Taking the trauma out of trauma: an easy to follow guide for the management of trauma to the permanent dentition.

UNLABELLED: Treatment of dental trauma can be an infrequent, unpredictable and stressful experience for a dental practitioner. Correct diagnosis and management of such cases is of primary importance in the prognosis of the affected dentition. We have therefore constructed a number of easy to follow algorithms in management, both short and long term, for the range of traumatic injuries that can affect the permanent dentition. CLINICAL RELEVANCE: Immediate as well as longer term management of dental trauma cases can be difficult, therefore a clear treatment plan is of great importance in successful results.

Dental Trauma Guide: a source of evidence-based treatment guidelines for dental trauma.

Diagnosis and treatment for traumatic dental injuries are very complex owing to the multiple trauma entities represented by six luxation types and nine fracture types affecting both the primary and the permanent dentition. When it is further considered that fracture and luxation injuries are often combined, the result is that more than 100 trauma scenarios exist, when the two dentitions are combined. Each of these trauma scenarios has a specific treatment demand and prospect for healing. With such a complexity in diagnosis and treatment, it is obvious that even experienced practitioners may have problems in selecting proper treatment for some of these trauma types. To remedy this situation, an Internet-based knowledge base consisting of 4000 dental trauma cases with long-term follow up is now available to the public and the professions on the Internet using the address http://www.DentalTraumaGuide.org. It is the aspiration that the use of this Guide may lead the practitioner to offer an evidence-based diagnosis and treatment.

The initial management of dento-alveolar trauma in general dental practice.

UNLABELLED: Dento-alveolar trauma presents commonly in general dental practice, but may prove difficult to manage for those unfamiliar with it. Timely and well-informed intervention can significantly improve the clinical outcome for the patient. This article aims to inform the clinician on best current practice for the assessment and initial management of dental traumatic injuries, incorporating current international guidelines and practical arrangements for follow-up care. CLINICAL RELEVANCE: The dental trauma patient often presents to the general dental practitioner and the appropriate emergency management plays a vital role in relieving pain, protecting the dentino-pulpal complex, reducing displaced teeth and improving prognosis.

Diagnóstico y tratamiento de luxaciones dentales en dentición decidua / Diagnosis and treatment of dental luxations in deciduous teeth

Los traumatismos dentoalveolares son muy frecuentes sobre todo en niños y se describen como lesiones que resultan de fuerzas externas; siendo en la actualidad uno de los problemas de salud que enfrenta la sociedad. Estas injurias no sólo dejan daños físicos sino, que también producen un impacto psicológico en el niño. Por lo general los traumatismos dentoalveolares se presentan asociados a otras injurias en los tejidos blandos. Siendo, la luxación dentaria la que representa el 71,3% de todas las lesiones dentales en dentición decidua. Las luxaciones se pueden presentar como: luxaciones laterales, intrusiones y extrusiones. El objetivo de la presente revisión es brindar información actualizada sobre el diagnóstico y tratamiento de luxaciones en niños.

Dentoalveolar injuries are very common especially in children, and are described as an injury resulting from an external force and today is one of the health problems that faces society. Dental injuries do not only leave physical damage but also produce a psychological impact on the child. Usually dentoalveolar injuries occur in association with other injuries of soft tissues. In all cases, tooth luxation accounts for 71.3% of all dental injuries in the primary dentition, and they are classified in lateral luxation, intrusive and extrusive. The objective of this review is to provide current information on diagnosis and treatment of luxated tooth in children.

Trauma kits for the dental office.

The old Boy Scout's motto, "Be Prepared," can be beneficially applied to the management of dental trauma. A large number of dental injuries occur every year, primarily in the 7- to 15-year age group. Preserving the natural dentition during that time period is critically important, because tooth loss at an early age presents significant lifelong dental problems. Being prepared to manage an emergency can make the difference between tooth loss and a successful outcome. Two factors contribute to achieving the better outcome: knowledge of the essentials of dental traumatology, and being prepared with the dental materials needed for appropriate treatment. It is the hope of the authors that these factors are clearly elucidated in this article.

Adverse outcomes of dental trauma splinting as related to displacement injury and pulpal blood flow level.

