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

A phenomenological exploration of experience of Syrian dentists with online Course "Traumatic dental injuries"

Background

Several learning modalities have been implemented to improve learning about Traumatic Dental Injuries (TDIs) worldwide. Free online courses about TDIs might be an effective and convenient approach for equipping Syrian dentists with essential competencies during the Syrian crisis. Therefore, this qualitative study with a descriptive phenomenological method was undertaken to explore the lived experience of Syrian dentists enrolled in an online course about TDIs and investigate areas requiring improvement.

Methods

Ethical approval was obtained from the Faculty of Dentistry, Damascus University, and the University of Dundee. Educational contents of the TDI course were developed. About 10 dentists who completed the TDI course, were interviewed. The interviews were recorded, transcribed, and analyzed to identify emerging themes. Inductive thematic analysis was performed to extract all data.

Results

About 10 clustered categories were first developed and this has led to the emergence of 3 themes that represent the lived experience including usefulness, challenges, and recommendations. Participants were so motivated and keen to take advantage of the course despite the personal, technical problems, and crisis-related challenges. TDIs course was effective for general and specialists despite the challenges they experienced. Factors that lead to effective TDIs courses as reported by participants were flexibility in time and location, interactivity with colleagues, other commitments, quantity and quality of content, easiness, and variety of virtual environment tools. Conversely, negative attitudes were linked to factors like lack of interest, unfamiliarity with the learning environment and tools, late participation, lack of confidence, anxiety about independent learning and insufficient interactivity and engagement tools.

Conclusion

Syrian dentists can benefit from online courses if constraints and various learning needs are addressed during the design and delivery of online courses. Future work is still required to identify other effective instructional modalities that equip Syrian dentists to overcome challenges and enhance their learning.

A pilot study on the global practice of informed consent in paediatric dentistry

Background

Conducting oral treatment early in the disease course, is encouraged for better health outcomes. Obtaining informed consent is an essential part of medical practice, protecting the legal rights of patients and guiding the ethical practice of medicine. In practice, consent means different things in different contexts. Silver Diamine Fluoride (SDF) and Silver Fluoride (SF) is becoming popular and cost effective methods to manage carious lesions, however, cause black discolouration of lesions treated. Obtaining informed consent and assent is crucial for any dental treatment-and has specific relevance with SDF/ SF treatments.

Methods

The aim of this paper is to describe informed consent regulations for dental care in a selection of countries, focusing on children and patients with special health care needs. An online survey was shared with a convenience sample of dental professionals from 13 countries. The information was explored and the processes of consent were compared.

Results

Findings suggest that there are variations in terms of informed consent for medical practice. In Tanzania, South Africa, India, Kenya, Malaysia and Brazil age is the determining factor for competence and the ability to give self-consent. In other countries, other factors are considered alongside age. For example, in Singapore, the United Kingdom, and the United States the principle of Gillick Competence is applied. Many countries' laws and regulations do not specify when a dentist may overrule general consent to act in the "best interest" of the patient.

Conclusion

It is recommended that it is clarified globally when a dentist may act in the "best interest" of the patient, and that guidance is produced to indicate what constitutes a dental emergency. The insights gathered provide insights on international practice of obtaining informed consent and to identify areas for change, to more efficient and ethical treatment for children and patients with special needs. A larger follow up study is recommended to include more or all countries.

Controversies in Dental Traumatology

The management of traumatic dental injuries is more a shade of gray than it is black and white because not all treatment procedures used for dental trauma management are fully evidence based. This chapter has highlighted some of the gray areas related to the treatment and outcome of traumatic dental injuries. Significant controversies in the management of luxation and avulsive injuries have been brought out. Adjunctive treatment such as antibiotic usage, tetanus vaccination, and pain management is also addressed.

Critical appraisal of the 2020 IADT Guidelines: A personal commentary

The 2020 International Association of Dental Traumatology (IADT) Guidelines feature several important changes in the treatment recommendations for traumatic dental injuries (TDIs) from the previous 2012 iteration of these Guidelines. This evidence-based narrative review aims to provide a detailed appraisal of five specific changes incorporated in the 2020 IADT Guidelines, based on the available literature evidence that may have prompted these changes. The paper discusses three excellent additions/changes to the new Guidelines: (i) inclusion of a core outcome set for reporting TDIs; (ii) more conservative management of primary dentition TDIs including the changed recommendations for radiation exposure and managing primary dentition luxation injuries; and (iii) the changes in the treatment recommendations for permanent dentition avulsion injuries. The paper further debates whether two other changes made in the current IADT Guidelines for-(i) intrusion injuries in immature teeth; and (ii) complicated crown-root fractures in mature teeth-have sufficient evidence to support the changed recommendations.

Dentists' Self-evaluated Ability in Diagnosing and Updating About Pulpotomy

OBJECTIVE

This study aimed to self-evaluate the knowledge of different dental professionals' profiles in Brazil on diagnosing and indicating pulpotomy in primary teeth and how these groups updated on this theme.

METHODS

Three groups (G1: professors, G2: specialists, and G3: professionals) answered an online questionnaire containing 20 questions and returned 416 questionnaires. Data were subjected to Chi-square associative tests and t tests, with P < .05.

RESULTS

G1 and G2 reported to indicate pulpotomy, highlighting the tendency of these groups towards seeking updates on this subject. All 3 groups used academic materials for updating. However, G2 had a high demand for updates through congresses, whilst G3 had a high demand for updates through social media (Google and Google Scholar). The most cited indication by G1 and G2 was "accidental pulp exposure" and by G3 was "teeth with extensive carious lesions that have involved the pulp with radiographic confirmation." All 3 groups opted for pulpotomy to keep the tooth in the arch. Thus, G1 and G2 are the groups who are more updated on the subject, using mainly academic materials, which can be associated with the fact that such groups indicated pulpotomy in primary teeth. The lower interest in searching about pulpotomy in G3 can be understood as a nonclinical application of the topic for this group.

