15 minutes, then stored in milk for 40 minutes. Radiographs reveal a buccal alveolar wall fracture. The dentist replants the tooth and plans the complete management protocol. Given the alveolar fracture AND the penicillin allergy, what is the correct combined splint + antibiotic protocol?
- A. Flexible splint for 2 weeks plus amoxicillin — the allergy record may be outdated and should be challenged
- B. Rigid splint for 4 weeks plus an alternative antibiotic — both protocols must be modified for this patient
- C. Flexible splint for 2 weeks plus doxycycline — standard wire splint regardless of fracture in children
- D. Rigid splint for 4 weeks but no antibiotics — the fracture contraindicates systemic antibiotic therapy
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Integration: (1) Alveolar fracture → rigid splint, 4 weeks (not standard 2-week flexible). (2) Penicillin allergy → alternative antibiotic (not amoxicillin). (3) Age 9 → doxycycline not recommended (<12). Three interacting modifications. SOURCE — Fouad AF et al. IADT Avulsion Guidelines, Dent Traumatol 2020;36:331-342, Sections 3.2.2, 5
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