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Injuries to Permanent Dentition Symposium| Volume 39, ISSUE 3, SUPPLEMENT , S2-S5, March 2013

Epidemiology of Traumatic Dental Injuries

  • Lars Andersson
    Correspondence
    Address requests for reprints to Dr Lars Andersson, Professor of Oral and Maxillofacial Surgery, Department of Surgical Sciences, Faculty of Dentistry, Health Sciences Center, Kuwait University, PO Box 24923, Safat 13110, Kuwait.
    Affiliations
    Department of Surgical Sciences, Faculty of Dentistry, Kuwait University, Kuwait City, Kuwait
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DOI:https://doi.org/10.1016/j.joen.2012.11.021
Epidemiology of Traumatic Dental Injuries
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      Abstract

      The oral region comprises 1% of the total body area, yet it accounts for 5% of all bodily injuries. In preschool children, oral injuries make up as much as 17% of all bodily injuries. The incidence of traumatic dental injuries is 1%–3%, and the prevalence is steady at 20%–30%. The annual cost of treatment is US $2–$5 million per 1 million inhabitants. Etiologic factors vary between countries and with age groups. Important public health implications such as how to best organize emergency dental care and how to prevent dental injuries, decrease cost, and increase lay knowledge are important factors needed to change epidemiologic data toward more favorable figures in the future.

      Key Words

      At least 4 million people die from trauma every year. Half of all deaths are in the 10–24 year age group, and trauma is the number 1 killer of individuals up to 40 years of age (
      • Eilert Petersson E.
      An epidemiologic study of non-fatal injuries [thesis].
      Karolinska Institute, Stockholm, Sweden1996
      ). Moreover, several hundred million people are injured by trauma every year (
      • Eilert Petersson E.
      An epidemiologic study of non-fatal injuries [thesis].
      Karolinska Institute, Stockholm, Sweden1996
      ). Trauma has a multitude of consequences for the traumatized individual, family members, and society. The impact is not only physical but also psychosocial and economic.

      Oral Injuries in Relation to Non-oral (Bodily) Injuries

      Oral injuries are most frequent during the first 10 years of life, decreasing gradually with age, and are very rare after the age of 30, whereas bodily nonoral injuries are seen most frequently in adolescents and young adults and are common throughout life (
      • Eilert-Petersson E.
      • Andersson L.
      • Sörensen S.
      Traumatic oral vs. non-oral injuries. An epidemiological study during one year in a Swedish county.
      Swed Dent J. 1997; 21: 55-68
      ,
      • Glendor U.
      • Andersson L.
      Public health aspects of oral diseases and disorders: dental trauma.
      in: Pine C. Harris R. Community Oral Health. Quintessence Publishing, London2007: 203-211
      ). Although the oral region comprises as small an area as 1% of the total body area, it accounts for 5% of all bodily injuries. In preschool children, oral injuries make up as much as 17% of all bodily injuries, with injuries to the head being the most common. This is in contrast to later in life when injuries to hands and feet are the most common (
      • Eilert-Petersson E.
      • Andersson L.
      • Sörensen S.
      Traumatic oral vs. non-oral injuries. An epidemiological study during one year in a Swedish county.
      Swed Dent J. 1997; 21: 55-68
      ).
      Simultaneous injuries to different oral tissues are commonly seen in patients presenting with oral trauma. Of all patients seeking consultation or treatment for injuries to the oral region, dental injuries are the most common and are seen in as many as 92% of patients presenting with oral injuries, whereas soft-tissue injuries to the same patients are seen in 28%, often simultaneously with dental injuries. Fractures involving the jaw are seen more rarely, in only 6% of all patients presenting with oral injuries (
      • Eilert-Petersson E.
      • Andersson L.
      • Sörensen S.
      Traumatic oral vs. non-oral injuries. An epidemiological study during one year in a Swedish county.
      Swed Dent J. 1997; 21: 55-68
      ,
      • Andersson L.
      • Kahnberg K.-E.
      • Pogrel M.A.
      Oral and Maxillofacial Surgery.
      Wiley-Blackwell, Oxford2010
      ).

