Dental Trauma Cases Research Articles

Initial management of dental trauma: musts, shoulds, and cans.

When dental trauma occurs, initial management on the day of injury has a determining influence on healing and thus on the prognosis of the affected teeth. Improper, delayed, and/or inconsistent treatment often has far-reaching consequences that cannot be reversed later, even with great effort, especially in children and adolescents. In most cases, it is unrealistic or impossible for the patient to get to a specialized dental trauma facility in time. Therefore, it is every dental practitioner's duty to provide adequate initial diagnosis and treatment of dental trauma at their dental practice, even if they do not have routine experience in this area. This article serves as a guide to the initial management of dental trauma. It utilizes a three-tiered approach to illustrate which initial management measures are absolutely essential (MUSTS), which should ideally be performed (SHOULDS), and which are not top priorities but can be performed (CANS) if the necessary time, training and experience, and equipment and facilities are available. For further treatment, dental practitioners should realistically assess the limits of their ability to treat complex dental trauma cases and, if necessary, they should refer the patient to a specialist or specialized treatment center. (Quintessence Int 2020;51:763-774; doi: 10.3290/j.qi.a45103; modified from a previously published article (in German) Quintessenz 2019;70(9):990-1002).

Acting and knowledge of emergency rescue teams in dental trauma

Dental trauma is common in patients assisted by rescue teams at sites of accidents and by emergency teams in hospitals. However, these professionals are given little or no information about taking care of the injured teeth and mouth. The aim of this study was to evaluate the level of knowledge of rescue and emergency teams’ professionals (physicians, Nurses, and Paramedics) concerning dental trauma first management. Material and methods: 196 professionals of rescue and emergency units had received a standard questionnaire of 5 questions concerning dental trauma first management and reserving avulsed dental tissue (tooth or its fragment). The results showed high level of attendance of dental trauma patients by paramedics, nurses, and physicians, with very low-level knowledge about dealing with such cases, and with moderate results about the best medium to reserve the avulsed tooth, and the actions taken during the rescue process. Conclusions: Our results show a high occurrence of cases of dental trauma attended by rescue and emergency medical teams, with a lack of knowledge. This suggests a need for more educational campaigns for these professionals with a long-term follow-up.Keywords: Traumatic dental injury, Tooth Avulsion, Emergence rescue teams.

Terapia Preventiva Pós Traumatismo Dental na Primeira Infância por Reabilitação Protética Funcional: Relato de Caso

Objetivo: Relatar um caso de traumatismo dental na primeira infância seguido de reabilitação protética funcional, dando um enfoque à utilidade dessa terapia nos pacientes infantis acometidos por tal situação. Detalhamento do Caso: Paciente do sexo feminino, 5 anos, compareceu à Clínica da Unidade Odontológica Infantil (UOI) do Centro Universitário do Estado do Pará (CESUPA) acompanhada de sua mãe, que historiou o acontecimento de trauma dental aos 2 anos de vida da sua filha por motivo de queda em um momento de lazer com velocípede. Levando em conta a gravidade do trauma e a preocupação na preservação do espaço até a erupção do germe do dente permanente, indicou-se a confecção e instalação de um aparelho protético funcional removível com dente de estoque. No controle, observou-se boa adaptação do aparelho pela criança e funcionalidade na fonética, estética e manutenção de espaço para o dente permanente, considerando-se a eficácia da terapia para prevenção de hábitos nocivos e maloclusões futuras. Discussão: As quedas infantis são descritas na literatura como a maior causa de traumas dentais, situação que foi identificada no referido caso. Para uma eficaz reabilitação de traumatismo dental, o tratamento deve ser imediato, obedecendo ao tipo de envolvimento causado às estruturas peri-dentais.