CONCLUSIONS

Professionals who work directly with paediatric dentistry (professors or specialists) felt more capable of diagnosing and treating cases of pulpotomy. In addition, most of the professionals used scientifically based sources for getting information and actualisation on the subject of pulp therapies.

Factors associated with the survival of primary maxillary anterior teeth after intrusive luxation: a retrospective longitudinal study

PURPOSE

To evaluate the survival rate of primary maxillary anterior teeth following intrusive luxation and identify associated factors.

METHODS

A retrospective longitudinal study was conducted at a primary dental trauma centre using 88 dental records of children with intrusive luxation between 2007 and 2018. The variables of interest were time the tooth remained in the alveolus, degree of intrusion, accentuated overjet, lip protection, visible plaque, compromised germ of the permanent successor, clinical signs of infectious and inflammatory processes, endodontic treatment, pulp canal obliteration, sex, age at the time of trauma, family income, mother's schooling, and immediate care. Descriptive, bivariate, and Cox regression analyses were performed (p < 0.05; 95% CI).

RESULTS

The 88 dental records of children with intrusive luxation included 128 teeth. Survival rate throughout the follow-up period was 65.6% (n = 84). Age older than three years and eight months (HR 2.28; 95% CI 1.04-4.99; p = 0.039), the development of an infectious process (HR 3.51; 95% CI 1.39-8.86; p = 0.008), development of an inflammatory process (HR 2.35; 95% CI 1.17-4.71; p = 0.016) and compromised germ of the permanent successor (HR 4.38; 95% CI 1.99-9.61; p < 0.001) were associated with a lower survival rate of intruded primary maxillary anterior teeth.

CONCLUSION

The survival rate during the follow-up period of intruded primary maxillary anterior teeth was considered high. A significantly lower survival rate was associated with age, the occurrence of an infectious process and inflammatory process, and the compromised germ of the permanent successor.

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.

Oral and maxillofacial literature from Middle East: a bibliometric analysis and list of top-100 most cited articles

OBJECTIVES

The aim of this work is to perform a bibliometric analysis on Middle Eastern oral and maxillofacial surgery through years and to compare the data with previous studies. A list of the top 100 most cited articles was generated.

METHODS

A Pubmed bibliographic search for literature journals specialized in oral and maxillofacial surgery in the Middle East was performed. A graphic representation of authorship and keywords was created with VOSviewer. Mendeley and Microsoft Excel were used for tabulation and data visualization. A list of the top 100 most cited articles was created using Web of Science. Some statistical tests were performed with a 95% confidence interval, which was considered significant.

RESULTS

A total of 6,536 articles were retrieved in fifteen selected oral and maxillofacial journals. A moderate correlation between number of publications and total population (R = 0.6052), low correlation with area (R = 0.302291), and a negligible correlation with the Human Development Index (HDI) were found (R = 0.1747). A disparity can be seen in the number of publications by country, leaded by Turkey (46.30%), Israel and Iran (13.68% each). The more common studied topic was oral surgery (25.77%), maxillofacial trauma (16.13%) and oral pathology (10.25%).

CONCLUSIONS

A useful list of the top 100 most cited articles on oral and maxillofacial surgery from Middle East has been created. Middle East publications on oral and maxillofacial surgery can be considered high quality (IF = 1.879). Some issues on performing an adequate selecting of MeSH keywords were discussed.

Mobile application as a learning tool for improving dental students' knowledge regarding dental trauma

INTRODUCTION

Current evidence suggests an important knowledge gain of health sciences' students and professionals with mobile devices (m-learning). This study aimed to verify whether different strategies of teaching (traditional lecture classroom, m-learning and association of both methods) would present greater efficacy in knowledge improvement regarding dental trauma in primary dentition.

MATERIALS AND METHODS

An action research study using a participatory approach was conducted with 36 undergraduate Brazilian dental students. A structured questionnaire composed of six clinical cases of traumatic injuries was initially applied to all students (pre-test). Participants were then randomly distributed into three experimental groups: TC-students who had access exclusively to traditional lecture classroom; APP-access exclusively to the mobile application; and TC-APP-access to both approaches. The traditional and technological methods had evidence-based content and visual resources of the subject. After interventions, all students responded to the same previous questionnaire (post-test). Wilcoxon and Kruskal-Wallis tests were performed for statistical analysis.

RESULTS

All tested groups obtained statistically significant improvement between their pre-test and post-test scores, for both diagnosis and treatment of dental trauma (p < .005). Nonetheless, no intergroup differences were observed amongst the scores of pre- and post-test for diagnosis (p = .159) and treatment (p = .206).

CONCLUSION

All teaching approaches applied obtained similar knowledge improvement of undergraduate dental students regarding traumatic injuries in primary teeth.

IADT 2020 Guidelines: What should the dental professional know?

Traumatic dental injuries are a common occurrence among children. Effective acute and long-term management of traumatic dental injuries can improve patient outcomes, especially in the paediatric patient. It is important that all dental professionals follow up-to-date, evidence-based guidance when treating patients. This article aims to highlight the main changes in the 2020 International Association of Dental Traumatology (IADT) Guidelines for Evaluation and Management of Traumatic Dental Injuries, to ensure that all dental professionals are fully aware of current guidelines and are managing patients appropriately.

Does the premature loss of primary anterior teeth cause morphological, functional and psychosocial consequences?

Premature loss of primary anterior teeth in deciduous arches is a controversial topic in the literature, especially due to the lack of robust scientific evidence regarding the types and magnitudes of the consequences involved. Morphological, functional, and psychosocial problems may arise from untreated premature loss of primary incisors and canines. The morphological problems include impaction and eruption disturbances of permanent successors; inclination and/or extrusion of adjacent and antagonist teeth, respectively; midline deviation; and crowding. Functional complications, such as speech disorders, aesthetic problems, and development of non-nutritive habits may occur, resulting in psychosocial implications, including a decrease in self-esteem, and even being targeted for bullying. The current critical review aimed to present and discuss the evidence available in the literature about the etiology, characteristics, implications and interventions resulting from the premature loss of primary anterior teeth. It is of utmost importance that future studies be developed to support the clinical decisions made by dental professionals on this topic.

