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 Dental trauma: epidemiology, etiology and classification

o The doctor was reading the slides most of the time, she just explained some points, but didnt add anything . o This lecture is an introduction and in the coming lectures we will talk about each subject in details. o Dr.arwa will give us a lecture about local anesthesia and another one about extraction in "preventive course" just for the first two weeks to prepare us for the clinic.

Dental trauma: tooth fractures have been described as a significant dental disease and are reported to be third most common cause of tooth loss behind caries and periodontal disease ,,, here this definition is talking about adults because tooth loss in adults mostly due to caries, periodontal disease and trauma. In children; periodontal disease is not that much common so the main cause is caries and trauma is the second cause. Epidemiology Trauma frequencies will vary in different countries in varying age groups. The frequencies differ among primary and permanent dentition. Trauma frequencies in children in primary dentition: o In primary dentition almost one-third have suffered a traumatic dental injury. o Most often tooth luxation, luxation means the injury is directed to the PDL. It is the most common because bone in children is very loose and the crown-root ratio is small as roots are shorter; so the tooth can be easily displaced. However; if we compare them with permanent teeth, bone is harder and
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roots are longer so if there is a direct fall on the floor the tooth is easy to be fractured. o In Boys the incidence is much higher than girls. Trauma frequencies in children in permanent dentition: o 20-30% have suffered dental injuries. o The typical injury is uncomplicated crown fracture. o Boys are almost one-third more frequently affected. Trauma incidences in the primary dentition : o Annual trauma incidences: mean the number of new injuries suffered during a year. o Peak incidences in the primary dentition are found at 2-3years of age where motor coordination is developing and children start moving around on their own, he bases on the chair and table and walk around the house, in this stage the motor coordination is stimulated and the weight of the head is larger than the body so this is causing the child to fall on the ground causing trauma, which is the main reason for trauma at this age.

Trauma incidence in the permanent dentition : Peak incidences for boys are found at 9-10 years where vigorous playing and sports activities become more frequent. Epidemiologic characteristics of dental trauma: Sex and age: in males more than females , in primary dentition luxation more common than crown fracture. Etiology: leading cause in primary dentition is falls, while in permanent dentition is sports and violence. Seasonal variation: in Jordan the frequencies in summer are more due to school holidays, children are going outside to play
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where they get injured. While in Switzerland its more in winter because they have winter sports like skating, so injuries may happen. In other words seasonal variation depends on countries and cultures. Type of injury: in primary teeth luxation, in permanent crown fracture. Soft tissue injuries: the most popular, in 50% of trauma cases ,it can be extra oral or intra oral Place of injury: at home, school or playground. Location of injury: anterior teeth get traumatized more than posteriors and in maxilla more than mandible; if the patient have class III skeletal relation then the mandible will get injured more.

Etiology: Causes of trauma: Iatrogenic injuries in newborns prolonged intubation in prematurely born infants, the tube sometimes causes pressure on the tooth bud leading to enamel hypoplasia. Prevalence of Falls in infancy due to lack of coordination etiologic factors: Child physical abuse. Falls are the Contact sports,bicycle injuries highest then fights ,horseback riding. & accidents and Road traffic accidents/motor vehicle then bicycle accidents. &sports. Assaults. Physical torture.

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Note in the prevalence table of etiologic factors (slide15) child abuse is 1% and this doesnt mean it is low but its not reported ,we dont ha ve actual number about child abuse. In the chart (slide 16): bicycle ,falls and sports cause trauma in girls more than boys ,while violence more in boys. Remember this is not a general rule; it depends on the country and the year of the study. Predisposing factors to trauma : (they are not direct reasons but they could predispose to trauma) The incidence of trauma increased with increased overjet, protrusion of upper incisors and incompetent lips, if the patient falls on his face he/she will be at risk of trauma. Medical history: Epilepsy, mental retardation , Attention Deficit Hyperactivity Disorder (ADHD) ,in ADHD the child is very hyperactive but his attention is low . Dental history: any dental condition which will weaken the Enamel and Dentin structure may dispose them to trauma like amelogenesis imperfecta (AI), dentinogenesis imperfecta (DI) and endo therapy, which may weaken the root especially apexification in a young age, because the root doesn't have much time to lay enough thickness of dentine . Low socio economic status and this is a debatable to some degree , because the poor neighborhood have more fighting and violence, but also in high SES have problems like drugs and violence ,so its debatable and cultural . Lack of mouthguards and faceguards during playing