Splinting of traumatically displaced permanent teeth has been described as an effective modality in the treatment of patients with dental injuries. The purpose of this study was to (i) investigate whether dental injury diagnosis may predict adverse outcomes occurring 96 weeks after splint removal, and (ii) evaluate whether the severity of adverse outcome is related to laser Doppler flowmetry (LDF) measurements of pulpal blood flow (PBF). In 206 trauma patients, 273 permanent maxillary incisors treated by repositioning and splinting, and the respective contralateral homologous control teeth were investigated clinically and radiographically, and by LDF to assess local PBF values. Dental displacement injuries were classified as grade I (subluxation), grade II (lateral or extrusive luxation) and grade III (avulsion or intrusive luxation). Outcomes were classified as 'absence of loss of sensitivity, periapical radiolucency, and/or grey discolouration of crown', type I (loss of sensitivity), type II (loss of sensitivity and periapical radiolucency or grey discoloration of crown) and type III (loss of sensitivity, periapical radiolucency and grey discoloration of crown). An adverse outcome was defined as the presence of 'periapical radiolucency and/or grey discoloration'. A multiple logistic regression analysis was used to compute the odds ratio (OR) for dental displacement injury for adverse outcome (n = 69) vs non-adverse outcome (n = 168). An ordinal stepwise regresssion was completed to assess the degree of association between PBF measurements and outcome groups. Significant increase in risk of an adverse outcome occurred with a grade II dental displacement injury (OR 14.3) (P = 0.000) and a grade III dental displacement injury (OR 19.9) (P = 0.000). PBF measurements that were significantly associated with more severe outcome were PBF levels of < or =3 perfusion units (PU) (OR 399.4) (P = 0.000), those of >3 PU and < or =6 PU (OR 100.5) (P = 0.000), and those of >6 PU and < or =9PU (OR 6.2) (P = 0.000). Diagnoses of displaced teeth predicted dental injury patients who went on to show adverse treatment outcomes of splinting. PBF measurements were related to the severity of adverse outcome.

[Sequelae of dental trauma: forensic medical aspects]. / Séquelles des traumatismes dentaires: aspects médico-légaux.

Dental trauma is a frequent condition which may occur alone or in combination with craniofacial trauma and/or other injuries. Many factors influence the gravity of the trauma and subsequent prognosis including age, anterior state, trauma etiology, treatment and follow up. In order to establish a prudent provisional or definitive expertise, the medical expert must have a panoramic view of the trauma. Time should be taken to consolidate facts and estimate prejudices on sound evidence. In certain cases outcome can be predicted. The medical expert should provide advice and counselling both for the patient and the mandating authority. In this article, iatrogenic dental accidents occurring during anesthesia or extraction will not be discussed.

[Injuries to permanent teeth. Part 2: Therapy of avulsion]. / Verletzungen der bleibenden Zähne Teil 2: Therapie der Dislokations-verletzungen.

The present paper describes the current treatment philosophy of dislocated or avulsed permanent teeth at our school. Splinting and medication (root canal treatment, systemic antibiotics, etc.) are targeted to minimize the initial inflammatory reaction and to reduce post-traumatic complications such as pulp necrosis and/ or external root resorption.

Treatment delays in paediatric dento-alveolar trauma at a tertiary referral hospital.

BACKGROUND: Paediatric dento-alveolar trauma is a common event. Delays in treatment can have adverse effects on long term outcomes and the aim of this study was to quantify the treatment delays in paediatric dento-alveolar trauma in a tertiary referral hospital. METHODS: All cases of paediatric dento-alveolar trauma over a two year period from July 2000 to June 2002 were identified and the charts were reviewed retrospectively. All children presenting to the emergency department with dento-alveolar trauma within 48 hours of injury during the time period were included. RESULTS: Forty-three patients were identified. The average age was 5.51 years, though there was a bias towards one and two year olds. Males were injured 1.5 times more frequently than females. There was an average delay of 9.6 hours between injury and treatment for all patients. Transit time from outside practitioners to hospital and waiting times in hospital made up the greatest delays. Children injured an average of 2.37 teeth and only 14 per cent were uncomplicated crown fractures. CONCLUSIONS: Children who present to children's hospitals for treatment of dento-alveolar trauma have more severe injuries than those treated elsewhere. They have large but potentially reducible delays between injury and treatment.