[Application of the dental trauma guide of the international association of dental traumatology in a group of paraguayan dentists]

Objective

To evaluate the application of the dental trauma guide according to the International Association of Dental Traumatology in a group of Paraguayan dentists from April to May 2021. The was a descriptive, cross-sectional, observational study. A group of Paraguayan dentists with internet access accepted to participate in the study. The measurement instrument was a closed questionnaire from Google Forms, distributed by instant messaging (WhatsApp) from January to April 2021. Based on the Guidelines for the Evaluation and Management of Traumatic Dental Injuries by the International Association of Dental Traumatology (IADT), the questionnaire includes 20 questions on the assessment of clinical and radiographic signs, determination of treatment variables, differentiation of the type of treatment, biological consequences of trauma, materials and splint time, and postoperative indications and medication.

Results

230 dentists participated; the mean age was 33 (SD = 6.4) years, 70.43% were women, 30.87% were general dentists, and 70.87% were practicing exclusively in private practice. 68.70% responded that they were familiar with the management and treatment of dentoalveolar trauma, while 70.87% had not heard or read about the IADT dental trauma guide. Regarding the level of knowledge, 60.00% scored an average mark.

Conclusion

Most of the dentists surveyed had moderate knowledge regarding the evaluation and management of traumatic dental injuries.

Dental arch perimeter changes as a result from premature loss of primary anterior teeth due to trauma: A case series in infant and pre-school children

BACKGROUND

The premature loss of primary anterior teeth in deciduous arches is a controversial topic in the literature, especially due to the lack of robust scientific evidence about the consequences in the arch perimeter space and magnitudes of the effects involved.

AIM

Evaluate the association between premature loss of primary anterior teeth and dental arch perimeter changes, according to clinical variables as deciduous arch type, erupted primary canines, midline involvement and deleterious oral habits, on infants and pre-school children.

DESIGN

Patients with avulsion or referral to extraction due to traumatic dental injuries (TDI) were evaluated. After the tooth loss, two trained operators measured the tooth/teeth space, both with a digital caliper and a dry tip compass. The clinical documentation included photographs and radiographs. Follow-up visits occurred from the baseline and every two months over a 12-month period. Chi-square test was used to evaluate the association between arch perimeter changes and clinical variables (α = 0.05). A descriptive statistic was performed to explore the magnitude of space changes, with 95% confidence intervals.

RESULTS

Eighteen infants/children (mean, 2.78 ± 1.39 years) were included. Nine patients presented space loss (50.0%) (mean, -1.32 mm), six patients gained space (33.3%) (mean, +1.55 mm), and three patients presented space maintenance (16.7%). Clinical variables did not influence dental arch perimeter changes.

CONCLUSIONS

Premature loss of primary anterior teeth, as well as deleterious oral habits, deciduous arch type, midline involvement and erupted primary canines, were not associated with dental arch perimeter changes.

Traumatic injuries in primary dentition and their immediate and long-term consequences: a 10-year retrospective study from the State University of Rio de Janeiro, Brazil

BACKGROUND/AIM

Dental trauma is a highly prevalent problem worldwide. The aim of this study was to describe characteristics of trauma to anterior primary teeth and its sequelae for primary and successor teeth over a 10-year period of assistance at the paediatric dental traumatology clinic in the State University of Rio de Janeiro, Brazil.

MATERIALS AND METHODS

The data were obtained from the dental records of children assisted from 2006 to 2016. Inclusion criteria were trauma to anterior primary teeth; aged <1 to 9 years at the time of trauma; and at least one follow-up appointment. The data concerning traumatized teeth, child's age, soft tissue injuries, types of traumatic dental injuries and sequelae in both dentitions were collected.

RESULTS

Of the 1230 dental records, 483 (39.3%) were eligible, consisting of 815 teeth. The mean age at the time of trauma was 37.4 months (239 males and 244 females). The most important characteristics were: tooth 51 was most affected; falls, at home, on a ceramic floor, were the main cause; gingival laceration, enamel fracture and intrusive luxation were the most frequent types of trauma; premature tooth loss of primary teeth and enamel discoloration in their successor were the most frequent sequelae; and injuries in the periodontal tissue were demonstrated as the highest risk for sequelae in successors (OR, 3.798; p< 0.001).

CONCLUSIONS

Most traumatic injuries occur in young children, in their home environment. Consequences for the primary teeth were more frequent compared to the permanent successor tooth. Traumatized primary teeth involving periodontal tissue have more chances to result in sequelae to their successor teeth.

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.

Knowledge of dental trauma among dental students. Lecture intervention protocol and follow-up over four academic courses

BACKGROUND AND AIMS

A study was made to evaluate knowledge of dental trauma among first-year dental students at the start of the career; assess the knowledge gained immediately after a lecture intervention; and evaluate persisting knowledge on an annual basis until the fourth year of the career.

MATERIAL AND METHODS

The study involved 29 volunteers from the first year of dentistry (School of Dentistry, Madrid Complutense University, Madrid, Spain). All the participants completed a previously validated questionnaire including questions referred to the management of dental trauma at the site of the accident, and other related aspects. This was followed by a brief lecture on the subject, and then the same questionnaire was administered again. Completion of the original questionnaire was subsequently repeated on an annual basis up until the fourth year of the career. Repeated measures analysis was used to assess the evolution of student knowledge.

RESULTS

Knowledge of the subject was seen to be lacking at the start of the career, but increased significantly as a result of the lecture intervention (P < .001). Over the subsequent courses, although the notions referred to dental trauma were seen to decrease with respect to the first evaluation, they remained high. All of the participants agreed on the need for informative campaigns referred to dental trauma targeted to students in the first courses of the health sciences.

CONCLUSIONS

It is necessary to impart knowledge on the prevention and immediate management of dental traumatisms in order to improve their prognosis. This learning is especially relevant to students in the first courses of the health sciences.

