Dental Trauma Cases Research Articles

A retrospective study of traumatic dental injuries

The prognosis of dental trauma cases varies depending on the time elapsed after the trauma before treatment started. The aim of this study was to examine epidemiological and dental data from traumatic injuries to primary and permanent teeth during the period from 2005 to 2010. The examinations aimed to determine the age and sex distributions of patients, the causes of tooth injury, the type of teeth injured, the monthly distribution of the trauma, the time elapsed between injury and treatment, and the classification of the traumatized teeth and their treatments. The dental trauma records of patients with an average age of 9 years, including 120 girls (35.3%) and 220 boys (64.7%), were evaluated. The most commonly affected teeth were the maxillary central incisors (66.24%). The main cause was falls (70.1%). In primary dentition, subluxation (36.4%) was observed in the highest percentage of injured teeth, and in permanent dentition, the most common observation was uncomplicated crown fractures (44.9%). Only 18 patients (2.9%) were referred to the clinic within 1 h following the injury. The most frequent treatment for primary teeth was examination and follow up (63.9%). Restoration with composite resin (26.3%) and root canal treatment (28.6%) were the most common procedures for permanent teeth. It was revealed that although the most frequent type of injury in permanent dentition was uncomplicated crown fracture, the root canal treatment was the most common treatment in permanent dentition. This finding suggests that when the checkup time after the injury was delayed, the pulp could lose vitality. This finding reveals that it is important to inform the parents about dental trauma and the importance of bringing their children fast to a dentist in trauma cases.

Dental Trauma Guide: A source of evidence‐based treatment guidelines for dental trauma

Diagnosis and treatment for traumatic dental injuries are very complex owing to the multiple trauma entities represented by six luxation types and nine fracture types affecting both the primary and the permanent dentition. When it is further considered that fracture and luxation injuries are often combined, the result is that more than 100 trauma scenarios exist, when the two dentitions are combined. Each of these trauma scenarios has a specific treatment demand and prospect for healing. With such a complexity in diagnosis and treatment, it is obvious that even experienced practitioners may have problems in selecting proper treatment for some of these trauma types. To remedy this situation, an Internet-based knowledge base consisting of 4000 dental trauma cases with long-term follow up is now available to the public and the professions on the Internet using the address http://www.DentalTraumaGuide.org. It is the aspiration that the use of this Guide may lead the practitioner to offer an evidence-based diagnosis and treatment.

Should Medical Students Be Educated About Dental Trauma Emergency Management? A Study of Physicians and Dentists in Kerman Province, Iran

Since physicians sometimes need to attend a case of dental trauma, it is necessary that they possess sufficient knowledge of management of traumatic dental emergencies. This study was conducted to assess the knowledge of dental trauma among dentists and physicians. A three-part questionnaire, including demographic data, knowledge, and self-assessment, was administered to 104 dentists and 151 physicians in Kerman Province, Iran. Data obtained from 255 completed questionnaires were statistically analyzed using t-test, Mann-Whitney U test, chi-square, and Pearson correlation coefficient. Among the physicians, only fourteen (9.3 percent) had received education regarding dental trauma. In contrast, seventy-seven dentists (74 percent) had received information on what to do if a tooth is traumatized. Regarding knowledge level, only 10.6 percent of the physicians had high knowledge, while 66.3 percent of the dentists demonstrated high knowledge. The differences of knowledge level between the two groups were statistically significant (p=0.0001). More than half of the dentists (58.3 percent) and nearly all the physicians (98.7 percent) were dissatisfied with their level of knowledge and suggested that further education on the topic should be offered.

