Traumatic injuries to the teeth

Abstract

Dental trauma in childhood and adolescence is common. At 5 years of age 31–40% of boys and 16–30% of girls, and at 12 years of age 12–33% of boys and 4–19% of girls, will have suffered some dental trauma. Boys are affected almost twice as often as girls in both the primary and the permanent dentitions. The majority of dental injuries in the primary and permanent dentitions involve the anterior teeth, especially the maxillary central incisors. Concussion, subluxation, and luxation are the most common injuries in the primary dentition, while uncomplicated crown fractures are most common in the permanent dentition. Prognosis of traumatic injuries has improved significantly in the last 20 years. This has been largely due to a greater understanding of dental pulp reaction patterns and vital pulp therapies. Children are most accident prone between 2 and 4 years for the primary dentition and between 7 and 10 years for the permanent dentition. Coordination and judgement are incompletely developed in children during the primary dentition years, and the majority of injuries are due to falls in and around the home as the child becomes more adventurous and explores his/her surroundings. Most injuries in the permanent dentition are caused by falls and collisions while playing and running, although bicycles are a common accessory. The place of injury varies in different countries according to local customs, but accidents in the school playground remain common. Sports injuries usually occur in the teenage years and are commonly associated with contact sports. Injuries due to road traffic accidents and assaults are most commonly associated with the late teenage years and adulthood, and are often closely related to alcohol abuse. One form of injury in childhood that must never be forgotten is child physical abuse or non-accidental injury (NAI). More than 50% of these children will have orofacial injuries (see also Chapter 4, Safeguarding Children). Accidental dental injuries can result from direct or indirect trauma. Direct trauma occurs when a tooth receives a direct blow, making this sort of injury more common at the front of the mouth.