Dental trauma: assessment and acute management of fractures.

Acute dental trauma is unscheduled and presents infrequently to the majority of practitioners. Therefore, a consistent, logical and systematic process for examination, prioritisation and management is imperative for all sustained injuries to have an optimal outcome. Fractures are a frequent sequela to dental trauma and can involve any aspect of the tooth structure or supporting alveolar bone. While some minor crown fractures may initially seem inconsequential, they may be a subtle indication to a more serious underlying root fracture. Concomitant injuries and injuries that have been initially missed are generally associated with poorer outcomes. The time sensitive management of traumatic dental injuries aims to preserve pulpal and periodontal health where possible. The follow up period for tooth or alveolar fractures are important to allow for early intervention if pathology develops.

MTA Pulpotomies: A Long-Term Case Series Outcomes Assessment of Complicated Crown Fractures.

BACKGROUND: This retrospective case series describes the outcomes of anterior teeth with complicated fractures treated using mineral trioxide aggregate (MTA) in pulpotomy procedures. METHODS: 33 teeth were treated with MTA pulpotomy procedures in an endodontic private practice. All patients had been referred to the practice for diagnosis and treatment of a pulpal exposure due to complicated crown fractures. The teeth were either recalled directly or "indirectly" by the referring dentist. Teeth recalled directly were categorized as healed, healing, non- surgical root canal treatment completed for either aesthetic or restorative reasons, or persistent disease. Teeth recalled indirectly were categorized as successful or failed. RESULTS: 27 teeth were available for recall; 20 teeth directly and 7 teeth indirectly. The mean recall for teeth recalled directly was 3.94 years and the mean recall for teeth recalled indirectly was 5.9 years. The recall range for teeth recalled directly was 0.51 to 10.49 years and for teeth recalled indirectly was 3.58 to 10.66 years. Of the cases available for direct recall, 13 of 20 teeth were healed positive to pulp tests, 4 of 20 teeth were healed negative to pulp tests and 3 of 20 teeth had non-surgical root canal treatment completed. 15 of the 20 teeth recalled directly where discolored. 7 of 7 teeth recalled indirect were successful as determined by the radiographs and a report from the restorative dentist. CONCLUSIONS: MTA is a viable alternative to calcium hydroxide for pulpotomies.

Trend of traumatic crown injuries and associated factors in preschool children.

The aim of this study was to assess trends in traumatic crown injuries (TCIs), their prevalence, and association with socioeconomic and clinical factors in preschool children over a 5-year period. A series of cross-sectional surveys was conducted in Santa Maria, Brazil, on children attending a National Day of Children's Vaccination. The same protocol was used in all surveys conducted in 2008, 2010, and 2013. Clinical examinations were performed to evaluate types of traumatic crown injuries using the O'brien index. A semi-structured questionnaire was answered by the parents. It provided information about several socioeconomic factors as well as the parents' perception of their child's oral health. The chi-square for trends test was used to verify changes in TCI prevalence throughout the years. The association between socioeconomic and clinical factors with TCI was assessed by the Poisson regression analysis. A total of 1,640 children were examined. The prevalence of TCIs decreased significantly from 2008 to 2013 (10.12%; p < 0.001). Central incisors were the most vulnerable to injury, independent of the year. Moreover, older children and those with inadequate lip coverage were more likely to present with some traumatic dental injury (p < 0.001). prevalence of traumatic crown injuries decreased following the years, however TCI remain an important subject to consider when planning oral health policies.

Trend of traumatic crown injuries and associated factors in preschool children

Abstract The aim of this study was to assess trends in traumatic crown injuries (TCIs), their prevalence, and association with socioeconomic and clinical factors in preschool children over a 5-year period. A series of cross-sectional surveys was conducted in Santa Maria, Brazil, on children attending a National Day of Children's Vaccination. The same protocol was used in all surveys conducted in 2008, 2010, and 2013. Clinical examinations were performed to evaluate types of traumatic crown injuries using the O'brien index. A semi-structured questionnaire was answered by the parents. It provided information about several socioeconomic factors as well as the parents' perception of their child's oral health. The chi-square for trends test was used to verify changes in TCI prevalence throughout the years. The association between socioeconomic and clinical factors with TCI was assessed by the Poisson regression analysis. A total of 1,640 children were examined. The prevalence of TCIs decreased significantly from 2008 to 2013 (10.12%; p < 0.001). Central incisors were the most vulnerable to injury, independent of the year. Moreover, older children and those with inadequate lip coverage were more likely to present with some traumatic dental injury (p < 0.001). prevalence of traumatic crown injuries decreased following the years, however TCI remain an important subject to consider when planning oral health policies.

A study of factors that influence the number of visits following traumatic dental injuries.