Dental Trauma Guide: A source of evidence‐based treatment guidelines for dental trauma

Diagnosis and treatment for traumatic dental injuries are very complex owing to the multiple trauma entities represented by six luxation types and nine fracture types affecting both the primary and the permanent dentition. When it is further considered that fracture and luxation injuries are often combined, the result is that more than 100 trauma scenarios exist, when the two dentitions are combined. Each of these trauma scenarios has a specific treatment demand and prospect for healing. With such a complexity in diagnosis and treatment, it is obvious that even experienced practitioners may have problems in selecting proper treatment for some of these trauma types. To remedy this situation, an Internet-based knowledge base consisting of 4000 dental trauma cases with long-term follow up is now available to the public and the professions on the Internet using the address http://www.DentalTraumaGuide.org. It is the aspiration that the use of this Guide may lead the practitioner to offer an evidence-based diagnosis and treatment.

First-Aid Algorithms in Dental Avulsion

Almost one fourth of traumatic dental injuries occur at schools or in their surroundings. Prevalence of tooth avulsion varies from 0.5% to 16% of all cases of dental trauma. Children with dental avulsion may seek help from school nurses so they should be able to provide first-aid treatment. However, many studies showed that the general level of knowledge of medical staff concerning tooth avulsion is unsatisfactory and that it could be improved by educational activities. This article attempts to give short algorithms of first-aid management of avulsed tooth.

Occurrence of traumatic dental injury in cases of domestic violence

The purpose of this study was to investigate the prevalence and types of traumatic dental injuries in situations of domestic violence. A coross-sectional study was conducted and data were collected from the police occurrence records to domestic physical aggression between 2001 and 2005. Of the 1,844 subjects who underwent medical evaluation, 15 had information pertaining to traumatic dental injuries. From the medical records, the forensic medical reports completed by the forensic medical experts who examined the victims after the aggression were reviewed and data of individuals with dental injuries (e.g., fractures, luxation and avulsion) were collected. In the selected sample, there was a predominance of individuals with injuries to the head and neck region (38.7%), and the frequency of traumatic dental injuries among all injuries to the head and neck region was 2.0%. The most frequently injured teeth were the maxillary incisors (31.8%), followed by the mandibular incisors (27.3%) and the maxillary canines (9.1%). In 31.8% of the injured teeth, the forensic experts did not specify the nomenclature. Of the dental trauma cases, 59.1% were fractures, 27.2% were luxations and 13.7% were avulsions. In conclusion, domestic violence was an important etiologic factor of traumatic dental injury. The aggression in all cases occurred in the form of punches and slaps. Fracture was the most common type of traumatic dental injury, and the most frequently injured teeth were the incisors.

Guidelines for dental radiography immediately after a dento‐alveolar trauma, a systematic literature review

The objective with this study was to search for and to analyze the presence of scientific papers, guidelines, and recommendations in dental literature regarding which radiographs should be prescribed after a dento-alveolar trauma. We know from earlier that guidelines and recommendations are available in general in dental traumatology. The International Association of Dental Traumatology (IADT) has earlier developed guidelines for the management of dental trauma cases in general. There are also recommendations about useful intraoral radiographic methods when caries and periodontal disease are studied. An additional objective was to provide some guidelines for general practitioners about the most accurate radiographic examination immediately after a dento-alveolar trauma using intraoral radiographs or a common extraoral imaging method. Because radiographs are an important diagnostic tool for establishing a correct differential diagnosis after a trauma, radiographic guidelines and recommendations are of importance to be able to start the correct treatment. PubMed Central, Cochrane and World Wide Web were searched and the identified existing guidelines for different intraoral radiographic methods in dentistry were analyzed and found to be very few. Those that were identified were in general not so detailed and specific. In conclusion, we found an explicit need for more detailed guidelines regarding which intraoral and other dental radiographs should be prescribed initially in dental traumatology.

