Primary tooth injuries in Norwegian children (1–8 years)

Abstract –  This prospective study examined the yearly incidence of traumatic injuries to primary teeth. The aim of the study was to find out more about dental injuries to primary teeth in Norwegian children. The study was performed in one county of Norway involving approximately 20 000 children in the age group 1–8 years. Twenty-seven public dental clinics and 42 dentists participated. The dentists attended information and calibration meetings and received illustrations of the classification of dental trauma as well as examples of how to fill in the forms correctly. Two hundred and sixty-six children were involved, including 447 primary teeth, recorded during a 1-year registration period (2003). The dental trauma incidence was 1.3% with 3.5-year old being the most accident-prone. Boys were significantly more often injured than girls, 164 versus 102 ( P  < 0.001). The upper central incisors were most involved (92%), with a non-significant difference between the right and left side. The minor periodontal injuries dominated (59%). Hard tissue injuries were far less frequent (13%). Avulsions were observed in 6.5% and intrusions in 7.5% of the injured children, being 5.5% and 5% of the injured teeth. Most of the injuries occurred either at home (38%) or at kindergarten (32%). Sixty-two percentage were falling accidents often sustained during children's play, and 25% were pure playing accidents.
Conclusion:  In Norwegian children aged 1–8 years, with a predominance of boys, the most common primary tooth injuries were minor luxations of the maxillary central incisors, sustained at an age of 3.5 years. As the traumas often occurred during children's play and/or were the consequence of falls, these are difficult to prevent. However, follow ups should be carried out to disclose pulpal or periodontal complications and/or developmental disturbances of the permanent successors.     

Traumatic injuries to permanent teeth in Turkish children, Ankara

Abstract –  The aim of this study was to identify the types and etiologies of dento-alveolar injuries among patients who were treated for injuries to maxillary and/or mandibular permanent teeth at the Gulhane Medical Academy, Department of Pediatric Dentistry, Center of Dental Sciences in Ankara, Turkey to provide a basis for determining optimal treatment approaches and educational needs. From a total of 4956 children aged 6–12 years (mean age: 8.91 ± 1.95) applying to the Center, 472 children (9.5%) were found to have suffered dental injuries during a period of 2 years. Injuries were classified according to drawings and texts based on the WHO classification system, as modified by Andreasen and Andreasen. Injury rates were highest among children age 6 and ages 8–10. The most frequently injured permanent teeth were the maxillary central incisors (88.2%), and the maxillary right central permanent incisor made up 47.2% of all injured teeth. The most common cause of dental trauma was falling while walking or running (40.3%). Most injuries involved a single tooth (64.8%). The most common type of injury was enamel fracture (44.6%). There was a significant difference in gender, where boys more often suffered from a dental hard tissue and pulp injury than girls ( P  = 0.019), whereas there was no difference in gender ( P  = 0.248) in the distribution of periodontal injuries. Injuries were found to occur more frequently during the summer ( P  < 0.001). Children with increased overjet were 2.19 times more likely to have dental injuries than other children. Considering that the incidence of traumatic dental injury is highest among children ages 6 and ages 8–10 as well as the fact that patients with increased overjet are more prone to dental trauma, preventive orthodontic treatment in early mixed dentition may play an important role in reducing traumatic dental injuries.     

Dental trauma in children and young adults visiting a University Dental Clinic

Abstract –  The aim of the study was to present the distribution of traumatic dental injuries in the permanent anterior teeth in 447 consecutively selected patients in the age interval of 6 to 25 years treated at the Department of Paediatric Dentistry at the University Dental Clinic in Rijeka, Croatia, in the period from 2001 to 2006. Data on age, gender, number of injured teeth and type of injury were taken from the dental records. Of all 447 consecutively selected patients with traumatic dental injury 56.2% were boys and 43.8% were girls with a male/female ratio 1.28:1 ( P  < 0.01). The highest frequency of tooth injuries occurred among 10- to 13-years-old children. Among 30.6% of the cases, two or more teeth were injured (38.6% in boys and 21.4% in girls). Traumatic injuries affecting teeth in the upper jaw were more frequent ( P  < 0.001). The most commonly affected teeth were the maxillary central incisors (42.4% of right central incisors and 38% of left central incisors). The most frequent injury was enamel and dentin fracture without pulpal involvement (38.7%). In conclusion, more attention should be paid to preventive measures.     

