Oral trauma in children.

Through the use of a new trauma form, the incidence of various types of oral trauma were reported at The Children’s Hospital Medical Center and two private pedodontic offices. During a one-year period, 338 cases of oral trauma were treated. The major cause of the trauma seen involved falls of various types. Sports and bicycle accidents accounted for a number of injuries as well. The number of traumath: injuries was highest in September, correlating with the beginning of the school year. The majority of the traumatic injuries were fractures, and most frequently inwdved permanent teeth. Displacement injuries, however, involved a higher proportion of primary teeth. The incidence and prevalence of traumatic dental injuries has been documented in many studies. The majority of these studies report statistics on fractured anterior teeth only. These reports are generally retrospective, examining given populations for past history of traumatic injury. EpidemiologicaI investigations suggest that the incidence of fractured teeth varies greatly depending on the population under study with regard to age, sex, and the fracture classification system utilized. In one of the earliest studies, Ellis reported that 4.2% of his sample of 4,251 secondary school children experienced fractures of the incisor teeth. ~ Grundy documented a 5.1% frequency of tooth fracture in a study of children 5-15 years of age. The Ellis Class I fracture type was the most prevalent. This was also one of the few studies which included a survey of primary, as well as permanent tooth fractures. 2 In a sample of 1,166 patients, Gutz reported a significantly higher frequency of coronal fracture (20.24%).3 Zadik, in one of the largest studies to date, examined 10,903 patients. He found an 8.7% prevalence of fractured anterior teeth. 4 A more recent study conducted by Macko concurs with the higher prevalence reported by Gutz; that population experienced a 19.1% fracture frequency. 5 Other factors which are reported often include differences in fracture, prevalence between sexes, and variation in the age at which fractures are most likely to occur. All of the above studies report a higher frequency of anterior tooth fracture among males. The most common age for tooth fracture was reported to be 8-10 years by most investigators. 2,3 Few studies have addressed the prevalence of other types of traumatic injuries in addition to anterior tooth fracture. Ravn conducted a five-year epidemiological study in Copenhagen, which recorded all traumatic injuries sustained over this time. 6 He reported a male/ female ratio of 1.6:1 with the largest number of injuries occurring in the 8 to 9-year age group. While 70% of the injuries recorded involved anterior tooth fracture, the incidence of luxation, exarticulation, and subluxation also were reported. The various causes of traumatic incidents were computed and the seasonal variation of traumatic incidents was noted. The current investigation is a prospective study designed to determine the relative frequency of various oral traumatic injuries, etiologic factors, seasonal variation, and potential target populations. Methods and Materials The present study was conducted at the Boston Children’s Hospital Medical Center and two private pedodontic offices from January I through December 31, 1979. All dental emergencies during this period were coded on a special dental trauma form specifically designed to yield clear and concise reports of the traumatic episode. The form insured accurate data, as well as easy statistical compilation. Information on 248 ORAL TRAUMA IN CHILDREN: Meadow et al. the patient’s age, sex, and time and cause of injury was recorded. Any previous trauma to the involved teeth also was noted. A diagram of the anterior dentition, both permanent and primary, was included so that a drawing of the tooth injury could be recorded easily. The patient’s occlusion, overbite, and overjet were documented. The trauma form was so well accepted by the staff, that is now in permanent use at the clinic and in private staff offices. It is important that pediatric dentists develop trauma forms for their own use. Numerous examples can be found in the literature. At the time of presentation a complete medical history was obtained. The time of the accident and the time of arrival at the clinic were noted. A brief history of the incident was recorded and thorough extraoral and intraoral soft tissue examinations were performed. Information regarding tetanus innoculations was recorded and pertinent and appropriate action taken. All lacerations and contusions were noted and drawn on the form. Following each incident of oral trauma, the child’s dentition was examined for fracture, displacement, mobility, discoloration, and tenderness. Mobility was recorded using a three-point grading scale. Tooth fractures were drawn on the form and classified using the standard Ellis classification. A Class I fracture indicates involvement of enamel only; Class II fractures involve enamel and dentin; and Class III fractures involve enamel, dentin, and the pulpal tissue. All root fractures were grouped together in this study. Displacements were classified according to the direction of movement -labial, lingual, mesial, or distal. Avulsions and intrusive injuries were treated as separate classifications. Those dental injuries resulting in no displacement, but exhibiting mobility were grouped as subluxation injuries. Alveolar and jaw fractures were listed separately. Other classification systems for traumatic injuries have been developed by both Andreasen and Johnson. 7,8 It was felt, however, that the shortened Ellis classification was the simplest and easiest to use in the current clinical study. The direct cause of any traumatic injury is at times difficult to discern. For the purpose of the present investigation, the injuries were classified using the TABLE 1. Cause of Oral Trauma Number of Percentage of all Cause Trauma Cases Trauma Falls 209 61.8 Sports 44 13.0 Bicycles 42 12.0 Fights 27 8.0 Accidents 9 3.0 Car accidents 6 2.0 Child abuse 1 0.2 following six groups: falls, sports, bicycles, fights, accidents, and car accidents. Radiographic examinations were performed in nearly all cases in which trauma had been sustained. In those cases involving very young children, efforts were made to obtain adequate radiographs where possible. Treatment modalities were recorded in a step-bystep manner to allow for easy review of the prescribed treatment. Home care instructions were given, and a follow-up clinic appointment was made when necessary.