      Incidence

      The incidence of dental injuries in children is, in most studies, in the range of 1%–3% in the population (
      • Andreasen J.O.
      • Andreasen F.M.
      • Andersson L.
      Textbook and Color Atlas of Traumatic Injuries to the Teeth.
      4th ed. Blackwell-Munksgaard, Oxford, United Kingdom2007
      ). The highest incidence for dental injuries per 1000 individuals is found up to 12 years of age; in higher ages, the incidence is lower (
      • Glendor U.
      • Halling A.
      • Andersson L.
      • et al.
      Incidence of traumatic tooth injuries in children and adolescents in the county of Västmanland.
      Sweden. Swed Dent J. 1996; 20: 15-28
      ). Boys are generally more often injured than girls (
      • Rocha M.J.C.
      • Cardoso M.
      Traumatized permanent teeth in Brazilian children assisted at the Federal University of Santa Catarina, Brazil.
      Dent Traumatol. 2001; 17: 245-249
      ,
      • Traebert J.
      • Peres M.A.
      • Blank V.
      • et al.
      Prevalence of traumatic dental injury and associated factors among 12-year-old school children in Florianopolis, Brazil.
      Dent Traumatol. 2003; 19: 15-18
      ). Some individuals are considered higher risk takers; they suffer from repeated dental trauma episodes (
      • Glendor U.
      • Halling A.
      • Andersson L.
      • et al.
      Incidence of traumatic tooth injuries in children and adolescents in the county of Västmanland.
      Sweden. Swed Dent J. 1996; 20: 15-28
      ,
      • Borssén E.
      • Holm A.K.
      Traumatic dental injuries in a cohort of 16-year-olds in northern Sweden.
      Endod Dent Traumatol. 1997; 6: 276-280
      ,
      • Chen Y.L.
      • Tsai T.P.
      • See L.C.
      Survey of incisor trauma in second grade students of Central Taiwan.
      Chan Gung Med J. 1999; 22: 212-219
      ,
      • Al-Jundi S.H.
      Type of treatment, prognosis, and estimation of time spent to manage dental trauma in late presentation cases at a dental teaching hospital: a longitudinal and retrospective study.
      Dent Traumatol. 2004; 20: 1-5
      ,
      • Glendor U.
      Epidemiology of traumatic dental injuries—a 12 year review of the literature.
      Dent Traumatol. 2008; 24: 603-611
      ).

      Prevalence and Trends

      The prevalence of dental injuries in the primary dentition appears to be rather stable at approximately 30% in most studies (
      • Glendor U.
      • Andersson L.
      Public health aspects of oral diseases and disorders: dental trauma.
      in: Pine C. Harris R. Community Oral Health. Quintessence Publishing, London2007: 203-211
      ,
      • Andreasen J.O.
      • Ravn J.J.
      Epidemiology of traumatic dental injuries to primary and permanent teeth in a Danish population sample.
      Int J Oral Surg. 1972; 1: 235-239
      ,
      • Garcia-Godoy F.
      • Morban-Laucher F.
      • Corominas L.R.
      • et al.
      Traumatic dental injuries in preschool children from Santo Domingo.
      Community Dent Oral Epidemiol. 1983; 11: 127-130
      ,
      • Granville-Garcia A.F.
      • de Almeira Vieira I.T.
      • da Silva Siqueira M.J.P.
      • et al.
      Traumatic dental injuries and associated factors among Brazilian preschool children aged 1-5 years.
      Acta Odontol Latinoam. 2010; 23: 47-52
      ). In the permanent dentition, most studies cite figures at approximately 20% in children and adolescents; this percentage is higher in studies extended to adults. There has not been any change in the number of dental traumas affecting children and adolescents during the past 3 decades in Scandinavia and in the United Kingdom (
      • Andreasen J.O.
      • Ravn J.J.
      Epidemiology of traumatic dental injuries to primary and permanent teeth in a Danish population sample.
      Int J Oral Surg. 1972; 1: 235-239
      ,
      • Borum M.K.
      • Andreasen J.O.
      Therapeutic and economic implications of traumatic dental injuries in Denmark: an estimate based on 7549 patients treated at a major trauma centre.
      Int J Paediatr Dent. 2001; 11: 249-258
      ,
      • Marcenes W.
      • Murray S.
      Changes in prevalence and treatment need for traumatic dental injuries among 14-year-old children in Newham, London: a deprived area.
      Community Dent Health. 2002; 19: 104-108
      ,
      • O'Brien M.
      Children's Dental Health in the United Kingdom 1993.
      HMSO, London1994
      ,
      • Skaare A.B.
      • Jacobsen I.
      Dental injuries in Norwegians aged 7–18 years.
      Dent Traumatol. 2003; 19: 67-71
      ). A large survey in the United States showed that 1 in 4 adults had evidence of incisal trauma (
      • Kaste L.M.
      • Gift H.C.
      • Bhat M.
      • et al.
      Prevalence of incisor trauma in persons 6 to 50 years of age: United States, 1988–1991.
      J Dent Res. 1996; 75: 696-705
      ). In Canada, a survey of self-reported dental injuries showed a prevalence of 15.5% in a population of adults aged 18–50 years (
      • Locker D.
      Self-reported dental and oral injuries in a population of adults aged 18-50 years.
      Dent Traumatol. 2007; 23: 291-296
      ). Traumatic oral injuries present a public health problem and can, in some countries where caries have decreased, be considered a more major threat to the anterior teeth (
      • Andreasen J.O.
      • Andreasen F.M.
      • Andersson L.
      Textbook and Color Atlas of Traumatic Injuries to the Teeth.
      4th ed. Blackwell-Munksgaard, Oxford, United Kingdom2007
      ). In order to be able to make comparisons between countries and within countries and in order to detect trends over time, there is a need for international standardized trauma registration (
      • Andersson L.
      • Andreasen J.O.
      Important considerations for designing and reporting epidemiologic and clinical studies in dental traumatology.
      Dent Traumatol. 2011; 27: 269-274
      ).

