Treatment Of Traumatic Dental Injuries Research Articles

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.

New guidelines for treatment of traumatic dental injuries in the primary dentition

New guidelines for treatment of traumatic dental injuries in the primary dentition

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.

IADT guidelines for treatment of traumatic dental injuries

In the emergency situation, immediate decisions have to be taken. The prognosis for many trauma injuries is depending on a prompt and correct decision. For the clinician, it is not easy to gather all information and draw conclusions from scientific literature when facing a trauma patient. There is a need for guidelines for the clinician in such situations. The International Association of Dental Traumatology (IADT) has developed guidelines for the emergency situation. This is the third time IADT is publishing guidelines for management of traumatic dental injuries. The first set of guidelines was published in 2001 and was followed by a new set of guidelines in 2007. It is now time to release a third set of guidelines. As pointed out before, we are today far from evidence-based traumatology (1). This is because of the fact that traumatology is a field where it is not possible or ethical in the acute phase of the injury to ask for consent from patient and parents to participate in a randomized controlled study. Instead, we must still rely on results from clinical studies on later treatment, often retrospective, studies and experimental in vivo studies (2, 3). When writing guidelines, IADT has formed core groups of experts of different specialties with experience in research and clinic who have searched the literature, discussed, shared experience, and presented guideline documents based on evidence and best practice for further discussion and final approval of the IADT board of directors. In this issue, the first series of guideline documents: Fractures and Luxation of Permanent Teeth is presented. In following issues, guidelines for Avulsed permanent teeth and guidelines for traumatic dental injuries in the Primary dentition will be presented. The documents will be found on IADTs web site http://www.iadt-dentaltrauma.org, and the articles can also be accessed and downloaded via the same web page. Clinicians and trauma patients worldwide will really benefit from this.

Prevalence of traumatic dental injuries and role of incisal overjet and inadequate lip coverage as risk factors among 4-15 years old government school children in Baddi-Barotiwala Area, Himachal Pradesh, India

To assess the prevalence of traumatic dental injuries (TDI) in school children in Baddi- Barotiwala, Himachal Pradesh, India. A cross-sectional survey was carried out in Government schools among 1059 government school children aged 4- 15 years. The study was conducted from October 2009 to March 2010 during the school hours. The demographic detail was carried on a structured questionnaire. The data regarding the traumatic injuries was recorded using modified Ellis' classification. Prevalence of TDI was found to be 4.15 %. 95.45% of the injuries were to the maxillary anterior teeth. Maxillary central incisor was the most common tooth to be affected due to trauma (54.5 %). Enamel with dentin fracture with pulp exposure was the main type of TDI (43.1%). The majority of TDIs were untreated (97.7 %). Falls (54.5%) were found to be the main cause. Over jet over 3 mm and inadequate lip coverage were found to be important contributing factors for TDIs. The present study revealed a relatively low prevalence of dental trauma, but still this figure represents a large number of children. Therefore, educational programs are to be initiated for the community regarding causes, prevention and treatment of traumatic dental injuries. It is crucial to generate considerable efforts to implement health promotion strategies to reverse the observed trends and to provide treatment to TDIs to prevent their biologic and psychological consequences.

Traumatic dental injuries and related factors among sixth grade schoolchildren in four Palestinian towns

Traumatic dental injuries (TDI) are recognized as an important dental public health issue among children. The West Bank, a part of the Palestinian Authority, is in immediate neighborhood to Israel. There are inadequate epidemiologic data among the Palestinian people, on dental health issues. To determine the occurrence of TDI to permanent teeth among sixth grade Palestinian schoolchildren living in four large towns of the West Bank and to investigate associations with anatomic and demographic factors. Eight hundred and four children were sampled and examined in Ramallah, Bethlehem, Hebron and Jericho. Data collection included clinical examinations in schools and questionnaires for demographic and socio-economic background. The prevalence of traumatic dental injuries was 17.7%. Enamel fractures and injuries involving dentine accounted for 41% and 42.5% of all injuries, respectively. The most affected teeth (89%) were upper central incisors. Only 5% of the injured teeth were treated. Results of multiple logistic regression confirmed that TDI were significantly (P < 0.001) more prevalent among boys, children presenting incisal overjet larger than 5 mm, and incompetent lip coverage. The relative high prevalence and very low levels of treated TDI identified in this study suggested that both prevention and treatment of TDI in the West Bank were inadequate.

