Dental-alveolar trauma in children is distressing to the child and parent. Its management can be equally difficult for the dentist. A traumatic dento/facial accident can compromise the integrity of a previously healthy dentition and result in an unsightly appearance, affecting the child’s self-esteem. A call from a distraught parent of a dento/facially injured child is one of the few acute emergencies seen by dentists that warrants rearrangement of the office schedule.
Most injuries in children are caused by falls and play accidents. Peak incidences in the primary dentition are found at two to three years of age, when the child is developing motor coordination. In the permanent dentition, peak incidences are found at nine to ten years of age, when vigorous playing and sport activities become more frequent. High velocity or sharp injuries cause fractures and luxations of teeth, while blunt trauma causes greater damage to soft tissues. Another major cause of dental injuries in young children is automobile and school bus accidents. Unrestrained children may hit the dashboard, windshield, or the seat in front of them during a sudden stop.
Children with chronic seizure disorders experience an increased incidence of dental trauma. The wearing of protective headgear and custom mouth guards are recommended for these high risk children.
Up to 50% of physically abused children suffer injuries to the head and neck. Signs of child abuse include injuries in various stages of healing, tears of the labial frena, and repeated injuries and injuries whose clinical appearance is not consistent with the history presented by the parent. Dentists who suspect child abuse in patients are required by law to report suspected cases to the proper authorities.
Thirty percent of children suffer trauma to the primary dentition and 22% of children suffer trauma to the permanent dentition by age fourteen years. Injuries occur in males in a 2:1 margin over girls. The anterior teeth are the most commonly involved. Injuries usually involve a single tooth, except with sporting injuries and motor vehicle accidents. The predominant predisposing factor is a Class II division 1 occlusion. As the overjet increases the frequency proportionately increases. The frequency of trauma to anterior teeth in a child with an overjet of 3-6mm is double that of a child with an overjet of 0-3mm. Children with an overjet greater than 6mm have a threefold frequency rate.1,6