Avulsion Injuries: Assessment and Management.

Avulsion injuries, though relatively uncommon, are one of the most serious of dentoalveolar injuries. Replantation at the scene of the incident is almost always the treatment of choice whenever possible. This paper outlines a step-by-step approach for the management of avulsion injuries, including a splinting protocol. This aims to support general dental practitioners in feeling more confident with managing these injuries.

Survival of immediate implants replacing traumatised teeth in the anterior maxilla.

Aim The provision of implants following traumatic dental injuries can hold many challenges, primarily in higher aesthetic regions. The purpose of this retrospective study was to assess the clinical outcomes of immediate implants placed in fresh extraction sites in the anterior maxilla following dental trauma.Materials and methods In total, 60 patients requiring teeth replacement with dental implants in the anterior maxilla were included in the study. Following a delayed loading protocol, the implants were restored with definitive single crowns or bridges. Implant and prosthetic survival, complications and periodontal health were recorded during follow-up.Results A total of 70 implants were placed in the anterior maxilla with three failures reported, resulting in an implant survival rate of 95.7% over a follow-up period of three years. No additional bone augmentation was undertaken and prosthetic survival recorded was 100%, with favourable periodontal outcomes achieved overall.Conclusion This study showed that implants immediately inserted into fresh extraction sites following dental trauma can constitute a predictable treatment strategy, presenting high implant survival rates over the follow-up period observed. Further well-designed controlled clinical trials are required to evaluate longer-term outcomes for this technique.

Traumatic dental injuries in adults attending a London-based trauma clinic in the UK: a seven-year survey.

Introduction This survey reports the incidence of traumatic dental injuries in an adult population attending an adult dental trauma clinic in a London teaching hospital.Materials and methods Retrospective data were collected from patients attending an adult dental trauma clinic between 2012 and 2018.Results In total, 1,769 patients attended, with more men seen (1,030; 58.2%) compared to women (739; 41.8%) and this was statistically significant (p <0.05). The most common aetiological factor was an accidental fall (728; 41.15%), followed by assaults (413; 23.35%), bicycle accidents (253; 14.3%), sports injuries (132; 7.46%) and road traffic accidents (84; 4.75%). Lateral luxation (833) was the most common traumatic injury and this was followed by avulsions (362; 17%). Enamel-dentine fractures were the most common type of fracture injury (1,273; 64%).Discussion This retrospective survey attempts to report on the incidence of traumatic dental injuries in a London-based cohort of patients attending a specialised dental trauma clinic. In line with other reports, there were more men than women affected, which is probably attributed to behavioural activities.Conclusion(s) Accidental falls are the most common cause of a traumatic dental injury, lateral luxation was the most common type of displacement injury and enamel-dentine fractures were the most common type of fracture injury.

Management of acute traumatic dental injuries in the orthodontic patient.

Knowledge of managing traumatic dental injuries (TDIs) is imperative for all dental practitioners. With the number of adults undertaking orthodontic treatment increasing, and children and adolescents alike continually being treated for orthodontics under the NHS in the UK, it is imperative that all clinicians - specialists and generalists - are aware of how to manage the orthodontic appliance in a patient presenting with a TDI in their active phase of orthodontics.This guidance will aid practitioners in implementing pragmatic approaches to manage the orthodontic appliance in a patient presenting with a TDI. Key focus will be given on fixed appliance therapy. Case examples and flow diagrams outlining best practice are given to manage the TDI and orthodontic appliance concurrently.

Emergency dental care triage during the COVID-19 pandemic.

Introduction Due to the COVID-19 pandemic, from 23 March 2020, routine dental treatment was stopped by the Chief Dental Officer, with the emphasis towards urgent dental care only.Aim To evaluate the activities of the emergency service at a secondary care Urgent Dental Care (UDC) hub during the COVID-19 pandemic.Materials and methods The total number of patients seen from 30 March to 20 June 2020 was recorded. The effectiveness of telephone triage and the appropriateness of patients invited for a clinical assessment were evaluated over a two-week period.Results The number of calls into the UDC hub were highest during the first few weeks, with up to 249 per day. The most commonly provided emergency treatments included extractions and pulp extirpations.Discussion As other UDC hubs opened, the number of calls reduced, with patients being directed to a UDC nearer to where they lived.Conclusions The dental profession had to make some significant changes in the way they worked due to the risk of COVID-19 transmission and due to the effects of the lockdown. This review highlights the effectiveness of telephone triage as well as its drawbacks.

