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PubMed2000

Diagnosis and management of dental injuries in children.

Approximately half of children sustain some type of dental injury. Management of injuries to the anterior teeth of preschool children is directed toward minimizing potential damage to the developing permanent teeth; therefore, heroic measures to save primary teeth are not indicated. Crown fractures in the permanent dentition, even those exposing the dental pulp, can be successfully treated hours after an injury. Prompt referral for dental treatment is advisable. Displacement injuries to permanent teeth constitute genuine dental emergencies in which the prognosis is directly related to the timeliness of treatment. Avulsed permanent teeth should be immediately reimplanted by any capable person. If that is impossible, the teeth should be placed in cold milk and the child referred for immediate treatment by a dentist. Mouthguards prevent dental injuries but are not widely used outside of a few organized sports. Efforts should continue to promote mouthguard use in all contact sports.

Child↗
PubMed2000

Trauma to the primary and young permanent dentitions.

It is the responsibility of the dentist to stay current on the latest techniques available to treat traumatic injuries. The charts included provide most of the potential emergency treatment possibilities, recommended follow-up treatment, and final treatment outcomes essential to providing the best care for our child patients. It is also the responsibility of the dentist to use evidence-based research when adopting treatment protocols. It is not appropriate to use anecdotal or single case studies as a basis for adopting treatment protocols. It is very difficult in this area of trauma to come up with good scientific research with adequate sample sizes and long-term data. Dr. J.O. Andreasen has excellent compiled long-term research on trauma. His books, Essentials of Traumatic Injuries to the Teeth and An Atlas of Replantation and Transplantation of Teeth are two very good books for any clinical practice.

Child↗
PubMed1989

[Root canal treatment and esthetic reconstruction in traumatology].

The use of calcium hydroxide in the treatment of traumatic injuries are reviewed in this paper and demonstrated by some clinical cases. The necessity of a proper crown reconstruction is also emphasized as it is impossible to use posts in these treatments.

Calcium Hydroxide↗
PubMed2005

Clinical investigation of traumatic injuries in Yeditepe University, Turkey during the last 3 years.

The aim of this study was to evaluate etiology, types of traumatic dental injuries, treatment and to determine the incidence of complications according to dental injuries in patients who referred to Yeditepe University, Faculty of Dentistry, Istanbul, Turkey. The study was based on the clinical data of the 161 traumatized teeth in 92 patients. WHO classification slightly modified by Andreasen & Andreasen for dental trauma was used. The causes and localization of trauma, traumatized teeth classification, treatment and complications were evaluated both primary and permanent teeth. The distribution of complications according to diagnosis and treatment of the injured teeth were evaluated. Of 35 (38%) girls and 56 (72%) boys with a mean age 7.6 +/- 3.5 (ranging 1-14.2) participated to study and the mean followed up was 1.72 +/- 1.28 years (ranging 0.10-3.8 years). From the 161 affected teeth, 69 (42.9%) were in primary teeth and 92 (57.1%) in permanent teeth. The highest frequency of trauma occurred in the 6-12 year age group. Overall boys significantly outnumbered girls by approximately 1:1.6. The most common type of injury in the primary and permanent teeth was seen as luxation (38%) and enamel fracture (20%) of the maxillary central incisors, respectively. Falls were the major sources of trauma both the primary (90%) and the permanent teeth (84%). In the primary dentition, the most common type of soft tissue injury is contusion (62.5%) and in the permanent dentition, it is laceration (49%). The most of the treatment choice was determined as examination only and extraction in primary teeth (58 and 24.6%, respectively) while it was applied as restoration and pulpectomy in permanent teeth (31.5 and 18.5%, respectively). Complications were recorded on 37 teeth (23%) with a most common type of necrosis (10.5%) and dental abscess (7.4%). Necrosis was more frequent in luxation whereas dental abscess were in crown fracture with pulpal involvement in both dentitions. The study showed that boys were more prone to dental traumas than girls. Falls were more frequent trauma type with a high complication risk. It reveals that the time of the immediate treatment showed the important predisposing factors that increase the success of treatment and decrease the risk of complication. The correct diagnosis of dental injuries is more important for eliminating the occurrence of complications.

