Dental Trauma in Children: A Quick Overview on Management.

Traumatic dental injuries (TDI) or tooth trauma have a global prevalence of 10-15%. These are often the cause of first visit to emergency room. Prognosis of teeth after injury is dependent on type of TDI, emergency treatment and time elapsed till definitive care. The low level of awareness among general public and medical practitioners often leads to delay in seeking treatment which often leads to pain, severe symptoms and poor prognosis. Pediatricians can play a significant role in identification of TDI, health advise, emergency care and referral to dentists. This paper highlights the important features to be noted in children with history of TDI and the key steps which needs to be taken in these situations.

Dental injuries in young athletes, a five-year follow-up study.

AIM: The aim of this study is to produce a clinical therapy protocol for a group of 20 athletes between the ages of 8 and 14, who all suffered traumas affecting hard dental and periodontal tissues. MATERIALS AND METHODS: This study involves a group of 20 athletes (10 male and 10 female) who had suffered dental traumas of varying severity. In order to collect the data, two classification systems were used: one for hard tissue traumas and another for periodontal lesions. The athletes were subdivided into lesion groups, treated depending on the type of lesions and then followed-up over a period of 5 years. A statistical analysis was carried out to study the association between type of lesions, types of sports and the number of teeth involved. RESULTS: We found that recovery time ranged from 3 to 5 days for uncomplicated fractures and up to 14 days for luxations. Only four complications were registered during the follow-up period and these were most likely due to the severity of the trauma. Out of the 20 athletes, 16 had begun and maintained the habit of using mouth protection devices when practicing their sport. The statistical analysis focused on the possible association between the risk levels of a sport and the typical lesions and complications that usually occur. Due to their high frequency, the two types of lesions taken into account in our study were complicated fractures (FP) and luxated/fractured teeth (LF). The average number of teeth involved varied according to the sport's risk level (medium or high) with averages of 1.6 teeth involved for medium-risk sports and 2.0 teeth for high-risk sports. CONCLUSIONS: What emerged in particular was the regular progress in the recovery time needed for the injuries sustained, with few complications or delays in rehabilitation; we also noted that the numerous athletes who habitually used mouthguards while competing during the recovery period did not suffer any recurrences of injuries or further complications. Regarding the results of our statistical analysis, no association was found between the sport's risk, the types of lesions and the occurrence of complications. In addition, analysis of the average number of teeth involved showed that there is no statistical evidence to reject the hypothesis that the ratios remain the same in the two groups.

Bones heal, teeth don't! The involvement of dentists in the acute and long-term management of patients injured in the Manchester Arena Bomb.

This paper outlines the involvement of dentists in the treatment of patients following the terror attack at Manchester Arena on 22 May 2017. It predominantly describes the role of the authors - a paediatric dental consultant and maxillofacial surgery dental core trainee (DCT). As a result of the incident a number of patients suffered oro-facial injuries, with many treated at Central Manchester Foundation Trust Hospitals' Manchester Royal Infirmary and Royal Manchester Children's Hospital. The major incident response of the trust is discussed, as are the presentation of blast injuries and corresponding NHS guidance. Two paediatric cases present the role of the paediatric dental consultant in the acute, intermediate and long-term management of these patients. The presentation of unique dento-alveolar injuries in the context of other trauma and their subsequent treatment demanded true multidisciplinary management. The importance of teeth and oral health to physical and psycho-social wellbeing and recovery was clear and recognised by other teams involved in the patients' management. The experience reinforced the overall impact dental health has on physical and psycho-social health, and how a holistic approach is integral to treatment of major trauma.

