Dental Trauma

Description

• Loss or fracture of a tooth and/or supporting bone and tissue due to trauma; can result in shifting of remaining teeth, loss of teeth, loss of alveolar bone, and displaced or nonunion of maxilla and/or mandible, resulting in functional and aesthetic deformities which can be difficult to correct
• It is not a disease but a consequence of a sudden, unexpected, circumstantial, accident, or impact injury.
• Systems affected: oral cavity, ENT

Epidemiology

• Dental injuries constitute 5% of all injuries worldwide and as many as 17% in preschool children (1,2).
• 92% of oral injuries are tooth injuries, 28% have soft tissue injury, and 6% jaw fractures (2).
• More prevalent in high-risk populations: children, special needs/handicapped individuals, athletes, military personnel, elderly (2)
• Traumatic dental injuries can occur from malocclusion, falls, sports injuries, accidents, assault, dangerous environmental conditions, risk-taking behaviors, oral piercings, or a combination (2,3).
• Male > female (2:1) (3)

Prevalence

• 20–30% prevalence across life span
• 5% of all U.S. school-age children with history of dental trauma; 30% in primary dentition; 20% in permanent dentition (2,3)
• Affects 30% of population by 14 years old (4)
• Upper incisors are most frequently involved in traumatic dental injuries (3).

Etiology and Pathophysiology

Direct force sufficient to overcome the bond between the tooth and periodontal ligament within the alveolar socket or disruption of enamel and dentin and/or pulp; force against maxilla or mandibular arch great enough to cause fracture

Risk Factors

• Physical and intellectual disabilities, any age (2)
• Contact sports without proper protective equipment (i.e., helmets, face guards, mouth guards)
• High-risk sports (e.g., football, boxing, wrestling, soccer, baseball, hockey, bicycling, skateboarding) (2)
• Age: youth <12 years (2)
• Tongue/mouth piercings (3)
• Prior dental trauma
• Male gender (1,2)

General Prevention

• Personal and social education aimed at prevention/early intervention (2,3)
• School policies against bullying and violence
• Mouth guards and helmets. Custom mouth guards are better than boil and bite guards which are better than stock guards (3).
• Avoid tongue and orofacial piercings.
• Wear seat belts.
• Physical environmental changes. Monitor home for slippery areas; childproof house with gates, pad sharp table edges (4,5)

Commonly Associated Conditions

• Tooth loss can cause loss of space in dental arch.
• Malocclusion causing functional problems; flared upper anterior teeth (3)
• Trauma to dentition resulting in pulpitis, which causes necrosis of the pulp
• Child or partner abuse: Be alert for history inconsistent with injuries (3,4).
• Contusion to temporomandibular joint
• Traumatic brain injury (2)