Knowledge of Turkish general dentists about traumatic dental injuries

Aim The purpose of this study was to evaluate the knowledge of Turkish dentists on different scenarios in dental traumatology. Materials and methods A two-part online questionnaire was used to collect data. The first part included questions about practitioners' demographics, their meeting frequency for trauma cases, their self-evaluated knowledge, educational information about dentistry. The second part included multiple-choice for 10 clinical scenarios about a variety of dental trauma cases and their complications. Results A total of 472 questionnaires returned. 55.5% of participants were general dentists. Overall, 7.8% reported extensive and comprehensive knowledge about dental trauma, 55.3% considered their dental traumatology knowledge to be sufficient, but incomplete, and 36.9% self-evaluated their knowledge as insufficient. 40.9% of participants refer their patients for diagnosis and treatment mostly to endodontists, pediatric dentists, and oral and maxillofacial surgeons. In questionnaire 2, overall the correct answer average was 5.79 based on 10 clinical scenarios. The average of correct answer in 1–5 years experience group was significantly higher than the groups having experience over 10 years. Conclusion Turkish general dentists demonstrated insufficient knowledge regarding the management of traumatized teeth. Informing the students during their undergraduate education and encouraging the clinicians to follow the updates in trauma guidelines may be beneficial for a higher success in trauma cases.

The relationship of previous dental trauma with new cases of dental trauma. A systematic review and meta-analysis.

Traumatic dental injuries (TDI) are a public health concern with high prevalence and recurrence rate. The aim of this study was to perform a systematic review and meta-analysis to determine whether previous dental trauma is a predictive factor for new episodes of TDI (recurrence or first episodes). Electronic searches were performed with no language or date restrictions. According to the PECOS strategy, cohort studies that investigated subjects with and without previous TDI, and its association with new TDI episodes, as primary or secondary outcomes, were included. Quality assessment and bias control were carried out according to Fowkes and Fulton guidelines. A meta-analysis was performed by sub-grouping studies into deciduous and permanent dentition, and the risk ratio (RR) was also calculated (P≤0.05). The evidence was quality-tested using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. After titles and abstracts were examined, and full texts were read, five studies were included in this systematic review. Four studies had high methodological quality, and one presented a risk of bias on confounding factors. No association and a positive association were determined between previous history of TDI and new episodes of TDI in the primary (RR 1.26 [0.99, 1.62], P=0.06) and in the permanent dentitions (RR 2.68 [1.20, 4.19], I2 =37%, P<0.00001), respectively. The pooled results demonstrated a positive association (P<0.00001) between previous dental trauma and new episodes of TDI (RR 2.17 [1.20, 3.90], P=0.01, I2 =83%) with moderate evidence quality level. Individuals that have suffered previous TDI present a greater risk of suffering new episodes of TDI.

Dental Emergency Attendance at an Australia Tertiary Children’s Hospital

Objective: Dental emergencies are a significant impact on the health system. The resource needs are complex and consume services in the tertiary health sector. It is important that we examine the reasons and types of attendances to look for ways to mitigate this demand. The aim was to identify the rate of dental emergencies according to age groups, genders and Indigenous status.Design: A retrospective analysis of dental emergencies at the Princess Margaret Hospital (PMH; tertiary children hospital in Perth) was performed. Setting: The study included data from hard-copy files of patients admitted to the PMH.Main outcome measures: The records of 239 children who attended the PMH in Perth with dental emergency problems during the first 3 months of 2017 were analyzed. Findings: The major reasons for dental emergencies were infection and trauma. The most common age group was children between 3 to 6 years old. In this age group, boys attended more than girls due to dental injury. Although there were equal presentations of dental infection and dental trauma cases, dental infection cases mostly required hospitalization and treatment under general anesthetic. Conclusion: While some dental emergencies are unavoidable, increasing awareness about dental hygiene, regular checkups and early dental treatments in children could decrease emergency visits and prevent conditions such as dental infections

Knowledge about traumatic dental injuries in the permanent dentition: A survey of Lithuanian dentists