Apicoformación de un incisivo lateral superior con MTA tras un traumatismo / MTA apexification of a maxillary lateral incisor after trauma

Un traumatismo dentario puede producir muchas complicaciones. Entre ellas podemos destacar la interrupción del desarrollo radicular o la afectación de los tejidos perirradiculares, pudiendo producirse una leve luxación o incluso una avulsión total del diente fuera de su alveolo. En este tipo de situaciones un buen diagnóstico y tratamiento precoz es importante para el pronóstico del caso. El incisivo lateral superior que vamos a presentar en este caso clínico presentaba un desarrollo incompleto del ápice. Frente a este tipo de situaciones la literatura presenta dos escenarios: realizar una apicoformación o bien una endodoncia regenerativa. Son muchos los factores que decantan el tratamiento por una u otra opción. En este caso realizamos una apicoformación con MTA en una sola sesión, pues las paredes del conducto parecen ser suficientemente gruesas y el diente es resistente. La apicoformación con MTA puede tener una alta tasa de éxito a largo plazo, debido a las propiedades de biocompatibilidad y sellado de este material, mientras consigamos desinfectar con irrigación el sistema de conductos. En la evolución del caso, la paciente se encontraba asintómatica y con signos de salud periapical

Dental trauma can cause many complications. Among them we can highlight the interruption of the radicular development or the affectation of the periradicular tissues, being able to produce a slight dislocation or even a total avulsion of the tooth out of its alveolus. In this type of situations a good diagnosis and early treatment is important for the prognosis of the case. The upper lateral incisor that we are going to present in this clinical case presented an incomplete development of the apex. Faced with this type of situation, the literature presents two situations: apexification or a regenerative procedure. There are many factors that decide the treatment by one or another option. In this case, we performed apexification with MTA in a single visit, since the walls of the canal appear to be thick enough and the tooth is resistant to fracture. Apexification with MTA can have a high rate of success in the long term, due to the properties of biocompatibility and sealing, while we manage to disinfect with irrigation the root canal system. In the follow-up, the patient was asymptomatic and with signs of periapical health

Traumatic dental injuries in Brazilian children and oral health-related quality of life.

BACKGROUND/AIMS: Population-based studies that investigate the impact of TDI on oral health-related quality of life (OHRQoL) among school children and its association with socioeconomic factors are scarce and offer conflicting results. The aim of this study was to evaluate the impact of TDI on OHRQoL among school children and its association with socioeconomic status. MATERIALS AND METHODS: A cross-sectional study was conducted with 588 12-year-old children enrolled in public and private schools in the urban areas in the city of Diamantina (southeastern Brazil). Clinical examinations were performed for the diagnosis of traumatic dental injury based on Andreasen's classification. The Child Perceptions Questionnaire (CPQ11-14 ), which has been validated for the population in Brazil, was employed to evaluate oral health-related quality of life. Socioeconomic status and overjet were also analyzed. Statistical analysis involved the chi-square test and logistic regression. RESULTS: A total of 29.4% of the students exhibited some type of trauma to at least one tooth. A negative impact on oral health-related quality of life was found in 53.1% of the sample. Traumatic dental injury was associated with a high impact on oral health-related quality of life [OR = 1.61 (95% CI: 1.08-2.39)] and overjet >3 mm [OR = 5.42 (95% CI: 3.66-8.02)]. However, no statistically significant associations were found between TDI and socioeconomic status. CONCLUSIONS: Prevalence of traumatic dental injury was high among the children who participated in the study, and it was associated with a high impact on oral health-related quality of life as well as overjet >3 mm.

Trauma in Permanent Teeth: Factors Associated with Adverse Outcomes in a University Pediatric Dental Clinic.

PURPOSE: The purpose of this study was to determine variables associated with adverse outcomes among traumatized permanent teeth in a university pediatric dental clinic. METHODS: Electronic charts of children treated at a university-based dental clinic for trauma in permanent teeth were analyzed. Variables evaluated included demographics (age, sex, American Society of Anesthesiologists classification, and insurance type), affected tooth location, trauma characteristics, type of dental trauma, elapsed time between trauma and initial treatment, elapsed time between the initial and final treatment, initial treatment type, and initial and final restoration type. Adverse outcomes were defined as root canal treatment, decoronation, and extraction. Associations between adverse outcomes and each variable of interest were calculated using chi-square and Fisher's exact test and logistic regression. The significance level was set at five percent. RESULTS: Adverse outcomes were significantly associated with the type of dental trauma (P=0.001), presence of luxation injury (P=0.048), initial dental treatment (P<0.001), and initial dental restoration type (P=0.019). CONCLUSIONS: Treating dental trauma in permanent teeth in a timely manner can strongly impact their prognosis.