International Association for Dental Traumatology guideline updates.

The International Association for Dental Traumatology has recently updated its guidelines following on from a consensus methodology. The update involves increased radiographic review, reduced splinting time for avulsed teeth and the recommendation against extraction of luxated primary teeth when displaced towards the permanent tooth germ. This article will highlight the relevant updates and introduce clinicians to the core outcome sets developed for traumatic dental injuries in both adults and children.

Dental Traumas - Things May Not Be as They Seem: A Case Report.

This case report describes a 52-year-old female patient who attended a specialist adult dental trauma clinic with a confusing history about a re-implanted avulsed maxillary left central incisor (UL1). Following examination, further investigations and clinical investigations, it was determined that the tooth had been re-implanted in the sub-periosteal space. The upper central incisor was extracted and re-implanted into the correct position and then managed by following the 2020 guidelines of the International Association for Dental Traumatology (IADT).This case highlights an unusual complication of managing avulsed teeth and draws attention to the challenges posed by using two-dimensional radiographic imaging when assessing dental injuries.A six-month follow-up appointment confirmed functional success and a reasonably satisfactory aesthetic outcome for the patient.

Traumatic Dental Injuries During the COVID-19 Pandemic.

This paper details the characteristics of traumatic dental injuries (TDIs) during the Coronavirus 2019 (COVID-19) pandemic in 2020 at an Urgent Dental Care hub at King's College Hospital Dental Institute, London, UK. For comparisons to be made, the characteristics of TDIs from a similar period in 2019 was also collected. Data was collected retrospectively from clinical records of patients suffering from dental trauma during both periods. An analysis was completed and conclusions drawn. The results suggest that the COVID-19 pandemic influenced the frequency, aetiology and type of TDIs. In order to suitably manage the provision of dental services, consideration must be given to the influence of pandemics on the characteristics of dental emergencies.

What are the important outcomes in traumatic dental injuries? An international approach to the development of a core outcome set.

BACKGROUND/AIMS: There are numerous treatment options following traumatic dental injury (TDI). Systematic reviews of different treatments are challenging owing to the diversity of outcomes reported between clinical studies. This issue could be addressed through the development and implementation of a agreed and standardized collection of outcomes known as a core outcome set (COS). The aim of this study was to develop a COS for TDI in children and adults. The secondary aim was to establish what, how, when and by whom these outcomes should be measured. MATERIALS AND METHOD: The project was registered with Core Outcomes Measures in Effectiveness Trials (COMET). A web-based survey was developed to capture the opinions of dentists globally as to which outcomes should be recorded. A list of outcomes was entered into a Delphi Survey and scored by an Expert Working Group (EWG). The scoring was repeated, followed by conference calls to discuss, refine and finalize the COS. The EWG split into small groups of subject-specific experts to determine how, when and by whom each outcome would be measured. RESULTS: The questionnaire was completed by 1476 dentists. The EWG identified 13 core outcomes to be recorded for all TDI's. An additional 10 injury-specific outcomes were identified. A table has been produced for each outcome detailing what, when, and how each outcome should be recorded. CONCLUSIONS: A robust consensus process was used to develop an international COS for TDI in children and adults. This includes both generic and injury-specific outcomes across all identified domains.

The Paradoxes of Phantom Bite Syndrome or Occlusal Dysaesthesia ('Dysesthesia').

Phantom bite syndrome was first described by Marbach over 40 years ago as a mono-symptomatic hypochondriacal psychosis. He used the term to describe a prolonged syndrome in which patients report that their 'bite is wrong' or that 'their dental occlusion is abnormal' with this causing them great difficulties. This strong belief about 'their bite' being the source of their problems leads to them demanding, and subsequently getting, various types of dentistry carried out by multiple dentists and 'specialists'. Sadly, even after exhaustive, painstaking, careful treatment, none of the dental treatments manages to solve their perceived 'bite problems'. This is because they suffer from a psychiatric illness involving a delusion into which they continue to lack insight, in spite of the failures of often sophisticated dental treatments.1,2,3 In summary, dental practitioners, or other specialists, who suspect that they might be dealing with such a problem should refer these patients early on for specialist management by an appropriate specialist within the secondary care settings, preferably before they get trapped into the time-consuming quagmire of their management. A 'Phantom Bite Questionnaire', which is available to download free, might help. Clinical relevance: This article aims to provide professionals in various fields with guidelines on detecting, diagnosing and managing patients with Phantom Bite Syndrome (PBS). This is desirable in order to prevent extensive, or unnecessarily destructive, or unstable dental treatment being undertaken on such patients in a vain attempt to solve their problems with 'dentistry' when, in fact, these are really due to underlying mental health issues.