In Lithuania, dental trauma cases are often treated by general dentists, but it is unknown whether their age, self-evaluation of trauma knowledge and practice location can predict their actual knowledge and management of trauma cases. The aim of this study was to evaluate whether these factors can be used to predict the actual knowledge and management of trauma cases. A 2-part questionnaire included 17 multiple-choice questions about practitioners' demographics, their self-evaluated knowledge and how frequently they treated traumatized permanent teeth as well as 13 clinical scenarios reflecting a variety of clinical trauma cases and their complications. A total of 980 randomly selected general dentists, representing 5 Lithuanian counties, participated in the study. The response rate was 59.4% (n=582). Overall, 82.3% of general dentists reported that they treated only a few dental trauma cases and 14.4% chose to refer their patients; 55.1% of dentists considered their dental traumatology knowledge to be sufficient but incomplete and 34.0% self-evaluated their knowledge as insufficient. The most knowledge (based on self-evaluation) was reported by the younger dentists (≤50years; P=.004). The mean correct knowledge score was 7.6±2.2 of the 13 clinical scenarios. Both bivariate and multivariate analyses showed that greater trauma-related knowledge was associated with a younger age. Better knowledge was observed amongst the dentists who self-evaluated their own knowledge as sufficient or as comprehensive. Lithuanian general dentists have insufficient dental traumatology knowledge. Better knowledge was observed amongst younger dentists (≤50years).

Knowledge and Attitude of Primary School Staff to Management of Dental Trauma in North-east of Iran in 2015

Introduction: The purpose of this study was to assess the level of primary Knowledge among school staffs in Iran with regards to the immediate management of dental trauma. Methods: The data, from 160 participants, were collected using questionnaire, which surveyed staff’s background, attitude and knowledge of dental trauma management. Results: The total number of school staff who responded to all of the questions in the questionnaire was 138; the response rate was 86%. 91.3% of the participants had more than 10 years of teaching experience. Only 24 cases (17.4%) have participated in training courses in regards to the dental trauma. 46.4% of the participants estimated their level of knowledge regarding the dental trauma as moderate and 42.8% as low and 7.2% without knowledge, however, 56.5% of them were highly interested in attending the training courses. Overall, the teachers’ knowledge on emergency management of the dental trauma cases presented in this study was deficient, especially in avulsed tooth management. Chi-square test showed that there was no statistically significant difference in the responses to the knowledge part of the questionnaire on age, gender, teaching experience and responsibility in school. Conclusion: The present report indicated the lack of knowledge among school staff on dental injuries managements. Organizing educational courses to improve the knowledge and awareness of school staff, as the first encounters of dental trauma in schools, seems necessary.

Tooth loss and survival analysis after traumatic injuries in primary dentition

Background/Aim: The aim of the present study was to investigate the treatment options, survival rate of traumatized primary teeth and evaluate the factors influencing the outcome. Material and Methods: The sample consisted of all dental trauma cases treated over a 14 years period at the Department of Pediatric and Preventive Dentistry, Dental Clinic of Vojvodina, Novi Sad. Criteria for inclusion in this study were: dental trauma to primary teeth and age in the moment of injury up to seven years. Dental trauma records were analyzed in order to obtain the following: gender and age of the child at the time of trauma, type of trauma, as well as the type and timing of treatment received. After data analysis a survival rate of traumatized primary teeth was evaluated. Results: The study was designed as retrospective and it included 225 children, with 346 traumatized primary teeth. The occurrence of trauma was higher in male patients (60,4%) and in children up to 4 years of age. Luxations were more frequent (72.8%) compared to isolated teeth fractures (20.8%), while the two types of injury combined were rare (6,3%). One year following dental trauma 231 teeth (0.67%) developed complications. Falls were the main cause of trauma (68.9%) and the presence of more than one traumatized tooth was frequent. A percentage of 48.8 children received dental care during first 24 h after the injury. Conclusions: Survival of injured primary teeth is relatively low, regardless of trauma type, time interval between injury and treatment and the type of provided treatment.

Polish school nurses' knowledge of the first-aid in tooth avulsion of permanent teeth.