Perfil do traumatismo em dentes decíduos e permanentes de crianças e adolescentes atendidos no Centro de Vigilância e Monitoramento de Traumatismo Dento-alveolar da Faculdade de Odontologia da Universidade Federal do Rio de Janeiro / Profile of dental trauma in primary and permanent teeth of children and adolescents attended at the Center for Surveillance and Monitoring of Dento-Alveolar Trauma of UFRJ

O trauma dental é considerado uma urgência odontológica de alta prevalência e um grave problema de saúde pública mundial, com alto impacto na qualidade de vida e de elevado custo no tratamento. Este estudo retrospectivo teve como objetivo avaliar o perfil dos traumatismos em dentes decíduos e permanentes de pacientes de 0 a 15 anos atendidas no Centro de Vigilância e Monitoramento de Traumatismos Dentários da UFRJ. Os dados sobre gênero, idade, tipo de trauma, dentes e tecidos mais afetado foram obtidos dos prontuários e após tabulação, foram analisados descritivamente e pelo teste do χ² (p < 0.05)sendo incluídos 333 dentestraumatizados, dos quais 70% eram decíduos e 30% permanentes. A média de idade das crianças com dentes decíduos e permanentes afetados foi de 3,35 ± 2,02 e 9,09 ± 2,44 anos, respectivamente. Indivíduos do gênero masculino tiveram mais dentes permanentes (64,4%) que decíduos (55,6%) traumatizados (p = 0.085). Os incisivos centrais superiores, tanto decíduos (68,9%), quanto permanentes (69,4%) foram os mais acometidos. Dentes decíduos apresentaram maior frequência (p < 0.001) de trauma em tecido de suporte (73,3%) e menor frequência em tecidos duros (40,7%) quando comparados aos permanentes (51,5% e 60,6%, respectivamente) (p = 0.001). O trauma mais frequente no tecido de suporte nos decíduos foi a subluxação (27,2%; p = 0.001) e nos permanentes, a luxação lateral (42,0%; p < 0.001). Nos tecidos duros, houve maior ocorrência de trauma em dentes permanentes do que em decíduos (p = 0.001), no entanto não foi observado diferença entre os tipos de dentes quando avaliados cada tipo de injúria independentemente (p > 0.005). Quando os dentes decíduos foram acometidos, houve maior frequência de trauma em mucosa gengival (31%; p = 0.022) e nos permanentes, lesões traumáticas no mento foram os mais prevalentes (20,8%; p = 0.009). Houve relato de recorrência de trauma em 26,3% das crianças com dentes decíduos e em 20,2% com permanentes traumatizados. Conclui-se que há diferenças importantes entre o perfil de traumatismo nos dentes decíduos e permanentes, assim sugerindo-se abordagem preventiva e terapêutica distinta para ambos os grupos avaliados.(AU)

Dental trauma is considered a highly prevalent dental emergency and a serious public health problem worldwide that has a great impact on quality of life and a high cost for treatment. This retrospective study aimed to evaluate the dental trauma profile in deciduous and permanent teeth from patients between 0 and 15 years old attended at UFRJ. The data regarding gender, age, classification of the trauma, teeth and more affected tissues were obtained from dental record. After tabulation, the data were analyzed descriptively and by the χ² test (p <0.05). Data from 333 traumatized teeth were included, of which 70% were deciduous and 30% were permanent. The mean age of children with primary and permanent affected teeth was 3.35 ± 2.02 and 9.09 ± 2.43 years, respectively. Male subjects presented more traumatized permanent teeth (64.4%) than primary ones (55.6%), (p = 0.085) The upper central incisors, both primary (68.9%) and permanent (69.4%) were the most affected. Primary teeth presented a higher frequency (p < 0.001) of supportive tissue trauma (73.3%) and lower frequency (p = 0.001) in hard tissues (40.7%) compared to permanent ones (51.5% and 60.6%, respectively). The most frequent trauma in the supportive tissue was the subluxation (27.2%; p= 0.001) and for permanent lateral luxation (42%; p < 0.001). In the hard tissues, permanente teeth presented higier prevalence of trauma than primary (p = 0.001), however there was not found statisticaal difference when each fracture injury was evaluated individually (p > 0.005). When the primary teeth were affected, there was a greater frequency of trauma in the gingival mucosa (31%; p = 0.022) and in the permanent ones, traumatic lesions in the chin were the most prevalent (20,8%; p = 0.009). There was a recurrence of trauma in 26.3% of the children with primary teeth and in 20.2% with traumatized permanents. It is concluded that there is a distinction between trauma profile in primary and permanent teeth, thus suggesting a distinct preventive and therapeutic approach for both groups evaluated.(AU)