Abscess↗
PubMed1989

[Biology of traumatic dental injuries].

As it is shown in Tables 1 and 2, there exist large gaps in the experimental basis for the treatment of dental trauma in both the primary and secondary dentitions. It can be seen that approximately 12% of presently accepted therapy are based on experimentally supported treatment principles. This has resulted in a myriad of varying and often conflicting treatment procedures. A systematic investigation of the effect of an acute dental trauma and various treatment procedures on the individual cellular systems would require tremendous scientific manpower. In contrast to this need, the extremely limited research activity in the area of dental trauma is cause for worry. Unless this research area is upgraded nationally and internationally, there is little hope that the random and empirical basis accepted in the treatment of traumatic dental injuries will ever be replaced by a scientifically based set of treatment principles which respect and enhance wound healing in the pulp and periodontium. Only by the fulfillment of this goal will the long-term prospects of traumatized dentitions be improved.

Adolescent↗
PubMed1999

Dental root resorption.

This article presents a review of physiologic mechanisms involved in various types of root resorption that may be encountered clinically. Included is a brief overview of suggested homeostatic mechanisms of the periodontal ligament and the role of the intermediate cementum in inhibiting root resorption. Root resorption (surface, inflammatory, and replacement) associated with traumatic injuries is discussed, with emphasis on etiology and the ability to provide treatment. The final discussion relates to other types of resorption, based on a classification of internal, cervical, and external resorption associated with periradicular pathosis and resulting from pressure in the periodontal ligament.

Humans↗
PubMed2004

Influence of the type of dental trauma on the pulp vitality and the time elapsed until treatment: a study in patients aged 0-3 years.

The purpose of the present study was to determine the influence of the type of trauma on the pulp vitality and the time elapsed until seeking dental care in children aged 0-3 years seen at the Baby Clinic of the Araçatuba Dental School, UNESP. A total of 1813 records were analyzed. Two hundred and three patients, corresponding to 302 traumatized teeth, were assessed clinically and radiographically. Hard-tissue injuries were the most frequent (52%), with a predominance of enamel crown fractures (41.4%), followed by concussions (12.6%) and intrusions (11.6%). Clinical and radiographic examination revealed that 72% of the traumatized teeth maintained pulp vitality. In the case of supporting-tissue lesions, 51.1% of the patients sought care within 1-15 days after injury, while in the case of hard-tissue injuries, 52.7% sought care only after 16 days. The results showed that supporting-tissue injuries had a significant influence on the faster seeking of dental care.

Child, Preschool↗
PubMed2000

On dental trauma in children and adolescents. Incidence, risk, treatment, time and costs.