Contradictions in the treatment of traumatic dental injuries and ways to proceed in dental trauma research*

Almost all treatment procedures used for dental traumas are still today not evidence-based, a fact, which makes it difficult to analyse the long-term outcome of healing and its relationship to treatment. Crown fractures with extensive dentin exposure represent a dominant injury in the permanent dentition. Accepted treatment philosophy is dentin coverage (dental liner and/or dentin bonded restoration) to prevent bacteria penetration into the pulp. Today there is, apart from deep proximal fractures, no evidence that this treatment is necessary to protect the pulp. In case of luxation injuries, the accepted treatment principles appear to be anatomically correct repositioning, stabilization with a splint and sometimes antibiotic coverage. In clinical studies, these principles could not be proven to optimize either periodontal or pulpal healing, the explanation possibly being that both reposition and application of splints in certain cases add extra damage to the pulp and periodontal ligament. In case of root fractures with dislocation, fast and optimal repositioning and rigid long-term splinting (i.e. 3 months) have been considered the principle of treatment. However, a recent clinical study has shown that short-term splinting with a semi-rigid splint appears to optimize fracture healing. In tooth avulsion with subsequent replantation, cleansing of the root surface for contamination and systemic antibiotics has been considered essential for pulp and periodontal healing. These treatment concepts have been derived from experimental studies in animals. However, their importance could not be verified in large clinical studies. Ideally, randomized clinical studies are needed in the future for selected trauma types. The influences of repositioning, splinting and the role of infection and antibiotics should be further investigated. However, for ethical reasons, it will be difficult to perform randomized studies on trauma victims and we will be forced in the future to rely on experimental animal studies supported by clinical observational studies.

Activities related to the occurrence of traumatic dental injuries in 15‐ to 18‐year‐olds

To assess the activities related to the occurrence of traumatic dental injuries (TDI) in order to establish the relationship between gender, socio-economic status (SES) and major TDI related events, using classification and examination procedures suitable for epidemiological purposes, in a sample of 15- to 18-year-old students in Taiwan. A random sample of 6312 15- to 18-year-old senior high school students in southern Taiwan was selected. Each was examined with standard clinical procedures and a questionnaire. The prevalence of TDI was 19.9%. The major TDI related events included sports and leisure activities (30.8%), eating (20.5%), falls (19.4%), traffic accidents (10.2%) and collisions (7.1%). Within TDI victims, sports and leisure related TDI were more prevalent among males (P = 0.001, OR = 1.640, 95% CI = 1.225, 2.195) and high SES adolescents (P = 0.014, OR = 1.991, 95% CI = 1.149, 3.449). The occurrence of non-accidental TDI was not related to age, gender and SES (P > or = 0.643). Traumatic dental injuries have become an important issue in public health and dentistry. Prevention and treatment of TDI should be emphasised to the public, the health professional and the policy maker. Future investigations into the relationship between TDI related events and their determinants are indicated.

小児期の歯の外傷への対応

小児期の歯の外傷への対応

Brazilian dentists’ knowledge regarding immediate treatment of traumatic dental injuries

The objective of this study was to assess the knowledge of dentists working in the city of Tubarão, southern Brazil, about the immediate treatment of traumatic dental injuries. A cross-sectional study was carried out involving all dentists who were working in the city in 2004 (n = 108). Data were collected through self-applied questionnaires with questions about sex, time elapsed since graduation, whether the dentists had attended postgraduate courses and also four questions about traumatic dental injuries in which the dentists selected the best answer. The response rate was 86.1%. For the two questions related to dental avulsion, 36.6% and 16.1% of professionals respectively, chose the correct answer according to the literature. For the question related to coronal fracture, 75.3% chose the correct answer. For the questions related to an incident without dental avulsion or fracture, 73.1% chose the correct answer. Time elapsed since graduation was the only variable statistically associated with the correct answer for the question related to coronal fracture. A significantly greater number of professionals with < or = 10 years of experience chose the correct answer when compared with professionals with >10 years experience (P < 0.001). It can be concluded that the great majority of professionals would not intervene according to the literature in the cases of avulsion. Less time elapsed since graduation was statistically associated with the correct answer in the coronal fracture case.

