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Epidemiology

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Trauma to children’s teeth is a very common event.1 The prevalence of these injuries varies depending on the population studied and the types of injuries reported. Studies indicate that as many as 46% of children sustained traumatic injuries to their primary or permanent teeth during childhood.2-4 Approximately 2% of children sustain such injuries annually.5 The majority of the injuries occur to the maxillary incisors due to their prominence in the dentition. Displacement injuries are more common in the primary dentition, because supporting bone in younger children is more flexible and pliable, while fractures are more common in the permanent dentition.

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Risk Factors

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Several factors influence the child’s individual risk of sustaining traumatic injuries to the orofacial complex. Males are more likely to sustain injuries,6 while the frequency and type of injuries varies with age.7 The greatest incidence of trauma to the primary dentition occurs at 2 to 3 years of age, when motor coordination is developing.8 The incidence peaks again between the ages of 8 and 10 years, which poses a risk to the maxillary anterior teeth.8 Children who are very active, such as those with attention deficit hyperactivity disorder (ADHD)6,9 or those with poor motor coordination such as with cerebral palsy,10 have greater risk of trauma. Socioeconomic status can also affect the risk of trauma to the dentition.6,11 Being a member of a non-nuclear family (ie, without two parents) will increase the risk of trauma.12 Children who are overweight12 and those with protrusive maxillary incisors13 are at greater risk of trauma. Individuals who have undergone general anesthesia with endotracheal intubation can experience “silent trauma” to their incisors (fractured or traumatized incisors during intubation).14 Failure to treat fractured teeth can impact a child’s daily performance, specifically in smiling, laughing, and showing teeth without embarrassment.15

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Clinical Management

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The most common injuries to permanent teeth occur secondary to falls, violence, traffic accidents, and sports.4 Most sporting activities have an associated risk of orofacial injuries due to falls, collisions, and contacts with hard surfaces or other players. There are numerous preventive measures to decrease these risks, such as wearing protective intraoral mouthguards and helmets during many activities. The Centers for Disease Control estimates that universal use of helmets would prevent 45,000 craniofacial injuries and 55,000 maxillary and mandibular injuries annually.16 Two types of mouthguards are recommended, depending on the stage of the child’s dentition. The “boil and bite” mouthguard (eFig. 375.1) is inexpensive and can be adapted to the child’s mouth by the parent. These types of mouthguards are especially helpful during the mixed dentition, when primary teeth are exfoliating and permanent teeth are erupting, as they require frequent replacement. The custom-made mouthguard (eFig. 375.2) is preferred due to its excellent fit but is more expensive, ...

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