TDI epidemiol, examination 2010

8/7/2019 TDI epidemiol, examination 2010

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Traumatic DentalTraumatic DentalInjuriesInjuries

(TDI)(TDI)

Classification, etiology,Classification, etiology,

epidemiologyepidemiologyDrDr-- suhad Alsuhad Al--jundijundi

20092009--20102010


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Dental trauma/ classicalDental trauma/ classical

classificationclassification Ellis classification of tooth fracture (1970):Ellis classification of tooth fracture (1970):

Class I: coronal fracture involving only enamelClass I: coronal fracture involving only enamel

Class II: coronal fracture involving enamel andClass II: coronal fracture involving enamel anddentine.dentine.

Class III: coronal fracture involving enamel,Class III: coronal fracture involving enamel,

dentine and exposing the pulp.dentine and exposing the pulp.

Class IV: root fractureClass IV: root fracture

Class V: avulsionClass V: avulsion


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Dental trauma/ clinical classificationDental trauma/ clinical classification

WHOWHO Injuries to dental tissue and pulpInjuries to dental tissue and pulp

Enamel infarctionEnamel infarction

Enamel fracture , uncomplicated

Enamel fracture , uncomplicated

Enamel dentine fracture, uncomplicatedEnamel dentine fracture, uncomplicated

Complicated crown fractureComplicated crown fracture

Uncomplicated crown root fractureUncomplicated crown root fracture

Complicated crown root fractureComplicated crown root fracture

Root fractureRoot fracture


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WHOWHO Injuries to periodontal tissueInjuries to periodontal tissue

ConcussionConcussion

Subluxation (loosening)Subluxation (loosening)

E

xtrusive luxation (partialE

xtrusive luxation (partialavulsion)avulsion)

Lateral luxationLateral luxation

Intrusive luxation (centralIntrusive luxation (centraldislocation)dislocation)

Avulsion or exarticulation orAvulsion or exarticulation orcomplete luxationcomplete luxation


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concussionconcussion

Tooth is markedly tender to percussion with noTooth is markedly tender to percussion with no

mobility or displacement.mobility or displacement.

Treatment: reassurance, instruct to soft diet,Treatment: reassurance, instruct to soft diet,prescribe analgesics, monitor vitalityprescribe analgesics, monitor vitality


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subluxationsubluxation

Tooth is mobile , not displaced, may be tenderTooth is mobile , not displaced, may be tender

to percussion.to percussion.

Treatment: instruct to soft diet, prescribe

Treatment: instruct to soft diet, prescribe

analgesics, splint is not necessary, but a flexibleanalgesics, splint is not necessary, but a flexiblesplint may be inserted for one week to ease pain.splint may be inserted for one week to ease pain.


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Lateral luxationLateral luxation

Displacement of the tooth in a direction otherDisplacement of the tooth in a direction other

than its long axis, lingually , buccaly, rarelythan its long axis, lingually , buccaly, rarelymesially or distaly,mesially or distaly,


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Axial luxationAxial luxation

Displacement of the tooth in the direction of itsDisplacement of the tooth in the direction of its

long axislong axis

Either intrusion, displacement into the socket

Either intrusion, displacement into the socket

Or extrusion, partial displacement from theOr extrusion, partial displacement from the

socket.socket.


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WHOWHO Injuries to supporting bone:Injuries to supporting bone:

Comminution of maxillary alveolarComminution of maxillary alveolar

socketsocket

Comminution of mandibularComminution of mandibular

alveolar socketalveolar socket Fracture of maxillary alveolarFracture of maxillary alveolar

socket wallsocket wall

Fracture of mandibular alveolarFracture of mandibular alveolar

socket wallsocket wall

Fracture of maxillary alveolarFracture of maxillary alveolarprocessprocess

Fracture of mandibular alveolarFracture of mandibular alveolarprocessprocess

Fracture of maxillaFracture of maxilla

Fracture of mandibleFracture of mandible


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WHOWHO Injuries to gingiva or oralInjuries to gingiva or oral

mucosamucosa

Contusion: bleedingContusion: bleeding

subepithelial, no break insubepithelial, no break inepitheliumepithelium

Abrasion: discontinuityAbrasion: discontinuity

of epitheliumof epithelium Laceration: a cut in theLaceration: a cut in the

soft tissues or skinsoft tissues or skin


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Dental trauma/ Epidemiological classificationDental trauma/ Epidemiological classification

WHOWHO

No injuryNo injury

Treated dental injuryTreated dental injury

Enamel fracture onlyEnamel fracture onlyEnamel/ dentine fractureEnamel/ dentine fracture

Pulp injuryPulp injury

Missing due to traumaMissing due to traumaExcludedExcluded


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Epidemiology of TDIEpidemiology of TDI

TDI remain to be a major dental public healthTDI remain to be a major dental public healthchallenge in youthchallenge in youth

TDI affect anterior region usually and requireTDI affect anterior region usually and requiremore complex treatment than dental cariesmore complex treatment than dental caries