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Classification of dental injuries to teeth: Proposed and modified by Andreasen and Andreasen based on WHO classification in 1978. Andreasen is a dentist who has many researches and puplication about trauma ,and he has a book named (Atlas of dental trauma) which is very useful book if you want to read it. He classified trauma according to anatomic, therapeutic and prognostic factors. Includes injuries to teeth, supporting tissues, gingival and oral mucosa. Can be applied to both permanent and primary dentitions. Classification of dental injuries : Injuries to the hard dental tissues and pulp . Injuries to the hard dental tissues , pulp and alveolar process . Injuries to the periodontal tissues . Injuries to the gingival or oral mucosa .

Injuries to the hard tissues & pulp Enamel infraction : incomplete fracture (crack) in enamel without loss of tooth substance . Enamel fracture : (uncomplicated crown fracture ) fracture with loss of tooth substance confined to enamel . Enamel-dentine fracture: (uncomplicated crown fracture) a fracture with loss of tooth substance confined to enamel and dentine but NOT involving the pulp . Complicated crown fracture: a fracture involving enamel , dentine and exposing the pulp .

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 Injuries to the hard dental tissues ,pulp and alveolar process Crown- root fracture: fracture involving enamel , dentine and cementum .it may or may not expose the pulp. Usually its diagonal in direction . Root fracture: fracture involving dentin, cementum and pulp, it could be apical ,in the middle or cervical . fracture of the alveolar socket (Mx or Mn) : fracture of the alveolar process which involves the alveolar socket ,some times this fracture occurs with luxation injury ,i.e. the tooth is intact the crown goes palatally and the apex goes labially . fracture of the alveolar process (Mx or Mn) : fracture of the alveolar process not the jaw bone, that may or may not involve the alveolar socket . Sometimes root fracture appears clinically only as displacement of the root, thats why X-rays are very necessary in management of trauma .later on you, will learn that each type of trauma has different types of x-rays. There is a website about guide lines of management of dental trauma which always updates these guidelines, because you have to refresh your information www.iadt-dentaltrauma.org Injuries to the periodontal tissues: Concussion: injury to tooth-supporting structures without abnormal loosening or displacement of the tooth, but with marked reaction to percussion, clinically and in radiographs there are no changes only the tooth becomes tender. Subluxation (loosening): injury to tooth supporting structures with abnormal loosening, but without displacement of the tooth. Extrusive luxation (partial avulsion): partial displacement of the tooth out of its socket, we take a radiograph to make sure that there is no root fracture.
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Lateral luxation: displacement of the tooth in a direction other than axially. Clinically the crown goes palatally and the root goes labially , in the x-ray there is widening in the PDL space. Intrusive luxation: displacement of the tooth into the alveolar bone. Accompanied by comminution or fracture of the alveolar socket. Avulsion (Exarticulation): complete displacement of the tooth out of its socket.

Injuries to the gingival or oral mucosa: Laceration of gingival or oral mucosa: a shallow or deep wound in the mucosa resulting from a tear, usually produced by a sharp object. Contusion of gingival or oral mucosa: a bruise usually produced by impact with a blunt object and not accompanied by a break in the mucosa, usually causing submucosal hemorrhage. Abrasion of gingival or oral mucosa: a superficial wound produced by rubbing or scraping of the mucosa, leaving a raw, bleeding surface. The doctor showed us some pictures about the previous cases which are in the slides please refer to them.

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