Elementary school staff knowledge and attitude with regard to first‐aid management of dental trauma in Iran: a basic premise for developing future intervention

The purpose of this study was to evaluate Iranian teachers' knowledge and attitude with regard to emergency management of dental trauma. A four-part questionnaire, including demographic data, knowledge, attitude, and self-assessment, was given to 422 teachers from 14 schools. Data obtained from 400 completed questionnaires were statistically analyzed using t-test, one-way anova and Pearson correlation coefficient. It was found that there was no statistically significant difference between knowledge and demographic variations (P > 0.05). However, there was a moderate positive association between knowledge and attitude toward emergency management of dental trauma (r = 0.38, P = 0.0001). The outcome indicated completely inadequate knowledge regarding the management of tooth fracture and avulsion. Most participants (94.3%) were unsatisfied with their awareness and suggested that further education on the topic should be offered. The present study revealed considerably low knowledge of the participants regarding the first-aid management of dental trauma for the study group. As teachers get an opportunity to attend a case of dental trauma, strategies to improve the teachers' knowledge seem crucial.

Multiple traumatic dental injuries: a case report in a young individual from the Samnitic necropolis of Opi Val Fondillo (VI–V century BC; Central Italy)

Traumatic dental injuries, although apparently rare in archaeological populations, can be found under certain circumstances affecting the dentition in a variety of ways. This paper contributes to the paleopathology literature by reporting one case of dental trauma. Evidence for differentiating antemortem/ perimortem dental trauma from postmortem damage is presented, and it is suggested that these injuries were sustained due to an accidental fall, supported by the morphology, location and extension of the injuries and characterization of the impact. These data provide a valuable information for a reconstruction of past behaviors in the Samnitic necropolis of Opi Val Fondillo (VI–V century BC; Central Italy).

Education on and prevention of dental trauma: it’s time to act!

Dental trauma is, unfortunately, not uncommon and may be even more prevalent in high-risk populations. It should be emphasized and acknowledged that many cases of dental trauma are preventable. Appropriate management includes primary prevention, i.e. avoidance of pathology development, and secondary prevention, i.e. early diagnosing and treatment of the pathology before significant morbidity occurs. The aim of this article is to provide a review of the current dental trauma literature with regard to education and knowledge and with relevance to primary and secondary prevention. As the duty of providing the public with measures for the maintenance of proper oral health is of the dental profession, the responsibility of providing primary and secondary prevention of dental trauma is of dentists, dental hygienists, and dental nurses. They may, and should, educate other medical, paramedical, and non-medical professionals, taking into account that those non-dental professionals could not maintain a high level of knowledge and service regarding dental trauma without a continuous backing by the dental professionals. It should be remembered that as the prevalence of dental decay has reduced in the Western world during recent decades, dental trauma plays a significant part in causing dental morbidity and mortality (tooth loss). It seems that now is the time to act for the benefit of our community and move from 'treating' toward 'managing' risk factors and prevention.

Non-accidental collision followed by dental trauma: associated factors

The aim of the present cross-sectional survey was to assess factors associated with non-accidental collision followed by dental trauma among adolescents in the city of Diamantina, Brazil. A total of 387 students from 12 to 15 years of age (mean = 14 SD = 0.9) were randomly selected. The study was carried out in two stages. Firstly, data were collected through dental examinations of permanent incisors. Secondly, a thorough interview was held with 85 adolescents who exhibited dental trauma in the dental examinations. The interview consisted of a detailed description of the incident and physical environment in which it occurred. Descriptive analysis and the chi-square test (P < 0.05) were performed. The prevalence of dental injury was 22% (n = 85). Dental trauma was more prevalent in boys (P = 0.001) and individuals with overjet >3 mm (P = 0.007) and inadequate lip coverage (P = 0.013). Analysis of the event revealed that 22.3% of the cases of dental trauma occurred because of non-accidental collision. Non-accidental collision followed by injury occurred mainly at school (P < 0.001) and in an environment with a concrete, tiled or ceramic floor (P = 0.001). No statistically significant associations were found between non-accidental collision and gender, age or mother's schooling. It was concluded that the non-accidental collisions happened especially at school and in indoor environments with a concrete, tiled or ceramic floor.