BackgroundThe frequency of dental trauma in schools is secondary only to accidents at home. The aim of this study was to evaluate the knowledge of first aid in the avulsion of permanent teeth presented by Polish school nurses from different areas.MethodsA cross-sectional study with the use of a structured self-administrative questionnaire was conducted in 2014 on school nurses working in randomly selected Polish provinces. The instrument consisted of demographic questions, questions referring to nurses’ experience and training in dental trauma and questions checking knowledge of first-aid in the avulsion of permanent teeth. The maximum number of points to be scored was eight. Data were analyzed with the Kruskal-Wallis, the Mann–Whitney U and Chi2 tests with the level of statistical significance at p < 0.05.ResultsThe final sample consisted of 164 nurses of which 70.1 % had experience with dental injuries and 45.7 % witnessed a tooth avulsion in pupils. 10.4 % nurses participated in training courses concerning tooth avulsion and 67.1 % of them independently broadened their knowledge. The knowledge of the first-aid management of an avulsed tooth was moderate (4.72 ± 1.95 points). 78.1 % of nurses chose a correct definition of the term of ‘tooth avulsion’. Only 7.3 % of them were aware that the replantation could be conducted by any witness of an accident. Saline was most often chosen as a proper transport medium for an avulsed tooth (57.9 %), whereas 16.1 % of nurses indicated milk. 13.4 % of evaluated nurses showed readiness to conduct an immediate replantation. Most respondents preferred calling child’s parents and advising them to bring the child to a dentist (63.4 %). The main factor influencing nurses’ level of knowledge was self-education (p < 0.001). Being a witness to dental trauma (p = 0.0032) and working in schools with sports classes (p = 0.0423) were positive determinants of improved knowledge. Nurses from large agglomerations had significantly lower knowledge (p = 0.005). The main source of information for self-education was the Internet.ConclusionsThe evaluated nurses were in need of education with regard to the management of dental trauma cases. The Internet should be used to deliver evidence-based knowledge to medical staff working at schools.

Guest Editorial

Welcome to The Management of Dental Trauma, a supplement of the Australian Dental Journal. I invite all dentists – no matter whether you are a general dentist or a specialist to read this supplement as it provides an ideal opportunity for you to update your knowledge in this important area of dental practice. Dental traumatology is unique in dentistry as it spans all of the specialty disciplines – some may be involved in the early stages to provide emergency care whilst others may be involved later to provide follow-up care. Trauma also involves all age groups and all patient population groups, plus public health aspects to study its incidence, prevalence, prevention, etc. – so it is truly relevant to every dental practitioner. Although a significant number of dental trauma cases present with relatively minor injuries to a single tooth, there are also many cases that have multiple injuries to several teeth plus the soft tissues and bones. Hence, this supplement has been developed to review dental trauma from a broader approach to help readers understand the tissue responses so they can apply the principles of management to each situation. The approach was not to repeat what can be found in various textbooks and other journal papers which provide valuable information about specific injuries and their management. Dealing with dental trauma is somewhat similar to other medical emergencies. Dental practitioners should maintain their knowledge and skills to provide basic life support for a person who collapses or has an accident – we train for this regularly and keep updated with the latest recommendations so we can help others in need. Likewise, we should regularly update our knowledge and skills for dental trauma cases as they usually present as emergencies and we need to be ready to provide the best treatment possible. This supplement provides an ideal opportunity to do so. I hope you enjoy and benefit from it. Thank you to all the authors, the reviewers, the Journal's Editor, Professor Mark Bartold am, and especially to the Senior Production Editor, Helen Pontikis, for all you have done to produce this supplement.

Dental Trauma Cases Treated at Aichi-Gakuin University Dental Hospital

Dental Trauma Cases Treated at Aichi-Gakuin University Dental Hospital

Combination of dentoalveolar traumatic injury: a case report (10-year follow-up)

Tooth Injury comprises a group of clinical conditions that can have the separation or breakage of the tooth and its surrounding tissues. A case of multiple concomitant dental trauma is reported. In 2004, a female patient, 11 years old, visited the dental office a half hour after a dental trauma caused by a fall in the pool. She complained of mild discomfort in the tooth 11; in a clinical analysis, it was partially displaced from its socket and showed grade 2 mobility; in a radiographic analysis, the tooth showed an increase in the periodontal ligament space, a diagnosis of extrusive luxation. The adjacent teeth 21 and 22, presented subgingival bleeding, diagnosed with subluxation. After preparing the treatment plan, clinical approach consisted of manual reduction of the tooth 11 and non-rigid splint of affected teeth. The patient received a prescription of antibiotic and anti-inflammatory. After 15 days, the splint was removed and the teeth 11, 21 and 22 showed pulpal sensibility, maintaining the same results for 4 months. In the 4th month, tooth 11 was diagnosed with pulp necrosis, thus requiring endodontic treatment. After 10 years, teeth were asymptomatic, with a slight color change in tooth 11; the cone beam scan indicated root resorption in the apical third of the three elements and the presence of dystrophic calcification of teeth 21 and 22. In conclusion, the injured teeth remain in function with relevant follow-up period, highlighting the search for a response, upon the purpose of the study.