Type-1 Dentine Dysplasia ­ Diagnostic and Clinical Challenges in Restorative Management.

Type-1 dentine dysplasia is a rare hereditary condition, associated with an abnormality in dentine formation. Deceptively, teeth have the clinical appearance of normality, however, radiographically, a different picture is seen; with multiple periapical radiolucencies associated with non-carious, unrestored teeth. This article reports the diagnostic and management challenges associated with dentine dysplasia in adults. Clinical relevance: Early diagnosis and preventive advice within primary care are imperative in the long-term outcomes.

Dental Attendance and Self-reported Oral Health Status of Renal Dialysis Patients: A Comparison of Results with the UK Adult Dental Health Survey.

PURPOSE: To compare the oral health status of renal patients attending a dialysis unit at a London teaching hospital with an age- and sex-matched sample from the Adult Dental Health Survey UK (ADHS) 2009. MATERIALS AND METHODS: Questions adapted from the ADHS 2009 national survey were used to interview renal dialysis patients about their oral health, oral hygiene and dental visits. Any significant differences between the two groups were statistically analysed using the chi-squared (χ2) test. RESULTS: Two hundred renal dialysis patients participated. More renal dialysis patients were edentulous (p < 0.0001) and those who were dentate had fewer teeth (p < 0.0001) compared to the ADHS 2009 participants. Although 12% of the renal dialysis patients had difficulty in finding a dentist, 77% were linked to a dental practice, but fewer reported that they had previously been shown how to brush their teeth compared to the dentate ADHS group (p < 0.0001). The frequency of brushing (twice daily) was similar in the dialysis and ADHS groups. CONCLUSION: Awareness for good oral health needs to be raised in this group of medically compromised patients regularly attending a hospital unit. The responsibility for achieving this goal needs to be shared by both dialysis teams and oral health care professionals. We suggest an 'oral health toolkit' be made available in dialysis units for both professionals and patients.

Adult Dental Trauma: What Should the Dental Practitioner Know?

The management of adult dental trauma can be a daunting challenge for practitioners at any level. Like medical emergencies, initial management can have a large influence on prognosis. It is important that practitioners understand the basic principles of managing the acute presentations of dental trauma. This article aims to illustrate a step-by-step approach in order to improve the management within general dental practice for better outcomes for patients.

Adult Dental Trauma: What Should the Dental Practitioner Know?

The management of adult dental trauma can be a daunting challenge for practitioners at any level. Like medical emergencies, initial management can have a large influence on prognosis. It is important that practitioners understand the basic principles of managing the acute presentations of dental trauma. This article aims to illustrate a step-by-step approach in order to improve the management within general dental practice for better outcomes for patients.

Dental Trauma Part 1- Acute Management of Luxation/Displacement Injuries.

Fortunately, traumatic dental injuries are a relatively uncommon occurrence in general dental practice. However, when they do present, timely diagnosis and treatment of such injuries is essential to maximize the chance of a successful outcome. This is the first part of a two-part series on traumatic dental injuries that are commonly encountered in the clinical setting. Part one will cover acute management of luxation/displacement injuries that primarily affect the supporting structures of the tooth, while part two will cover the management of fracture injuries associated with teeth and the alveolar bone. Clinical relevance: A simple, step-by-step approach in the diagnosis and clinical management of acute luxation/displacement injuries should be part of a dental clinician's knowledge.

Dental Trauma 2- Acute Management of Fracture Injuries.

Fortunately, traumatic dental injuries are a relatively uncommon occurrence in general dental practice. However, when they do present, timely diagnosis and treatment of such injuries is essential to maximize the chance of a successful outcome. This is the second part of a two-part series on traumatic dental injuries that are commonly encountered in the clinical setting. Part one covered the management of acute luxation/displacement injuries affecting the supporting structures of the tooth, while part two will cover the management of fracture injuries associated with teeth and the alveolar bone. Clinical relevance: Traumatic dental injuries are uncommon occurrences in everyday general dental practice. This article aims to provide a simple, step-by-step approach in the diagnosis and clinical management of acute fracture injuries.

