Traumatic Dental

Injuries
(TDI)
Classification, etiology,
epidemiology
Dr- suhad Al-jundi
2009-2010
 Dental trauma/ classical
classification
 Ellis classification of tooth fracture (1970):
Class I: coronal fracture involving only enamel
Class II: coronal fracture involving enamel and
dentine.
Class III: coronal fracture involving enamel,
dentine and exposing the pulp.
Class IV: root fracture
Class V: avulsion
Dental trauma/ clinical classification
WHO
 Injuries to dental tissue and pulp
 Enamel infarction
 Enamel fracture , uncomplicated

 Enamel dentine fracture, uncomplicated

 Complicated crown fracture

 Uncomplicated crown root fracture

 Complicated crown root fracture

 Root fracture
Dental trauma/ clinical classification
WHO
 Injuries to periodontal tissue
 Concussion
 Subluxation (loosening)
 Extrusive luxation (partial
avulsion)
 Lateral luxation
 Intrusive luxation (central
dislocation)
 Avulsion or exarticulation or
complete luxation
 concussion
 Tooth is markedly tender to percussion with
no mobility or displacement.
 Treatment: reassurance, instruct to soft diet,
prescribe analgesics, monitor vitality
 subluxation
 Tooth is mobile , not displaced, may be tender
to percussion.
 Treatment: instruct to soft diet, prescribe
analgesics, splint is not necessary, but a
flexible splint may be inserted for one week to
ease pain.
 Lateral luxation
 Displacement of the tooth in a direction other
than its long axis, lingually , buccaly, rarely
mesially or distaly,
 Axial luxation
 Displacement of the tooth in the direction of
its long axis
 Either intrusion, displacement into the socket
 Or extrusion, partial displacement from the
socket.
Dental trauma/ clinical classification
WHO
 Injuries to supporting bone:
 Comminution of maxillary alveolar
socket
 Comminution of mandibular
alveolar socket
 Fracture of maxillary alveolar
socket wall
 Fracture of mandibular alveolar
socket wall
 Fracture of maxillary alveolar
process
 Fracture of mandibular alveolar
process
 Fracture of maxilla
 Fracture of mandible
Dental trauma/ clinical classification
WHO
 Injuries to gingiva or
oral mucosa
 Contusion: bleeding
subepithelial, no break
in epithelium
 Abrasion: discontinuity
of epithelium
 Laceration: a cut in the
soft tissues or skin
 Dental trauma/ Epidemiological classification
WHO

No injury
Treated dental injury
Enamel fracture only
Enamel/ dentine fracture
Pulp injury
Missing due to trauma
Excluded
 Epidemiology of TDI
 TDI remain to be a major dental public health
challenge in youth
 TDI affect anterior region usually and require
more complex treatment than dental caries
 Dental caries has declined whereas TDI still
 Oral region is only 1% of all body it accounts
for up to 17% of all body injuries (Sweden)
 Worldwide maxillofacial trauma account for
9-33% of all trauma at ER dept in hospitals
 Prevalence
 Highly diverse internationally
 Generally it is high
 In UK 1 in 5 children
 In US 1 in 4 adults
 Prevalence in Jordan and region
 Traumatic injuries to permanent anterior teeth among 12-year-
old schoolchildren in Jordan.
Hamdan MA, Rajab LD. Community Dent Health. 2003
Jun;20(2):89-93.
 Traumatic dental injuries in children presenting for treatment
at the Department of Pediatric Dentistry, Faculty of Dentistry,
University of Jordan, 1997-2000.
Rajab LD. Dent Traumatol. 2003 Feb;19(1):6-11.
 Prevalence of dental trauma in 5-6- and 12-14-year-old boys
in Riyadh, Saudi Arabia.
Al-Majed I, Murray JJ, Maguire A. Dent Traumatol. 2001
Aug;17(4):153-8.
 Incidence
 Very few studies
 30% sustained injury to primary dentition,
22% to permanent dentition (Andreasen and Ravn 1974)
 |n Australia incidence of 1 in 20 cases of TDI per
1000 per year in 6-12 yr olds ( Stockwell 1988)
 In Sweden for boys 1.6, for girls 1 per 100
individuals per year in 0-19 yr olds (Glendor et al
1996)
Age, Sex, socioeconomic distribution
 Sex: Boys more than girls
 Ethnic minorities more TDI
 Age: mostly in the 1st 10 yrs of life, decreases
with age
 Two peaks are seen one at age 2-4 yrs, then 8-
10 yrs (Andreasen and Ravn 1972)
 Socioeconomic: higher class more trauma
 Repeated trauma
 4-49% to the same child
 8-45% to the same teeth
 Prevention is necessary
 Predisposing factors
 Increased overjet:\ 2 times more
 Inadequate lip coverage: increase trauma 3
fold