OBJECTIVE: To investigate in children the factors that influence the number of visits per tooth following traumatic dental injuries (TDI) to the permanent dentition. METHOD: A retrospective convenient sample of 100 children who had been treated for TDI at Leeds Dental Institute was identified. A multilevel negative binomial regression model was developed to identify factors influencing the number of visits per tooth. Data including age, gender, postcode, number of visits, treatment provided, number of teeth injured, type of periodontal and hard tissue diagnoses, healing modality, root maturity, pulp and tooth survival, and any history of previous or subsequent trauma to same tooth were analysed using SPSS 18.0 and MLWIN. RESULTS: 186 teeth were affected by trauma in 100 patients. Median total number of visits per tooth was six visits with a range of 1-22 visits. The factors that were found to influence number of visits included: distance travelled, hard tissue diagnosis, periodontal injury diagnosis and pulp survival (P < 0.05). A mile increase in distance travelled from home to clinic led to a 1.2% reduction in the number of visits per month (-0.012; SE 0.005), a diagnosis of a severe hard tissue injury was associated with 44% increase (0.362; SE 0.105) compared to no hard tissue injury, a diagnosis of a complicated periodontal injury compared to no periodontal injury was associated with a 30% increase (0.260; SE 0.124), a diagnosis of a uncomplicated periodontal injury compared to no periodontal injury was associated with a 31% increase (0.271; SE 0.124) and a diagnosis and treatment for a non-vital tooth in comparison to a vital tooth led to a 26% increase (0.230; SE 0.080) in the number of visits. There was a significant variation in the number of treatment visits at patient level (0.260; SE 0.048). CONCLUSION: Complicated hard tissue injuries, complicated and uncomplicated periodontal injuries, diagnosis and treatment for pulp necrosis and the distance between clinic and patient's home all significantly influenced the number of visits needed to treat TDI.

Incisor trauma in a Turkish preschool population: prevalence and socio-economic risk factors.

OBJECTIVE: This study aimed to assess the prevalence of traumatic injuries of the primary incisors in preschool children from 2 to 5 years old in South-Eastern Anatolia, Turkey. Additionally, the relationship between traumatic dental injuries, parents' education level, family income, size of incisal overjet and the presence of anterior open bite were examined. BASIC RESEARCH DESIGN: A cross-sectional survey CLINICAL SETTINGS: Data were collected through oral examinations and structured interviews, and included socio-economic indicators. PARTICIPANTS: A total of 727 children of both genders were included in the study. 122 of these children were aged 2; 183 aged 3; 178 aged 4 and 186 aged 5. RESULTS: The prevalence of dental injuries was 8.0% (n = 58). The highest frequency of trauma in the primary teeth was observed at the age of 4. Boys experienced more dental injuries than girls, 12.2% and 4.0%, respectively. The most common crown fracture was in enamel only (57%) followed by crown fracture of enamel and dentin (19%). CONCLUSION: The prevalence of dental injuries in Turkish preschool children was very low. The children with incisal overjet greater than 5mm and anterior open bite experienced more dental injuries in primary teeth than their counterparts with normal occlusion. Socio-economic indicators were not statistically significantly associated with the occurrence of traumatic dental injuries.

Fibre reinforced composites--alternative for lost teeth replacement.

The loss of an anterior tooth can affect a patient psychologically and socially. This trauma can be minimized by the immediate replacement of the lost tooth, preferably using a fixed prosthesis. This paper describes the immediate replacement of anterior lost teeth by using fibre reinforced composite materials, although these techniques can be employed very successfully in the replacement of posterior teeth as well. The abutment teeth can be conserved, with little or no preparation, making this procedure truly minimally invasive and keeping the technique reversible. Additional advantages are that the procedure is completed at the chairside in a single visit, thereby avoiding laboratory costs and saving time while waiting for the finished prosthesis. This technique can be used as an interim measure or as a permanent prosthesis.

A study into dentists' knowledge of the treatment of traumatic injuries to young permanent incisors.

OBJECTIVE: The aims of this study were to evaluate dentists' knowledge of the emergency treatment of traumatic injuries to young permanent incisors, and to investigate barriers to treatment. DESIGN: A closed-ended questionnaire was sent to 1023 general dental practitioners (GDPs) and community dental officers (CDOs) in West/North Yorkshire and Humberside, UK. METHODS: The questionnaire comprised 17 questions. Six questions asked for general information about the participants (i.e. profession, age, gender, year of graduation, training or education on dental trauma, and willingness to provide emergency care), 10 were relevant to the emergency treatment of crown fractures, root fractures, luxation and avulsion injuries, and the last question queried any perceived barriers to treatment. Results. Seven hundred and twenty-four questionnaires were returned, a response rate of 71%, and these indicated that dentists' knowledge of the emergency treatment of dentoalveolar trauma in children was inadequate. The CDOs were significantly more knowledgeable than the GDPs, as were younger and more recently graduated dentists compared with older ones. The GDPs regarded the difficulty of treating children and the inadequate fees of the UK National Health Service as important barriers to treatment. Dentists who attended continuing dental education courses on dental traumatology had a more thorough knowledge than those who did not. CONCLUSION: Overall, the dentists' knowledge of the emergency treatment of dentoalveolar trauma in children was inadequate. Greater emphasis on undergraduate and postgraduate education in this area is indicated.

Traumatic injuries to permanent anterior teeth among 12-year-old schoolchildren in Jordan.

