Traumatic dental injuries (TDIs) in children

Question 1

Prevalence in permanent dentition

Answer 1

12% 12yos & 10% 15yos had sustained visible injury to one or more permanent incisors (UK child dental health survey 2013)
Decline over past 4 decades for 15yos: 26% in 1983; 17% in 1993; 13% in 2003
Peak incidence 8-10yrs
M:F ratio 2:1

Question 2

Prevalence in primary dentition

Answer 2

Boys 31-40%
Girls 16-30%
Why such a wide range?

Question 3

Aetiology

Answer 3

Falls and collisions
Contact sports
Assault
Non-accidental injury
Other activitis: bicycle injuries, swimming, car accidents, skiing, horse riding, trampolining

Question 4

Contact sports

Answer 4

Rugby
Football
Karate/ judo
Hockey
Boxing

Question 5

Predisposing factors

Answer 5

> overjet (2x risk if iverjet >6mm)
Poor lip coverage
Previous trauma (> risk of 4-30%)
Epilepsy (poorly controlled)
Poor motor control
Obesity
Poor life circumstances
ADHD

Question 6

Prevention

Answer 6

• Mouthguards for sports
• Seatbelts
• Safety straps in wheelchairs
• Early orthodontic
  intervention
• Playground design

Question 7

Classification

Answer 7

Enamel infraction
Enamel fracture - uncomplicated crown fracture
Enamel - dentine fracture - uncomplicated crown fracture
Complicated crown fracture
Root fracture (coronal 1/3, middle 1/3 or apical 1/3; horizontal or oblique)

Question 8

Dentoalveolar injuries

Answer 8

Concussion
Subluxation
Luxation

Question 9

Concussion

Answer 9

-injury to tooth supporting structures without abnormal loosening or displacement of tooth

Question 10

Subluxation

Answer 10

Injury to tooth supporting tissues with abnormal loosening, but without displacement of the tooth

Question 11

Luxation

Answer 11

• Intrusion (inwards)
• Extrusion (outwards)
• Lateral (buccal, lingual) - tipping (percussion - can sound dull)
• Avulsion (comes out)

Question 12

Alveolar injuries

Answer 12

• Crushing/ compression of alveolar wall
• Fracture of alveolar socket wall
• Fracture of alveolar process
• Fracture of maxilla +/- mandible

Question 13

Epidemiology - most common type of injury to permanent tooth?

Answer 13

Enamel fracture

Question 14

Primary management

Answer 14

Time important for all

• e.g. cover with GIC or composite quickly
• put back in place quickly

Question 15

History

Answer 15

• Patient details
• Attended with?
• C/O
• HPC
When?
Where? (could have swallowed it)
How?
lost tooth or tooth fragment accounted for?
• Head injury? Other associated injuries?
• Treatment already received elsewhere?
• Past medical history
Cardiac, Diabetes, Epilepsy, Bleeding disorder,
Allergies, Tetanus?
• Past dental history
• Safeguarding concerns (Child Protection Plan)

Question 16

Examination

Answer 16

E/O 
Bony: step deformities, unable to open/close jaw
Soft tissues: swelling, bruising, lacerations
(wound contamination?)
Tip - clean the patient up first!
Include a diagram if
helpful and take good
clinical photos (importance
medico-legally)
I/O Soft tissues
-lacerations
-haematoma
-torn fraenum

Question 17

Examination of teeth

Answer 17

Charting
Fractures/ pulpal exposures
Discoloration (old injuries)
Mobility (luxation or root fracture?)
Displacement – visual/ occlusion/
Buccal tenderness
Tender to pressure?
Sound on percussion (ankylosis, old injury)

Question 18

Examination of occlusion

Answer 18

Can the patient bite together, does it feel

normal?

Question 19

Radiographs

Answer 19

• Assist initial diagnosis
• Basis for comparison with later films
• Size of pulp
• State of development of apex
• Presence of root fractures (may need to take 2 x-rays at different angles)
• State of periapical region
• Lip lacerations – tooth/ glass fragments
• Jaw fracture
• Relation to permanent successor

Question 20

Vitality (sensibility) testing

Answer 20

• Clinically – discoloration, sinus
• Ethyl chloride
• Electric pulp testing
• If tooth is concussed/ luxation injury, nerve
damage may not recover for 3 months
• Don’t need to do sensibility testing for acute
injury when tooth is obviously vital

Question 21

IADT guidelines

Answer 21

IADT guidelines