Successful minimally invasive intervention in a primary central incisor after root fracture: A case report

Root fractures vary in severity, extent, and location, according to the physical and mechanical aspects of the accident. Root fractures are rare in primary teeth and they affect dentin, cementum, periodontal ligament and the pulp. This paper reports a case of a two-and-a-half-year-old baby who had a root fracture of the upper right primary central incisor (tooth 51) as a consequence of trauma that was managed with minimally invasive intervention. After clinical and radiographic examinations, the presence of tooth mobility, pain, bleeding and a horizontal apical root fracture was diagnosed on tooth 51. The treatment of choice was splinting for 120 days, which can deliver excellent results regardless of the patient's age. The tooth was preserved without needing endodontic intervention until its physiologic exfoliation and normal eruption of its permanent successor. As sequelae to the fractured tooth 51, there was some coronal color alteration and dystrophic calcification of the root canal. This tooth did not develop ankylosis or mobility during the follow-up period. After 57 months of follow-up, repositioning and splinting were appropriate ways to manage this horizontal root fracture in the apical third of this primary tooth. It allowed the tooth to be preserved in the arch with normal function.

Dental trauma in toddlers 1-3 years of age living in multicultural areas of Stockholm, Sweden: A retrospective cohort study

BACKGROUND/AIM

Traumatic dental injuries are common and affect many children. The aim of this retrospective study was to investigate the prevalence and characteristics of dental trauma as well as the costs and resource use in a cohort of children aged 1-3 years in low socioeconomic areas (low income and educational level) of Stockholm.

MATERIALS AND METHODS

Data were extracted from a larger intervention trial and analyzed for the prevalence and other characteristics of dental trauma as well as patient characteristics of children (n = 1346) from six dental clinics in low-income, multicultural areas. Variables describing the trauma, socioeconomic status, direct and indirect costs, and time spent at the emergency visit for the dental trauma were retrieved from the dental records. The study also recorded which healthcare profession handled the first and follow-up visits.

RESULTS

The prevalence of dental trauma in the study cohort was 8.2%, and higher among boys (n = 71) than girls (n = 39). Boys exhibited a significantly higher risk for dental trauma (OR, 1.76; 95% CI = 1.17-2.65). Maxillary incisors were the teeth most often traumatized, and lateral luxation was the most common diagnosis. The mean time spent per child during the first year following the dental trauma was 36 min, and the mean costs per child were EUR 878. The total average per-child cost (direct and indirect costs) for dental trauma was EUR 2107. Dental visits due to traumatic injuries were significantly less common among children with an immigrant background and in families with an income ≤EUR 2000 per month.

CONCLUSIONS

Toddlers in families who have a low socioeconomic status, a foreign background, and live in multicultural areas of Stockholm visit dental clinics for traumatic dental injuries less often than non-immigrant children living in families with a high socioeconomic status.

Evaluation of the impact of a dental trauma care program on oral health-related quality of life of children and their families

BACKGROUND/AIM

A traumatic dental injury (TDI) may have physical and psychosocial consequences for children and their families, and it may impact their oral health-related quality of life (OHRQoL). The aim of this study was to assess the OHRQoL of children affected by TDI and their families after enrollment in the Dental Trauma Care Program (DTCP).

METHODS

This longitudinal clinical study involved a consecutive sample of 2- to 6-year-old children registered in the DTCP over a period of six years. Parents/caregivers were interviewed and the OHRQoL questionnaire was completed. The Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS) was used before and after treatment. The Andreasen criteria were used to classify TDIs. The patients were treated (minimal intervention/invasive intervention) according to TDI severity (uncomplicated/complicated). Based on the Kolmogorov-Smirnov test, the Wilcoxon non-parametric test was used to compare the ECOHIS total scale/subscales/domains before and after enrollment in the DTCP. The longitudinal changes were calculated using effect size measured by the Standardized Response Means (SRM). TDI severity and treatments were also evaluated.

RESULTS

The total ECOHIS mean scores were 7.4 ± 9.2 and 0.8 ± 2.5, before and after TDI treatment (p < .001), respectively. ECOHIS scores dropped by 6.6 points after treatment, demonstrating a positive reduction in the impact on OHRQoL, as reflected by the satisfactory responsiveness of ECOHIS (0.9). The changes following treatment, independent of TDI severity and type of treatment, were significant (p < .001) in children and the family section.

CONCLUSIONS

The impact of TDI on OHRQoL reduced after the enrollment of patients and their families in the DTCP.

Dentistry and the COVID-19 Outbreak

INTRODUCTION

Infection prevention in dental practice is a principle of utmost importance aiming to protect patients, the dental team, and ultimately, public health. The recent pandemic of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has instigated worldwide public concern. This highly contagious disease has called for profound changes in patient care around the world. The goal of this article is to review the current literature and introduce essential knowledge about COVID-19, recommend management protocols and adequate protection for dental professionals during the outbreak.

MATERIAL AND METHODS

The literature search was conducted from April to June 2020. After full-text screening a total of 85 studies were included.

RESULTS

Given the novelty of SARS-CoV-2, some characteristics of the virus remain yet unknown. The virus is aerosol-transmissible and, because of the nature of dental procedures, this puts dental professionals and patients at a high risk of contamination by this pathogen. Adequate management protocols and specific protective approaches are essential to minimise the spread of COVID-19 in dental settings during the outbreak.

DISCUSSION

The overall impact of COVID-19 in health care worldwide is yet to be determined. This constitutes a significant limitation to this review because the information obtained risks being outdated as the pandemic progresses. The prudent practitioner will use this review as a starting point and continue to proactively update themselves as the outbreak continues. Further studies are required to investigate the potential impact of infections with SARS-CoV-2 within dental settings.

What is new in the 2020 International Association of Dental Traumatology emergency treatment guidelines?

