Dental injuries in Norwegians aged 7-18 years

Delayed orthodontic extrusion of a traumatically intruded immature upper permanent incisor - a case report

Dental injuries are probably the most common orofacial injuries sustained during sports and play. Intrusion or intrusive luxations occur when the teeth are driven into the alveolus by an axially directed impact. This article describes the clinical case of an 8-year-old patient who suffered complete intrusive luxation of an immature permanent central incisor following an accident. An attempt at spontaneous re-eruption failed to facilitate re-emergence of the tooth beyond 2 mm. The recommended wait-and-see strategy in anticipation of spontaneous re-eruption should cease to be an option when no further elongation can be observed. Orthodontic extrusion or surgical re-positioning is a valid treatment alternative when the former fails. In this case, although the recommended time period for effecting orthodontic extrusion had elapsed, this procedure was undertaken successfully presumably owing to the application of controlled, biologically optimal forces. A review of the extruded tooth a year later revealed no clinical or radiographic signs of loss of vitality. This was confirmed radiographically by the completion of root development, an intact lamina dura and no evident signs of resorption.

Prevalence of traumatic injuries to permanent dentition and its association with overjet in a Swiss child population

OBJECTIVE

Dental trauma is a very common issue in dentistry and its occurrence has been related to many factors. The aim of this study was to evaluate the prevalence of traumatic dental injuries in the permanent dentition among Swiss children and its association with overjet.

MATERIAL AND METHODS

A sample of 1900 children aged 6-13 years was prospectively evaluated to determine the number and types of injuries, the influence of overjet on the risk of suffering trauma and the relationships between trauma, age, gender and life conditions.

RESULTS

The observed prevalence of trauma was higher for boys, with a slight risk increase with age and a peak frequency at the age of 10 years. Most of the injuries (91.2%) involved the upper front teeth; 87.2% of all injuries were hard tissue injuries (enamel or dentin fractures), and 12.8% only subluxation and luxation injuries. Children with an overjet of 6 mm or more had a four times higher risk of suffering trauma, compared with those with less overjet.

CONCLUSION

This cross-sectional study confirmed most of the results from earlier studies dealing with epidemiological factors of dental injuries to the permanent dentition. Of all the variables analysed, overjet stood out as the most significant risk factor: an increased overjet of 6 mm or more had a major impact on the risk of trauma, which would speak in favour of early orthodontic correction of an increased overjet to reduce the prevalence of dental trauma.

Spontaneous re-eruption of a permanent maxillary central incisor after 15 years of ankylosis--a case report

Intrusion injuries are considered among the most severe forms of dental trauma, potentially leading to ankylosis as a late consequence. In 1991, a 7-year-old boy suffered a traumatic intrusion leading to an infraposition of tooth 21 along with its immobility. Based on the clinical findings, including bright-sounding percussion testing, disappearance of the periodontal space and a failed attempt at orthodontic movement, a diagnosis of ankylosis was made. Following prosthetic restoration of the infrapositioned tooth, spontaneous re-eruption occurred 15 years later. With the help of a partial multibracket appliance, the tooth could be adjusted to occlusal level and was then restored to the patient's satisfaction. Radiographically, it was demonstrated that extrusion of the tooth had been accompanied by a significant gain in local alveolar bone volume. While a wait-and-see strategy cannot be recommended as a treatment option following ankylosis, considering that spontaneous re-eruption after several years is an extremely rare finding, elucidating the mechanisms at work in spontaneous re-eruption at a cellular level might create an opportunity for iatrogenic triggering of re-eruption, thus paving the way to new forms of therapy.

A retrospective study of 889 injured permanent teeth

The aim of this study was to investigate pre-injury factors, causes of dental injuries and healing complications after traumatic injuries to permanent teeth. The analysed sample comprised 889 permanent teeth of 384 patients, who were treated in the Dentistry Department in Faculty Hospital in Pilsen. Enamel-dentin fractures [233 teeth (26.2%)] and lateral luxations [207 teeth (23.3%)] were the most frequent injuries. The age of the patients at the time of injury varied between 7 and 65 years. Predominantly, children were affected [587 injured teeth (66.0%)]. The most frequent causes of injuries in patients older than 11 years were various sport activities, predominantly bicycling. Pulp necrosis was observed in 239 teeth (26.9%). It was the most frequent post-traumatic complication in all types of dental traumas. Teeth with a completed root formation demonstrated a higher prevalence of pulp necrosis than teeth with an incomplete root formation in all types of luxation injuries. External root resorption was observed in 144 teeth. The rate of inflammatory resorption differed between the various types of luxation injuries (extrusive luxation 5.6%, lateral luxation 11.6%, intrusive luxation 33.3%). Following avulsion and replantation, active inflammatory resorptions were diagnosed in 13 (26.5%) of 49 replanted teeth and ankylosis/replacement resorptions were observed in 21 (42.9%) of 49 replanted teeth. After avulsion, primarily, immature teeth were affected by these complications. Within the observation period of 5 years, 39 teeth (4.4%) had to be removed (16 teeth with root fractures, 19 avulsed and replanted teeth, 3 luxated teeth, 1 tooth with crown-root fracture).

