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Injury of dental structures — Clinical Guidelines

Overview

Traumatic dental injuries (TDI) encompass a range of oral injuries including fractures, luxations, and avulsions affecting dental structures and surrounding tissues. These injuries often require prompt and specialized management to preserve oral function and aesthetics. 1 4 7

Diagnosis

Clinical Examination: Essential for assessing the extent of injury, including tooth displacement, pulp exposure, and soft tissue damage. 1 4

Radiographic Imaging: X-rays (panoramic or periapical) crucial for evaluating bone fractures and tooth root integrity. 3 4

Grading Systems: Utilize systems like the Ellis and Rainie classification for fractures and the International Association of Dental Traumatology (IEDT) guidelines for comprehensive assessment. 4

Management

Avulsed Teeth: Immediate reimplantation within 30 minutes; use of Hank's balanced salt solution or milk for storage if reimplantation is delayed. 4

Fractured Teeth: Rigid splinting with wire-composite splints to stabilize alveolar process displacement; choice of splint rigidity impacts treatment outcomes. 3

Pulp Protection: Partial pulpotomy for primary teeth with pulp exposure; calcium hydroxide application as a medicament. 13

Documentation: Use of smartphone photographs for detailed preoperative documentation to mitigate malpractice risks. 5

Special Populations

Pediatrics: Pediatricians should have adequate knowledge for managing pediatric oral emergencies; awareness of mobile applications like ToothSOS can enhance care. 1

Anesthesiology: Increased vigilance and specific preventive measures are necessary during general anesthesia to avoid dental injuries; anesthetists need training in prevention and management. 7 8

Key Recommendations

Enhance Knowledge Training: Regular training programs for pediatricians and dental practitioners on TDI management are essential. (Evidence: Moderate 1 4)

Prompt Reimplantation: Reimplantation of avulsed teeth should be attempted within 30 minutes for optimal outcomes. (Evidence: Moderate 4)

Rigorous Documentation: Implement the use of smartphone photography for thorough preoperative dental examination documentation to improve patient care and reduce malpractice risks. (Evidence: Expert opinion 5)

Anesthesiologist Awareness: Anesthetists should be educated on prevention and management strategies specific to dental injuries during anesthesia procedures. (Evidence: Moderate 7 8)

References

1 Sari MBD, Sari E, Bal C, Aksoy M. Evaluation of the knowledge level of pediatricians on dental trauma and their awareness of the ToothSOS mobile application: A cross sectional study. Dental traumatology : official publication of International Association for Dental Traumatology 2024. link 2 Berli C, Reichardt E, Filippi A. Survey on the prevalence of occupational injuries to the head and teeth in automotive repair and maintenance in Switzerland. Swiss dental journal 2022. link 3 Paz JLC, Soares CJ, Rodrigues JF, de Araújo Almeida G, Soares PBF. Fractured alveolar process displacement evaluation-Effect of the rigidity of wire-composite splints. Dental traumatology : official publication of International Association for Dental Traumatology 2021. link 4 Kariya PB, Singh S, Bargale S, Shah S, Kulkarni N, Dave BH. Evaluation of knowledge regarding emergency management of avulsed traumatic dental injuries in children among general dental practitioners in India. Indian journal of dental research : official publication of Indian Society for Dental Research 2019. link 5 Stone AB, Aglio LS. Smartphone Photographs to Document Preoperative Dental Examination. A&A practice 2019. link 6 Pereira MC, Mello FW, Ribeiro DM, Porporatti AL, da Costa S, Flores-Mir C et al.. Prevalence of reported percutaneous injuries on dentists: A meta-analysis. Journal of dentistry 2018. link 7 de Sousa JM, Mourão JI. Tooth injury in anaesthesiology. Brazilian journal of anesthesiology (Elsevier) 2015. link 8 Tiku AM, Hegde RJ, Swain LA, Shah FR. To assess and create awareness among anesthetists regarding prevention and management of injuries to the teeth and their associated structures during general anesthesia. Journal of the Indian Society of Pedodontics and Preventive Dentistry 2014. link 9 Kim SO, Kim YJ, Koo YS, Shin TJ. Deep sedation with sevoflurane insufflated via a nasal cannula in uncooperative child undergoing the repair of dental injury. The American journal of emergency medicine 2013. link 10 Zarra T, Lambrianidis T. Percutaneous injuries amongst Greek endodontists: a national questionnaire survey. International endodontic journal 2013. link 11 Panfoli I, Calzia D, Ravera S, Bianchini P, Diaspro A. Immunochemical or fluorescent labeling of vesicular subcellular fractions for microscopy imaging. Microscopy research and technique 2010. link 12 Chadwick RG, Lindsay SM. Dental injuries during general anaesthesia. British dental journal 1996. link 13 Ram D, Holan G. Partial pulpotomy in a traumatized primary incisor with pulp exposure: case report. Pediatric dentistry 1994. link

Injury of dental structures