Influence of a Parafunctional Oral Habit on Root Fracture Development After Trauma to an Immature Tooth

Root fractures in immature teeth are rare because the resilience of the alveolar bone is more favorable to the occurrence of luxation. This article reports a case of traumatic injury in an immature permanent tooth that progressed to root fracture, having a parafunctional oral habit as the possible modifying factor of case evolution. A 12-year-old boy presented for treatment complaining of a defective restoration and mild pain on the maxillary right central incisor. The patient had a history of crown fracture in this tooth due to trauma 2 years before. The clinical examination showed healthy gingival tissues and no abnormal tooth mobility, whereas radiographic projections revealed healthy periradicular tissues, incomplete root formation, and no visible root fracture. As pulp necrosis was diagnosed, calcium hydroxide therapy was started for canal disinfection and subsequent obturation. However, after 4 weeks of treatment, a horizontal fracture line was observed radiographically in the root's middle third. The patient denied a new traumatic injury, but revealed the habit of chewing on a pencil. Refraining from the deleterious oral habit was strongly advised, and root canal filling with mineral trioxide aggregate was performed to treat the root fracture. After 4 years of follow-up, the tooth has normal function and no abnormal mobility. Images suggestive of remodeling at the apical end of the coronal segment and replacement resorption of the apical segment are seen radiographically. This case demonstrates the need of following cases of dental trauma and the possible influence of parafunctional oral habits as modifying factors of case progression.

Evaluation of care of dentoalveolar trauma

ObjectivesThe aim of this study was to evaluate cases of dental trauma treated at the specialized center of Pontifical Catholic University of Paraná, Curitiba, Brazil, during a period of 2 years.Material and MethodsA total of 647 patients were evaluated and treated between 2003 and 2005. Data obtained from each patient were tabulated and analyzed as to gender, age, etiology, time elapsed after the injury, diagnosis (type of trauma), and affected teeth.ResultsThe results revealed that male individuals aged 7 to 13 years presented the highest prevalence of injury, and falling was the main causal factor. In most cases, the time elapsed between the accident and the first care ranged from 4 to 24 h. A total of 1,747 teeth were affected, with higher incidence of concussion/subluxation and coronal fracture, followed by lateral luxation and avulsion. The permanent maxillary central incisors were the most commonly affected teeth.ConclusionThe frequency and causes of dentoalveolar trauma should be investigated for identification of risk groups, treatment demands and costs in order to allow for the establishment of effective preventive measures that can reduce the treatment duration and costs for both patients and oral health services.

A geographical population analysis of dental trauma in school-children aged 12 and 15 in the city of Curitiba-Brazil.

BackgroundThe study presents a geographical analysis of dental trauma in a population of 12 and 15 year-old school-children, in the city of Curitiba, Brazil (n = 1581), using a database obtained in the period 2005-2006. The main focus is to analyze dental trauma using a geographic information system as a tool for integrating social, environmental and epidemiological data.MethodsGeostatistical analysis of the database and thematic maps were generated showing the distribution of dental trauma cases according to Curitiba's Health Districts and other variables of interest. Dental trauma spatial variation was assessed using a generalized additive model in order to identify and control the individual risk-factors and thus determine whether spatial variation is constant or not throughout the Health Districts and the place of residence of individuals. In addition, an analysis was made of the coverage of dental trauma cases taking the spatial distribution of Curitiba's primary healthcare centres.ResultsThe overall prevalence of dental trauma was 37.1%, with 53.1% in males and 46.7% in females. The spatial analysis confirms the hypothesis that there is significant variation in the occurrence of dental trauma, considering the place of residence in the population studied (Monte Carlo test, p = 0,006). Furthermore, 28.7% of cases had no coverage by the primary healthcare centres.ConclusionsThe effect of the place of residence was highly significant in relation to the response variable. The delimitation of areas, as a basis for case density, enables the qualification of geographical territories where actions can be planned based on priority criteria. Promotion, control and rehabilitation actions, applied in regions of higher prevalence of dental trauma, can be more effective and efficient, thus providing healthcare refinement.

