Subluxation injuries of maxillary primary anterior teeth:epidemiology and prognosis of 207 traumatized teeth

Resident: Jason Hencler
Date: 8/21/09

Article title: Subluxation injuries of maxillary primary anterior teeth: epidemiology and prognosis of 207 traumatized teeth

Author(s): Irwin Fried, DDS; Pamela Erickson, DDS, PhD; Stephane Schwartz, DDS, MsD; Kathleen Keenan, PhD
Journal: Pediatric Dentistry
Volume #18 ; Number 2; Page 145-151 Year: 1996

Major topic: Subluxation
Type of Article: Retrospective case study

Main Purpose: Investigate the epidemiology, sequelae, and prognosis of injuries to the maxillary primary anterior dentition.

Overview of method of research: Retrospective chart audit to identify patients who sustained subluxation injuries to the maxillary primary anterior dentition between 1982 and 1993. Information was gathered pertaining to the child and all aspects of the trauma. All post-traumatic sequelae, treatment or administration of antibiotics were also evaluated. Data were distributed into the following six time intervals of examination post-trauma: 0-10, 11-30, 31-91, 92-183, 184-365, and 366-730 days. A total of 207 teeth were evaluated in 134 patients (81 male, 53 female) sustaining subluxation injuries to the maxillary primary anterior dentition.

Findings: Central incisors involved 66.2%, lateral incisors involved 33.3%, and only one case involved a canine. Age of patients ranged from 0.8 -7.5 years with trauma more common in males. Physiologic root reorption was found in 38.0% and only 6.8% of the study teeth demonstrated pathologic root resorption. Crown fractures were noted in only 5.8% of the study teeth and 91.5% of patients sustained no alveolar fractures. Patient discomfort was not a common complaint at follow-up examinations. Discoloration, however, increased with time. Periapical radiolucencies were uncommon, while pulpal calcification increased with time.

Key points in the article discussion: Trauma to the maxillary primary anterior dentition is very common. Central Incisors were affected most of the time. Mean age of study patients sustaining subluxations was 3.5 years. Most common etiology of traumatic injuries in this study group was simple falls indoors (52%). The high incidence of traumatic falls is consistent with the developing motor coordination in young children. Subluxations are often not the only tooth injury sustained in a particular accident. Avulsions and/or luxations were found 58.2% of the time along with subluxation injuries. Crown and root fractures were found 5.8% and were infrequent probably due to the relative plasticity of bone in young children which absorbs most of the force during an impact. The treatment of subluxated teeth varies and this study found that 80.2% of the time teeth required no dental treatment. Antibiotics were administered only in cases were a potential for systemic infection such as avulsion or luxation where there is an increased likelihood that the gingiva was lacerated. Discoloration has frequently been reported following traumatic injuries to teeth. This study showed an increase of discoloration over time. A yellow discoloration is thought to be due to partial pulp canal obliteration. A pink tooth is due to blood pigments entering the dentinal tubules at the time of trauma. A gray discoloration is generally thought to be significant of pulpal necrosis. Discoloration should be used as an adjunct in diagnosis, but not as the sole predictor of prognosis and in determining the need for EXT. Other studies found discolored primary teeth failed to develop any radiographic and/or clinical pathology. This study found that incidence and severity of pulpal calcification increases with time. Other studies have found that prognosis following pulp obliteration was favorable and normal root resorption usually occurred.

Summary of conclusions:
Highest incidence of trauma occurred in males 3-4 yo. and females 1-3 yo. Central incisors were most commonly affected typically the result of falls.
More than half the patients were seen within 3hrs of the trauma.
The majority of teeth had a mobility ranging between 1.6 and 2.5mm following trauma.
Treatment included occlusal reduction, splinting, and EXT, but most teeth received no treatment.
Tooth discoloration increased with time after trauma.
Mobility improved with time, with the majority of teeth returning to a normal physiological range.
Pulpal calcification increased in incidence and severity with time.
Low patient return was noted on follow-up, indicating low morbidity of subluxation injuries.

Assessment of article: Great article, an easy read. There is a lot of interesting epidemiological information like patient demographics that wouldn’t be particularly useful for clinical treatment of trauma. Conversely, I thought that the prognosis conclusions made by this study would be helpful when considering treatment options in the clinical setting while managing a patient with subluxation trauma.