Over the past eight years, there have been marked changes in the recommendations for the management of traumatic dental injuries (TDIs). The recently published International Association of Dental Traumatology (IADT) guidelines for the emergency management of TDIs provide a comprehensive manual for clinicians to refer when assessing and managing patients presenting with these types of injuries. Clinicians should be prepared to utilize these new guidelines which were released in 2020. The aim of this short communication is to support those with previous knowledge regarding the IADT guidelines, to identify the changes in treatment modality, and to provide backing for those exposed to trauma guidelines for the first time. In the present communication, the areas of TDIs have been separated into primary and permanent teeth plus avulsions, with a tabular format highlighting the main changes in the emergency management from the previous version in 2012. This format has been devised to aid the clinicians' understanding of the variations over time and facilitate recall of the new guidelines. For the first time, the 2020 IADT Guidelines present a Core Outcomes Set (COS) that includes outcomes that were relevant to all TDIs and outcomes related to only one or several TDIs. However, the COS is not the object of the present publication.

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.

Online consultation and emergency management in paediatric dentistry during the COVID-19 epidemic in Wuhan: A retrospective study

BACKGROUND

The COVID-19 pandemic posed a great challenge to paediatric dentistry, which confronted with the restriction of service and resource shortage.

AIM

To retrospectively analyse the information of children's dental online health consultation during the COVID-19 pandemic in China, and to provide methods to distinguish between dental emergencies and non-emergencies as well as their management.

DESIGN

We collected all the online consultation information in Dept. of Paediatric dentistry, School & Hospital of Stomatology, Wuhan University, from 2 February to 31 March 2020, and extracted the information of age, gender, reason for consultation, description of symptom, and preliminary diagnosis of the children.

RESULTS

A total of 474 online consultations of paediatric dentistry were included within 59 days during lockdown, and 190 (40.1%) were dental emergencies and 284 (59.9%) non-emergencies. Of 190 emergency consultations, 186 (97.9%) showed swelling, pain, and trauma with or without systemic symptoms. Among 284 non-emergency consultations, retained primary teeth (n = 126) and orthodontic consultation (n = 53) were the most common reasons for consultation.

CONCLUSION

The paediatric emergency and non-emergency problems should be clearly distinguished and sufficient instructions provided in the special period of COVID-19. Priorities also should be set to deal with urgent conditions after the release of lockdown.

Traumatic dental injuries and pulp sequelae in an adolescent population

BACKGROUND/AIMS

Traumatic dental injuries (TDI) occur frequently and may result in pulp sequelae. This includes pulp necrosis with infection, pulp canal obliteration and root resorption. The aim of this study was to assess the prevalence and risk factors of pulp sequelae after TDI among Norwegian adolescents.

MATERIAL AND METHODS

A retrospective longitudinal study, including historical clinical data, was conducted with 16-year-old pupils in western Norway. All first-grade pupils, born in 1997 (n = 5184), attending public high schools, were invited to participate and to respond to an electronically administered closed-ended questionnaire (response rate 39.6%, n = 2055). Consent was given to access the dental records in the Public Dental Health Service in Hordaland, where information regarding TDI (diagnosis and treatment) and radiographs were interpreted. Only TDIs to anterior teeth were recorded (canine to canine in the maxilla and mandible). Outcome variables of TDI were registered and analysed using logistic regression, Kaplan-Meier survival estimates and log-rank test.

RESULTS

The prevalence of TDI in the sample population was 16.4% (338 pupils), with a total of 637 teeth involved. The number of included teeth for analysis was 571 (90.5%). The prevalence of pulp necrosis with infection was 7.5%. Moderate and severe TDI was associated with a higher frequency of pulp necrosis with infection. Pulp canal obliteration and root resorption were found in 2.8% and 2.3% of teeth with TDI, respectively. Dental hard tissue injuries were more prone to the development of pulp necrosis than luxation injuries and combination injuries. The relationship between root development stage and development of pulp necrosis with infection was not statistically significant.

CONCLUSIONS

Occurrence of different pulp sequelae among teeth affected with TDI was low. Moderate and severe TDI were more at risk of developing pulpal complications and hard tissue injuries were at higher risk of developing pulp necrosis with infection.

A cross-sectional evaluation of knowledge among Chinese dentists regarding the treatment of traumatic injuries in primary teeth

BACKGROUND/AIM

Injuries to the primary dentition affect children's esthetics, function, and mental health. They may also affect the development of the permanent teeth. The knowledge of dentists about deciduous tooth trauma is rarely evaluated. The aim of this study was to evaluate the knowledge and attitude of dentists in China regarding traumatic dental injuries to primary teeth.

MATERIAL AND METHODS

A self-administered online questionnaire containing questions on demographic data and knowledge based on a clinical scenario was given to a purposive sample of dentists, recruited by a non-probability convenience sampling method. The chi-square test was used for statistical analysis, with the significance level set at P <.05.

RESULTS

A total of 394 out of 409 dentists provided valid data. There was no significant difference in demographic data. Questions about the treatment of hard dental tissue injuries in primary teeth presented a correct-response rate of 66.4%, with the highest correct-response rate for enamel fracture (n = 368, 93.4%) and lowest for complicated crown-root fracture with pulp exposure (n = 104, 26.4%). Questions about treatment of luxation injuries in primary teeth presented a correct-response rate of 66.6%, with subluxation presenting the highest correct-response rate (n = 391, 99.2%). Factors associated with higher correct-response rates were specialist disciplines, educational qualifications, workplaces, experience of injured teeth treated, and educational experience about primary tooth trauma. No significant differences were found in the correct-response rates of dentists with different years of work experience. Lack of cooperation from children was considered a major obstacle for treatment. Special lectures and Internet courses were the most preferred methods of obtaining knowledge.

CONCLUSION

The results suggest that it is necessary to enhance dental trauma education for dentists in China. More attention needs to be paid to trauma in primary dentition to ensure adequate treatment for traumatized primary teeth.

Knowledge and Attitudes about Dental Trauma Among the Students of the University of Split

Objectives

Dental trauma among children is a common problem, and everyone who works with them needs to possess appropriate knowledge and skills to provide proper care at the site of the accident. The aim was to evaluate the knowledge of emergency management of dental trauma among students who should be capable of managing such injuries in their future career.