Knowledge of emergency management of avulsed teeth: a survey of dentists in Beijing, China

There is a high frequency of dental trauma cases in China, where tooth avulsion is one of the most serious scenarios. The knowledge of how to take care of an avulsion is of great importance to the outcome of such an injury. This knowledge among dentists in Beijing, China has never been tested before. The purpose of this study was to evaluate professional experience and knowledge of emergency management of dentists working in urban and suburban areas of Beijing, China. A two-part questionnaire was distributed to 175 urban and 99 suburban dentists in Beijing. The first part contained personal and professional information of the participating dentists. The second part evaluated dentists' knowledge about the emergency management of avulsed teeth. Data were entered into a SPSS database and analyzed using the chi-square test and Fisher's exact test for each question. All dentists had a college or above degree. Almost five times as many urban dentists compared to suburban dentists presented with a Master or PhD degree. The knowledge levels of the participants presenting with correct answer in the respective knowledge areas were; storage medium (15.8%) intra-canal medication (45.0%), type of splint (45.1%) and splinting period (10.2%). Significantly more urban dentists (50.6%) compared to suburban dentists (34.8%) (P = 0.016), used calcium hydroxide paste as an intracanal medicament, and significantly more urban dentists (51.3%) than suburban dentists (34.1%) chosed a flexible splint (P = 0.008). The results revealed an uneven pattern of knowledge between urban and suburban dentists regarding the emergency management of avulsed teeth. The study highlighted Chinese dentists' need for continuing education in order to improve current knowledge in emergency management of avulsed teeth.

Clinical practice

Approximately 50% of children under the age of 15 are victims of various kinds of injuries in the orofacial region. Post-traumatic complications may occur, including crown discolouration, cervical root fracture, ankylosis, root resorption and tooth loss. The most severe complication after dental injury in primary dentition can affect the developing permanent tooth germ, and various consequences may be seen several years later when the permanent tooth erupts. In the permanent dentition, the most severe dental injury affects the surrounding alveolar bone structure and will lead to loss of the tooth. Current literature emphasises that awareness of appropriate triage procedures following dental trauma is unsatisfactory and that delay in treatment is the single most influential factor affecting prognosis. What should a paediatrician know, and more importantly, how should he/she advise parents and caretakers? In an emergency situation such as tooth avulsion, reimplantation within 30 min is the best treatment option at the site of the accident. If reimplantation of the tooth is impossible, milk, saline or even saliva are the preferred transport media. The prognosis for an avulsed tooth depends upon prompt care, which is a determinant factor for successful treatment of the traumatised tooth. In all other dental trauma cases, it is important to refer the child to a paediatric dentist, to follow up the healing process and reduce late post-traumatic complications. With timely interventions and appropriate treatment, the prognosis for healing following most dental injuries is good. In conclusion, it is important that paediatricians are able to inform parents and caretakers about all possible and long-lasting consequences of different dental injuries.

Awareness of management of dental trauma among medical professionals in Pondicherry, India

The aim of the study was to establish the level of knowledge on the management of dental trauma among physicians at Pondicherry, India. A questionnaire was designed and was given to physicians working in medical colleges or as residents in advanced training programs in medicine in Pondicherry, India. The questionnaire contained a clinical situation of tooth avulsion and various treatment options. Only 5.5% of the medical professionals knew about reimplantation and none knew that the patients' mouth was the best transport medium. 90% of them accepted that they had no knowledge on dental trauma management. As the physicians get an opportunity to attend a case of dental trauma in emergency or private practice, it is vital that they possess sufficient knowledge on primary management of tooth avulsion, before referring to dentists.

