Dentists’ management of dental injuries and dental trauma in Australia: a review

Indications for root canal treatment following traumatic dental injuries to permanent teeth

The dental pulp may respond favourably or unfavourably to traumatic dental injuries. The most serious unfavourable responses are pulp necrosis and infection of the root canal system. These cause apical periodontitis and/or external inflammatory resorption of the tooth. The following injuries require root canal treatment as part of their emergency management-(A) complicated crown fractures (but some may be suitable for conservative pulp treatments, such as pulp capping, partial pulpotomy or pulpotomy), (B) complicated crown-root fractures, (C) supra-crestal coronal third root fractures and (D) injuries where pulp necrosis is predictable or highly likely to occur AND where there has been damage to the root surface and/or periodontal ligament with the aim of preventing external inflammatory resorption. This latter group of injuries are avulsion, intrusion, lateral luxation with a crown fracture, extrusion with a crown fracture (all in fully developed teeth) plus avulsion with a crown fracture and intrusion with a crown fracture (both in incompletely developed teeth). All other injuries should not have root canal treatment commenced as part of the emergency management, but they must be reviewed regularly to monitor the pulp for any adverse changes to its status, particularly pulp necrosis and infection of the root canal system.

Retrospective analysis of the outcomes of pulpotomies in traumatised permanent anterior teeth

BACKGROUND/AIM

Complicated crown fractures are frequently encountered in the paediatric population and pulpotomy procedures (either partial or coronal) are recommended to maintain the pulp. The aim of this study was to determine the pulp outcomes of permanent teeth with complicated crown fractures treated with pulpotomy in a hospital-setting and to identify potential factors which may influence the outcomes.

MATERIAL AND METHODS

Data for this retrospective study were extracted from dental records of patients with complicated crown fractures and treated with pulpotomies at a single centre between 1 January 2015 and 30 August 2019. Pulp outcomes were determined, and the associations between the outcome and independent variables were assessed using the Chi-Square test of independence and the Point-Biserial Correlation Test. Predictors of outcome were identified using the binary logistic regression model.

RESULTS

The overall success of pulpotomy in managing traumatised permanent teeth was 61%, which was lower than those previously reported. Pulp healing was seen in 54.1% and 73.7% of teeth treated with partial pulpotomies and coronal pulpotomies, respectively. The presence of a radiographically detectable dentine bridge (p < .01) and longer clinical experience of the clinician (p < .04) was significantly associated with successful outcomes. The history of pain and the stage of root development were identified as significant predictors of the outcome.

CONCLUSION

Pulpotomy is a viable treatment modality for complicated crown fractures in the paediatric population. However, appropriate case selection and further training may be required to ensure improved pulp healing outcomes. A longer follow-up period should be considered to identify late-stage complications.

Dental trauma simulation training using four splinting models: A cross sectional study

BACKGROUND/AIM

Opportunities for dental students to obtain clinical experience in the management of traumatic dental injuries are scarce, and most dentists encounter difficulties with their first trauma patients after graduation. The aim of this study was to question students on the ease of handling of four types of flexible splints, with two common methods of bonding to the tooth.

MATERIAL AND METHODS

A total of 161 fourth year dental students completed a simulated treatment of an avulsed tooth using orthodontic wire, Twistflex wire, nylon fishing line, and Powermesh as splints. The bonding materials were composite resin (Spectra ST LV) or glass ionomer cement (GC Fuji LC Ortho). The students then answered 16 questions on a 5-point Likert scale, or with an open answer field.

RESULTS

Most students agreed (48.8%) or strongly agreed (31.3%) that the simulated trauma exercise assisted their learning. There was strong agreement (68.8%) and agreement (28.7%) that the simulation added value to their dental training compared to didactic training only. Similarly, 52.3% of participants strongly agreed and 40% agreed that they felt engaged in the learning activity. Only 53.8% of the participants agreed and 7.5% strongly agreed that the simulation felt realistic. Most students (56.2%) found a Powermesh/composite splint was the easiest to place, and nylon fishing line/GC Fuji LC Ortho splints was the least difficult to remove (35%).