Materials and Methods

A cross-sectional survey regarding dental trauma emergency management was conducted on 679 students from five different studies using a questionnaire. The obtained data were analyzed by the Student t-test or one - way ANOVAusing the Tukey's post-hoc test and multiple linear regression analysis (p<0.05).

Results

The total knowledge score regarding the emergency management of dental trauma among examined student was 4.32±2.25 (max 10). The positive association of the knowledge score was observed with the age of student (β=0.722, p≤0.001). A similar relation was observed depending on whether they received dental injuries training during their academic education (β=2.365, p≤0.001), as well as students’ assessment of the importance of knowledge regarding dental trauma emergency management (β=0.433, p≤0.001).

Conclusions

It can be concluded that the surveyed students have limited knowledge regarding dental injuries and their emergency management procedures. The obtained data emphasized the importance of additional education of all professions that may encounter dental trauma injuries to improve the outcomes of dental trauma treatment.

Assessment of Parents’ Knowledge and Attitudes on Emergency Management of Permanent Avulsed Teeth in Western Saudi Arabia

Objective:

One of the most common dental injuries is dental avulsion. This study, conducted in the western region of Saudi Arabia, aimed to evaluate parent’s knowledge and attitudes regarding the emergency management of avulsed permanent and deciduous teeth in children.

Methods:

A cross-sectional study was conducted among 393 parents recruited from six dental clinics and hospitals in Makkah and Jeddah, Saudi Arabia. The data were collected with a self-administered questionnaire that assesses the level of knowledge for managing deciduous and permanent avulsed teeth.

Results:

The total score for correct answers about managing permanent avulsed teeth had a mean of 4.77 and a standard deviation of 2.14 (out of 10 questions). With a permanent avulsed tooth, 35.37% were aware of dental reimplanting, 27.7% identified milk as an appropriate medium, and 57.5% would seek professional help immediately after dental trauma. Females and participants with a bachelor’s or higher degree had significantly higher levels of knowledge than males and participants with a high school or lower education. There were 28.5% of respondents who had a previous history of dental trauma for a child. A total of 62.1% knew that there is a difference in managing deciduous versus permanent teeth, but only 40.7% knew the proper management for deciduous avulsed teeth. Previous history of child dental avulsion was not found to be associated with more knowledge on managing avulsed deciduous or permanent teeth.

Conclusion:

Parents in the western region of Saudi Arabia have inadequate levels of knowledge to manage deciduous and permanent tooth avulsion. More efforts should be applied for conducting promotional health campaigns aimed at improving parents’ knowledge.

Corona virus disease bring a new challenge for the dentistry: A review

An outbreak of coronavirus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (SARS-CoV-2) began in the city of Wuhan in China and has widely spread worldwide. While human strains of coronavirus (CoV) are associated with about 15% of cases of the common cold, the SARS-CoV-2 may present with varying degrees of severity, from flu-like symptoms to death. It is currently believed that this deadly CoV strain originated from wild animals at the Huanan market in Wuhan, a city in Hubei province. Bats, snakes, and pangolins have been cited as potential carriers based on the sequence homology of CoV isolated from these animals and the viral nucleic acids of the virus isolated from SARS-CoV-2 infected patients. Common clinical signs of the infection comprises of respiratory symptoms in the form of fever, cough, shortness of breath, and breathing difficulties. In more severe cases, infection results in pneumonia, severe acute respiratory syndrome, kidney failure, and even death. Standard recommendations advocated to prevent spread of infection consist of frequent hand washing, covering mouth and nose when coughing and sneezing. This article, based on our experience and relevant guidelines and research, introduces essential knowledge about CoV in dental settings and provides recommended management protocols for dental practitioners affected areas.

Coronavirus Disease 2019 (COVID-19): Emerging and Future Challenges for Dental and Oral Medicine

The epidemic of coronavirus disease 2019 (COVID-19), originating in Wuhan, China, has become a major public health challenge for not only China but also countries around the world. The World Health Organization announced that the outbreaks of the novel coronavirus have constituted a public health emergency of international concern. As of February 26, 2020, COVID-19 has been recognized in 34 countries, with a total of 80,239 laboratory-confirmed cases and 2,700 deaths. Infection control measures are necessary to prevent the virus from further spreading and to help control the epidemic situation. Due to the characteristics of dental settings, the risk of cross infection can be high between patients and dental practitioners. For dental practices and hospitals in areas that are (potentially) affected with COVID-19, strict and effective infection control protocols are urgently needed. This article, based on our experience and relevant guidelines and research, introduces essential knowledge about COVID-19 and nosocomial infection in dental settings and provides recommended management protocols for dental practitioners and students in (potentially) affected areas.

Evaluation of the Application of Italian National Guidelines for Prevention and Management of Dental Injuries in Developmental Age

Background: The objective of this study is to evaluate the application of National guidelines for prevention and clinical management of traumatic dental injuries (NGPCMTDI) in developmental age published by the Italian Ministry of Health. Methods: In the present retrospective and multicenter study, 246 patients who underwent dental injury were selected to assess the management of the traumatic event compiled with the protocol provided by the National guidelines. Each health worker involved completed a form related to the dental injury in order to standardize the collected data. Two reference centers have been identified for data collection. Analyses for comparisons between groups were performed using the _X² test for categorical variables or by Fisher exact test as appropriate. Statistical significance was assumed at p < 0.05. Results: Evaluating the distribution by age we concluded that: 27.24% of the enrolled patients were aged 1–5 years, 51.63% 6–10 years, and 19.92% 11–17 years. The dental injuries occurred in 10.16% of the situations at home, 50.81% at school, 28.86% during recreation, and 9.35% at the gym. The deciduous dentition is involved in 34.96% of the traumas while the permanent dentition is involved in 69.51%. Conclusion: From the present study it emerged that the National guidelines are not uniformly applied.