Dental Data of the Athens 2004 Olympic and Paralympic Games

The Athens University, School of Dentistry, accepted the challenge to organize the Dental Health Services in the Athens 2004 Olympic and Paralympic Games in order to provide the best quality of oral health services to the athletes, coaches, escort members and Olympic Village personnel. Data from the whole activity protocol of the Athens 2004 Games Dental Health Services - the reception, admission and treatment protocols, the facilities and the infrastructure, the number of cases treated per specialty and the experience gained - were recorded. During the Olympic Games, there were more than 1400 dental cases in more than 650 patients, elite athletes, escort members, coaches and staff of the Olympic Village. Among them 313 fillings, 100 root canal therapies, 57 mouthguards and 9 dental trauma cases were treated. During the Paralympic Games, there were more than 240 dental cases in more than 220 patients. Among them 73 fillings, 12 root canal therapies, 21 extractions and 3 dental trauma cases were treated. In such events, highly trained dentists are needed and if possible, specialized in operative dentistry or endodontics. The role of team dentist seems to be of great importance.

Dental trauma that require fixation in a children's hospital

Children and adolescents who suffer traumatic injuries often seek emergency treatment at a Children's Hospital. Complex injuries to permanent teeth and their periodontium require immediate repositioning and stabilization. Many of these emergencies are treated by pediatric dental residents at the Women and Children's Hospital of Buffalo, Buffalo, New York. The purpose of this study was to characterize these complex injuries of permanent teeth that require emergency treatment in a Children's Hospital. All of the cases of dental trauma which had involved permanent teeth and which had been treated with a splint in 2001 and 2002 were reviewed. There were 79 patients that were between 5 and 19 years of age with twice as many males (54) as females (25). The number of males increased from childhood (5-10 years) to early adolescence (11-15 years) and then decreased rapidly in late adolescence (16-19 years), whereas the number of females decreased steadily with age. Most of the incidents occurred during the summer months (72%), particularly in June and July (42%), and Fridays and Saturdays were the busiest days of the week. Most of the injuries were caused by organized and recreational sporting activities (39%) and accidental falls (33%), followed by interpersonal violence (15%) and a few motor vehicle accidents (7%). The 173 permanent tooth injuries were mostly luxations (62%) or avulsions (20%), with only a few fractures of the alveolar bone (5%) or tooth root (1%). Most of the displacements were lateral luxations (40%) or extrusions (18%) with only a few intrusions (3%). These injuries most commonly afflicted the maxillary central incisors (54%), followed by the maxillary laterals (18%) and mandibular centrals (17%). The emergency treatment that was provided at the Children's Hospital included replantation and repositioning, and the placement of a semi-rigid or flexible splint.

Knowledge of paediatric dentistry by recently-qualified general dentists: a pilot study

To determine an overview of opinions and knowledge of paediatric dentistry amongst a group of recently-qualified dentists working within the Scottish Hospital Dental Service. A prospective questionnaire-based survey undertaken at Dundee Dental Hospital and School, NHS Tayside, Scotland. The survey evaluated dentists' opinion of managing the child patient and the location of dental treatment as well as knowledge of trauma, minor oral surgery, developmental disorders, mixed dentition problems and joint paediatric/orthodontic scenarios. Data were available for 15 dentists (M: 7; F: 8), median age 25.00 (inter-quartile range 25.40, 27.20) years. Of the respondents, 73.3% enjoyed treating children, although concerns regarding the management of both dental trauma and paediatric minor oral surgery cases were noted by 93.3% and 100% of dentists respectively. Concerning the location of treatment for the child patient, 66.7% believed that this should be 'shared-care' between the general dental practitioners (GDP) and Community Dental Service (CDS), whilst 20.0% and 13.3% observed that this should be undertaken within the CDS and GDP respectively. None of the dentists felt that treatment should be undertaken either privately or within the hospital services. Overall, dentists were best able to answer questions relating to mixed dentition and paediatric/orthodontic problems and least able to do so for minor oral surgical conditions. This pilot study offers baseline data regarding both opinions and also knowledge of paediatric dentistry amongst a group of recently-qualified dentists. Further educational opportunities in this discipline at the postgraduate level may be beneficial.