      Economic Impact

      The total lifetime costs of accidental bodily injuries in the United States has been calculated to be US $406 billion (
      • Corso P.
      • Finkelstein E.
      • Miller T.
      • et al.
      Incidence and life time costs of injuries in the United States.
      Inj Prev. 2006; 12: 212-218
      ,
      • Finkelstein E.
      The Incidence and Economic Burden of Injuries in the United States.
      Oxford University Press, New York2006
      ), which is 4.2% of the gross domestic product. This figure corresponds well with a Swedish study, in which the overall costs of accidental bodily injuries also were estimated to be 4% of the gross national product (
      • Jansson B.
      Samhällets Utgifter för Personskador.
      Folkhälsoinstitutet, Stockholm1994
      ). The costs for loss in only productivity caused by accidental bodily injuries (US $326 billion) was due to lost wages, benefits, marketable goods and services, and the loss of ability to perform daily responsibilities at home (
      • Finkelstein E.
      The Incidence and Economic Burden of Injuries in the United States.
      Oxford University Press, New York2006
      ).

      Cost of Dental Trauma

      Studies have shown that complicated injuries to teeth are of major significance with respect to time and cost (
      • Borum M.K.
      • Andreasen J.O.
      Therapeutic and economic implications of traumatic dental injuries in Denmark: an estimate based on 7549 patients treated at a major trauma centre.
      Int J Paediatr Dent. 2001; 11: 249-258
      ,
      • Glendor U.
      • Jonsson D.
      • Halling A.
      • et al.
      Direct and indirect costs of dental trauma in Sweden: a 2-year prospective study of children and adolescents.
      Community Dent Oral Epidemiol. 2001; 29: 150-160
      ,
      • Glendor U.
      • Halling A.
      • Andersson L.
      • et al.
      Type of treatment and estimation of time spent on dental trauma. A longitudinal and retrospective study.
      Swed Dent J. 1998; 22: 47-60
      ,
      • Glendor U.
      • Halling A.
      • Bodin L.
      • et al.
      Direct and indirect time spent on care of dental trauma: a 2-year prospective study of children and adolescents.
      Endod Dent Traumatol. 2000; 16: 16-23
      ,
      • Borssén E.
      • Källestål C.
      • Holm A.K.
      Treatment time of traumatic dental injuries in a cohort of 16-year-olds in northern Sweden.
      Acta Odontol Scand. 2002; 60: 265-270
      ). In a Swedish study, direct costs (average treatment time, costs of health care professionals and other labor, capital costs, and supplies) plus indirect costs (costs due to loss of production or leisure) were estimated to be US $3.3–$4.4 per 1 million individuals in patients up to 19 years of age (
      • Glendor U.
      • Jonsson D.
      • Halling A.
      • et al.
      Direct and indirect costs of dental trauma in Sweden: a 2-year prospective study of children and adolescents.
      Community Dent Oral Epidemiol. 2001; 29: 150-160
      ). However, we know that much of the expensive treatment is carried out in the adult years. In Denmark, the annual cost of treatment only (acute trauma service, follow-up, and subsequent restoration) of traumatic dental injuries (including adults) ranges from US $2–$5 million per million inhabitants per year (
      • Borum M.K.
      • Andreasen J.O.
      Therapeutic and economic implications of traumatic dental injuries in Denmark: an estimate based on 7549 patients treated at a major trauma centre.
      Int J Paediatr Dent. 2001; 11: 249-258
      ).
      Dental trauma is more time-consuming and costly to treat than many other outpatient accidental injuries. The average number of visits treated on an outpatient basis during 1 year because of a dental trauma to a permanent tooth has been shown to range from 1.9–9.1 (
      • Glendor U.
      • Halling A.
      • Andersson L.
      • et al.
      Type of treatment and estimation of time spent on dental trauma. A longitudinal and retrospective study.