Minor traumatic injuries to the permanent dentition

Treatment of traumatized teeth generally occurs in two phases: short-term emergency treatment and stabilization followed by endodontic management and review. These authors recently reviewed the endodontic considerations in the treatment of traumatized permanent anterior teeth, and in this article review the early management of traumatized permanent teeth. Preoperative assessment and emergency management are emphasized, as is the treatment of immature teeth for which continued development of the root system must be encouraged. Factors influencing long-term prognosis are discussed and the influence of various management strategies evaluated.

Orthodontic management of traumatic avulsion of permanent incisors in a child with sickle cell anaemia: a case report

Introduction

Avulsion of permanent teeth in children resulting from trauma is an acute emergency presentation. When not adequately managed, it may result in functional and aesthetic disturbances, with implications for more complicated and prolonged treatment which require planning and biocompatibility in terms of forces used in moving the teeth orthodontically. Literature is scarce on a reported case of this nature and this is the first report in the literature in Nigeria.

Case presentation

We report on a case of avulsion of both maxillary central incisors in an 8-year-old male child of Sub-Saharan African ethnicity with sickle cell anaemia. One of the incisors produced by the parents was replanted at the clinic. The replanted tooth was later traumatized during the course of treatment which resulted in mobility and subsequent extraction of the tooth. At a later presentation at the clinic, orthodontic therapy was instituted. While orthodontic therapy has been considered to be completely noninvasive, special precautions should be taken in the clinical management of sickle cell anaemia patients to prevent local vaso-occlusive events.

Conclusion

The sequeale of traumatic avulsion in a medically compromised patient with sickle cell anaemia is presented. Prompt and early presentation for dental management is very important; while prevention and management of dental trauma should be recognized as a public health issue. Dental trauma in sickle cell anaemia can be minimized by practicing preventive measures with the use of mouth guard which is an effective device for preventing dental injuries, and patients should be advised to wear them during activities to prevent dental injuries.

Crown-root fracture of a lower first primary molar: report of an unusual case

Dental traumas are highly prevalent lesions in primary teeth, but crown-root fractures are seldom observed in posterior teeth of this dentition. The aim of the present report was to describe the diagnosis, treatment, and a 24-month follow-up of an unusual case of complicated crown-root fracture in a lower first primary molar of a 3-year-old boy.

The endodontic management of traumatized permanent anterior teeth: a review

Despite the many journal articles and reviews that have been published regarding the treatment of trauma to teeth, the endodontic management of these injuries is often still not fully understood. The purpose of this review is to establish clear and up-to-date guidelines for practitioners who are faced with treating dental injuries on a day-to-day basis, based on an assessment of current available scientific information relating to the endodontic management of these injuries. Treatment is discussed under the headings: infractions, uncomplicated crown fractures, complicated crown fractures, crown-root fractures, root fractures, luxation injuries, avulsion, root resorption, pulp canal obliteration and open-apex teeth. Emphasis is placed on the treatment of traumatized immature teeth where maintenance of pulp blood supply is important to encourage continued development of the root system. Only the treatment of traumatized permanent anterior teeth is reviewed. Information contained in this article is based on a review of the literature on dental trauma which involved a MEDLINE search using the key words "dental trauma" and the individual topics listed above. The guidelines produced by the International Association of Dental Traumatology, the American Academy of Pediatric Dentistry and the American Association of Endodontists were also reviewed and the recommendations contained in this paper are in concert with the major recommendations of these bodies.

An oral health promotion program for the prevention of complications following avulsion: the effect on knowledge of physical education teachers

The aim was to assess the knowledge levels of physical education teachers before and after a seminar, presented by dental faculty as part of a community outreach program, in which the need for immediate treatment because of avulsion of permanent teeth has been emphasized, and to compare knowledge levels of teachers who attended the seminar with those who did not. Physical education teachers attended a seminar presented by senior faculty of the Hebrew University-Hadassah School of Dental Medicine as part of an educational campaign in the community. The seminar included clear instructions on the appropriate treatment of avulsed permanent teeth, which were appropriate for physical education teachers. The teachers completed two multiple-choice self-administered anonymous questionnaires related to immediate treatment they could provide in cases of permanent teeth avulsion. One hundred and twenty-six teachers completed the first questionnaire, 2 months before the seminar. One hundred teachers completed the second questionnaire 10 months after the seminar. Of these, 70 attended the seminar and 30 did not. Thirty-two teachers who attended the seminar had completed both questionnaires. The percentage of teachers who provided expected 'correct' answers in the first questionnaire (11% and 16%) was significantly lower than that in the second questionnaire (23% and 68%). The percentage of teachers who provided correct answers in the second questionnaire among those who attended the seminar (24% and 69%) was not significantly different from those who did not attend the seminar (20% and 66%). An educational campaign in the community with a seminar targeted towards a cohort of physical education teachers can improve the knowledge of the teachers, even those who did not attend the seminar, probably by means of a contamination effect. Despite the improvement, which was found, the level of knowledge after the campaign remained low and more public health promotion efforts are indicated.