BACKGROUND: Dental trauma occur in childhood and adolescence with consequences in time and costs for both patient and family. The scientific knowledge of these matters is scarce. For some individuals, dental trauma will result in long, time-consuming and costly treatments in childhood which will continue into adulthood. AIM: The thesis aimed to increase the knowledge of incidence, risk, treatment, time and costs spent on dental traumas to primary and permanent teeth in children and adolescents. MATERIAL AND METHOD: The material for the studies emanated from the county of Västmanland, Sweden, and the municipality of Copenhagen, Denmark, and from a Swedish nation-wide material (Folksam). The material was collected from accident reports, dental files, dental trauma forms, questionnaires and telephone interviews. Descriptive, prospective and analytical methods were used. A classification of uncomplicated and complicated dental traumas was presented. RESULTS: The incidence of dental trauma to boys was higher, compared to girls, in the county of Västmanland in almost all age groups. For both sexes, the first years in life and the first years in school were the most accident prone periods with incidence twice as high as the average incidence for all children and adolescents in the county. Every third trauma was complicated with injuries to the pulp or periodontal ligaments. Every second patient with a dental trauma to permanent teeth suffered from multiple dental trauma episodes (MDTE) during a period of 12 years. In almost every second patient with MDTE, at least one of the affected teeth had sustained repeated trauma episodes. The risk of sustaining MDTE increased when the first trauma episode occurred in the age interval of 6-10, compared to 11-18 year olds. During a 12-year period, treatment times for complicated traumas were 2.0 and 2.7 times higher for primary and permanent teeth, respectively, compared to corresponding values for uncomplicated traumas. On average, direct time (treatment time) represented 11% and 16% of the total time, while the direct costs (health care service, transport, loss of personal property and medicine) represented 60% and 72% of the total costs of traumas to primary and permanent teeth, respectively, during a 2-year period for cases of a nation-wide material. CONCLUSION: Dental traumas are frequent and some individuals are injured several times. Besides treatment time, efforts from the family are substantial in time and costs. Parameters such as degree of severity, access to treatment and place of injury are of major importance to both patient and family and should be considered when calculating time and costs of dental trauma in children and adolescents.

Accidents↗
PubMed1992

Trauma involving the dentition and supporting tissues.

Successful treatment of traumatic injuries depends on timely action by the patient and a quick and accurate diagnosis by the dentist. Although most injuries are minor and of an urgent nature, displaced or missing teeth are true emergencies. The mismanagement of dental traumatic injuries has provided much information as well as questions for research that have resulted in the increased retention of teeth with as little treatment as possible. Maintaining pulp vitality when possible, utilizing the therapeutic effects of calcium hydroxide, and returning teeth to function as soon as possible are keys to predictable prognosis.

Dental Pulp↗
PubMed2000

Direct and indirect time spent on care of dental trauma: a 2-year prospective study of children and adolescents.

The aim was to account for the total time spent by professional care-givers (direct time) and by patients and companions engaged as support and help (indirect time) to treat and otherwise attend to children and adolescents with dental trauma to primary and permanent teeth. The study was based on a random sample of 192 children and adolescents with dental traumas reported to an insurance company and prospectively followed up by telephone interviews over a period of 2 years after the trauma episode. On average, direct time represented 16% of total time for all visits for dental trauma to permanent teeth and 11% for trauma to primary teeth. The most extensive type of indirect time was transport time, which took up 30% of the total time spent on injuries to permanent teeth and 36% for injuries to primary teeth. Multiple regression analysis of the impact of dental and demographic injury variables on the time variables showed that complicated trauma was associated with extended time, direct as well as indirect, for permanent and primary teeth injuries. Our estimate of the average relative increase in total time spent by patients and companions in cases of complicated injury to permanent teeth was 117% (95% confidence interval [CI], 52-211) for patients and 112% (95% CI, 42-217) for companions. For transport time a strong predictor was access to a dental clinic near the place of residence. Lack of access could extend the average transport time by 180% (95% CI, 80-335) for patients and 163% (95% CI, 67-317) for their companions in cases of injuries to primary teeth.

Absenteeism↗
PubMed1995

Traumatic injuries in the preschool child.

The dental management of traumatic injuries in the preschool child demands a careful and methodical approach to the clinical patient care. Insurance claims and litigation possibilities require detailed documentation of the accident, the nature and extent of the injury and all treatment rendered, follow-up care, and verbal instructions given to the parent. The prognosis of the treatment and the damage to the permanent teeth depend upon the nature and extent of the injury and, in part, upon the treatment rendered and the follow-up care received by the patient. The dental records must be retained until the permanent teeth erupt to fully assess the extent of the damage to the developing dentition.

Child Abuse↗
PubMed1998

Initial treatment of traumatic dental injuries by dental practitioners.