      Swed Dent J. 1998; 22: 47-60
      ,
      • Glendor U.
      On dental trauma in children and adolescents.
      Swed Dent J. 2000; 140: 1-52
      ,
      • Solli E.
      • Nossum G.
      • Molven O.
      Ressursbruk ved behandling av tannskader hos norske 6–18 åringer [in Norwegian].
      Nor Tannlaegeforen Tid. 1996; : 328-333
      ,
      • Nguyen P.M.T.
      • Kenny D.J.
      • Barret E.J.
      Socio-economic burden of permanent incisor replantation on children and parents.
      Dent Traumatol. 2004; 20: 123-133
      ), whereas a similar figure for bodily injuries is 1.5 (
      • Lindqvist K.S.
      • Brodin H.
      One-year economic consequences of accidents in a Swedish municipality.
      Accid Anal Prev. 1996; 28: 209-219
      ).

      Etiologic Factors and Variations between Countries and Societies

      Etiologic factors are very much related to the age of the patient. In preschool children, falls are the most common cause of oral injuries, whereas in school age children, injuries are most ofen caused by sports or hits by another person. In adolescents and young adults, assaults and traffic accidents are the most common etiologic factors (
      • Glendor U.
      Aetiology and risk factors related to traumatic dental injuries—a review of the literature.
      Dent Traumatol. 2009; 25: 19-31
      ,
      • Guedes O.A.
      • de Alencar A.H.G.
      • Pécora J.D.
      • et al.
      A retrospective study of traumatic dental injuries in a Brazilian Dental Urgency Service.
      Braz Dent J. 2010; 21: 153-157
      ). In this group, oral injuries are often related to alcohol (
      • Perheentupa U.
      • Laukkanen P.
      • Veijola J.
      • et al.
      Increased lifetime prevalence of dental trauma is associated with previous non-dental injuries, mental distress and high alcohol consumption.
      Dent Traumatol. 2001; 17: 10-16
      ,
      • Santos S.E.
      • Marchiori E.C.
      • Soares A.J.
      • et al.
      A 9-year retrospective study of dental trauma in Piracicaba and neighboring regions in the state of São Paulo, Brazil.
      J Oral Maxillofac Surg. 2010; 68: 1826-1832
      ) and occur most frequently during leisure hours and during weekends (
      • Eilert-Petersson E.
      • Andersson L.
      • Sörensen S.
      Traumatic oral vs. non-oral injuries. An epidemiological study during one year in a Swedish county.
      Swed Dent J. 1997; 21: 55-68
      ,
      • Santos S.E.
      • Marchiori E.C.
      • Soares A.J.
      • et al.
      A 9-year retrospective study of dental trauma in Piracicaba and neighboring regions in the state of São Paulo, Brazil.
      J Oral Maxillofac Surg. 2010; 68: 1826-1832
      ). They are associated with the lifestyle that is prevalent today in many Western societies (
      • Eilert-Petersson E.
      • Andersson L.
      • Sörensen S.
      Traumatic oral vs. non-oral injuries. An epidemiological study during one year in a Swedish county.
      Swed Dent J. 1997; 21: 55-68
      ,
      • Andersson L.
      • Kahnberg K.-E.
      • Pogrel M.A.
      Oral and Maxillofacial Surgery.
      Wiley-Blackwell, Oxford2010
      ,
      • Perheentupa U.
      • Laukkanen P.
      • Veijola J.
      • et al.
      Increased lifetime prevalence of dental trauma is associated with previous non-dental injuries, mental distress and high alcohol consumption.
      Dent Traumatol. 2001; 17: 10-16
      ,
      • Andersson L.
      • Hultin M.
      • Nordenram Å.
      • et al.
      Jaw fractures in the county of Stockholm (1978–1980). General survey.
      Int J Oral Surg. 1984; 13: 194-199
      ).
      In the developing world, traffic accidents are the most common cause of injuries and deaths. The same pattern was observed some decades ago in many Western countries, but traffic preventive measures in these countries have decreased the number of accidents dramatically, although the number of cars has increased considerably. Some countries have been very successful in reducing the number of deaths and injuries caused by traffic.