Traumatic dental injury in permanent teeth: knowledge and management in a group of Brazilian school teachers.

School is a place with a high frequency of dental trauma, and several studies have shown that teachers' knowledge in how to act during acute dental emergencies is lacking. Therefore, this study aimed to assess the knowledge and actions of a group of Brazilian school teachers relative to dental trauma in permanent teeth. A cross-sectional, observational study, from 27, schools randomized by lot was performed. All 205 teachers in the 27 schools answered a structured and self-administered questionnaire. The questionnaire contained questions about the participants' education level, work experience and first-aid training, as well as knowledge about and attitudes towards dental trauma in permanent teeth as well as their experience in dental emergency situations. Of the 205 teachers, 91.2% reported having no knowledge about dental trauma and 16.6% of teachers had seen cases of acute dental trauma. Among the 205 teachers, 23.9% had received first-aid training and 4.1% had been educated in dental trauma. Regarding actions of acute injuries to permanent teeth, the teachers showed a significant error rate. No association was found between the level of education and first-aid training or experience with dental trauma. In relation to the experience of the teacher, association was found when managing trauma to soft tissue. The knowledge and actions of Brazilian schoolteachers in relation to care of acute injuries in permanent teeth were inconsistent and based on unfounded concepts, beliefs and intuition, and lack of training. Continuing education of teachers in oral care due to a dental trauma should be a good plan of action.

Protective dental splint for oroendotracheal intubation: experience of 202 cases.

BackgroundDental injury as a result of oroendotracheal intubation during general anesthesia is very common. We report our experiences of using mouthguard to prevent dental injury during intubation based on our protocol.MethodsThis retrospective study enrolled patients referred for preanesthetic evaluation, those patients with a history of any of the dental treatments to their anterior teeth listed on our fabrication protocol from January 1, 2009 to June 30, 2010.ResultsNo cases of dental trauma during oroendotracheal intubation were reported among the 202 patients who used a protective device. 66% of the patients had risk factors for hard tissue damage aged 10-40 years. At the ages of 40-70 years, the incidence of risk group for periodontal damage was higher.ConclusionsPreanesthetic consultation was effective for preventing dental injury, so preanesthetic questionnaire and proper dental consultation would be helpful.

Frequency of root resorption following trauma to permanent teeth.

This retrospective study evaluated the frequency of development of root resorption in dental trauma cases involving supporting tissue. For 249 traumatized teeth of 125 patients aged between 7 and 51 years, we collected data on the gender and age of the patient, the teeth involved, the type of trauma, and the period between dental injury and initial examination. Radiographic parameters examined in relation to root resorption included the presence of inflammatory external root resorption, internal root resorption, replacement resorption, and canal calcification. Data were analyzed by chi-squared test, Fisher's exact test, and mult iple logistic regression (P < 0.05). The results indicated that there was a significant relationship between the period from the date of injury until initial examination and the occurrence of inflammatory external resorption (P = 0.0199), as well as the type of injury (P = 0.0406). Furthermore, external resorption was most frequently associated with intrusive luxation (92.8%), followed by avulsion (89.0%), lateral luxation (80.2%), and extrusive luxation (77.4%). Among the types of dental injury, replacement resorption was observed more frequently in cases of avulsion (87.2%). The only factor that was significantly associated with this type of resorption was the type of injury (P < 0.0001). Root resorption is observed more frequently and its risk of development is higher in cases of severe trauma, especially avulsion and intrusive luxation.

Epidemiology and outcomes of dental trauma cases from an urban pediatric emergency department.