The aim of this study was to investigate the nature of initial treatment provided by dental practitioners to children aged 1-17 years with various types of traumatic dental injuries at public dental clinics in Tanzania. Questionnaires on initial treatment were mailed to 188 practitioners and returned by 138 (73%). The reported treatments were analyzed in relation to the dental practitioners' qualifications and area of practice. Extraction of injured teeth was frequently reported for 64% of the injuries and prescription of antibiotics was reported by 67%, 48% and 46% of the practitioners for soft tissue injuries, concussion, and alveolar fracture respectively. Practitioners working at the Faculty of Dentistry were less involved in treating dental trauma than those at urban and rural clinics (P = 0.001), while no significant association was found with the level of education of the practitioners. Equal proportions of practitioners, about one-third each, reported correct, unnecessary and wrong treatment options. The quality of the treatments provided could not be explained by background variables. It can be concluded that dental practitioners in Tanzania provide a lot of over-treatment for traumatic dental injuries. Therefore, it is suggested that efforts should be made to improve and standardize treatment methods in Tanzania.

Adolescent↗
PubMed1990

[A histopathological study on hypoplasia of the enamel].

The research on the development and injury of the hard tissue of teeth was studied by the pedodontic departments of nine dental schools. We participated in this research and studied histopathologically hypoplasia of the enamel in particular. There were seven selected teeth which had obvious hypoplasia of the enamel. We conducted observations with the naked eye, replica, general microscopy, polarized light microscopy, fluorescence microscopy, and microradiography. Moreover we studied to classify these cases into three types, that is to say, the injury factors of whole body, locality, and unknown origin. The results obtained were as follows. 1) As for the injury factors for the whole body, the bottom of the enamel defects were located corresponding to the incremental line of Retzius in the case of enamel hypoplasia of the deciduous teeth. Also enamel hypoplasia was located near the dentino-enamel junction corresponding to the surface of hypoplasia. 2) As for the injury factors with respect to locality, the bottom of enamel defects were located corresponding to the incremental line of Retzius. The dentino-enamel junction was irregular and discontinuous, still more a part of that area, and the dentin protruded or was exposed. 3) As for the injury factors of unknown origin, hypoplasia was located from the surface of the enamel but it did not spread. Also the hypoplasia of the enamel did not correspond to the incremental line of Retzius. 4) Five cases had fluorescence lines in enamel or dentin.

Dental Enamel Hypoplasia↗
PubMed1994

Dental injuries, temporomandibular disorders, and caries in wrestlers.

The aim of this study was to examine the prevalence of dental injuries, temporomandibular disorders (TMD), and dental caries in a group of champion wrestlers. Twenty-six male wrestlers, with a mean age of 23 yr, and an age-matched control group participated in the study. A questionnaire was used with questions on trauma, frequency of headache, intensity of practicing sports, use of sugar-containing "sports drinks", use of mouth guards, and previous TMD problems. Four bitewing radiographs were taken in all subjects. In addition, three intraoral apical radiographs of maxillary and mandibular frontal regions were taken in the wrestlers. The number of existing teeth, dental caries, amount and type of restorations, and dental injuries were recorded. Examination of the stomatognathic system comprised bilateral palpation of the masseter and temporal muscles and temporomandibular joints, and evaluation of the mandibular movements. None of the subjects had drunk sports drinks or worn mouth protectors regularly. The wrestlers had more frequent and severe dental injuries localized to the frontal region of the maxilla than the controls. No statistical differences were found in the prevalence of caries or TMD between the groups.

Adolescent↗
PubMed1982

Treatment of avulsed permanent teeth: an update.

Every dental practitioner should be familiar with the current treatment recommendations for avulsed teeth. This article has attempted to update the practitioner in both the collection of data and treatment modalities for such traumatic injuries. The long-term prognosis of avulsed teeth has improved both because of the decrease in splinting time, which decreases the incidence of replacement resorption and the use of calcium hydroxide, which produces a better apical seal and decreases the incidence and severity of inflammatory resorption.

Child↗