      Prevention

      It is difficult to prevent dental injuries, but sports injuries appear to offer some opportunities for prevention by the use of properly fitted custom-made mouthguards in contact sports such as boxing, ice hockey, rugby, and American football. There is a lack of evidence as to efficacy of different mouthguards in well-designed studies (
      • Maeda Y.
      • Kumamoto D.
      • Yagi K.
      • et al.
      Effectiveness and fabrication of mouth guards.
      Dent Traumatol. 2009; 25: 556-564
      ). The World Health Organization Health Promoting School program suggests that finding solutions for dental trauma is a public health problem (
      World Health Organization
      Health Promoting Schools: A Healthy Setting for Living, Learning and Working.
      WHO, Geneva1998
      ). In society, a wide range of actions can be implemented (
      • Glendor U.
      • Andersson L.
      Public health aspects of oral diseases and disorders: dental trauma.
      in: Pine C. Harris R. Community Oral Health. Quintessence Publishing, London2007: 203-211
      ,
      • Sheiham A.
      • Watt R.G.
      The common risk factor approach: a rational basis for promoting oral health.
      Community Dent Oral Epidemiol. 2000; 28: 399-406
      ):
      • •
        Personal and social education aimed at developing life skills
      • •
        School policies against bullying and violence
      • •
        Physical environment changes
      • •
        School health policies
      • •
        Alcohol policies
      • •
        School provision of mouthguards
      • •
        Links with health services