Healing of 208 intra-alveolar root fractures in patients aged 7-17 years.

This retrospective study consisted of 208 root-fractured, 168 splinted and 40 not splinted incisors in young individuals (aged 7-17 years) treated in the period 1959-1973 at the Pedodontic Department, Eastman Institute, Stockholm. Clinical and radiographic analyses showed that 69 teeth (33%) had developed hard tissue (fusion) healing of fragments. Interposition of periodontal ligament (PDL) and bone between the fragments was found in 17 teeth (8%). Interposition of PDL alone was found in 74 teeth (36%). Finally, non-healing with pulp necrosis and inflammatory changes between fragments was seen in 48 teeth (23%). Various clinical factors were analyzed for their relationship to the healing outcome with respect to healing/no healing and type of healing (hard tissue versus interposition of bone and/or PDL). Immature root and positive pulp sensitivity at time of injury was found to be significantly related to both pulp healing and hard tissue repair of the fracture. The same applied to concussion or subluxation of the coronal fragment compared to luxation with displacement (extrusive or lateral luxation). This relation was also represented by the variable millimeter diastasis between fragments before and after repositioning. Repositioning appeared to enhance the likelihood of both pulp healing and hard tissue repair. A positive effect of splinting, splinting methods (cap splints or orthodontic bands with an arch wire) or splinting periods could not be demonstrated on either pulp healing or type of healing (hard tissue versus interposition of bone and/or PDL). In conclusion, the findings from this retrospective study have cast doubts on the efficacy of long-term splinting and the types of splint used for root fracture healing. It is suggested that the role of splinting and splinting methods be examined in further studies.

Treatment of trauma to the primary and young permanent dentitions.

An overview of the various possibilities for trauma to the primary and young permanent dentition has been presented. Appropriate treatment procedures have been described. Advances in dental science have been great, and dental materials have become superior to what they were just a few years ago. The dentist must never forget the variabilities of human responses to any of the treatment techniques, however, and the dentist must never be dogmatic in approach. The dentist should be able to diagnose, interpret, and alter any of the treatment techniques as more scientific evidence is obtained.

Management of sports-related tooth displacements and avulsions.

Between 500,000 and 750,000 dental injuries occur each year during sports activities in the United States. Twenty percent of these are tooth displacements: extrusive or lateral luxations, intrusions, or exarticulations. Such injuries pose serious problems and the manner in which they are treated can affect the prognosis. This article discusses displacement injuries and recommends optimal treatment for each type of displacement.

Intrusion injuries of primary incisors. Part I: Review and management.

Intrusion injuries commonly occur in the primary dentition. They can be described as luxation injuries resulting from an axially directed impact, which drives the tooth deeper into the alveolar socket. The impact results in compression of and damage to the periodontal ligament as well as injury to the pulp of the intruded incisor. In addition to rendering treatment to the intruded primary tooth, the dentist must also be aware of the possibility of an injury to the developing permanent teeth germs located in close proximity to the roots of the injured primary teeth. This review will discuss the characteristics, implications, and management of intrusion injuries of primary incisors.

Intrusion injuries of primary incisors. Part III: Effects on the permanent successors.

Intrusion injuries of the primary dentition are highly associated with developmental disturbances of their successor teeth. The age of the child at the time of injury, the direction and severity of the intrusion, and the presence of alveolar bone fracture are important variables influencing the effect of primary tooth intrusion on the developing permanent germ. The developmental defects of the permanent successor tooth range from mild alteration in enamel mineralization to severe sequestration of the developing germ. This article will review the developmental anomalies of the permanent incisors induced by intrusion injuries of their predecessors.

Dental management of traumatic injuries to the primary dentition.

There is considerable information on traumatic injury management of permanent teeth. However, there are no conclusive guidelines for treating traumatized primary teeth. This article will summarize a number of issues relative to primary dentition trauma and provide a system for treatment.