Factors associated with traumatic dental injuries among 12-year-old schoolchildren in South India

Abstract –  Aims : To assess the prevalence of, and correlates of traumatic dental injuries among 12-year-old schoolchildren in Kerala. Material and Methods :  A cross-sectional, two-stage cluster sampling technique was used. The sample size included 838 12-year-old school children. Traumatic dental injuries to the anterior teeth were evaluated clinically by one examiner. Teeth examined were maxillary and mandibular incisors and canines. The children answered a structured questionnaire on sociodemographics, subjective oral health assessments and behavioural aspects. Results :  Six per cent of the 12-year-old school children had traumatic dental injuries to the anterior teeth. The right central incisors were most frequently affected. Multiple logistic regression analysis showed that boys (Adjusted Odds Ratio (Adj OR) = 2.2, 95% Confidence Interval (CI) = 1.1–4.1) and children who disagreed that good marks in school were important to them (Adj OR = 2.3, 95% CI = 1.2–4.3) had a higher probability of having traumatized teeth than other children. Conclusions : The prevalence of traumatized anterior teeth among 12-year-olds in Kerala was low compared with other studies. Being male and negative about future career were associated with a higher probability of having a traumatized tooth.     

Pattern of traumatic dental injuries in children attending the University Dental Hospital, Sri Lanka

Abstract – Aim : The aim of this study was to determine the pattern of traumatic dental injuries in children seeking care at the Division of Paediatric Dentistry, the Dental Hospital, University of Peradeniya, Sri Lanka. Material and methods : The sample consisted of patients attending the Division Paediatric Dentistry, University Dental Hospital for traumatic dental injuries between February 2003 and May 2006. The data were collected by means of an interviewer administered questionnaire to parent/guardian and a clinical examination. Results : A total of 197 children aged between 2 and 17 years had sought treatment for 304 traumatized teeth. Half of the patients had sought treatment more than 1 month after the trauma occurred. The most frequent cause for dental trauma was a fall (89%) whilst compromised aesthetics was the most common reason for seeking care (48%). Maxillary central incisors were the most affected teeth. Of the permanent teeth, 49% had sustained uncomplicated fractures involving only the enamel and dentine. Pulp therapy ranging from pulpotomy to root canal treatment was the treatment of choice for most of the traumatized permanent teeth (46%). In the deciduous teeth, a fracture involving enamel, dentine and the pulp was the most common (35%). Conclusions : As there was a considerable delay in seeking care for these injuries, it is recommended that educational programs be conducted for parents to create awareness about the importance of immediate management of traumatized teeth.     

Knowledge of general practitioners dentists about the emergency management of dental avulsion in Curitiba, Brazil

Abstract –  The prognosis of traumatized teeth in general and of avulsed teeth in particular depends on prompt and appropriate treatment. Management of traumatic injuries may be a challenge to the non-specialized dentist, as they may occur when dentists are least prepared for it. The objective of this research was to investigate the knowledge of general practitioner dentists about the emergency management of dental avulsion in Curitiba, PR, Brazil. A group of 250 professionals were interviewed. The questions were related to knowledge of how to treat traumatic avulsion of teeth. The results suggest that the level of knowledge on the management of dental avulsion of the general practitioners dentists in Curitiba is adequate.     