Dental caries has declined whereas TDI stillDental caries has declined whereas TDI still

Oral region is only 1% of all body it accountsOral region is only 1% of all body it accounts

for up to 17% of all body injuries (Sweden)for up to 17% of all body injuries (Sweden)Worldwide maxillofacial trauma account for 9Worldwide maxillofacial trauma account for 9--

33% of all trauma at ER dept in hospitals33% of all trauma at ER dept in hospitals


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PrevalencePrevalence

Highly diverse internationallyHighly diverse internationally

Generally it is highGenerally it is high

In UK 1 in 5 childrenIn UK 1 in 5 children In US 1 in 4 adultsIn US 1 in 4 adults


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Prevalence in Jordan and regionPrevalence in Jordan and region

Traumatic injuries to permanent anterior teeth among 12Traumatic injuries to permanent anterior teeth among 12--yearyear--old schoolchildren in Jordan.old schoolchildren in Jordan.

Hamdan MA, Rajab LD. Community Dent Health. 2003Hamdan MA, Rajab LD. Community Dent Health. 2003Jun;20(2):89Jun;20(2):89--93.93.

Traumatic dental injuries in children presenting for treatment atTraumatic dental injuries in children presenting for treatment atthe Department of Pediatric Dentistry, Faculty of Dentistry,the Department of Pediatric Dentistry, Faculty of Dentistry,University of Jordan, 1997University of Jordan, 1997--2000.2000.

Rajab LD. Dent Traumatol. 2003 Feb;19(1):6Rajab LD. Dent Traumatol. 2003 Feb;19(1):6--11.11.

Prevalence of dental trauma in 5Prevalence of dental trauma in 5--66-- and 12and 12--1414--yearyear--old boys inold boys inRiyadh, Saudi Arabia.Riyadh, Saudi Arabia.

AlAl--Majed I, Murray JJ, Maguire A. Dent Traumatol. 2001Majed I, Murray JJ, Maguire A. Dent Traumatol. 2001Aug;17(4):153Aug;17(4):153--8.8.


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IncidenceIncidence

Very few studiesVery few studies

30% sustained injury to primary dentition, 22%30% sustained injury to primary dentition, 22%

to permanent dentitionto permanent dentition (Andreasen and Ravn 1974)(Andreasen and Ravn 1974) |n Australia incidence of 1 in 20 cases ofTDI per 1000|n Australia incidence of 1 in 20 cases ofTDI per 1000

per year in 6per year in 6--12 yr olds ( Stockwell 1988)12 yr olds ( Stockwell 1988)

In Sweden for boys 1.6, for girls 1 per 100 individualsIn Sweden for boys 1.6, for girls 1 per 100 individuals

per year in 0per year in 0--19 yr olds (Glendor et al 1996)19 yr olds (Glendor et al 1996)


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Age, Sex, socioeconomic distributionAge, Sex, socioeconomic distribution

Sex: Boys more than girlsSex: Boys more than girls

Ethnic minorities more TDIEthnic minorities more TDI

Age: mostly in theAge: mostly in the 11stst 1010 yrs of life, decreasesyrs of life, decreaseswith agewith age

Two peaks are seen one at ageTwo peaks are seen one at age 22--44 yrs, thenyrs, then 88--1010

yrs (Andreasen and Ravnyrs (Andreasen and Ravn 19721972)) Socioeconomic: higher class more traumaSocioeconomic: higher class more trauma


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Repeated traumaRepeated trauma

44--49% to the same child49% to the same child

88--45% to the same teeth45% to the same teeth

Prevention is necessaryPrevention is necessary


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Predisposing factorsPredisposing factors

Increased overjet:Increased overjet:\\ 2 times more2 times more

Inadequate lip coverage: increase trauma 3 foldInadequate lip coverage: increase trauma 3 fold

Factors affecting coronal fracture of anterior teeth in North Jordanian children.Factors affecting coronal fracture of anterior teeth in North Jordanian children.

AlAl--Khateeb S, AlKhateeb S, Al--Nimri K, Alhaija EA.Nimri K, Alhaija EA.

Dent Traumatol. 2005 Feb;21(1):26Dent Traumatol. 2005 Feb;21(1):26--8.8.


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Teeth involvedTeeth involved

Mostly anterior teethMostly anterior teeth

Maxillary central incisor most commonlyMaxillary central incisor most commonly

involvedinvolved Maxillary lateral incisor less involvedMaxillary lateral incisor less involved

Same applies to primary dentitionSame applies to primary dentition

Usually a single tooth is involvedUsually a single tooth is involved Sometimes multiple teeth and mutliple injuriesSometimes multiple teeth and mutliple injuries


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Types of TDITypes of TDI

Most common is enamel fractured , then enamelMost common is enamel fractured , then enamel

and dentine fractureand dentine fracture

In primary dentition mostly it is in the form ofIn primary dentition mostly it is in the form ofinjury to supporting structuresinjury to supporting structures

In cross sectional studies, soft tissue injury is notIn cross sectional studies, soft tissue injury is not

assessedassessed

In hospital samples, more severe injuries areIn hospital samples, more severe injuries arereportedreported


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Place and seasonal variationPlace and seasonal variation

Place: mostly home, then school, then otherPlace: mostly home, then school, then other

public placespublic places

Seasonal: wide range of results, some reportSeasonal: wide range of results, some reportmore in Summer, some more in winter.more in Summer, some more in winter.Depends on local cusoms.Depends on local cusoms.