OBJECTIVES: To assess the prevalence and related factors of incisor trauma among 12-year-old Jordanian schoolchildren. DESIGN: Cross-sectional study among schoolchildren. A sample of 1.878 schoolchildren aged 12 years, 940 boys and 938 girls, were randomly selected from 128 schools in urban and rural areas. Ellis classification was used to record the dental injuries on incisors. RESULTS: Of the children examined 13.8% showed dental trauma. Difference in prevalence between boys (17.1%) and girls (10.6%) was statistically significant (p < 0.05). Maxillary central incisors were the most affected (79.2%) and the most common type of crown injury was enamel-dentin fracture (40.6%). The relationship between dental injuries and socio-economic indicators was not statistically significant. There was a tendency for children with an incisal overjet greater than 5.0 mm to have experienced dental injuries (p < 0.01). Treatment need due to dental injuries was very high but less than untreated damage. CONCLUSION: The prevalence of traumatic injuries to permanent incisors in 12-year-old Jordanian schoolchildren was close to that found in other countries. Being a boy and having overjet greater than 5.0 mm were significant predisposing factors to dental injuries.

Prevalence of teeth with untreated dental trauma among nursery and primary school pupils in Dar es Salaam, Tanzania.

The aim of this study was to investigate the prevalence of teeth with untreated dental trauma among children aged 4-15 years in Dar es Salaam, Tanzania. A sample of 4524 children from three districts of different socio-economic status in the Dar es Salaam area was examined for signs of dental trauma in 1998/99. In 21% of all children examined, at least one type of untreated dental trauma was observed. A high percentage of untreated dental trauma was observed at the ages of 4 and 15 years. The most frequently observed type of dental trauma was enamel fracture (67%) followed by enamel-dentin fracture (26%). A significant gender influence on the occurrence of untreated dental trauma was observed, with more boys (23%) having untreated dental trauma than girls (19%). A higher percentage of untreated dental traumas was observed among children in the district with highest SES (26%) compared to the prevalence in the other two districts (14-17%). The findings of this study show that dental traumas are prevalent among Tanzanian children. Therefore, provision of information to the lay community about the importance of early management of dental trauma, ways of preventing trauma and appropriate handling of avulsed teeth is essential in order to minimize the rate of dental injuries and the related complications.

Assessment of vital pulp therapy for nine complicated crown fractures and fifty-four crown reductions in dogs and cats.

Subjective owner assessment of the success of vital pulp therapy was performed for complicated crown fracture (n = 9) and crown reduction (n = 54) of canine teeth in dogs and cats. Our results documented that owners are not able to accurately determine the outcome of vital pulp therapy. Objective assessment of vital pulp therapy for teeth receiving crown reduction indicated maintenance of vitality in 28 of 28 (100%) teeth. Subjective and objective assessments of vital pulp therapy performed > 7-days following complicated crown fracture indicated 9 of 9 (100%) teeth were non-vital. A poor prognosis for maintenance of tooth vitality is warranted for vital pulp therapy of complicated crown fractures with prolonged pulp exposure regardless of the age of the patient. Whereas, an excellent prognosis can be provided for vital pulp therapy following crown reduction. Semiannual, postoperative oral and radiographic examinations are recommended for a minimum of 2-years to assess vitality in all teeth receiving vital pulp therapy.

Type of treatment and estimation of time spent on dental trauma--a longitudinal and retrospective study.

The consequences of traumatic tooth injuries (dental trauma) are time-consuming and costly treatment and follow-ups, of which our knowledge is scarce. Consequently the aim of the present study was to measure the total time of treatment of uncomplicated and complicated traumas to primary and permanent teeth. The study was performed in three steps based on a randomly selected sample of Danish children and adolescents living in the municipality of Copenhagen, Denmark: (I) A descriptive analysis of traumas affecting 106 children and adolescents all born in 1970 and randomly chosen among the total number of patients treated. Treatments took place between 1972 and 1988. (II) A study of the time and frequency of different types of emergency and planned treatment estimated by 14 dentists employed by the municipal dental service. (III) Calculation of the total treatment time on the basis of the results from (I) and (II). The most common traumas were luxations of primary teeth and fractures of permanent teeth. The most frequent treatments dealt with were uncomplicated crown fractures and luxations followed by other different diagnoses of complicated traumas. The treatment time for primary teeth for uncomplicated traumas were used mostly for information, while the time for complicated traumas was used for follow-ups. The treatment time for traumas to permanent teeth was dominated by follow-ups, irrespective of the complication status. Only 3% of uncomplicated traumas of permanent teeth resulted in endodontic treatment, compared to 67% with complicated traumas. Uncomplicated traumas to primary teeth required a total of 2.5 visits and 0.8 hrs treatment time, while 4.3 visits and 1.6 hrs per individual were used for complicated traumas. For permanent teeth with uncomplicated traumas 9.2 visits and 3.2 hrs were required, and for complicated traumas 16.4 visits and 8.5 hrs per individual. The respective treatment times for complicated traumas for primary and permanent teeth were 2.0 and 2.7 times higher, compared to the corresponding uncomplicated traumas. There were no gender differences in type of injury and number of visits for injuries to primary and permanent teeth.