The art and science of managing traumatic injuries to primary teeth

Conservative management of a horizontal root fracture in a primary maxillary central incisor: Case report

Dental trauma occurs frequently in toddlers and the treatment protocols vary depending on each case. Thus, clinicians must not only plan the treatment but also consider any possible sequelae and characteristics related to the child and the family. The aim of this paper was to report a case of a three-year-old boy who had a horizontal root fracture in the middle third of the primary maxillary right incisor root (tooth 51) and crown discoloration of the primary maxillary left incisor (tooth 61) which were successfully treated with conservative management. The management was established in agreement with the family and was based on active surveillance. The clinical and radiographic follow-ups showed no changes besides pulp canal calcification of the left incisor throughout the eight years of follow-up. The pulps remained normal with no pathological signs throughout their life cycle and the permanent successors erupted normally, presenting an excellent result of the non-invasive approach adopted.

Dental trauma characteristics in the primary dentition in Greifswald, Germany: a comparison before and after German unification

BACKGROUND

The data on the distribution and pattern of dental trauma in the primary dentition are very rare.

AIM

To investigate primary dental trauma patterns in relation to gender, age, time and cause for a recent paediatric cohort and to compare this with a historic one before German unification.

METHODS

This retrospective study compared the patterns of dental trauma injuries at the trauma centre at Greifswald University/Germany for a recent paediatric cohort (2014-16, 103 children) with a historic one (1974-1989, n = 120). The data contained details on etiology, injury types and treatment delivered for 450 injured teeth (247 historic, 203 recent).

RESULTS

In both cohorts, the occurrence was more common in males than females (63%/55%, resp.) with an age peak from 2 to 6 years. Maxillary incisors were most affected (89.6%/88.6%, resp.) and periodontal ligament injuries dominated (77.8%/90.3%, resp.). Almost half of the injuries occurred at home (46.6%), mostly due to falling (48.5%) or during playing (37.8%) in the recent paediatric cohort which provided better forensic data due to insurance issues and potential concern about child abuse. Advice and follow up was the most common approach in the recent paediatric cohort (76%).

CONCLUSION

Even after 30 years and a change in the health care system due to German unification, the patterns of dental traumatic injuries in the primary dentition were similar.

Remote diagnosis of traumatic dental injuries using digital photographs captured via a mobile phone

BACKGROUND

Intra-oral photographs have been aided diagnosis of several pathologies in teledentistry. Mobile phone cameras may produce high-quality photographs, presenting itself as a viable tool for remote diagnosis of traumatic dental injuries.

AIM

To evaluate the levels of interexaminer agreement in cases of traumatic dental injuries when comparing diagnoses conducted in person and remotely.

MATERIAL AND METHODS

The sample included 40 patients with 73 traumatized teeth, and a total of 90 diagnoses, who had presented to two dental clinics, one private, and the other public, in Brazil's Federal District. The dental history and clinical examination data were registered in electronic forms, and digital photographs were captured with a mobile phone camera and uploaded to a cloud drive. Six remote examiners formulated their diagnoses based solely on photographic analysis. Thereafter, they were provided with additional clinical data and asked to provide a second round of diagnoses. These diagnoses were compared to those conducted in person, which were considered the gold standard. The data were analyzed with Gwet's AC1 interexaminers' measure to evaluate the agreement between the in-surgery and remote diagnoses.

RESULTS

The levels of interexaminer agreement between the in-surgery and remote diagnoses formulated exclusively with images were 0.83 or higher (95% confidence interval: 0.73-0.91), and 0.93 or higher (95% confidence interval: 0.88-0.97), when clinical information was available.

CONCLUSION

The precision of the remote diagnoses was comparable to the diagnoses conducted in person. The levels of interexaminer agreement were higher when clinical data were included with the images. Mobile phones may be an effective tool for capturing images that assist in the remote diagnosis of traumatic dental injuries.

Enamel defects on permanent successors following luxation injuries to primary teeth and carers' experiences

BACKGROUND

Trauma to primary teeth may have consequences.

AIM

To study frequency of enamel defects in permanent successors after luxation injuries, and to report carers' experiences.

METHODS

Children 8-15 years (n = 170) suffering luxation injury to primary dentition in 2003 were reexamined in 2010. Permanent successors (n = 300) were clinically examined and photographed. Data from dental records, registration form and a questionnaire were analysed by cross-tabulation and tested by chi-square and t-test.

RESULTS

Enamel defects were registered in 130 successor teeth, 22% due to trauma, 21% due to other aetiological factors (MIH, dental fluorosis, idiopathic). Successors with enamel defects were after concussion 8%, subluxation 18%, lateral luxation 41%, intrusion 38% and avulsion 47%. Enamel defects were associated with the child's age and severity of the injury (P < 0.05). Six children had enamel defects in successors of non-injured primary teeth. Anxiety recorded by carers was associated with severity and number of injured teeth (P < 0.05). According to carers eight children developed dental fear, seven were younger than 3.5 years and had had their injured teeth removed.

CONCLUSION

Minor luxation injuries and indirect trauma may cause enamel defects in permanent successors. Lower age at injury, severity and number of injured teeth affect carer and child negatively.

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition

Traumatic injuries to the primary dentition present special problems and the management is often different as compared with the permanent dentition. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialities were included in the task group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care for management of primary teeth injuries. The IADT cannot and does not guarantee favorable outcomes from strict adherence to the guidelines, but believe that their application can maximize the chances of a positive outcome.

Bilateral complicated crown fractures secondary to chin injury: a case report

Traumatic injuries to the chin are not uncommon in children. Nevertheless, crown fractures, which are common sequelae to this type of injury, might be overlooked, especially if dental care is not sought immediately after a visit to a non-dental facility. The present case report reviews the delayed diagnosis and treatment outcome of a bilateral posterior complicated crown fracture affecting mandibular second primary molars in a young child. Pharmacologic and orthodontic considerations are also discussed in the paper.