      Increasing Lay Knowledge

      The prognosis is decided at the place of accidents for many injuries. Appropriate first aid measures should be carried out as soon as possible after trauma (
      • Andreasen J.O.
      • Bakland L.K.
      • Flores M.T.
      • et al.
      Traumatic Dental Injuries. A Manual.
      3rd ed. Wiley-Blackwell, Oxford, United Kingdom2011
      ,
      • Malmgren B.
      • Andreasen J.O.
      • Flores M.T.
      • et al.
      International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition.
      Dent Traumatol. 2012; 28: 174-182
      ,
      • DiAngelis A.J.
      • Andreasen J.O.
      • Ebeleseder K.A.
      • et al.
      International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth.
      Dent Traumatol. 2012; 28: 2-12
      ,
      • Andersson L.
      • Andreasen J.O.
      • Day P.
      • et al.
      International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth.
      Dent Traumatol. 2012; 28: 88-96
      ). For avulsed teeth, it is critical that not just the professionals have first aid knowledge. Key individuals close to the injured child such as children, parents, teachers, school nurses, health care professionals, and coaches ideally should know what to do with an avulsed permanent tooth at the scene of an accident. Yet most studies have reported a low level of knowledge about how to deal with first aid dental trauma (
      • Andersson L.
      • Al-Asfour A.
      • Al-Jame Q.
      Knowledge of first-aid measures of avulsion and replantation of teeth: an interview of 221 Kuwaiti schoolchildren.
      Dent Traumatol. 2006; 22: 57-65
      ,
      • McIntyre J.D.
      • Lee J.Y.
      • Trope M.
      • et al.
      Elementary school staff knowledge about dental injuries.
      Dent Traumatol. 2008; 24: 289-298
      ,
      • McIntyre J.D.
      • Lee J.Y.
      • Trope M.
      • et al.
      Effectiveness of dental trauma education for elementary school staff.
      Dent Traumatol. 2008; 24: 146-150
      ,
      • Glendor U.
      Has the education of professional caregivers and lay people in dental trauma care failed?.
      Dent Traumatol. 2009; 25: 12-18
      ,
      • Kargul B.
      • Welbury R.
      An audit of the time to initial treatment in avulsion injuries.
      Dent Traumatol. 2009; 25: 123-125
      ,
      • Cardoso L.C.
      • Poi W.R.
      • Panzarini S.R.
      • et al.
      Knowledge of fire-fighters with special paramedic training of the emergency management of avulsed teeth.
      Dent Traumatol. 2009; 25: 58-63
      ,
      • Zhao Y.
      • Gong Y.
      Knowledge of emergency management of avulsed teeth: a survey of dentists in Beijing, China.
      Dent Traumatol. 2010; 26: 281-284
      ,
      • Trivedy C.
      • Kodate N.
      • Ross A.
      • et al.
      The attidudes and awareness of emergency department (ED) physicians towards the management of common dentofacial emergencies.
      Dent Traumatol. 2012; 28: 121-126
      ).
      The lack of adequate knowledge of first aid for dental injuries among lay people is probably due to the fact that acute dental trauma care generally is not included in their education or in first aid textbooks (
      • Zadik Y.
      Oral trauma and dental emergency management recommendations of first-aid textbooks and manuals.
      Dent Traumatol. 2007; 23: 304-346
      ,
      • Emerich K.
      • Gazda E.
      Review of recommendations for the management of dental trauma presented in first-aid textbooks and manuals.
      Dent Traumatol. 2010; 26: 212-216
      ). There have been attempts made to increase dental trauma first aid knowledge in dental trauma. For example, a short lecture followed by a discussion about replantation of avulsed teeth has been shown to be an effective method to increase dental trauma first aid knowledge (
      • Glendor U.
      • Andersson L.
      Public health aspects of oral diseases and disorders: dental trauma.
      in: Pine C. Harris R. Community Oral Health. Quintessence Publishing, London2007: 203-211
      ,
      • McIntyre J.D.
      • Lee J.Y.
      • Trope M.
      • et al.
      Effectiveness of dental trauma education for elementary school staff.
      Dent Traumatol. 2008; 24: 146-150
      ,
      • Al-Asfour A.
      • Andersson A.
      • Al-James Q.
      School teacher's knowledge of tooth avulsion and dental first aid before and after receiving information about avulsed teeth and replantation.
      Dent Traumatol. 2008; 24: 43-49
      ,
      • Levin L.
      • Jeffet U.
      • Zadik Y.
      The effect of short dental trauma lecture on knowledge of high-risk population: an intervention study of 336 young adults.
      Dent Traumatol. 2010; 26: 86-89
      ,
      • Yeng T.
      • Parashos P.
      Dentists' management of dental injuries and dental trauma in Australia: a review.
      Dent Traumatol. 2008; 24: 268-271
      ,
      • Yeng T.
      • Parashos P.
      An investigation into dentists' management methods of dental trauma to maxillary permanent incisors in Victoria, Australia.
      Dent Traumatol. 2008; 24: 443-448
      ). The distribution of leaflets or posters with first aid information (
      • Glendor U.
      • Andersson L.
      Public health aspects of oral diseases and disorders: dental trauma.
      in: Pine C. Harris R. Community Oral Health. Quintessence Publishing, London2007: 203-211
      ,
      • Al-Asfour A.
      • Andersson L.
      The effect of a leaflet given to parents for first aid measures after tooth avulsion.
      Dent Traumatol. 2008; 24: 515-521
      ,
      • Lieger O.
      • Graf C.
      • El-Maaytah M.
      • et al.
      Impact of educational posters on the lay knowledge of school teachers regarding emergency management of dental injuries.
      Dent Traumatol. 2009; 25: 406-412
      ,
      • Arikan V.
      • Sönmez H.
      Knowledge of primary school teachers regarding traumatic dental injuries and their emergency management before and after receiving an informative leaflet.
      Dent Traumatol. 2012; 28: 101-107
      ) also has been shown to be an effective method. Emergency telephone services can be helpful for cases related to dental trauma and may provide valuable support provided that people are aware of the emergency telephone numbers and that there is an emergency service organized (
      • Lienert N.
      • Zitzmann N.U.
      • Filippi A.
      • et al.
      Teledental consultations related to trauma in a Swiss telemedical center: a retrospective survey.
      Dent Traumatol. 2010; 26: 223-227
      ).
      The development of technology has increased access to information. A recent study pointed out that the most preferred sources of information regarding the emergency management of tooth avulsion, regardless of sociodemographic characteristics, are the Internet for young people and the television for elderly people (
      • Al-Sane M.
      • Bourisly N.
      • Almulla T.
      • et al.
      Laypeoples' preferred sources of health information on the emergency management of tooth avulsion.
      Dent Traumatol. 2011; 27: 432-437
      ). Information on the Internet must be reliable and should, therefore, be given by a medical professional (
      • Al-Sane M.
      • Bourisly N.
      • Almulla T.
      • et al.
      Laypeoples' preferred sources of health information on the emergency management of tooth avulsion.
      Dent Traumatol. 2011; 27: 432-437
      ). Smartphones also can be used to reach professional information about dental trauma first aid measures. One such a app for the public is DENTAL TRAUMA, which can be downloaded onto iPhones and Android phones.

