JCDA - Canadian Dental Association

Clinical Abstracts
The Clinical Abstracts section of JCDA features abstracts and summaries from peer-reviewed dental publications. It attempts to make
readers aware of recent literature that may be of interest to oral health care workers. It is not intended to provide a systematic review of
the topic. This month’s selection provides an update on dental trauma. The articles were chosen by Dr. Preeti Prakash, a recent graduate
of the Master of Science program in Dental Public Health at the University of Toronto, and Dr. David Locker, director of the Community
Dental Health Services Research Unit at the University of Toronto. A commentary is provided that puts these articles into context for
readers.
Commentary
Dental trauma is injury to the mouth, including teeth,
lips, gums, tongue and jawbones. The most common dental
trauma is a broken or lost tooth. Dental trauma can have
long-lasting implications and prognosis may be uncertain. 1
Most studies of dental trauma have concentrated on specific
subpopulations based on age groups or geographic areas. It
is difficult to compare the results of various investigations
because of differences in trauma classifications used in these
studies. The National Institute of Dental Research has
developed an index of tooth trauma among both children
and adults for use in epidemiologic studies. Using this
index, Kaste and others reported the first national U.S. data
on injury to the incisor teeth among individuals aged 6–50
years (see Abstract 1). Almost 25% of the U.S. population
had at least one traumatized permanent incisor. These
injuries may be on the rise. One study of children living in
a disadvantaged community in the United Kingdom
reported a substantial increase in prevalence over a 3-year
period (Abstract 2).
Dental trauma can be classified as intentional or unintentional.
Domestic violence, altercations and assaults are
examples of intentional injuries; accidents are classified as
unintentional. Accidents around the home are a major
source of injury to the primary dentition, while accidents at
home and school account for injuries to the permanent
dentition. 2 Accidents resulting from falls are the most
common cause of dental trauma, followed by sports-related
injuries, violence and road traffic accidents. An important
predisposing factor for dental trauma is a large maxillary
overjet, incomplete lip coverage and maxillary protrusion.
Childhood obesity also increases the risk of traumatic
dental injury (Abstract 3). Dental trauma can leave psychological
or psychosocial scars. Most children with dental
trauma report some impact on their daily lives, including
feeling embarrassed when laughing or smiling and having
672 November 2003, Vol. 69, No. 10
Dental Trauma: An Important Public Health Issue
Preeti Prakash, BDS, MSc
David Locker, BDS, PhD
problems when eating or when cleaning their teeth
(Abstract 4).
The economic implications of dental trauma are almost
unknown. Depending on the nature and extent of the
injury, treatment may require several dental visits and may
involve one or more general dentists or specialists.
Treatment costs can be in the thousands of dollars. A
trauma centre in Copenhagen, Denmark, reported treating
more than 7,000 patients with over 16,000 traumatized
teeth during an 11-year period. Two-thirds of these teeth
had complicated injuries. Annual treatment costs were estimated
to range from $2 to $5 million US per one million
inhabitants (Abstract 5).
The guidelines of the International Association of
Dental Traumatology provide basic information on
management of injuries, prevention and first aid. 3
According to Gift and Bhat, although 89% of all U.S.
injuries require medical attention, less than half are treated
first in hospital (Abstract 6). They report that an estimated
5.9 million episodes of orofacial trauma were treated in
private dental practice in the U.S. in 1991, representing an
average of 46 episodes of care per year per practice.
Clearly, the prevalence of dental trauma, its psychosocial
and economic costs, and the extent of demand for treatment
in general practice mean that it should be regarded as
an important public health issue. Despite the importance of
dental trauma, there are few Canadian data on its prevalence,
severity or risk factors. C
References
1. McTigue DJ. Diagnosis and management of dental injuries in children.
Pediatr Clin North Am 2000; 47(5):1067–84.
2. Bastone EB, Freer TJ, McNamara JR. Epidemiology of dental trauma:
a review of the literature. Aust Dent J 2000; 45(1):2–9.
3. Flores MT, Andreasen JO, Bakland LK, Feiglin B, Gutmann JL,
Oikarinen K, and others. Guidelines for the evaluation and management
of traumatic dental injuries. Dent Traumatol 2001; 17(5):193–8.
Journal of the Canadian Dental Association