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EtiologyEtiology

Human behavior:Human behavior:

Risk takingRisk taking

Peer relationshipPeer relationship HyperactivityHyperactivity

Stress behaviorStress behavior

Environmental factorsEnvironmental factors

DeprivationDeprivation

OvercrowdingOvercrowding


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EtiologyEtiology

Unintentional injuriesUnintentional injuries Falls and colisionsFalls and colisions

Physical leisure activities:Physical leisure activities: High risk sports: American football, hockey, ice hockey, rugby, martialHigh risk sports: American football, hockey, ice hockey, rugby, martial

sports, skating (FDI)sports, skating (FDI)

Medium risk sports: basket ball, diving, squash, gymnastics (FDI)Medium risk sports: basket ball, diving, squash, gymnastics (FDI)

Contact sports: high TDIContact sports: high TDI

Protect face and teeth, improve playgroundsProtect face and teeth, improve playgrounds

Traffic accidentsTraffic accidents

Inappropriate use of teethInappropriate use of teeth

illnessillness


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EtiologyEtiology

Intentional injuriesIntentional injuries

Physical abusePhysical abuse

Iatrogenic proceduresIatrogenic procedures


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Mechanism of dental injuriesMechanism of dental injuries

Trauma type: direct, indirectTrauma type: direct, indirect

Factors of impact to teeth:Factors of impact to teeth:

Energy of impact

Energy of impact

Resilience of impacting objectResilience of impacting object

Shape of impacting objectShape of impacting object

Angle of direction of forceAngle of direction of force


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Treatment needs and lay knowledgeTreatment needs and lay knowledge

in societyin society

Treatment is insufficient and knowledge isTreatment is insufficient and knowledge islacking in most societieslacking in most societies Knowledge and attitude of Jordanian school health teachers with regards toKnowledge and attitude of Jordanian school health teachers with regards to

emergency management of dental trauma.emergency management of dental trauma.

AlAl--Jundi SH, AlJundi SH, Al--Waeili H, Khairalah K.Waeili H, Khairalah K.

Dent Traumatol. 2005 Aug;21(4):183Dent Traumatol. 2005 Aug;21(4):183--7.7.

Knowledge of Jordanian mothers with regards to emergency management ofKnowledge of Jordanian mothers with regards to emergency management ofdental trauma.dental trauma.

AlAl--Jundi SH. Dent Traumatol. 2006 Dec;22(6):291Jundi SH. Dent Traumatol. 2006 Dec;22(6):291--5.5.

Dental emergencies presenting to a dental teaching hospital due toDental emergencies presenting to a dental teaching hospital due tocomplications from traumatic dental injuries.complications from traumatic dental injuries.

AlAl--Jundi SH. Dent Traumatol. 2002 Aug;18(4):181Jundi SH. Dent Traumatol. 2002 Aug;18(4):181--5.5.


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Examination, guidelinesExamination, guidelines

HistoryHistory

Clinical examinationClinical examination

Sensibility testingSensibility testing Radiographic examinationRadiographic examination

ExtraoralExtraoral

IntraoralIntraoral CT scanningCT scanning

MR scanningMR scanning


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HistoryHistory

Personal detailsPersonal details

WhenWhen

WhereWhere

HowHow Treatment elsewhereTreatment elsewhere

Previous injuryPrevious injury

Did trauma cause loss of consciousness, vomiting,Did trauma cause loss of consciousness, vomiting,headache, drowsiness, amnesiaheadache, drowsiness, amnesia

Pain in teethPain in teeth


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Examine facial skeleton and extraoral structuresExamine facial skeleton and extraoral structures

Examine soft tissues and record injuriesExamine soft tissues and record injuries

Examine teeth and record injuriesExamine teeth and record injuries Record displacement of teeth if presentRecord displacement of teeth if present

Record abnormalities in occlusionRecord abnormalities in occlusion

Abnormal tooth or alveolar mobilityAbnormal tooth or alveolar mobility Palpation and percussionPalpation and percussion


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Sensibility testing of teethSensibility testing of teeth

MechanicalMechanical

ThermalThermal

ElectricElectric

Laser doppler flowmetryLaser doppler flowmetry


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Radiographic examinationRadiographic examination

Radiographic examinationRadiographic examination

ExtraoralExtraoral

IntraoralIntraoral

CT scanningCT scanning

MR scanningMR scanning


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Documents

TDI epidemiol, examination 2010