Traumatismos dentarios en niños y adolescentes / Dental Trauma in Children and Adolescents

Los traumatismos dentoalveolares son lesiones que afectan a los dientes y los tejidos de sostén, incluyendo desde la pérdida de la integridad del diente hasta el desplazamiento total o parcial de su posición anatómica. Actualmente constituyen la segunda causa de atención odontopediátrica después de la caries. La búsqueda de información se realizó en la base de datos de PubMed de INFOMED y EBSCO; se utilizó dental trauma como descriptor. También se revisaron revistas médicas nacionales e internacionales en INFOMED, así como libros de texto. Se describieron los aspectos esenciales y actuales de los traumatismos en cuanto a prevalencia e incidencia, clasificación, etiología, factores predisponentes, localización, tipo de lesión, pronóstico y alteraciones de los dientes en desarrollo.(AU)

Dental and alveolar traumas are lesions that affects teeth and supporting tissue they may range from the loss of the whole integrity of the tooth to the total or partial displacement of its anatomical position. Nowadays they are the second cause of dentist pediatric care after cavities. The searching for information was carried out in PubMed and INFOMED and EBSCO using the descriptor dental trauma. In International and national medical journals were also reviewed as well as books. The current and essential aspects of traumas were described taking into account prevalence, incidence, classification, etiology, predisposing factors, site, kind of lesion, prognosis and teeth alteration.

Splinting of teeth following trauma: a review and a new splinting recommendation.

With advances in the understanding of healing processes of the periodontium, pulp and alveolar bone following various injuries, the role of splinting has become relatively well defined. This is generally reflected in the guidelines for trauma management published by the International Association of Dental Traumatology. While the widespread use of composite resin as an adhesive in various functional/flexible splinting systems has over many years allowed ease of application, removal of the material is not only time consuming but more seriously accompanied by minor or major iatrogenic damage to enamel. Dental materials science has continued to provide new materials and amongst them the development of resin activated glass-ionomer cement suitable for orthodontic bracket cementation has allowed the development of an alternative simplified splinting regimen for traumatized teeth which offers ease of application and removal with minimal or no iatrogenic damage to enamel.

Valoração do dano estético odontológico utilizando três métodos: relato de caso pericial civil / Valuation of dental aesthetic damage using three methods: report of expert civil case

Objetivo: o presente trabalho tem como objetivo relatar um caso de perícia odontológica civil em queforam empregadas e comparadas três metodologias para valorar o dano estético odontológico associadoàs perdas dentais. Relato de caso: tratou-se de uma perícia civil ajuizada para ressarcimento de danos,realizada no Serviço de Assessoramento Pericial da Faculdade de Odontologia de Piracicaba daUniversidade Estadual de Campinas/Brasil. O periciado estava num caminhão que foi atingido por umapedra projetada em direção oposta à sua, pelo trabalho de um trator que se encontrava na beira doacostamento cortando grama, sendo atingindo o vidro do veículo e a face do periciado. Após atendimentono hospital local, nenhum outro tratamento foi realizado desde então. Foram empregados 3 métodos paravaloração do dano estético envolvendo perda dental: 1) dano estético dental, 2) escala de sete graus, e 3)Análise da Impressão e do Impacto do Prejuízo Estético “AIPE”. Conclusão: a utilização de diferentesformas para valorar o dano estético em casos que envolvem desdentados parciais com lesões cicatriciaismostrou a importância do perito odontólogo estar atualizado e ter conhecimento sobre as abordagensexistentes, realizar uma descrição pormenorizada e padronizada das lesões, bem como estar atento paraindicar uma visão completa da pessoa portadora de dano estético à autoridade requisitante com autilização de metodologias adequadas para valorar esse tipo de dano.

