Hidden Consequences of Dental Trauma: The Social and Physiological Effects

Resident’s Name: Jessica Wilson

Program: Lutheran Medical Center - Providence

Article title: Hidden Consequences of Dental Trauma: The Social and Physiological Effects

Author(s): Lee & Divaris.

Journal: Pediatric Dentistry

Year. Volume (number). Page #’s: 2009. 31(2). 96-101.

Major topic: Dental Trauma

Overview of method of research: Conference Paper

Purpose:
Review effects of trauma, its treatment, cost and long-term emotional and social implications.

Findings:
80% of dental injuries occur in those under 20 years of age.
Oral region makes up only 1% of the whole body, but accounts for about 5% of all injuries. This percentage is even higher in children.
25% people in the US between the ages of 6 and 50 years of age have had some sort of injury to a maxillary anterior. By high school graduation 50% of teenagers have had a dental injury.
Canadian study found trauma to maxillary incisors in 12-14 year-olds had a greater impact on social aspect than functional pr psychological aspects of life.
Another Canadian study reported 64% of dental injuries were untreated enamel fractures and these untreated injuries were more likely to produce chewing difficulty and avoidance of laughing or smiling.
A combination of experience of pain, emotional distress, shock and physical impairment create a lasting memory of dental trauma and has the potential to produce future dental anxiety/fear. However, one Croatian study found that children who have experienced some sort of dental trauma exhibited less dental anxiety.
Children who experience dental trauma may be considered “accident prone children”. This is demonstrated by a study that found about 50% children who suffered a permanent tooth dental injury had multiple dental injuries over 12 years and about half of those will be re-injuries to the same tooth.
Parents’ priorities regarding treatment for avulsed incisors in their child is:
1. Treatment of pain 2. Prompt treatment 3. “Replanting the incisor so that the child will still have a front tooth for school”
About 90% patients and their parents report having to miss school and or work due to the injury and transportation was reported as requiring the most indirect time (about 1/3 of the total treatment time).
One study of 195 patients, the treatment of dental injuries required anywhere from 3-17 dental visits. A study in London found the median number of visits required to be 8 and median treatment length to be over 21 months with more serious injuries requiring more visits as does treatment at teaching institutions.
Due to the difficulty of calculating total cost of treatment of dental injuries only wide ranges of cost have been established from 0-several thousand dollars. It was estimated that in 1991 the total cost of direct treatment of dental injuries in private practice in the US would approach $870 million.
Estimated life expectancy of a fixed prosthesis is 11 years.
The restoration of anterior missing teeth secondary to trauma is often not satisfactory to patients. A Swedish study reports that 39% of adults who had dental trauma as a child were unhappy with a restoration 15 years post-trauma.
One challenge in treating dental injuries is the fact that many patients do not seek immediate or appropriate care. Another may be the lack of specialists. In the developing world, the esthetic aspect of dental injuries may not be of top priority. Rather, the extraction of a tooth in order to produce a predictable pain-free result.

Key points/Summary:
Developed guidelines, decision trees or recommendations should be utilized when treating dental emergencies as these are evidence based. Practitioners often provide delayed or inappropriate treatment due to inexperience in emergency treatment.
Treatment that is considered routine in adults may be challenging in children and adolescents due to their sensitive growth and development periods. Cooperation, compliance and follow up are critical for good outcome. This is especially true in developing dentition as inappropriate treatment or no treatment may have catastrophic consequences more quickly than in adults.
Many adults are not satisfied with permanent dental restorations therefore esthetic concerns should not be overlooked in treating children.

Assessment of Article: Although there were some interesting facts pointed out in this article it seems to review what we already would assume regarding anterior dental injuries in the permanent dentition.