      Organization of Emergency Care

      The prognosis for some dental injuries (eg, avulsion injuries) depends on early and correct treatment (
      • Andersson L.
      • Andreasen J.O.
      • Day P.
      • et al.
      International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth.
      Dent Traumatol. 2012; 28: 88-96
      ). For this reason, it is important that a dental emergency service be organized in each geographic region. Ideally, such a service would be provided on a 24-hour basis. During office hours, dental clinics can provide emergency service. However, because the majority of dental injuries occur outside office hours (
      • Eilert-Petersson E.
      • Andersson L.
      • Sörensen S.
      Traumatic oral vs. non-oral injuries. An epidemiological study during one year in a Swedish county.
      Swed Dent J. 1997; 21: 55-68
      ) other solutions also must be provided. A well-functioning emergency service outside office hours can be provided via a central dental emergency clinic or hospital.
      Studies have shown that treatment of dental trauma in emergency care services is often inadequate (
      • Maguire A.
      • Murray J.J.
      • al-Majed I.
      A retrospective study of treatment provided in the primary and secondary care services for children attending a dental hospital following complicated crown fracture in the permanent dentition.
      Int J Paediatr Dent. 2000; 10: 182-190
      ,
      • Kahabuka F.K.
      • Willemsen W.
      • van't Hof M.
      • et al.
      Initial treatment of traumatic dental injuries by dental practitioners.
      Endod Dent Traumatol. 1998; 14: 206-209
      ,
      • Kahabuka F.K.
      • Willemsen W.
      • van't Hof M.
      • et al.
      Oro-dental injuries and their management among children and adolescents in Tanzania.
      East Afr Med J. 1999; 76: 160-162
      ) and that patients are not always satisfied with the care provided. The International Association of Dental Traumatology has issued guidelines for emergency management of traumatic dental injuries, which can be accessed on the Internet (www.iadt-dentaltrauma.org). An interactive website has been introduced for clinicians where guidance is given for every unique emergency case and the dentist can provide data from the individual case (Dental Trauma Guide, www.dentaltraumaguide.org). The advantage with the Internet is that guidelines for emergency situations are more accessible worldwide than printed books and manuals. A link to the Internet, either via computer or smartphone, is enough to gain direct information for emergency management.

      Acknowledgments

      This lecture has been partly based on data from a recently performed literature review, which is going to be published in a textbook chapter in the coming year. The author wish to thank Dr Glendor for giving his permission to use some of these data in this presentation.
      The author denies any conflicts of interest related to this study.

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      Article info

      Footnotes

      This article is being published concurrently in Pediatric Dentistry 2013;35(2). The articles are identical. Either citation can be used when citing this article.

      Identification

      DOI: https://doi.org/10.1016/j.joen.2012.11.021

      Copyright

      © 2013 American Academy of Pediatric Dentistry and American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

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