Dental Trauma

Dental Trauma is a topic covered in the 5-Minute Pediatric Consult.

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Basics

Description

Dental trauma is defined as fractured, displaced, or lost primary or permanent teeth.

Epidemiology

  • 30% of children suffer from traumatic dental injuries to the primary dentition, with the highest incidence at 2 to 3 years of age.
  • 22% of children suffer from traumatic dental injuries to the permanent dentition occurring secondary to falls, traffic accidents or bicycles, violence, sports, and physical abuse
  • 70% of cases involve maxillary incisors.
  • Displacement injuries are most common in the primary dentition. Crown fractures are more common in the permanent dentition.

Risk Factors

  • Sex:
    • In the primary dentition, the prevalence of injuries ranges from 31% to 40% in boys and from 16% to 30% in girls.
    • In the permanent dentition, the prevalence of dental trauma in boys ranges from 12% to 33% as opposed to 4–19% in girls.
  • Age:
    • The most common age for trauma in the primary dentition is from 1.5 to 2.5 years of age when the child is learning to walk.
    • In the permanent dentition, the peak age ranges from 8 to 10 years of age.
  • Season:
    • Injuries occur more in summer months than in winter, depending on the population and demographics being studied.
  • Occlusion:
    • Increased “overjet” (protrusion of upper incisors) and insufficient lip closure are predisposing factors to traumatic injuries.

General Prevention

  • Most sports injuries can be prevented with appropriate use of mouth guards.
  • The American Academy for Sports Dentistry lists 40 sports for which it recommend the use of mouth guards, including: acrobatics, baseball, basketball, cycling, discus, shot put, horseback riding, gymnastics, handball, racquetball, squash, judo, karate, rollerblading, rugby, motor cross, parachuting, skiing, soccer, surfing, skateboarding, ice skating, trampoline, tennis, volleyball, wrestling, weight lifting, and water polo.

Pathophysiology

  • Basic tooth structures: enamel (white outer layer), dentin (yellow inner layer), pulp (nerves, blood vessels, connective tissue), cementum (layer covering roots), periodontal ligament (PDL; supports tooth in socket)
  • Types of injuries (Figure 3)
    • Infraction: fracture of the enamel without loss of tooth structure; a “crack” in the enamel
    • Uncomplicated crown fracture: fracture with loss of tooth substance confined to enamel or dentin and not involving the pulp
    • Complicated crown fracture: fracture involving enamel and dentin with a pulp exposure
    • Crown/root fracture: fracture involving enamel, dentin, and cementum
    • Root fracture: dentin and cementum fracture involving the pulp
    • Concussion: injury to tooth-supporting structures, no abnormal loosening or displacement
    • Subluxation: injury to tooth-supporting structures with abnormal loosening, no displacement
    • Lateral luxation: lateral displacement of the tooth in its socket with fracture of alveolar bone plate
    • Intrusion: tooth forced into the socket and locked into position in the bone
    • Extrusion: tooth displacement partially out of the socket
    • Avulsion: complete displacement totally out of the socket
    • Alveolar process fracture: fracture of alveolar bone containing tooth

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