CONCLUSION

Wire-free splints with composite bonding were judged as the easiest to place by students, while glass ionomer cement was the easiest to remove.

Prevalence and Patterns of Traumatic Dental Injuries in the Permanent Dentition: A Three-Year Retrospective Overview Study at the University Dental Clinic of Vienna

The aim of this study was to retrospectively analyze the prevalence and patterns of traumatic dental injuries (TDIs) in permanent teeth at the University Dental Clinic of Vienna and examine influential variables. The study included all patients with dental trauma in permanent teeth who presented at the University Dental Clinic of Vienna (Austria) between 2014 and 2016. Dental records, including age, gender, location of trauma, type of trauma, cause of TDI, and location of the traumatic incident, were obtained. Clinical oral and radiographic examinations were conducted in accordance with the current guidelines of the German Society of Dental, Oral, and Craniomandibular Sciences (DGZMK). The sample comprised 1132 permanent teeth of 578 patients with TDIs. The most frequently injured teeth were upper central incisors (n = 719, 63.5%), followed by upper lateral incisors (n = 231, 20.4%). Fractures were the most frequent injury type (53%, n = 596). TDIs mostly occur due to falling accidents. The majority of traumatic incidents occurred at home (79.4%, n = 459). The injury characteristics are comparable to the results of other international studies. Due to the high prevalence of TDIs in dental medicine, dental practitioners should be equipped to effectively manage their immediate care and treat potential long-term complications.

Dentists' knowledge of dental trauma based on the International Association of Dental Traumatology guidelines: An Australian survey

Background/Aim

Traumatic dental injuries are the result of impact injuries to the teeth and/or soft and hard tissues within and around the vicinity of the oral cavity and pose a very serious public health dilemma. The aim of this study was to appraise the level of knowledge of dentists in Australia regarding the management of traumatic dental injuries based on the International Association of Dental Traumatology (IADT) guidelines.

Methodology

A link to an electronic questionnaire investigating personal and professional information and twelve questions about dental trauma was distributed by email using the Qualtrics Survey Software to ensure anonymity of the respondents, to members of the Australian Dental Association. The respondents were grouped according to demographic characteristics and practice profiles. Data were evaluated by the Student’s T test or one‐way ANOVA with post hoc testing using Fisher's least significant difference, with the α level set at 5%.

Results

A total of 180 complete responses were obtained. The overall mean number of correct answers was 7.55 ± 1.91 from a maximum possible score of twelve. Gender, year of primary dental qualification, dentist identity (general dentist or specialist), area of main practice or region worked by the practitioner did not significantly affect the mean scores. However, increased knowledge of the IADT guidelines was significantly associated with the number of trauma cases treated and the dentists' self‐reported knowledge.

Conclusions

The overall knowledge of Australian dentists regarding the management of traumatic dental injuries based on the IADT guidelines was generally good but it was also deficient in some areas.

Pediatricians' Knowledge of Emergency Management of Dental Injuries and Use of Mouthguards: A Cross-Sectional Survey

AIM

Dental injuries are one of the most frequent oral health problems in children and adolescents. This study aimed to evaluate Croatian pediatricians' knowledge and practice regarding dental injuries management and the use of mouthguards as means of protection against traumatic injuries.

MATERIALS AND METHODS

A questionnaire-based cross-sectional survey conducted among 186 pediatricians examined their demographic characteristics, knowledge and experience with dental injuries. Student t-test or one-way ANOVA, with Tukey's post-hoc were used to analyze obtained data (p ≤ 0.05).