Objective: the aim of this paper is to present a case of civil expert examination in dentistry area, in whichthree methods were applied and compared for valuing aesthetic damage associated to tooth loss. Casereport: the case involved a civil expert examination requested for damage compensation, held at theAdvisory Expert Service of the Piracicaba Dental School, State University of Campinas/Brazil. Theexamined patient was wounded on the face when he was in a truck that was hit on the glass by a rock,projected from the opposite direction, by a tractor on the roadside, cutting grass. After care at the localhospital, no treatment was carried out. Three methods were used to evaluate the aesthetic damageinvolving the tooth loss: 1) dental aesthetic damage, 2) seven degrees scale, and 3) Aesthetic Perceptionof Injury Analysis or “AIPE”. Conclusion: the use of different ways to value the aesthetic damage in casesinvolving partial edentulous individuals, with cicatricial lesions showed the importance of the dental experton being updated and having knowledge on existing approaches, on performing detailed and standardizeddescription of the lesions, as well as on being alert to provide a complete vision of the aestheticallydamaged person to the requesting authority, using adequate methodologies to evaluate the injury.

Classification and Epidemiology of Traumatic Dentoalveolar Injuries in Dogs and Cats: 959 Injuries in 660 Patient Visits (2004-2012).

The objective of this study was to determine the epidemiology of traumatic dentoalveolar injuries (TDI) in dogs and cats and to evaluate the applicability of a human classification system for TDI in dogs and cats. All patients diagnosed with a TDI were identified from the University of Wisconsin-Madison School of Veterinary Medicine Dentistry and Oral Surgery Service case log and the hospital patient processing software. The study population consisted of 621 dogs and cats, in a total of 660 patient visits from 2004 to 2012, admitted for oral treatment and subsequently diagnosed with at least one TDI Medical records including diagnostic imaging studies were reviewed to group the injury according to a classification system used in humans for TDI. Patient signalment, tooth injured, and number of injuries per patient were recorded and tabulated. The overall prevalence of TDI was 26.2%. The mean +/- SD number of TDI per patient was 1.45 +/- 0.85. All 14 classes of TDI recognized by the classification system utilized in humans were identified, and all (100%) TDI identified in this study were classifiable using this system. Enamel-dentin-pulp fracture was the most common TDI (49.6%). The most commonly injured teeth were the mandibular or maxillary canine teeth (35.5%). The most common age for dogs and cats with TDI were 3-6 years (33.0%) and 7-10 years (31.3%). With a frequency of 1 in 4 animals, TDI are common and represent a significant pet health concern. Most TDI are considered severe and require timely, and sometimes immediate, treatment. The adoption and utilization of a complete classification system, such as the one used in this study, is recommended in order to improve future epidemiological study of TDI in animals.

Management of dental trauma by general practitioners.

BACKGROUND: Patients who sustain dental trauma commonly present to their general practitioner (GP) or the emergency department, especial-ly to seek help after hours. It is important, therefore, for medical practitioners to correctly diagnose and manage these patients. OBJECTIVE: The purpose of this paper is to familiarise GPs with different presentations of dental-related trauma, and a brief management plan for each condition. DISCUSSION: Time is of the utmost importance when dealing with trauma in the dentition. Initial management of dental trauma, primarily by GPs working in rural or remote areas, can have a significant impact on the prognosis of oral hard and soft tissues.

Managing pediatric dental trauma in a hospital emergency department.