Severe sequelae of acute dental trauma in the primary dentition – a case report

Abstract –  The incidence of traumatic injuries to primary teeth is high. Previous studies report frequencies ranging from 4% to 33% of all children. The damage limitation and the prevention of sequelae are goals that shall direct the treatment for dental trauma. Inappropriate approachs to dental trauma can cause more damage than the trauma itself. This article describes the diagnosis, management and follow-up of a 5-year-old boy who presented with uncommon sequelae of an inappropriate approach following a severe luxation of the primary maxillary right central incisors 2 years ago.     

An investigation into dentists' perceptions of barriers to providing care of dental trauma to permanent maxillary incisors in children in Victoria, Australia

BACKGROUND: Perceived barriers in the treatment of dental trauma may influence the optimum management of dental trauma. Any hesitation that dentists might have in managing dental trauma is important to investigate. The aim of this study was to investigate dentists' perceptions of barriers to providing care of dental trauma to permanent maxillary incisors in children. METHODS: A self-completion questionnaire survey containing six questions on demographic data and 15 questions relating to barriers to treating dental trauma was mailed to 693 dentists in Victoria, Australia. RESULTS: The response rate achieved was 61 per cent. Of the respondents, 90 per cent had no hesitation in treating dental injuries and 80 per cent of these frequently agreed that dentists should treat all dental trauma. Approximately half the dentists (51.5 per cent) frequently found uncooperative children to be the main barrier to providing care. CONCLUSION: The overall consensus from the present study was that treating dental trauma is not unappealing for dentists in general practice.     

Root resorption in dental trauma: 45 cases followed for 5 years

Abstract –  We aimed to: (i) study the prevalence of root resorption after luxation or avulsion injuries on permanent teeth referred to our dental clinic over a 3-year period; (ii) study the relationship between type of injury and resultant type of resorption complication; and (iii) evaluate success of treatment protocols for various resorption complications. We observed 1943 patients with dental trauma, aged between 2 and 26 years, referred to the Accident and Emergency Department of the Dental Clinic, University of Brescia, from 1st September 1997 to 31st December 2001. Of these, 261 permanent teeth had sustained luxation ( n  = 188) or avulsion ( n  = 73) injuries. Permanent teeth luxation and avulsion injuries occurred most often in upper incisors (75%) of patients mostly aged 12–21 years, with males more commonly affected than females (68.3% vs. 31.7%). These cases were followed for 5 years, and complications and response to treatment were recorded. Root resorption was observed in 45 (17.24%) of these cases. Of the 45 cases with resorption, 9 were associated with luxation injury (20%) while 36 (80%) with avulsion. We distinguished 30 cases of inflammatory root resorption (18 transient and 12 progressive) and 15 cases of ankylosis and osseous replacement. When resorption was recognized, quick and effective treatment could still result in an excellent functional and aesthetic outcome for these teeth.     

Traumatic intrusion of permanent teeth. Part 1. An epidemiological study of 216 intruded permanent teeth

Abstract –  An epidemiological study of traumatic intrusion of permanent teeth was performed on 216 teeth in 151 patients treated over a 50-year period at a major trauma center in Denmark (Copenhagen). This analysis showed that intrusion of permanent teeth was of rare injury only affecting 1.9% of traumatic injuries involving permanent teeth. The main etiologic factor appeared to be falling which resulted in axial impacts on maxillary or mandibular teeth. The most common injury patterns were intrusion without additional injuries (33.5%) and intrusion with crown fractures (60.5%). A few cases were combinations of intrusion and either crown/root-fractures or root fractures (6%). Most often one tooth was intruded (46.3%), followed by two teeth (32.4% ) and three or more teeth (21.3%). The majority of intruded teeth were displaced 2–8 mm. The age group of 6–12 years of age was most frequently involved and boys appeared to experience intrusion injuries more frequently than girls, and at an earlier age. Maxillary central and lateral incisors are the primary victims of intrusions and this seems to be identical to other trauma types and is possibly related to the known exposure to impacts of maxillary incisors. The reliability of clinical findings, such as lack of mobility (81.8%), metallic percussion tone (72.5%), and no pain to percussion (66%) was reasonably high, whereas a radiographic feature such as the obliteration of the periodontal ligament space appeared to be only a partly reliable diagnostic tool (52%).     