RESULTS

The overall mean score of knowledge on the management of dental injuries was 3.6 ± 1.53 points. Male pediatricians (p = 0.016), those who witnessed dental injuries (p = 0.003), and those who had more than ten years of pediatric practice (p = 0.027) showed better knowledge. The results of multiple linear regression analysis demonstrated impact between pediatricians' knowledge in the emergency treatment of traumatic dental injuries concerning the level of health care (practice settings) (β = -0.254, p = 0.002) and the number of patients treated by a pediatrician per day (β = -0.187, p = 0.030).

CONCLUSION

Pediatricians have a low level of knowledge regarding the primary care of traumatic dental injuries. An additional course on dental injurie management should be recommended as part of the physician and pediatricians' educational training.

Malaysian dental students' knowledge of managing dental trauma in children

OBJECTIVE

This study sought to assess dental students' training and experiences in addressing traumatic dental injury (TDI), and, more specifically, their knowledge of TDI management in children.

METHODS

All Year 1 to Year 5 dental students (n = 413; response rate = 72.9%) were invited to participate in an online, self-administered survey, which was based on a validated questionnaire. Quantitative data were analysed via chi-squared test (p < .05) using the Statistical Package for the Social Sciences software program.

RESULTS

Only a few students were found to have undergone first-aid training in TDI (19.3%) and to have encountered TDI incidents (10.6%) before. Almost all preclinical and clinical students agreed that TDI constitutes an emergency (97.8% vs. 99.4%, respectively) and that tooth avulsion requires immediate care (97.1% vs. 99.0%, respectively). However, almost half of the students (48.8%) did not know the management protocols for a fractured tooth. Compared with clinical students, a significantly lower percentage of those in preclinical study knew the following: (1) the main cause of TDI, (2) the teeth that most commonly experience avulsion, (3) the management protocols for an avulsed tooth (e.g., handling, transportation and urgency of professional intervention) and (4) the management protocols for a fractured tooth (e.g., appropriate storage medium and need for immediate treatment). Amongst the clinical students, a significantly lower percentage of those in Year 3 knew how to transport and store avulsed and fractured teeth, and which teeth are most likely to experience avulsion.

CONCLUSION

This study identified areas of TDI education in need of further refinement. Revision of the dental curriculum in terms of design, content, teaching method and delivery time may thus be warranted.

Developing a prototype dental trauma e-learning course for medical education

This article aims to demonstrate how an expert feedback process was used to identify emerging issues within a prototype extracurricular course on dental trauma and show how the feedback was addressed prior to piloting the course more widely. Dowse's Design Research Model was adapted for the design and development of a prototype dental trauma e-learning course. This paper will focus on step five, gathering expert feedback and the evaluation process. Four critical features emerged from the feedback that ought to be incorporated into the e-learning course design, namely, 1) keep resources clinically relevant; 2) keep resources simple to learn; 3) make resources easy to understand; and 4) support self-learning. The results demonstrate the value of an expert feedback process for improving a prototype designed to address a major gap in knowledge among medical doctors identified in the literature.

A 5-year data report of traumatic dental injuries in children and adolescents from a major dental trauma center in Greece

BACKGROUND/AIM

Prevalence and demographic characteristics of traumatic dental injuries (TDI) differ in different countries. The aim of this retrospective study was to assess TDI in primary and permanent teeth among children and adolescents who presented to the Department of Paediatric Dentistry, National and Kapodistrian University of Athens, Greece, during the last 5 years.

MATERIAL AND METHODS

Dental records of 236 new patients who presented with dento-alveolar trauma to the Postgraduate Dental Clinic from 1/1/2014 to 31/12/2019 were reviewed. Data recorded were gender, age, month of the year the injury occurred, type of trauma, and number of traumatized teeth. Injuries were classified as fracture, luxation, or combination injuries. Descriptive statistics, chi-squared (x² ), and Fisher's exact tests were used to evaluate the results. Level of significance was set at 5%.