Best Splinting Methods in Case of Dental Injury-A Literature Review

The objective of this manuscript was to review the literature on dental trauma splints and discuss materials used for splinting injured teeth in terms of their properties and conditions that are required for optimal stabilization. A literature search was conducted in the PubMed database with the keywords: "trauma splints", "dental trauma" and "traumatic dental injuries". The search was limited to English language publications. 42 publications fulfilled the inclusion criteria and were in accordance with the current recommendations. Optimal splinting of the teeth after trauma is one of the main predictors for pulpal and periodontal healing. The splints stabilize and protect the teeth, creating favorable conditions for the regeneration of the supporting tissues. Their application and removal should be easy and fast without any additional irritating of the surrounding tissues. The materials used to stabilize the injured teeth should keep the tooth in the original position, allowing for its physiological mobility.

Disparities in Access to Oral Health Care

In the United States, people are more likely to have poor oral health if they are low-income, uninsured, and/or members of racial/ethnic minority, immigrant, or rural populations who have suboptimal access to quality oral health care. As a result, poor oral health serves as the national symbol of social inequality. There is increasing recognition among those in public health that oral diseases such as dental caries and periodontal disease and general health conditions such as obesity and diabetes are closely linked by sharing common risk factors, including excess sugar consumption and tobacco use, as well as underlying infection and inflammatory pathways. Hence, efforts to integrate oral health and primary health care, incorporate interventions at multiple levels to improve access to and quality of services, and create health care teams that provide patient-centered care in both safety net clinics and community settings may narrow the gaps in access to oral health care across the life course.

Importance of Photography Education to Improve Image Quality for Accurate Remote Diagnoses in Dental Trauma Patients: Observational Study

Background

High-quality photos are critical for the remote diagnosis of dental trauma and thus are beneficial to the prognosis. The quality of the images obtained using a cell phone depends on the level of dental and photography knowledge of the person who is taking the photos.

Objective

This study aimed to determine the efficacy of photography education in improving images used for the remote diagnosis of dental trauma.

Methods

The subjects comprised 30 laypeople and 30 dentists who were randomly assigned to 15 subgroups with 2 subjects in each. Each subject was asked to take photos of their own anterior teeth and those of their partner on the assumption that an accident occurred using both an iPhone 4s and iPhone 6. Education about how to take an appropriate photo of the anterior teeth for teleconsultation purposes was then provided, after which photos were taken again. Photos were assessed by a dentist for their usefulness in diagnosis.

Results

This study analyzed 965 photos: 441 taken by laypeople and 524 taken by dentists. Photos taken after providing education had significantly higher scores for all assessment items than those taken before education (P<.05). The scores were also significantly higher for photos taken using the rear camera than those taken using the front camera (P<.02). The iPhone 6 did not have overwhelming advantages. The photos taken by dentists had significantly higher scores than those taken by laypeople for most of the evaluated items.

Conclusions

Both laypeople and dentists might find photography education useful for when they are taking photos to be used in teleconsultations. The type of cell phone does not significantly affect the usefulness of such photos.

Sequelae in permanent teeth after traumatic injuries to primary dentition

Traumatic injuries to the primary dentition are critical events in dentistry not only due to the need for urgent care, but also since they have potential sequelae in the permanent dentition, with a prevalence ranging from 12% to 74%. The aim of this article was to provide an overview of the prevalence, etiology, and clinical and radiographic characteristics as well as the management of permanent teeth sequelae resulting from traumatic injuries to their deciduous predecessors. An extensive literature review was performed to reveal the current evidence on enamel discoloration with or without hypomineralization/hypoplasia, crown dilaceration, odontoma-like malformation, root anomalies, partial or complete arrest of root formation, sequestration of the permanent tooth germ, and eruption disturbances.

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.

Just the facts: Pediatric Dental and Oral Injuries

A 16-month-old presents to the emergency department (ED) after a fall while running at home. Her mother noted some blood in the child's mouth and believed there was a tear in the skin above the front teeth.

Italian guidelines for the prevention and management of dental trauma in children

Dental trauma is a frequent occurrence in children and adolescent and a correct diagnosis and treatment are essential for a favourable long-term prognosis. The present Guidelines aim to formulate evidence-based recommendations to assist dentists, paediatricians, surgeons, teachers, school and sport staff, parents in the prevention and first aid of dental trauma in children and to provide a careful assessment of the medico-legal implications, reviewing the first draft of the guidelines published in 2012. A multidisciplinary panel on the behalf of the Italian Ministry of Health and in collaboration with the WHO Collaborating Centre for Epidemiology and Community Dentistry of Milan, developed this document. The following four queries were postulated: 1) Which kind of precautions the health personnel, parents, sports and educational personnel must activate in order to prevent the dental trauma damage? 2) How an orofacial trauma in paediatric patients should be managed either in the Emergency Care Unit and/or in private dental office? 3) What criteria should be adopted by a dentist private practitioner to fill in a certificate in cases of dental and/or tempomandibular joint trauma occurring in children and adolescents? 4) What are the elements that should lead clinicians to suspect a non-accidental dental trauma? A systematic review and analysis of the scientific literature published in English, Italian and French from 2007 to 2017 regarding dental trauma in children and adolescents aged 0-18 years was performed, and about 100 papers were analysed and included. The following four domains were analysed and discussed: Dental Trauma Prevention Strategies and Health Education, First aid in orofacial and dental trauma, Certificate of the dental trauma, Oral and dental signs of child abuse and neglect. Twenty-eight recommendations were draw up and codified by the panel according to the Methodological handbook, produced by the Istituto Superiore di Sanità, in order to guide physicians in the prevention and first aid of dental trauma in children and adolescents. In addition, a careful assessment of the medico-legal implications is reported in this document.

Best clinical practice guidance for prescribing dental radiographs in children and adolescents: an EAPD policy document

BACKGROUND

The European Academy of Paediatric Dentistry (EAPD) proposes this best clinical practice guidance to help practitioners decide when and how to prescribe dental radiographs in children and adolescents.