Traumatic dental injuries in children presenting for treatment at the Department of Pediatric Dentistry, Faculty of Dentistry, University of Jordan, 1997–2000

Abstract  – Data pertaining to traumatic dental injuries of children seeking care at the teaching clinics of the Department of Pediatric Dentistry, Faculty of Dentistry, University of Jordan over a period of 4 years were analyzed. The prevalence of traumatic dental injuries was 14.2% from 2751 subjects. The peak incidence of injury was 10–12-year age group. Boys were more affected (18.3%) than girls (10.1%). Most injuries occurred at home (63.2%), and falls were the leading cause of injuries (49.9%). Most injuries involved one tooth (69.3%) and maxillary central incisors were the most affected teeth (90.4%). The commonest injury was uncomplicated crown fracture (62.5%), then complicated crown fracture (28.7%). Only 17.1% of children sought treatment the same day or the day after the injury. At the initial examination, cases seen after a long post-traumatic period required more complicated treatment than those presented within a short time period. Preventive educational program should be instituted in Jordan, directed at parents and school teachers to inform them about the importance of traumatic dental injuries and the benefit of immediate attendance for dental treatment. Furthermore, improving the knowledge of dental practitioners through continuing education would also help in minimizing sequelae of traumatic dental injuries.     

Dental injuries in Norwegians aged 7–18 years

Abstract  – In this prospective study, baseline information regarding trauma to permanent teeth is presented. The aim of the study was twofold: to increase the knowledge of dental injuries in young Norwegians and to examine whether a rise in the number of dental trauma had occurred during the last 10–15 years. Both an urban and a rural area were included, constituting 12% of the 7–18-year-olds living in the country. A total of 1275 children in this age group suffered dental injuries in the capital city of Oslo and in the rural area of Nord-Trøndelag during a 1-year registration period. The children were examined by calibrated dentists in the public dental health service. The service offers regular, free recalls, and 98% of the children attend. The dental injuries were classified according to WHO's classification system. The dental trauma incidence found was 1.8% (2.0% in Oslo and 1.3% in Nord-Trøndelag). Nearly 50% of the children were in the age group 8–10 years. Ninety-seven per cent of the accidents involved the incisors, and the minor trauma dominated. Age and gender were predisposing factors. Boys were nearly twice as often injured as girls and this difference increased with age. No increase in the annual frequency of dental injuries was observed.     

Traumatic dental injuries among primary school children in Sulaimani city, Iraq

Abstract –  A cross-sectional survey was carried out through clinical examination of anterior teeth among 4015, 6- to 13-year-old children enrolled in 20 public primary schools of Sulaimani city, northern Iraq. The prevalence and pattern of traumatized anterior teeth were studied in relation to age, gender, type of injury, dental treatment needs, place and cause of the trauma in addition to occlusal relation and upper lip position. The prevalence of children with traumatic dental injuries was found to be 6.1% (243 children) of the total sample. Age and gender were highly significantly associated with dental trauma ( P  < 0.001). Males were more affected than females and the prevalence increased with age. Simple enamel fracture was the most common type of injury followed by enamel-dentine fracture and concussion. The maxillary central incisors were found to be most affected by trauma followed by mandibular central incisors and the maxillary lateral incisors. The number of injured teeth per child was 1.38 (totally 336 anterior teeth were found with dental trauma) and single tooth trauma was the most common type (69.5%). Results showed that only 7% of the traumatized anterior teeth received treatment and about half (48.7%) of the remaining traumatized teeth did not need dental treatments, while the least treatment type needed was extraction (3.5%). The highest proportions of traumatized children were found with class II division 1 malocclusion and inadequate upper lip coverage. Falls and playing were the most common causes of dental injury, while home was the most common place of trauma occurrence. 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 treatments of traumatic dental injuries.     

