I section 12 Oral Surgical Procedures in Children nesting enamel maturation and resulting in a permanent hypomineralized enamel defect. ll Hertwig’s Epithelial Root Sheath Chronic trauma o the Hertwig’s epithelial rootsheath (HERS), such as orthodontic intrusion of immature teeth often leads to fragmentation. An acute wauma to the epithelial root sheath wansmitted indirectly for example by the intrusion, of a primary tooth can damage HERS and lead to partial or complete arrest of root development. IN Gingival and Periosteal Complex ‘The gingival attachment is often tom during luxation and displacement injuries. Ininjury to the underlying bone, firstly the cortical bone plate loses an important part ofits vascular supply and secondly, the cellular cover of bone provided by the innermost layer of periosteum is partially or totally removed. i Periodontal Ligament: Cementum Complex Following a severe dental injury, the periodontal ligament (PDL) must respond to a variety of insults, these include temporary compressive, tensile or shearing stresses which result in hemorrhage, edema, rupture or contusion of the PDL. Dentin: Pulp Complex Any deviation in the composition of the organic structure of dentin may lead to fracture. Thus patients suffering from. dentinogenesis imperfecta have a high-tisk of tooth fractute. Furthermore, the exposure of dentinal tubules during trauma leads to bacterial invasion with a resultant permanent or ‘wansitory inflammatory reaction in the pulp. Two basic Incidence and prevalence of traumatic injuries + Prevalence in primory dentition is 11 to 30 percent ond ‘permanent dentition is 5 to29 percent (Table 63.3) + Boys show more frequency than girs n permanent teeth, no significant sex aifeence in primary teeth + Peak incidence n boys is 2 to 4 year and 9to 10 year andingils is2t03years + Focal injuries are mare common In boys of 6 to 12 yeor of age, ‘mandible is most afected + Teeth involved: = 37 percent upper centro incisor = 18percent lower central incisor = percent ower lateral incisor = 3 percent upper lateral incisor ' Most frequent injury in primary teeth is luxation and permanent teeth is uncomplicated crown fracture (Figs 63.1 A oH). responses determine pulpalwound healingresponse. General feature of the pulpal wound healing response is replacement of damaged tissue with newly formed pulpal tissue along the pulpo-dentinal border. ETIOLOGY Pollowing factors can be attributed: + Falls in infancy + Child abuse—battered child syndrome + Sports injuries + Horse riding + Automobile injury + Assaulttorture + Mental retardation, epilepsy + Drugrelated injuries + Developmental defects of enamel and dentin like dentinogenesis imperfecta, Distribution of eause of injury ‘Cause oftoath fracture | Frequency Percent fall 107 660 Sports 5 50 Traffic accident 19 190 Violence 4 40) ‘other 6 60 MECHANISM OF DENTAL INJURIES + Direct nauma: Occurs when tooth itself is struck, eg, ‘against table or chaiz + Indirect trauma: Seen when the lower dental axch is forcefully closed against upper, eg. blowto chin. ‘The extent of trauma can be assessed by four factors given by Hallet in 1954 (Fig 63.2) 1. Energy of impact ergy = Mass x Velocity + Hence ifthe impacting object either has more mass orhas high velocity the impact will be more 2. Resilience of impacting object: + This can be either hard or sot + More injury is bound to occur in the ease of former and less in case of ater. 3. Shape of impacting object: The nature of wound depends ‘on whether the abject shaxp or blunt. 4. Direction of impacting force: Type of fracture will dizeetly depend on ditection. CLASSIFICATION OF TRAUMATIC INJURIES. Although numerous classifications have been mentioned in literature about traumatic injury to anterior teeth (Table 63.2), the focus will remain on some specific classifications which are explanatory and have stood the test of time.Chapter 63 Traumatic injuries to Anterior Teeth tt Yours 2 Years 3 Years B Tam 60%. Percentage 2 2 a Z 50%. 215% 2701 Present GDI Absent a” wal = 261% 20% Boon 8 127% Female 1.3% ‘One Two Three re] 11 Years 12 Years 13 Years TDI Present TDIAbsent| rm wo nx en 8 40% i 30%. a 127% 152% 20% 10% 0%: ————————— _,, | Fall Accidents “Sports Fight Collson Assouls pry” Cine! Gisela! Cla Cla 69% 51% 3.0% Figs 63.18 to H: (A) Distrbution of sample according to sex; (3) Distribution of sample according to age: () The provalence of traumatic dental injury; (0} The prevalence of traumatic dental injury by gender; (E) The distribution of traumatic dental injury according to age; (F)Disteibution according to the number of fractured tech among children; (6) Distribution of patents according to cause of fracture; ()Olstrbution of fractured teeth according to Ell and Davey cassifiation of injuryTIE section 12 Oral Surgical Procedures in Children [TABLE 63.1: Reported frequencies of traumatic dental injuries in various counties Examiner Year Country ‘Age aroups_| Sample see [ No. with dental injures No, % Kesser ia? | Germany woz (aas7 ‘(ae Marcus 951 usa 17 150 25 160 Keser 951-58 | Germany rary 20.000) 7-98 1048 18. ‘Grundy 1955) England 5-15 25, 37 53 fs 960) Canada = 4251 78 42 Mewen etal 1967 England 3 2.905 239) a2 ‘Wallentin 1967 Germany ans [893 75 Beck 1966) New Zealand) 15-21 2.185 201 94 Buttner 968) Switzerland = 7.000 a aa Akoata 969) Nigeria 25) 410 us, Hargreaves and Craig 1970 England a1) 17.831, 59 Land et al 1970) Sweden 7 702, 8 125 ‘ehutzmannsky 1970 Germany 26 3.098 109) 78 22.708 52 Gute 19711 usa 13 1.166 202 ‘O’Maliane 972 land e9 2792 128. ‘Andreasen and Ravn 1972 Denmark 27 487 302 736 487 223 Bergink 1972 Holland 1116) 943) 142, 154. Zadiket 972 israel 14 10.903 [948 a7 Clarkson eF 1973 England a7 756 74 98 15-59 1.608 348 92 Holm and anvdsson 974 ‘Sweden 3 208: 50 249) PatkowskaIndya and Plonka| 974 Poland 10-15 1.06 38 avn 1974 Denmark 1s 7s000__|oses [329 Wieslander and tind 1974) Sweden 16 2.065 280) 87 Zadik 975) israel ee 965) na York etal 1978 New Zeaand FTE] 430) 7 167, 2ivinen 1979 Finland 16 S 198 Sanchez etal 1981) Dominican Republic [3-6 38 166. Baghadiet 982, rag 12 6.090 467 76 Baghadi etal 2984) sudan en 3507 Sa Garcia Godoy eta. 1981) Dominican Republic _| 7-16 596 184 Garcla-Godoy eal oT omimican Republic [3-5 800) 280) 35.0 Garcia-Godoy 1984) Domimican Republic | 5-14 1.633 a 300) Garcia Godoy eta 2985) Domimican Republie_[ 6-17, 2.200 146) 2. Holland et 1986) rend 15 1.106 403 164 Uiland Teramoto 988 Japan a8 15 a 28 Yagat etl 1988 lag a4 2.389 sea 244 Kaba and Marechaux 1989) Swtteriand ar 262, 108 Ravn 989) Denmark 6 391 % 20 Hunter eta 1990 UK Fre] 968) 153) Forsberg and Tedestam 2990) Sweden 7-15; 1635 483 303, Sanchez and Garcia Godoy 1980) Mesico 313 2.010) 287, 28.4 Bijela et al 990 rar 1-6 576 74 302