METHODS

Four expert working groups conducted each a systematic review of the literature. The main subjects were radiation protection, intraoral dental radiography (bitewing and periapical radiographs), panoramic radiography (PR) and cone-beam computed tomography (CBCT). In addition, three workshops were held during the corresponding EAPD Interim Seminar in Chania (Crete, Greece) in 2019. On the basis of the identified evidence, all invited experts presented their findings and during the workshops aspects of clinical relevance were discussed.

RESULTS

Several clinical-based recommendations and statements were agreed upon.

CONCLUSION

There is no or low-grade evidence about the efficacy of dental radiographic examinations in young populations. The given recommendations and rationales should be understood as best clinical practice guidance. It is essential to respect the radiological principles of an individualized and patient-specific justification. When a dental radiograph is required, its application needs to be optimized, aiming at limiting the patient's exposure to ionising radiation according to the ALADAIP principle (As Low As Diagnostically Achievable being Indication-oriented and Patient-specific).

Physician Confidence in Dental Trauma Treatment and the Introduction of a Dental Trauma Decision-Making Pathway for the Pediatric Emergency Department

OBJECTIVES

The objectives of this study were to (1) survey and report the awareness and confidence of pediatric emergency medicine physicians in the management of dental trauma and (2) determine the prevalence of dental trauma decision-making pathway utilization in the pediatric emergency department.

METHODS

A survey was distributed through e-mail to the pediatric emergency medicine discussion list via Brown University LISTSERV. The survey study included 10 questions and was multiple-choice. The survey contained questions about physician confidence and their use of a dental trauma decision-making pathway.

RESULTS

A total of 285 individuals responded to the survey. Somewhat confident was the most common response (61%) followed by not confident (20%) and confident (19%) by respondents in treating dental trauma. Forty-one percent of respondents felt comfortable, 39% somewhat comfortable, 19% not comfortable, and 1% not sure in replanting an avulsed tooth. Only 6% of respondents reported that their pediatric emergency department always or sometimes uses a dental trauma decision-making pathway, whereas 78% of pediatric emergency departments do not.

CONCLUSIONS

We believe that the adoption of a decision-making pathway will provide timely management, improve emergency physician comfort, and enhance outcomes for pediatric patients presenting with a dental trauma. A future multicenter review will aim to evaluate these goals based on the utilization of our dental trauma decision-making pathway.

Dental Trauma in Children: A Quick Overview on Management

Traumatic dental injuries (TDI) or tooth trauma have a global prevalence of 10-15%. These are often the cause of first visit to emergency room. Prognosis of teeth after injury is dependent on type of TDI, emergency treatment and time elapsed till definitive care. The low level of awareness among general public and medical practitioners often leads to delay in seeking treatment which often leads to pain, severe symptoms and poor prognosis. Pediatricians can play a significant role in identification of TDI, health advise, emergency care and referral to dentists. This paper highlights the important features to be noted in children with history of TDI and the key steps which needs to be taken in these situations.

In the Dental Implant Era, Why Do We Still Bother Saving Teeth?

Teeth are vital sensory organs that contribute to our daily activities of living. Unfortunately, teeth can be lost for several reasons including trauma, caries, and periodontal disease. Although dental trauma injuries and caries are more frequently encountered in a younger population, tooth loss because of periodontal disease occurs in the older population. In the dental implant era, the trend sometimes seems to be to extract compromised teeth and replace them with dental implants. However, the long-term prognosis of teeth might not be comparable with the prognosis of dental implants. Complications, failures, and diseases such as peri-implantitis are not uncommon, and, despite popular belief, implants are not 99% successful. Other treatment options that aim to save compromised or diseased teeth such as endodontic treatment, periodontal treatment, intentional replantation, and autotransplantation should be considered on an individual basis. These treatments have competing success rates to dental implants but, more importantly, retain the natural tooth in the dentition for a longer period of time. These options are important to discuss in detail during treatment planning with patients in order to clarify any misconceptions about teeth and dental implants. In the event a tooth does have to be extracted, procedures such as decoronation and orthodontic extrusion might be useful to preserve hard and soft tissues for future dental implant placement. Regardless of the treatment modality, it is critical that strict maintenance and follow-up protocols are implemented and that treatment planning is ethically responsible and evidence based.

Evaluation of knowledge among general dentists in treatment of traumatic injuries in primary teeth: A cross-sectional questionnaire study

Objective:

The purpose of the present study was to assess the knowledge of General dentist regarding the management of dental traumatic injuries of primary teeth.

Materials and Methods:

A total of 100 general dentists were selected and a validated questionnaire was distributed among the dentist to assess their knowledge on treatment strategies regarding traumatized primary teeth.

Statistical Analysis:

Data were entered into SPSS version 20.0 for percentages. The correct answers were tested in relation to the dentists’ years of experience using the Chi-square test.

Results:

Analyzing the questionnaire for knowledge, 49% of dentists answered accurately regarding avulsed primary teeth, 36% of dentists answered appropriately regarding crown and root fractures, and 55% of dentists gave appropriate answers regarding luxation injuries. Chi-square test showed a statistically significant difference only for 2 questions in relation to the dentist's years of experience (P < 0.05).

Conclusion:

There is a lack of consistency in the knowledge among general dentist regarding traumatic dental injuries of primary teeth. There is a need to create awareness and education regarding traumatic injuries of primary teeth.

Developmental Disturbance of a Maxillary Permanent Lateral Incisor Following Trauma at the Age of 16 Months: A 6-Year Follow-Up

A 3 year and 8 months old Chinese boy was referred for a consultation regarding his missing maxillary anterior teeth. He had a history of trauma to his primary maxillary anterior teeth due to a fall at the age of 16 months. Clinical examination of the patient indicated multiple carious lesions and inadequate oral hygiene. Radiographic examination revealed intrusion of the primary left lateral incisor, with evidence of damage to the permanent tooth germ. Subsequently, the patient was followed-up for almost six years during which his permanent maxillary left lateral incisor erupted exhibiting an unusual morphology. Clinically enamel hypoplasia and radiographically dens invaginatus were evident in affected tooth.