Does the canine dental follicle cause resorption of permanent incisor roots? A computed tomographic study of erupting maxillary canines

We performed computed tomography (CT) on 107 children and adolescents aged 9-15 years with 176 unerupted maxillary canines (152 erupting ectopically and 24 erupting normally) to determine whether there is an association between widened dental follicles of the maxillary canines and resorption of the adjacent incisors during eruption. Contiguous axial (transverse) CT scans were obtained through the maxilla in the region of the canines. The width and shape of the dental follicles were recorded, as were any contacts between the follicles and the crowns of the maxillary canines and neighboring incisors. Fifty-eight lateral incisors (38%) and 14 central incisors (9%) had some type of root resorption. The position of the maxillary canine in relation to the root of the lateral incisor varied greatly, as did the width and shape of the canine dental follicle. Follicle width ranged from 0.5 mm to 7.0 mm. The mean +/- SD width of dental follicles was, on average, larger for the ectopically positioned canines (2.9 +/- 0.8 mm) than for the normally erupting canines (2.5 +/- 0.8 mm) (P < or = .01). We found that during eruption, the follicle of the erupting maxillary canine frequently resorbed the periodontal contours of adjacent permanent teeth but not the hard tissues of the roots. We concluded that the dental follicle did not cause root resorption of permanent teeth. Resorption of neighboring permanent teeth during maxillary canine eruption was most probably an effect of the physical contacts between the erupting canine and the adjacent tooth, active pressure during eruption, and cellular activities in the tissues at the contact points, all of which are part of the eruptive mechanism. The findings also confirm an association between root resorption of deciduous canines and the dental follicles of erupting permanent canines.     

Dental emergencies presenting to a dental teaching hospital due to complications from traumatic dental injuries

Abstract  – In Jordan, only two surveys of dental trauma have been carried out. The aim of this study was to determine the incidence and pattern of dental emergencies resulting from traumatic injuries, as well as treatment provided to children presenting with these dental emergencies. Over a 1-year period, 620 children presented to our pediatric dental clinics with dental emergencies; 195 (31%) of these emergencies were a consequence of dental trauma to 287 teeth and were included in the study. The average time between the trauma and the dental emergency was 5 months. Pain or sensitivity was the most frequent presenting symptom (31.3%) followed by swelling or sinus tract (17.4%). The age of these patients ranged from 15 months to 14 years, with an average age of 9.3 years. Males accounted for 75.4% of the children in the samples, whereas females accounted for only 24.6%. The main cause of dental trauma was falling during play (58.5%); the least common cause was motor vehicle accidents, accounting for only 1.5% of all injuries. Most of the dental injuries occurred at home (41.5%), around noon time. The most commonly involved teeth were permanent maxillary central incisors accounting for 79.5% of all teeth involved by dental trauma. The most frequently encountered type of trauma in this sample was crown fracture seen in 76.6% of the teeth . Soft tissue injuries were estimated to occur in 16.9% of the children. The treatment received by the children in the sample ranged from no active treatment (6.2%) to elaborate dental procedures such as pulp therapy (41.3%) and prosthetic replacement of missing teeth (5.1%).     

Orthodontic movement in traumatically intruded teeth: a case report

Abstract  – Intrusive luxation of permanent mature teeth is one of the most serious injuries to the periodontal ligament in dental traumatology. Various treatment approaches are currently practised. The treatment of choice for traumatically intruded teeth was to combine orthodontic repositioning and endodontic treatment. This case report describes the treatment of a 50-year-old male patient, with four completely intruded mature permanent maxillary incisors. Orthodontic extrusion was initiated 1 week after the trauma. After 10 days, the crowns of the teeth were exposed to start endodontic therapy. Nine weeks after the injury and 8 weeks after the beginning of orthodontic extrusion, the intruded incisors were back about to their original position before the displacement occurred. All treatment management as well as a follow-up 8 years after the trauma are described.     

