Developmental disturbances of the permanent teeth following trauma to the primary dentition

Meghan Sullivan Walsh September 2, 2010

Literature Review - LMC/ Providence Pediatric Dentistry

Developmental disturbances of permanent teeth following trauma to the primary dentition.

Resident: Meghan Sullivan Walsh

Program: Lutheran Medical Center - Providence

Article Title: Developmental disturbances of permanent teeth following trauma to the primary dentition.

Authors: Thomas von Arx, DMD

Journal: Australian Dental Journal

Volume Number, Year, Pages ; 38:1 1993, Pages 1-10

Major Topic: Study of permanent tooth malformation following trauma to the primary dentition.

Overview of Method of Research: One hundred and ninety-five children treated for a dental emergency in the Department of Oral and Maxillofacial Surgery, Kantonsspital, Lucerne, Switzerland between 1977 and 1998 were recalled in 1990. Of these children one hundred and fourteen children could be reexamined. The children were categorized into groups based on original trauma, eruption stage of permanent succedaneous tooth and developmental disturbances to the permanent teeth.

Key Points: The total number of traumatized teeth in these patients were 255. The majority of injuries affected the maxillary central incisors then laterals. Male to female ratio was 1.6:1 and the mean age at time of trauma was 3.6 years old. The study showed that 23 percent of the reexamined teeth showed developmental disturbances. Approximately one in four teeth interfered with the odontogenesis of it’s successor. The majority of tooth disturbances were enamel hypoplasia and or enamel defects. Intrusion bore the highest risk of tooth disturbances with 54% of these injuries resulting in some affect of the permanent dentition. No disturbance was found in any of the cases with a crown of root fracture even when the pulp was exposed. All the other types of developmental disturbances were seen to have some correlation to time at which the primary tooth was injured. Odontome-like teeth were most likely to develop following injury at an early age such as one year old. Crown dilaceration occurred mostly in the age range of 1.5-3.5 and root malformation occurred later at four and five years of age. The author concluded that enamel continues to maturate and mineralize until the time of eruption which can explain why enamel disturbances and discoloration may effect all age groups.

Assessment of the Article: This was a great clean and simple study. I was impressed with the number of patients they were able to follow up with especially many years after sustaining the injury. The author did note that his numbers may be off due to the fact that only 56% of these teeth could be examined clinically. Many of these patient’s did not have their permanent teeth yet erupted and so these teeth were examined radiographically. We should make note of the high incidence of damage to the permanent dentition especially following an intrusion and remember to tell our parents that is is likely that their permanent dentition will be effected.