Smartphones and dental trauma: the current availability of apps for managing traumatic dental injuries.

BACKGROUND/AIM: There is a general consensus regarding the lack of awareness regarding the emergency management of traumatic dental injuries amongst laypersons and dental professionals. This article aims to provide an overview of the apps available for traumatic dental injuries using smartphones. These apps may serve as a gateway for raising awareness of traumatic dental injuries. MATERIALS AND METHOD: Three smartphone devices were used to access their respective app stores (Nokia Lumia 635 with Windows Phone OS 8.1; iPhone 5 with iOS 8.1; Samsung Galaxy Ace II with Android OS v2.3.6 Gingerbread). Nine phrases were searched: broken tooth/teeth; chipped tooth/teeth; dental emergency; dental injury; dental trauma; fractured tooth/teeth; knocked-out tooth/teeth; tooth/teeth injury; and tooth/teeth trauma. RESULTS: Seven apps for the Android and one app for the Apple operating system were relevant. The only Apple iOS app retrieved (Dental Trauma) was also found for the Android OS (Dental Trauma First Aid) and had the endorsement of the International Association of Dental Traumatology. AcciDent was the only app dedicated to traumatic dental injuries targeted solely towards dental professionals. Five other apps (Chipped Tooth Solution, Dental Crown Repair, Fixing Cracked Tooth, Repairing the Front Tooth and Solution to Broken Tooth) appeared to come from the same source (KBES). No traumatic dental injury apps were found for the Windows Phone OS. CONCLUSION: There are apps available for both patients and dentists that range in quality and on the whole lack real-life photographs. Future apps should continue to provide good quality, evidence-based and validated material.

What do dental students know about trauma?

AIM: To assess the baseline knowledge, knowledge acquisition and retention of dental undergraduate students in dental trauma, and the impact of a lecture on their level of confidence in managing traumatic dental injuries. MATERIAL AND METHODS: A total of 145 dental undergraduate students from King's College London were invited to attend a lecture on dental trauma. The participants were asked to complete a questionnaire on dental trauma before (T0), immediately after (T1) and 6 months (T2) following a 1-h lecture. RESULTS: Seventy of the 145 students participated in the study. The level of knowledge at T0, T1 and T2 was 64.9%, 83.2% and 69.5%, respectively. The increase in score was statistically significant between T0 and T1, and between T0 and T2. A significant decrease in score was also found between T1 and T2. Sex, level of education and whether or not the participants received previous teaching in dental trauma were not significant in predicting a change in score. The level of confidence increased significantly from 2.14 at T0 to 3.13 at T2. Participants who received teaching in dental trauma previous to the lecture were significantly more confident at T0. CONCLUSIONS: Lectures are effective at improving the knowledge and retention of knowledge of dental undergraduate students in dental trauma. However, retention of the knowledge is time limited suggesting that education should be repeated after a certain period of time to ensure that a high level of knowledge is maintained.

Challenges in treating traumatically intruded and ankylosed permanent incisors: a case report with a multidisciplinary approach.

This report discusses the challenges, complications and management of traumatic intrusion injuries affecting the permanent dentition. A case is described where trimming of the incisal edge of a severely intruded and ankylosed upper lateral incisor resulted in an unexpected re-eruption of the tooth. It is suggested that the vibrations from drilling may have disrupted the ankylosis, initiating spontaneous re-eruption and this approach could provide a minimally invasive and conservative pathway to treating ankylosed teeth. Clinical Relevance: To date no effective treatment has been described to reverse the development of replacement root resorption leading to the loss of the affected tooth. The hypothesis proposed here suggests that mechanical vibrations, if strong enough, may disturb the ankylosis and allow re-eruption of the intruded tooth.

The value of cone beam CT in assessing and managing a dilated odontome of a maxillary canine.

A case of an unusual anomaly in a maxillary canine is described. A deep enamel invagination resulted in pulpal necrosis, longstanding infection and development of an associated radicular cyst. Diagnostic X-ray imaging was invaluable in demonstrating the complex root anatomy of the dilated odontome. In particular, a cone beam CT scan helped in the formulation of an appropriate treatment plan. Clinical Relevance: Three-dimensional imaging using cone beam CT was valuable in this case to demonstrate the complicated anatomy of a rare dental anomaly, and to help plan treatment.