Traumatic tooth injuries to primary teeth of children aged 0–3 years

Abstract –  The purpose of this study was to analyze data according to gender, age, cause, number of traumatized teeth, type of tooth and trauma, from the records of traumatized children (0–3 years) referred to the Ondokuz Mayıs University, Dental Faculty, Department of Pedodontics in middle Black Sea region of Turkey. A total of 563 boys and girls participated in the study. Traumatic dental injuries were recorded using the classification of the World Health Organization modified slightly by Andreasen & Andreasen. Traumatic dental injuries were identified in 17.4% of the children. The largest percentage of injuries were in the 13–18 months old children with no significant gender differences ( P  > 0.05). Periodontal tissue injuries were the most common (84.7%) with no statistical difference between different ages or gender ( P  > 0.05). The main etiological factor of traumatic dental injury was falls (73.5%) and it was not different between age and gender ( P  > 0.05). The maxillary central incisors were involved in a higher percentage of traumatic injuries (98%), with no differences between the right and the left sides ( P  > 0.05). Treatment was sought for 37.4% of children within 1–7 days. It is suggested that parents should be informed about prevention of traumatic injuries and to contact a dentist immediately.     

Successful minimally invasive management of primary maxillary central incisors after lateral luxation: a case report

Lateral luxation in primary maxillary incisors is a traumatic injury that can lead to darkening of the tooth, pulp necrosis, root resorption, and damage to the permanent teeth. Management of this kind of trauma typically includes pulpectomy or extraction in cases of root resorption. However, in young children, removal of the tooth may be psychological stressing, especially for the parents, while increased mobility can make immediate endodontic treatment difficult to perform. This article outlines a severe palatal luxation on the maxillary right central incisor treated with conservative management in a 2-year-old boy. At the one-year follow-up appointment, the surrounding bone was healthy, the roots displayed physiological resorption, the crowns showed color improvement, and there was no radiographically noticeable damage to the permanent teeth.     

Replantation of permanent incisors in children using Emdogain®

Abstract –  The aim of this study was to determine whether application of an enamel matrix protein derivative, Emdogain^® (Biora AB Malmo, Sweden) to the root surface of avulsed permanent incisors would improve postreplantation outcomes in a pediatric population. Between June 1999 and May 2002, 25 avulsed permanent maxillary incisors (22 centrals and three laterals) were treated with Emdogain^® and followed for up to 32 months, mean duration 20.6 months (range: 6.9–32.5 months). Mean patient age at the time of treatment was 12.0 years (range: 7.7–17.6 years) and mean extra-alveolar duration was 185 min (range: 100–300 min). At the end of their follow-up each of the replanted incisors demonstrated radiographic evidence of replacement root resorption and clinical evidence of ankylosis. None of the replanted teeth were affected by inflammatory root resorption and there was no evidence of infection. When compared with the control samples from Barrett and Kenny ( Endod Dent Traumatol 1997;15:269–72.) and Andersson et al. ( Endod Dent Traumatol 1989;5:38–47.) this sample treated with the Emdogain^® protocol demonstrated significantly less root resorption than either of the control samples ( anova , P  < 0.0001). Although the Emdogain^® protocol did not produce periodontal regeneration, it did eliminate inflammatory resorption and infection and led to significantly less root resorption compared with the two historical controls.     

The prevalence of traumatic dental injuries: a 24-month survey

The aim of the present investigation was to assess the prevalence of dental traumatic injuries in children referred to Queen Fabiola Children's Hospital, Free University of Brussels, Belgium. This study was based on the clinical data of 457 traumatized teeth in 214 children. Most injuries involved 2 teeth (51%). Of these, maxillary central incisors were the most affected teeth (89%). The highest frequency of trauma occurred between 2 and 4 years of age. Falls were the most common cause of injury in both girls and boys. The most common type of injury in the primary and permanent teeth was subluxation. Gingival and mucosal laceration was the most common type of soft tissue lesion (61%). Only 42% of children came for dental treatment on the same day that they were injured.