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

Al-Khateeb S, Al-Nimri K, Alhaija EA.
Dent Traumatol. 2005 Feb;21(1):26-8.
 Teeth involved
 Mostly anterior teeth
 Maxillary central incisor most commonly
involved
 Maxillary lateral incisor less involved
 Same applies to primary dentition
 Usually a single tooth is involved
 Sometimes multiple teeth and mutliple injuries
 Types of TDI
 Most common is enamel fractured , then
enamel and dentine fracture
 In primary dentition mostly it is in the form of
injury to supporting structures
 In cross sectional studies, soft tissue injury is
not assessed
 In hospital samples, more severe injuries are
reported
 Place and seasonal variation
 Place: mostly home, then school, then other
public places
 Seasonal: wide range of results, some report
more in Summer, some more in winter.
Depends on local cusoms.
 Etiology
 Human behavior:
 Risk taking
 Peer relationship

 Hyperactivity

 Stress behavior

 Environmental factors
 Deprivation
 Overcrowding
 Etiology
 Unintentional injuries
 Falls and colisions
 Physical leisure activities:
 High risk sports: American football, hockey, ice hockey, rugby,
martial sports, skating (FDI)
 Medium risk sports: basket ball, diving, squash, gymnastics (FDI)
 Contact sports: high TDI
 Protect face and teeth, improve playgrounds
 Traffic accidents
 Inappropriate use of teeth
 illness
 Etiology
 Intentional injuries
 Physical abuse
 Iatrogenic procedures
 Mechanism of dental injuries
 Trauma type: direct, indirect
 Factors of impact to teeth:
 Energy of impact
 Resilience of impacting object

 Shape of impacting object

 Angle of direction of force

 Treatment needs and lay knowledge
in society
 Treatment is insufficient and knowledge is
lacking in most societies
Knowledge and attitude of Jordanian school health
 teachers with regards to
emergency management of dental trauma.
Al-Jundi SH, Al-Waeili H, Khairalah K.
Dent Traumatol. 2005 Aug;21(4):183-7.
Knowledge of Jordanian mothers with regards to emergency management

of dental trauma.
Al-Jundi SH. Dent Traumatol. 2006 Dec;22(6):291-5.
 Dental emergencies presenting to a dental teaching hospital due to
complications from traumatic dental injuries.
Al-Jundi SH. Dent Traumatol. 2002 Aug;18(4):181-5.
 Examination, guidelines
 History
 Clinical examination
 Sensibility testing
 Radiographic examination
 Extraoral
 Intraoral

 CT scanning

 MR scanning
 History
 Personal details
 When
 Where
 How
 Treatment elsewhere
 Previous injury
 Did trauma cause loss of consciousness, vomiting,
headache, drowsiness, amnesia
 Pain in teeth
 Clinical examination
 Examine facial skeleton and extraoral structures
 Examine soft tissues and record injuries
 Examine teeth and record injuries
 Record displacement of teeth if present
 Record abnormalities in occlusion
 Abnormal tooth or alveolar mobility
 Palpation and percussion
 Clinical examination
 Sensibility testing of teeth
 Mechanical
 Thermal

 Electric

 Laser doppler flowmetry

 Radiographic examination
 Radiographic examination
 Extraoral
 Intraoral

 CT scanning

 MR scanning