Effect of treatment delay upon pulp and periodontal healing of traumatic dental injuries –a review article.

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Craig Elice Date: 9/04/2009
Article title: Effect of treatment delay upon pulp and periodontal healing of traumatic dental injuries –a review article.
Author(s): Andreasen JO, Andreasen FM, Skeie A, et al.
Journal: Dental Traumatol. 2002
Volume (number): 18: 116-128
Major topic: Dental Trauma Treatment timing
Type of Article: Review of Literature
Main Purpose: The purpose of this article was to evaluate clinical and experimental studies when a treatment delay factor was analyzed. These treatment timing factors were divided into acute (<3>24 hrs). The studies were selected from a Medline search.
Materials and Methods: The studies were evaluated according to the following types of injuries: Enamel/Dentin fractures, Complicated crown fractures including pulp exposures, Crown root fractures, Alveolar fractures, Concussion and subluxation, Extrusion and lateral luxation, Intrusion, Avulsions, and Primary tooth trauma.
Findings: Enamel/Dentin fractures: There are few symptoms reported, and aside from the occurrence of luxation complications, there is very low risk of pulp complications. Pulp complications occur in 1-3% of cases on average regardless of timing of treatment. Complicated crown fractures which include pulp exposures: It is common to have stimulated pain such as during mastication and temperature changes. If pulp caps or partial pulpotomy is the treatment of choice than no time relationship was show between treatment and pulpal healing. However, if cervical pulpotomy is planned then a subacute approach has a better prognosis for pulp healing. Crown/root fracture: In these cases, the coronal fragment should be removed and the pulp should be extirpated in its entirety especially if the root development is mature. Treatment has no relation to timing. Root fractures: Pain is usually related to tooth displacement. Studies indicate no proof of treatment timing as it relates to prognosis. Alveolar fractures: Pain is present during coclusion on displaced tooth bone segment. The two studies evaluated indicate healing of bone is good, but the PDL and pulp often develop complications. A strong relationship exists between treatment time and risk of pulpal necrosis was reported, but the studies were biased. Acute treatment timing is indicated. Concussion and subluxation: Pain to occlusion and mastication but not spontaneous. Mobility may be related. No conclusions could be drawn between this injury type and timing of treatment. Extrusion and lateral luxation: Although no study yielded a significant relationship between treatment timine and periodontal ligament healing, it was suggested that to reduce clinical symptoms. An acute or subacute treatment time is indicated. Root development seems to have more relevance in time of healing of pulpal or PDL tissue. Intrusion: This type of injury has the most severe pulpal and periodontal injury prognosis regardless of treatment timing. Treatment considerations include immedicate extrusion or delated extrusion Avulsions: Prognosis is reated to storage medium and length of extra-alveolar timing. Acute timing for reimplantation is essential, but splinting may occur in a subacute time frame. Primary tooth trauma: most injuries are lateral locations and intrusions. The extent of the injury determines the prognosis of the permanent tooth more so than the timing of treatment. An acute treatment approach is more appropriate for injuries affecting occlusion. Otherwise subacute treatment is warranted.
Key points/Summary : Few acute treatment indications are supported by the literature as it relates to dental trauma. Repositioning and splinting of teeth has a questionable prognosis when treatment timing is considered. However the immediacy of antibiotics to prevent dental infection appear to be appropriate.
Assessment of article: Lots of data to support the conclusion that we do not as dentists need to rush to the office to treat dental truama

Dental Trauma in Children: A Survey

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Craig Elice Date: 9/04/2009
Article title: Dental Trauma in Children: A Survey
Author(s): Perez R, Berkowitz R. Mcllveen L. et al
Journal: Endodontic Dental Traumatology
Volume (number): 1991 (7): 212-3
Major topic: Dental Trauma
Type of Article: Survey
Main Purpose: The purpose of this article was to determine the type and prevalence of injuries presenting to the pediatric dental service of the Children’s National Medical Center in Washington D.C..
Materials and Methods: This twelve month study consisted of 227 patients who reported to the Children’s Medical Center with a traumatic dental injury. A clinical evaluation was performed and the indicated dental radiographs were exposed. Demographic information consisting of patient age, sex, time and cause of injury, intraoral and extraoral soft tissue injury, fractured or displaced teeth, and lastly alveolar fracture. All crown fractures were classified using Ellis classification and root fractures were noted. Displacements were divided as follows: Group 1—sensitivity to percussion and mobile without displacement; Group 2—extrusion from socket; Group 3 –intrusion; and lastly Group 4—avulsion.
Findings: Of the 227 patients, 96 were less than 5 years of age, 85 were 5-12 years, 46 were greater than 13. The leading cause of injury was due to falls at 46%. 132 (58%) children sustained soft tissue injury, approximately 33% sustained at least one fractured tooth, 62% sustained a displacement injury, and approximately 6% presented with an alveolar fracture which was usually associated with an automobile accident.
Key points/Summary : Falls were the most common cause of dental injury, males have a greater prevalence of dental trauma than females, injuries occur more frequently during the late spring, summer and early fall than other seasons. Soft tissue injury occurs in approximately half of all dental trauma.
Assessment of article: Well presented article yielding trauma patterns consistent with private practice

Orofacial trauma in child abuse: types, prevalence, management, and the dental profession's involvement

Department of Pediatric Dentistry

Lutheran Medical Center

Date: 08/28/2009

Article title: Orofacial trauma in child abuse: types, prevalence, management, and the dental profession's involvement

Author(s): Howard L. Needleman, DMD

Journal: Pediatric Dentistry

Volume (number): Vol 8

Month, Year: 1986

Major topic: Child abuse

Minor topics: dental trauma management

Type of Article: Review of Literature

Main Purpose: Review types of injuries to the primary dentition and present evidence based treatments

Overview of method of research: Review of Literature as well as professional opinion

Findings:

Trauma to the head and associated areas occurs in approximately 50% of cases of physically abused children.

Soft tissues are the most common injury in child abuse and are usually on the face

Injuries to the upper lip and frenum are common findings in severely abused children

As dentists make an effort to be aware of these injuries, abuse detection will increase.

Key points/Summary :

• Common abuse findings: Fractures, subdural hematomas, abrasions & lacerations, contussions & ecchymoses, bursns, bites, dental trauma.
• In the past, dentists have done a poor job reporting abuse; dentists have not always been aware that they are legally mandatory reporters.
• The primary goal in detection is to bring the needed social services to families to help them overcome their problems.
• How to detect abuse:
• Is the injury consistent with the history?
• Are there signs of previous traumas?
• Is there bruising at various levels of healing?
• Does the parent exhibit unusual behavior are does the child seem to be traumatized?
• Is there evidence of neglect or poor supervision?
• Make appropriate referrals when pathology presents you are uncomfortable treating
• If the injury is within your realm of specialty, then treat appropriately.
• Soft tissue: use ice packs
• Abrasions: cleanse and dress as needed
• Frenum tears: suture only if alveolar bone is exposed and the wound opens with lip movement
• Suture choice: 5-0 or 6-0 silk for skin removing them 4 days post-op; 3-0, 4-0 chromic gut for muscalature; 4-0, 5-0 plain gut for mucosa.
• Human bites: very serious, antibiotics recommended and don't close wound. (refer this)
• Facial fractures are relatively rare, but nasal fractures occur most frequently. Refer all alveolar and mandible fractures to an oral surgeon--even if treatment is not indicated.

Assessment of article: A solid review of child abuse as it pertains to pediatric dentistry, but a lot of the literature used is really dated. It would be nice to see a current article on this same topic.