Background
Trauma to the teeth may result in fractures, avulsions, or displacements. Injury to primary teeth more often results in displacement of teeth rather than fractures. Maxillary and mandibular incisors are the most commonly displaced primary teeth.
Pathophysiology
A typical cause is a directed force sufficient to overcome the bond between the affected tooth and the periodontal ligament within the cradling alveolar socket. Displacement may be in the form of subluxation, intrusion into the alveolar socket, or extrusion from the socket with tearing of the apical neurovascular bundle. All these forces may lead to pulp necrosis and apical abscess formation.[1]
Epidemiology
Frequency
United States
Dental displacement is the most common injury to primary dentition.[2]
International
A study conducted in Sweden showed that approximately 7% of all physical injuries involved the oral cavity. In patients aged 0-19 years, 9% of all injuries involved the oral cavity. More than 50% of physical trauma in child abuse cases occurs in the head and neck region. During the Korean War, 3000 maxillofacial injuries occurred.[3]
Mortality/Morbidity
Trauma to the teeth is not life threatening; however, associated maxillofacial injuries and fractures can compromise the airway. Morbidity to the teeth may be individualized to primary and permanent teeth.
Almost half of teeth with luxation injuries become necrotic after 3 years.
- Primary teeth - Failure to continue eruption, color changes, infection, abscess, loss of space in the dental arch, ankylosis, injury to the permanent teeth, abnormal exfoliation
- Permanent teeth - Color changes, infection, abscess, loss of space in the dental arch, ankylosis, resorption of root structure, abnormal root development[4]
Sex
Male-to-female ratio is 2-3:1.
Age
Average age of injury is variable. In youths, falls and sporting activities account for the majority of injuries. In the later teenaged years, motor vehicle collisions (MVCs) and assaults account for the majority of injuries.
Gutmann JL, Gutmann MS. Cause, incidence, and prevention of trauma to teeth. Dent Clin North Am. Jan 1995;39(1):1-13. [Medline].
Josell SD, Abrams RG. Traumatic injuries to the dentition and its supporting structures. Pediatr Clin North Am. Jun 1982;29(3):717-41. [Medline].
Devlin DH. A historical review of dental and facial skeletal trauma. J Calif Dent Assoc. Feb 1996;24(2):29-34. [Medline].
Majorana A, Bardellini E, Conti G, Keller E, Pasini S. Root resorption in dental trauma: 45 cases followed for 5 years. Dent Traumatol. Oct 2003;19(5):262-5. [Medline].
Harwood-Nuss A, Linden C, Luten R, eds. Dental injuries. In: The Clinical Practice of Emergency Medicine. Philadelphia, Pa: Lippincott, Williams & Wilkins; 1996:418-421.
Bakland LK, Andreasen JO. Examination of the dentally traumatized patient. J Calif Dent Assoc. Feb 1996;24(2):35-7, 40-4. [Medline].
Josell SD. Evaluation, diagnosis, and treatment of the traumatized patient. Dent Clin North Am. Jan 1995;39(1):15-24. [Medline].
Flores MT, Andersson L, Andreasen JO, Bakland LK, Malmgren B, Barnett F, et al. Guidelines for the management of traumatic dental injuries. I. Fractures and luxations of permanent teeth. Dent Traumatol. Apr 2007;23(2):66-71. [Medline].
Al-Jundi SH. Type of treatment, prognosis, and estimation of time spent to manage dental trauma in late presentation cases at a dental teaching hospital: a longitudinal and retrospective study. Dent Traumatol. Feb 2004;20(1):1-5. [Medline].
Robert JR, Hedges JR. Emergency dental procedures. In: Clinical Procedures in Emergency Medicine. Philadelphia, Pa: WB Saunders Co; 1991:1045-1064.
Rosen P, Barkin R. Dental emergencies. Emergency Medicine Concepts and Clinical Practice. Vol 3. 3rd ed. St Louis, Mo: Mosby-Year Book; 1992:2381-2398.
Krasner P, Rankow HJ. New philosophy for the treatment of avulsed teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. May 1995;79(5):616-23. [Medline].
Trope M. Protocol for treating the avulsed tooth. J Calif Dent Assoc. Mar 1996;24(3):43-9. [Medline].
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