Guidelines for the evaluation and management of traumatic dental injuries.

Abstract

Epidemiological studies reveal that one out of two children sustains a dental injury, most often between the ages of 8 and 12. Crown fracture is the most frequent type of trauma, generally resulting from accidents, sport activities, or violence. In most dental trauma, a rapid and appropriate treatment can lessen its impact from both an oral health and an aesthetic standpoint. New technology and an improved understanding of the inflammatory process have led to a more conservative approach in managing dental trauma. The International Association of Dental Traumatology (IADT), conscious of the variation in the treatment of dental trauma, has developed these guidelines as a type of consensus statement. These guidelines reflect much thoughtful discussion among members of the IADT as well as a detailed review of international dental literature. In cases in which the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. Guidelines are needed to assist dentists as well as other health care professionals in delivering the best care possible in the most efficient manner. It is very important to promote public awareness and to educate the population at greatest risk for dental injury. Therefore, this report includes basic information on both prevention and first aid. The correct application of these techniques immediately following the trauma should improve short and long-term outcome. Because the management of injuries to the primary and permanent dentition differs significantly, separate guidelines have been developed for children with primary dentition and cases where permanent teeth are involved. In addition, these guidelines do not address issues relating to the diagnosis and treatment of major facial trauma of the bone and soft tissue, which is a critical first step in the overall management of trauma patients. The evaluation and treatment of maxillofacial trauma that may coexist with dental trauma, goes beyond the scope of these recommendations. The classifications listed below summarize diagnostics steps and therapeutic interventions and will be referenced throughout the guidelines. x Conditions for which there is evidence and/or general agreement that a given procedure or treatment is beneficial, useful, and effective. xx Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment. xxx Conditions for which there is evidence and/or general agreement that a procedure/treatment is not useful/effective and in some cases may be harmful. Andreasen JO, Andreasen FM, Bakland LK, Flores MT. Traumatic dental injuries. a manual. Copenhagen: Munksgaard; 1999. Andreasen JO, Andreasen FM. Textbook and color atlas of traumatic injuries to the teeth, 3rd edn. Copenhagen: Munksgaard; 1994. Andreasen JO, Ravn JJ. Epidemiology of traumatic dental injuries to primary and permanent teeth in a Danish population sample. Int J Oral Surg 1972;1:235–9. Blomlof L. Milk and saliva as possible storage media for traumatically exarticulated teeth prior to replantation. Swed Dent J 1981;Suppl 8:1–26. Cvek, M. Endodontic management of traumatized teeth. In: Andreasen JO, Andreasen FM, editors. Textbook and color atlas of traumatic injuries to the teeth, 3rd edn. Copenhagen: Munksgaard; 1994. Cvek M. Changes in the treatment of crown-fractured teeth during the last two decades. In: Proceedings of the Second International Conference on Dental Trauma; 1991. p. 53–64. Ryan TJ, Anderson JL, Antman EM, Brannif BA, Brooks NH, Califf RM, et al. ACC/AHA guidelines for the management of patients with acute myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Management of Myocardial Infarction). J Am Coll Cardiol 1996;28:1328–428. Tronstad L. Pulp reactions in traumatized teeth. In: Gutmann JL, Harrison JW, editors. Proceedings of the International Conference on Oral Trauma. Chicago: AAE; 1986.