Background
Dental fractures are commonly observed with other oral injuries. Early recognition and management can improve tooth survival and functionality. Approximately 82% of traumatized teeth are maxillary teeth. Fractures to the maxillary teeth are distributed among the central incisors (64%), lateral incisors (15%), and canines (3%). See the image below.
Cross section of an Ellis III dental fracture.
Pathophysiology
The typical cause is severe force to the teeth sufficient to disrupt the enamel, dentin, or both of a tooth. In a study of 1610 children, predisposing factors included postnormal occlusion, an overjet exceeding 4 mm, a short upper lip, an incompetent lip, and mouth breathing.
Epidemiology
Frequency
United States
More than 50% of physical trauma in child abuse occurs in the head and neck region.
International
In a study conducted in Sweden, approximately 7% of all physical injuries involved the oral cavity. In patients aged 0-19 years, 9% of injuries involved the oral cavity. During the Korean War, 3000 maxillofacial injuries occurred.
Mortality/Morbidity
Trauma to the teeth is not life threatening; however, associated maxillofacial injuries and fractures can compromise the airway. In trauma with mandibular fracture, the teeth in the upper jaw may be at higher risk than teeth in the lower jaw. [1] Morbidity to the teeth may be individualized to primary and permanent teeth. Fractures are more common in permanent teeth; primary teeth usually become displaced.
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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
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Permanent teeth - Color changes, infection, abscess, loss of space in the dental arch, ankylosis, resorption of root structure, abnormal root development
Sex
The male-to-female ratio is 2-3:1.
Age
The average age of injury varies. In youths, falls and sporting activities account for most injuries. In later teenaged years, motor vehicle collisions (MVCs) account for most injuries.
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Cross section of an Ellis III dental fracture.