The purpose of this retrospective study was to determine the outcomes of traumatized teeth treated in a pediatric emergency department. The records of pediatric patients presenting to the pediatric emergency department of a pediatric hospital over a 56-month period were reviewed and pertinent data were extracted. Treatment outcomes and contributing factors were analyzed for cases with greater than 6 months of follow up. A total of 264 patient records (548 traumatized teeth) were investigated. The mean age of the children was 8.2 years and 62% were boys. The most common ages for dental trauma were between 2-4 years and 8-10 years. Permanent dentition comprised 53% of the traumatized teeth. Extrusive and lateral luxations (29.5%) were the most common injuries encountered. Two hundred and thirty seven teeth (43%) presented for follow-up visits, and the mean duration of follow up was 55.6 days. The number of cases with more than 6 months of follow up decreased to 122 (22%). Of these, 31 (6%) teeth were extracted at the time of injury. Outcomes were ascertained for the remaining 91 (17%) teeth. Emergency dental treatment led to uncomplicated retention of teeth beyond 6 months in 58% of these cases. Luxation injuries had a higher success rate than avulsions (P = 0.046). After receiving emergency dental care in the emergency department, 43% of the teeth presented for follow-up dental care and only 22% were followed up for greater than 6 months. Emergency department treatment translated to successful retention of teeth in 58% of the cases with documented follow up. Severe periodontal injuries resulted in treatment complications.

General Dental Practitioners' Knowledge about the Emergency Management of Dental Trauma.

The aim of this descriptive cross-sectional study was to assess the general dental practitioners (GDPs)'s knowledge regarding the emergency management of traumatic dental injuries (TDI) in Isfahan, Iran. In this study a two-part questionnaire consisting of 14 questions was distributed among 241 GDPs. Part 1 included seven questions focusing on personal and professional information and part 2 asked questions about seven given cases of dental traumas. One score was dedicated to each correct answer; the total score of 0 to 4 was considered as poor knowledge, while scores 5-8, 9-11 and 12-14 were assigned as moderate, good and excellent knowledge, respectively. The data were analyzed using the Student's t-test and one-way ANOVA. Spearman's and Pearson's correlation coefficient were used to determine the associations between the emergency treatment knowledge and dentists' professional information. With regards to the level of GDP's knowledge, the mean score was 7.61±2.68 suggesting a moderate score; a total of 177 (73.2%) of the dentists showed a moderate level of knowledge. A significant association was found between the frequency of dental trauma cases that were encountered and treated by GDPs in their daily practice (P=0.004, r=0.2). The overall knowledge of GDPs about the emergency management of TDI in the selected community was moderate.

Taking the trauma out of trauma: an easy to follow guide for the management of trauma to the permanent dentition

Treatment of dental trauma can be an infrequent, unpredictable and stressful experience for a dental practitioner. Correct diagnosis and management of such cases is of primary importance in the prognosis of the affected dentition. We have therefore constructed a number of easy to follow algorithms in management, both short and long term, for the range of traumatic injuries that can affect the permanent dentition. Immediate as well as longer term management of dental trauma cases can be difficult, therefore a clear treatment plan is of great importance in successful results.

Avulsion of permanent teeth with open apex: a systematic review of the literature

Considered the most serious of dental in�uries, avulsion is known as the total displacement of tooth out of its socket. Treatment includes immediate replantation and its success is directly related to several factors. Objective: This paper aimed to review the literature in a systematic way on dental avulsion of permanent teeth with open apex, covering various topics such as: reason for avulsion; storage media; time out of the socket; use of antibiotics; splinting time; tooth vitality; presence of resorption and/or obliteration of pulp canal; and following-up time. Material and methods: PubMed/MedLine database and Dental Traumatology journal were searched, from May to June of 2011, and several studies comprising the current and classic literature were listed using the following terms: tooth avulsion, open apex, permanent and case report. Results and conclusion: Twelve cases reports were selected. Cases of dental trauma in open apex teeth may have a good prognosis if the following steps are taken: the hydration of the tooth and immediately replantation. It is important to search dental care, even if everything seems solved, and the tooth following-up should be performed periodically as informed by the dentist.