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

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%).

Clinical investigation of traumatic injuries in Yeditepe University, Turkey during the last 3 years

The aim of this study was to evaluate etiology, types of traumatic dental injuries, treatment and to determine the incidence of complications according to dental injuries in patients who referred to Yeditepe University, Faculty of Dentistry, Istanbul, Turkey. The study was based on the clinical data of the 161 traumatized teeth in 92 patients. WHO classification slightly modified by Andreasen & Andreasen for dental trauma was used. The causes and localization of trauma, traumatized teeth classification, treatment and complications were evaluated both primary and permanent teeth. The distribution of complications according to diagnosis and treatment of the injured teeth were evaluated. Of 35 (38%) girls and 56 (72%) boys with a mean age 7.6 +/- 3.5 (ranging 1-14.2) participated to study and the mean followed up was 1.72 +/- 1.28 years (ranging 0.10-3.8 years). From the 161 affected teeth, 69 (42.9%) were in primary teeth and 92 (57.1%) in permanent teeth. The highest frequency of trauma occurred in the 6-12 year age group. Overall boys significantly outnumbered girls by approximately 1:1.6. The most common type of injury in the primary and permanent teeth was seen as luxation (38%) and enamel fracture (20%) of the maxillary central incisors, respectively. Falls were the major sources of trauma both the primary (90%) and the permanent teeth (84%). In the primary dentition, the most common type of soft tissue injury is contusion (62.5%) and in the permanent dentition, it is laceration (49%). The most of the treatment choice was determined as examination only and extraction in primary teeth (58 and 24.6%, respectively) while it was applied as restoration and pulpectomy in permanent teeth (31.5 and 18.5%, respectively). Complications were recorded on 37 teeth (23%) with a most common type of necrosis (10.5%) and dental abscess (7.4%). Necrosis was more frequent in luxation whereas dental abscess were in crown fracture with pulpal involvement in both dentitions. The study showed that boys were more prone to dental traumas than girls. Falls were more frequent trauma type with a high complication risk. It reveals that the time of the immediate treatment showed the important predisposing factors that increase the success of treatment and decrease the risk of complication. The correct diagnosis of dental injuries is more important for eliminating the occurrence of complications.

Dental trauma and its association with anatomic, behavioral, and social variables among fifth and sixth grade schoolchildren in Jerusalem

With the decrease in dental caries prevalence, public health should place emphasis on other dental diseases. Dental trauma is an irreversible pathology which after occurrence is characterized by life-long debilitating effects.

OBJECTIVES

To measure the prevalence of trauma in anterior permanent teeth among children, and to assess the associations with social, behavioral, and orthodontic variables.

METHODS

A total of 1195 fifth and sixth grade schoolchildren participated, representing the general Jewish population of Jerusalem. Trauma, incisal overjet and lip competence were measured by two calibrated examiners in the schools. Reasons and location of trauma were assessed according to telephone interviews with the parents of the children with severe trauma.

RESULTS

The total prevalence of dental trauma was 29.6%. Severe trauma, at least involving the dentine, was found among 13.5% of the children. Severe dental trauma was more prevalent among children with an incisal overjet of 4-6 mm (adjusted OR=1.50, P=0.049) or more than 7 mm (adjusted OR=2.51, P=0.018); with incompetent lips (adjusted OR=2.31, P<0.001), who learned in public religious schools (adjusted OR=1.59, P=0.048) and were males (adjusted OR=1.45, P=0.041). The main reason for dental trauma in all surroundings was falling, but sports and violence (not at orthodox private schools) were also important reasons.

CONCLUSIONS

Based upon these findings a community effort is being planned and initiated with the aim of educating sports teachers, teachers, health personnel, and schoolchildren regarding awareness of dental trauma prevention, with emphasis on utilizing mouth guards and early orthodontic intervention, when financially possible.

Etiological factors related to dental injuries in Norwegians aged 7-18 years

Prevention of diseases and injuries is a field of priority for the health authorities in Norway. In 1990, an interdepartmental project was established in order to reduce the number of accidents, including dental injuries. The purpose of the present study was to examine the causes of dental injuries, the place of event and the possibilities for prevention. During a 1-year period, all new trauma episodes affecting children aged 7-18 years were registered by calibrated dentists in the public dental health service in the county of Nord-Trøndelag and in the capital city of Oslo. A distinction was made between school and leisure time accidents. The severity of injuries was classified as mild, moderate or severe, and the dentists were asked tojudge whether the severe injuries were preventable. Nearly half of the 1275 injured individuals (48%) were injured at school. Almost half of the leisure time injuries occurred during children's play. Sports and traffic accidents were less common. Sports accidents represented only 8% of the total number of injuries, the same as the number of individuals injured by violence. Statistically significant associations were observed between the cause of injury and county (P < 0.001) and the cause of injury and age group (P < 0.001). In total, 4% of all injuries were classified as severe, of which only one-third were assumed to be preventable. In summary, because of the complexity of etiological factors, it is neither easy to prevent dental injuries nor to make guidelines on prevention.