Traumatic dental injuries (TDIs) are highly prevalent in children, particularly in the primary and mixed dentition stages. They represent one of the most common dental emergencies in pediatric patients, often resulting from falls, sports activities, and accidents.
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✅ Types of Traumatic Dental Injuries
TDIs in children are classified according to the World Health Organization (WHO) and the International Association of Dental Traumatology (IADT) guidelines. The main categories include:
° Crown fractures (enamel or enamel-dentin)
° Crown-root fractures
° Root fractures
° Luxation injuries (concussion, subluxation, extrusion, lateral luxation, intrusion)
° Avulsion
Each type of injury presents unique diagnostic features and management protocols.
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Diagnosis involves clinical examination, radiographic assessment, and patient history. Key diagnostic steps include:
° Assessing tooth mobility, sensitivity, and displacement.
° Evaluating pulp vitality through sensibility testing (in older children).
° Identifying associated soft tissue injuries and possible alveolar fractures.
° Radiographic imaging using periapical, occlusal, or panoramic radiographs depending on injury type.
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° Crown fractures: Management ranges from smoothing minor enamel fractures to composite restoration or pulp therapy if the pulp is exposed.
° Luxation injuries: Treatment may involve observation, repositioning, splinting, or extraction depending on severity.
° Avulsion: Immediate replantation is the best prognosis for permanent teeth. Primary teeth should not be replanted due to risk of damage to developing permanent successors (Fouad & Abbott, 2020).
° Root fractures: Stabilization with flexible splints and long-term monitoring are essential.
馃搳 Differences Among Traumatic Dental Injuries in Children
| Type of Injury | Key Characteristics | Management Approach |
|---|---|---|
| Crown Fractures | Loss of enamel/dentin; pulp may be exposed | Restoration, pulp therapy if exposure occurs |
| Luxation Injuries | Mobility, displacement, or intrusion of the tooth | Observation, repositioning, splinting, or extraction |
| Root Fractures | Fracture line affecting root structure | Stabilization with splints, follow-up monitoring |
| Avulsion | Complete displacement of tooth from socket | Immediate replantation (permanent teeth); no replantation for primary teeth |
馃挰 Discussion
Traumatic dental injuries in children demand immediate and careful intervention to minimize long-term complications, such as pulp necrosis, ankylosis, or developmental disturbances in permanent teeth. The management strategy depends largely on the child’s age, dentition stage, and type of injury. While modern guidelines from the IADT provide structured protocols, challenges include compliance, prognosis prediction, and follow-up in pediatric patients (Bourguignon et al., 2020).
馃攷 Recommendations
° Educate parents and caregivers on emergency management of avulsed teeth, emphasizing immediate replantation or storage in suitable media.
° Ensure routine follow-ups to monitor pulp vitality and root development.
° Use protective measures, such as mouthguards, during sports to prevent injuries.
° Apply minimally invasive techniques whenever possible to preserve pulp vitality in young patients.
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Traumatic dental injuries in children represent complex clinical challenges requiring prompt diagnosis and evidence-based management. A multidisciplinary approach involving pediatric dentists, endodontists, and parents ensures optimal outcomes. Preventive strategies and long-term monitoring are essential to reduce complications and improve the prognosis of traumatized teeth.
馃摎 References
✔ Andersson, L. (2018). Epidemiology of traumatic dental injuries. Journal of Endodontics, 44(3), S19–S27. https://doi.org/10.1016/j.joen.2017.11.013
✔ Bourguignon, C., Cohenca, N., Lauridsen, E., Flores, M. T., O’Connell, A. C., Day, P. F., ... & Tsilingaridis, G. (2020). International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations. Dental Traumatology, 36(4), 314–330. https://doi.org/10.1111/edt.12578
✔ Fouad, A. F., & Abbott, P. V. (2020). Endodontic-related traumatic dental injuries: Epidemiology, diagnosis, and treatment considerations. Endodontic Topics, 39(1), 1–11. https://doi.org/10.1111/etp.12295
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