RESULTS

The age of the patients ranged from 1 to 18 years old, with a mean of 8.63 years (SD: 3.52). There were 395 anterior traumatized teeth and 2 cases with traumatized posterior teeth. Children suffered trauma more often at the ages of 5 years, 7 years, and 11 years. In this cohort, 60% were boys who had a higher chance of having trauma than girls (odds ratio = 1.418 95% CI = 0.724, 2.777). Most TDI occurred in March and May, followed by June and February, and most traumatized teeth were permanent (80%). Maxillary central incisors in both dentitions were injured most often and significantly more compared to lateral incisors (p < 0 .01). The most common type of injury was a fracture in the permanent dentition (60%) and luxation injuries (69%) in the primary dentition.

CONCLUSIONS

Traumatic dental injuries in this cohort occurred mostly in spring, affected boys more than girls, permanent teeth more than primary teeth, maxillary incisors more than mandibular incisors, and central incisors more than lateral incisors, while children aged 5, 7, and 11 years old had the most injuries.

Profiles of traumatic dental injuries among children aged 0-15 years in Cappadocia, Turkey: A retrospective cohort study

BACKGROUND/AIM

Traumatic dental injuries are among the most serious dental public health problems in children. The aim of this retrospective study was to evaluate the dental trauma profile of primary and permanent teeth among children aged 0-15 years who presented to a university hospital.

MATERIAL AND METHODS

The study included 650 patients (1,000 primary and permanent teeth) who presented with a history of dental trauma to the Department of Pediatric Dentistry, Faculty of Dentistry, Erciyes University between 2016 and 2019. Traumatized teeth were assessed according to the Andreasen classification. The following information was recorded: age, gender, teeth affected by trauma, etiologies of trauma, place and season of trauma, type of trauma, type of treatment, and time between the trauma and treatment.

RESULTS

In total, 650 patients (240 females, 410 males) and 1,000 incisors (212 primary teeth, 788 permanent teeth) were evaluated. The average age of the patients was 8.89 ± 3.41 years, and dental injuries were more frequent between 8 and 10 years of age. The maxillary central incisors, both primary (40.1%) and permanent (42.8%), were the most frequently affected teeth. The main cause of traumatic dental injuries was falls. Most accidents occurred at school and home. The most common type of dental injuries recorded was luxation injuries in the primary teeth (21.5%) and enamel-dentin fractures (35.9%) in the permanent teeth. Only 48 teeth were treated during the first hour after injury.

CONCLUSIONS

The most common type of traumatic injury affecting permanent teeth was enamel-dentin fractures, and primary teeth were luxation injury. Only 4.8% of teeth were treated within the first hour after trauma.

The Incidence of Complications of Dental Trauma and Associated Factors: A Retrospective Study

Objective

The aim of this work was to study the incidence of complications of dental traumatisms and look for associations between factors related to trauma and the occurrence of complications. Materials and Methods. It is a longitudinal retrospective study on a sample of 125 traumatized teeth. The sample is taken from patients consulting the dentistry service at the hospital Sahloul Sousse between 2014 and 2017. Criteria for including a patient were presence of a permanent incisor affected by a subluxation, intrusion, lateral luxation, extrusion, or avulsion injuries associated or not with concomitant dentoalveolar injuries. Data were collected using a questionnaire. The information about etiology of trauma, delay of consultation, orientation of the patient, kind of injury, and emergency treatment and complications were obtained from the patients' records.

Results

The incidence of complications was 8%: external root resorption was present in 70% of cases, surface resorption was observed in 10% of cases, and replacement resorption in 10%, ankylosis in 10%. About pulpal complications, pulp necrosis was found after 4 weeks of follow-up, as well as the internal root resorption after one year. The most common cause of the trauma was the fall (40%). The majority of patients came for emergency consultation within “1 to 3 days,” and the coronary fracture without pulp exposure was the first diagnosis (20.60%). Statistical analysis showed no significant relationship between the cause of the trauma and the complication (P=0.577) and between the delay of consultation and complication (P=0.577) and between the delay of consultation and complication (P=0.577) and between the delay of consultation and complication (

Conclusion

Treatment of dental injuries is usually delayed and not given as much attention as general medical treatment that can explain the occurrence of pulpal and periodontal complications. Immediate consultation and treatment could improve long-term prognosis of the injured tooth.