Traumatic dental injuries and their management among children aged 6 -12 years in Dar es salaam, Tanzania

Aim : The aim of this study was to determine, by utilizing patient records, the various types of dental trauma and the treatment provided among children aged 6 - 12 years. Materials and Methods : A retrospective cross sectional survey was conducted at Dental department, Muhimbili National Hospital, Dar es Salaam, Tanzania. The subjects were obtained from the register books available at the Dental Department of the Muhimbili National Hospital. Records of all sixty seven (67) dental patients aged six to twelve years who received treatment for dental trauma from January 2001 to January 2003 were obtained. Results were presented in tables and the data analysed using Epi Info 2002 statistical package. Results : All together, sixty-seven children presented with a total of 101 injured teeth. The age distribution of the study group was found to have a peak at 6 - 9 years. Thirty-nine children (58.2%) sustained injuries to one tooth, 24 (35.8%) children had injuries to two teeth and only 4 (6%) children injured three or more teeth. Of the 101 total injured teeth, deciduous teeth constituted 16.8% and permanent teeth 83.2%. The upper anterior teeth (incisors and canines) in both dentitions were the most frequently affected teeth (76.2%), followed by the lower anterior teeth, while posterior teeth (premolars and molars) were the least affected. The most frequently observed dental injury was complicated crown fracture (36.6%), followed by uncomplicated crown fracture (30.7%). Subluxation and Extrusion were the least sustained types of dental injury (2.0%) and there was no case with a tooth avulsion. The most frequently offered treatment of injured teeth was either crown build-up, root canal treatment or splinting. Only 20% of all teeth were extracted. Conclusion : From this study it is concluded that the observed correct treatment of traumatic dental injuries is the success in the part of hospital based management, but controversy remain in the community based management of dental injuries. The findings of this report thus stress the importance of prevention of dental trauma and to minimize its complications through proper treatment, use of mouth guards, supervision of children during play, orthodontic treatment of proclined incisors, and educational programs. Tanzania Dental Journal Vol. 12(1) 2005: 9-12

Aetiology and rates of treatment of traumatic dental injuries among 12‐year‐old school children in a town in southern Brazil

The objective of this study was to assess the prevalence, aetiology, place of occurrence and rates of treatment of traumatic dental injuries (TDI) among 12-year-old schoolchildren in Herval D'Oeste, Brazil. A cross-sectional survey was carried out through clinical examination of upper and lower permanent incisors and interviews with 297, 12-year-old schoolchildren enrolled in public and private schools. Intra-examiner diagnosis variability, measured by kappa values on tooth-by-tooth basis was above 0.7. The prevalence of TDI was 17.3% (95% CI 12.7-21.9). Children who had an incisal overjet size >5 mm were 3.5 (95% CI 1.5-8.1) times more likely to have TDI than children who had an incisal overjet of <5 mm (P = 0.005). The most common type of injury found was enamel fracture alone. Of the total of 87 traumatized teeth, only 27.6% were treated. Acid etch restorations were the most common treatment provided. Acid etch restorations were the most common type of treatment needed. The majority of the cases of TDI occurred at home (17.8%) and at school (17.8%). Collisions (24.5%), mainly with doors, and physical leisure activities (20.0%) such as cycling and playing soccer were the main activities related to TDI aetiology. It can be concluded that there is a great treatment need reflecting neglect of TDI treatment. The main causes of TDI were collisions and physical leisure activities.

Traumatic injuries in the primary dentition.

As a support for the guidelines published in 2001, a review of the literature was carried out using the evidence-based approach in order to update the state of the art regarding epidemiology and treatment of traumatic dental injuries in the primary dentition. An online search in Medline, and a review of expert literature, lead to the conclusion that most luxation injuries heal spontaneously, and unless more conclusive evidence is available, conservative treatment of acute dental trauma for preschool children is suggested. Pain control, the dentist's ability to cope with the child's anxiety, and follow-up instructions in oral hygiene techniques will allow many primary teeth that are currently lost at the time of injury to be saved.

Treatment time of traumatic dental injuries in a cohort of 16-year-olds in northern Sweden

The aim of the present study was to account for treatment time and number of visits required for treatment of traumatic dental injuries in a cohort of 16-year-olds, born in 1975, and residing in the county of Västerbotten, Sweden, and to analyze the correlation between total treatment time and background factors. The study material comprised 1012 dental records from the Public Dental Health Service containing information on dental injuries to primary and/or permanent incisors or canines. The mean total treatment time per individual was 1.3 h, with a range of 0.1 to 27.5 h. For injuries to the primary dentition, the mean number of visits per individual was 2.2. One visit was sufficient in 21% of the trauma episodes. In the permanent dentition, each trauma episode required a mean of 3.4 visits, and 90% of the patients had to return for follow-up visits. The correlation between explanatory variables and total treatment time was described and analyzed by linear multiple regression analyses. Degree of severity and number of injured teeth were two parameters of major significance to treatment time. Treatment by a specialist had an impact on time in the permanent but not in the primary dentition. In the permanent dentition, the treatment time increased if the dental injury occurred before the age of 11 years. Treatment time was not dependent on where the clinic was located or on gender of the injured child. Different diagnoses could explain 33% of the variation in treatment time in the permanent dentition.