PURPOSE: The purpose of this study was to: (1) examine types of dental trauma presenting to a hospital emergency department (ED); (2) describe the medical services provided to these patients; and (3) quantify time spent during ED encounters for dental trauma emergencies. METHODS: Records of 265 patients who presented to the ED with dental trauma over a three-year period were reviewed. Demographics, injury types, triage acuity, pain scores, and dental/medical treatment and times were analyzed. RESULTS: Patient demographics and injury types were similar to previous studies. Eighty-two percent of patients received mid-level triage scores; 41 percent of patients had moderate to severe pain. The most frequently provided medical services were administration of analgesics and/or prescriptions (78 percent). The mean times were: 51 minutes waiting for a physician; 55 minutes with dentists; and 176 minutes total time. Higher triage acuity and pain levels resulted in significantly longer wait times for physician assessment. Dental evaluation, including treatment, averaged 32 percent of time spent at the hospital. CONCLUSIONS: A dental clinic is the most efficient venue for treating routine dental trauma. Patients in this study spent the majority of time waiting for physicians and receiving nondental services. Most patients required no medical intervention beyond prescriptions commonly used in dental practice.

Time delays in treating dental trauma at a children's hospital and private pediatric dental practice.

PURPOSE: The purpose of this study was to compare the time interval between a child sustaining a dental injury and the rendering of treatment in a hospital setting and a private pediatric dental practice. METHODS: Data were collected from the patient records of children treated for dental trauma at a children's hospital emergency department, a children's hospital dental clinic, and a private pediatric dental practice. Data included demographics and the time, date, type of injury, and its treatment. RESULTS: Injuries were more severe, treatment was more complex, and the time interval between injury and treatment was longer for those children treated in the hospital setting versus private practice, regardless of distance traveled. Children treated at their dental home experienced fewer treatment delays. Insurance status, medical complexity, and associated injuries were not related to treatment delays. CONCLUSIONS: Children who seek emergency care for traumatic dental injuries in a hospital setting experience greater delays in treatment compared to those seeking care in a private practice setting. These findings might not be generalizable to other hospital settings or private practices due to the inherently unique characteristics of the sites used in this study.

Traumatic dental injuries in Turkish children, Istanbul.

AIM: Some of the commonly encountered dental emergencies are traumatic dental injuries. The aim of this study was to evaluate traumatic dental injuries with regard to age, gender, etiology, classification of trauma, teeth involved, place of injury, and treatment received by patients who were referred over a 2-year period to the Istanbul University, Faculty of Dentistry, Clinics of Pedodontics, Istanbul, Turkey. MATERIALS AND METHODS: The study was based on the clinical data of 154 patients (337 traumatized teeth). The children were examined clinically for dental injuries by the same investigator. The following information was recorded: age, gender, etiology, localization, place, number of injured teeth, type of trauma, type of tooth, time elapsed between injury and treatment, and treatment provided. Traumatized teeth were assessed according to the classification of the World Health Organization slightly modified. RESULTS: A total of 154 patients aged 1-13 years presented a total of 337 traumatized teeth (255 permanent and 82 primary). 94 boys (61%) and 60 girls (39%) with a mean age of 7.91 ± 3.15 years participated in the study. Dental injuries were frequent in the 6-12 year age group. The most common type of dental injuries recorded was luxation injuries (43.3%), uncomplicated crown fractures (20.5%), and complicated crown fractures (19.4%). The main causes were falls (55.2%) and being struck by an object (22.1%). The most frequent treatment was examination only (31.8%). CONCLUSIONS: In childhood, a correct diagnosis may affect the management methods and prevent the occurrence of complications after treatment for traumatic dental injuries. Therefore, continuing education programs offering the latest updates in the management of traumatized teeth should be provided for dental and medical practitioners.

Management of dental trauma in a primary care setting.

The American Academy of Pediatrics and its Section on Oral Health have developed this clinical report for pediatricians and primary care physicians regarding the diagnosis, evaluation, and management of dental trauma in children aged 1 to 21 years. This report was developed through a comprehensive search and analysis of the medical and dental literature and expert consensus. Guidelines published and updated by the International Association of Dental Traumatology (www.dentaltraumaguide.com) are an excellent resource for both dental and nondental health care providers.

Management of traumatic tooth injuries in the dental office.

Dental trauma is sudden, unscheduled, and the dentist and staff must be adequately equipped to expeditiously and properly treat the patient to assure the best possible outcome. This paper reviews current dental trauma guidelines to provide the correct treatment protocol to ensure the best prognosis. The case report illustrates the technique of avulsion care, RCT care, and functional splinting in a successful manner.