Knowledge of General Dental Practitioners and Specialists about Emergency Management of Traumatic Dental Injuries in Qassim, Saudi Arabia

Context. Studies about knowledge of emergency management of traumatic dental injuries (TDIs) which affect children by general dental practitioners (GDPs) and specialists in Saudi Arabia are lacking.

A proposal to introduce dental trauma into medical education: An insight

THE PROBLEM

This proposal aims to tackle the common poor management of traumatic dental injury (TDI) by medical doctors and subsequent poor healthcare outcomes for patients. The literature reports that most medical doctors, in either private practice or hospital emergency departments, lack the knowledge, skills, and confidence needed to adequately assess and manage victims of TDI. This is due to little or no clinical dentistry and dental trauma education being included in their medical studies.

THE GAP IN THE LITERATURE

From a review of the literature, there is a clear lack of learning provision for medical students on the topic of dental anatomy and trauma. In addition, there appears to be no formal university theoretical and clinical training during medical school.

THE PRACTICAL IMPLICATIONS

The introduction of dental trauma into the medical curriculum will provide students with a better understanding of the importance of early management for better patient outcomes. Medical doctors competent in managing emergency dental trauma procedures will be able to provide a higher standard of care that could prevent potentially lifelong negative repercussions for the patient.

Knowledge of emergency management of avulsed tooth among intern dental students: a questionnaire based study

Background Traumatic dental injuries (TDIs) represent a major public health problem because of their increasing prevalence and psychosocial impact. Avulsion, one of the most complicated TDIs comprising of 1-16% of all injuries. The present study aimed to assess the current knowledge regarding management of avulsed teeth among dental interns in the city of Hyderabad. Subjects Dental interns of the Panineeya Institute of Dental Sciences and Research Centre, Hyderabad. Method A validated, self-administered 23-item questionnaire was used to obtain demographic details and data on dental avulsion management. Descriptive analyses were carried out on frequency, and a comparison of knowledge score was carried out using a chi-squared test and an independent t-test. Results More than half of the study subjects gave correct responses for most of the items on knowledge regarding avulsion. Around 45.4% of the study populations were categorized with low levels of correct knowledge, with more females (46.6%) having significantly lower levels compared to males (p = 0.03). However, the mean knowledge scores between males (15.5 ± 4.74) and females (16.5 ± 1.68) were comparable (p = 0.15). Conclusion Based on the findings of the study, a majority of dental student interns were aware of the basic procedures to be followed in cases of avulsion.

Undergraduate experience and self-assessed confidence in paediatric dentistry at the University of Jordan Dental School

INTRODUCTION

The aims of the study were to audit the number and types of clinical procedures completed by the undergraduate dental students in the paediatric dentistry course at the University of Jordan Dental School and to present data on self-reported confidence in a variety of aspects of paediatric dentistry.

MATERIALS AND METHODS

A retrospective audit of clinical logbooks for the entire class of 120 dental students in their fifth clinical year was performed. Key clinical procedures performed in the paediatric clinics were recorded including treatment performed on both primary and permanent teeth. Students were requested to complete an anonymous questionnaire to assess confidence related to six activities using a visual analogue scale (VAS).

RESULTS

All students performed restorations in primary teeth with the majority providing approximal restorations (91%), pit and fissure restorations (89%) followed by stainless steel crowns (81%). In addition, all students performed a pulpotomy for a primary tooth, extraction of a primary tooth and fissure sealants. Only a quarter of the students treated a traumatised incisor. Students considered themselves most confident (VAS ≥ 7) in performing operative dentistry, examination, diagnosis and treatment planning and providing preventive therapy. They were least confident in the management of dento-alveolar trauma (VAS = 3.8).