Therapeutic and economic implications of traumatic dental injuries in Denmark: an estimate based on 7549 patients treated at a major trauma centre.

To analyse the type and extent of injuries presented by patients seeking treatment for traumatic dental injuries at a major trauma centre. Furthermore, to analyse acute and subsequent treatment demands and treatment costs. A therapeutic and economic analysis was performed of 7549 patients treated for traumatic dental injuries in a major trauma centre located at the University Hospital in Copenhagen, Denmark. Cases were divided into uncomplicated (concussion, subluxation, enamel and enamel-dentine fractures) and complicated cases (crown fractures with exposed pulps and crown-root fractures, luxation injuries with displacement of the tooth and bone fractures). Primary tooth injuries were found in 2874 patients, involving 5443 teeth, among which 62.8% had complicated injuries. Permanent tooth injuries were found in 4525 patients, involving 10,673 teeth, among which 40.4% had complicated injuries. The cost of treatment (including acute trauma service, follow-up and subsequent restoration) was estimated to be 0.6-1 mill USD a year for the patients treated in this trauma centre. If this figure is transferred to the estimated trauma population in Denmark, a yearly cost of traumatic dental injuries appears to range from 2 to 5 mill USD per 1 mill inhabitants per year according to the treatment scenario. Thus, treatment of traumatic dental injuries comprises an expensive part of the health services in Denmark.

Effect of a consensus statement on initial treatment for traumatic dental injuries.

The aim of this study was to investigate the influence of a consensus statement on dental practitioners' choice of initial treatment for traumatic dental injuries. Dental practitioners working at government dental clinics in eight cluster sample regions of mainland Tanzania were requested to participate in the study; that is, to record the treatment they provided to children aged 1-17 years seeking dental consultation after injury for a period of 12 months. Six months after the beginning of data collection, a consensus statement was introduced. After the dental practitioners received the consensus statement, the correct treatment they provided increased from 51% to 57%. The unnecessary treatments increased from 54% to 59%, while wrong treatments decreased from 55% to 42%. Only a small improvement was observed in the percentage of correct treatments, but there was a slightly significant improvement in the percentage of wrong treatments provided before and after introduction of the consensus statement. We conclude that the consensus statement had a slight influence on the dental practitioners' choice of initial treatment for dental trauma in the desired direction.

Treatment of traumatic dental injuries in a cohort of 16-year-olds in northern Sweden.

The prevalence and yearly incidence of traumatic tooth injury between 1 and 16 years of age have been studied in a cohort of 16-year-olds, born in 1975, and residing in the County of Västerbotten. The study material comprised 3007 dental records from the Public Dental Health Service. Of these, 1040 contained information on dental injuries. Out of 1000 injured primary teeth, 32% were lost, either avulsed at the time of the accident or extracted due to complications. A majority (92%) of the extractions was performed at the first or second follow-up. A total of 690 tooth injury episodes had occurred in the permanent dentition, involving 981 teeth. In 10% of the teeth more than one diagnosis was recorded for the same tooth. 416 restorations were performed due to crown fractures, the majority at the emergency visit. 44% of the patients had to come back one or more times to revise the composite restoration. Complicated fractures or serious luxation injuries constituted only 5% of the total number of injuries in the permanent dentition. 77 (8%) of the traumatised teeth were treated endodontically. Two percent of the teeth with uncomplicated crown fractures required endodontic treatment due to pulp necrosis, while 28% of teeth with a combination of crown fractures and luxation injury were endodontically treated. Out of 6 avulsed incisors, 4 survived after endodontic treatment. A total of 7 incisors were lost as a consequence of the injuries. A specialist treated 4% of the patients.

Treatment of Traumatic Dental Injuries: Shift in Strategy

A more conservative approach to the treatment of traumatic dental injuries has been made possible by knowledge concerning the pathogenesis of external root resorption, increased knowledge about wound healing processes in the pulp and periodontium, as well as by advances in restorative dentistry (reattachment of crown fragments with a dentin bonding system, the use of adhesive bridges, and advances in autotransplantation and implantation). However, a rethinking by the public, clinicians, and third-party payers is necessary for these procedures to gain wider acceptance. The present article describes the state of the art of treating dental trauma in the hope that these advances can become an accepted part of the dental trauma armamentarium and not merely scientific curiosities.