CONCLUSION

Students at the University of Jordan Dental School were found to have good experience of clinical paediatric operative dentistry with the majority performing pulp therapy, preformed crowns and extractions. Deficiencies have been reported in student exposure to dental trauma, and these are being addressed.

Emergency care provided in a Greek dental school and analysis of the patients' demographic characteristics: a prospective study

OBJECTIVES

The aim of this study was to evaluate the incidence of pain of endodontic origin and its relationship with socio-economic and demographic factors among patients seeking unscheduled urgent dental care.

METHODS

Patients attending the Emergency Clinic of Athens Dental School, Greece, between November 2011 and June 2012, were evaluated to determine their socio-economic profile, dental problem and treatment required. The facility operated from Monday to Friday, from 8.30 am to 1.00 pm, excluding the 4 weeks encompassing the Christmas and Easter holidays. In total, 533 patients were assessed regarding gender, age, ethnicity, occupation, reason for visiting, diagnosis and treatment provided. The data obtained were recorded, reviewed, coded and analysed using Poisson regression models.

RESULTS

Mondays and Wednesdays were the busiest days of the week. The most common occupation among the patients was 'unemployed'. Pain of endodontic origin (reversible or irreversible pulpitis, or acute apical periodontitis) was the prevailing reason for the visit. The most frequent treatments administered were pulpectomy and drainage. Prescriptions for medications were rare.

CONCLUSION

Services were requested primarily by individuals who were experiencing acute pain of endodontic origin, had low or no income and were available during morning hours, probably because of the service's low cost and operational hours. Prospective studies, such as the present investigation, can provide epidemiological evidence and indicate areas in the infrastructure of emergency services which may be improved. Additionally, such studies can provide rationale for public insurance programs and can generate profiles of the patients who utilise these low-cost public services.

Mouthguard Use and Awareness of Junior Rugby League Players in the Gold Coast, Australia: A Need for More Education

OBJECTIVE

To investigate knowledge, attitude, and awareness of appropriate mouthguard use, as well as the management of traumatic dental injuries (TDIs).

DESIGN

Cross-sectional survey.

SETTING

Community survey.

PARTICIPANTS

Four hundred ninety-four junior rugby league players and their coaches in the Gold Coast, Australia.

INTERVENTIONS

Data were collected anonymously during training sessions by means of a survey questionnaire, followed by a presentation on mouthguards and the management of TDIs.

MAIN OUTCOME MEASURES

Descriptive statistics on the frequency distribution of the demographic characteristics, knowledge, and use of mouthguards as well as the relationships between the type of mouthguard worn and questions related to mouthguard use.

RESULTS

The majority of players surveyed reported wearing a mouthguard (68.2%). Cost (40.1%) and not believing that they work (35.7%) were listed as the main reasons for not doing so. The boil-and-bite type was the most used by players (64.7%). Almost 44% of coaches and 50% of players responded that only a dentist can manage an avulsed tooth, that a tooth had to be reinserted within 15 minutes (40.6% and 21.9%, respectively), and that either water or milk can be used to transport an avulsed tooth to the dentist (100% and 82.2%, respectively).

CONCLUSIONS

Education related to the correct use of mouthguards and the management of TDIs should be ongoing for players, their caregivers, and their coaches and should be required as part of the training of coaches to prevent injury in rugby league.

CLINICAL RELEVANCE

This study found that although the overwhelming majority of junior rugby league coaches encourage the wearing of mouthguards, only two-thirds of the players do so. Players' compliance to wear mouthguards is largely influenced by their perception of efficacy and its comfort. Educational campaigns with involvement of dental practitioners, related to the correct use of mouthguards and the management of TDIs, should be ongoing for players, their caregivers, and their coaches and should also be required as part of the training of coaches.