It is important for healthcare professionals to properly triage children who present with dental trauma or pain for problems originating from the oral cavity. This chapter will provide clinicians with information allowing them to assess whether emergent care can be provided onsite or if the care needs to involve dental professions outside of the presenting venue.
PATHOGENESIS AND EPIDEMIOLOGY
Trauma to children’s teeth is a very common event, affecting approximately 2% of children annually. The prevalence of these injuries varies depending on the population studied and the types of injuries reported; as many as 46% of children sustain traumatic injuries to their primary or permanent teeth during childhood. Males are more likely to sustain injuries, while the frequency and type of injuries vary with age. The greatest incidence of trauma to the primary dentition occurs at 2 to 3 years of age, when motor coordination is developing. The incidence peaks again between the ages of 8 and 10 years, which poses a risk to the permanent maxillary anterior teeth.
The majority of injuries involve 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. Children who are very active, such as those with attention-deficit/hyperactivity disorder (ADHD), or those with poor motor coordination, such as those with cerebral palsy, have greater risk of trauma. Socioeconomic status can also affect the risk of trauma to the dentition; the risk is increased in those without a nuclear family (ie, without 2 parents). Children who are overweight and those with protrusive maxillary incisors 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). Failure to treat fractured teeth can impact a child’s daily performance, specifically in smiling, laughing, and showing teeth without embarrassment.
The most common injuries to permanent teeth occur secondary to falls, violence, traffic accidents, and sports. Most sporting activities have an associated risk of orofacial injuries due to falls, collisions, and contact 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 and Prevention estimates that universal use of helmets would prevent 45,000 craniofacial injuries and 55,000 maxillary and mandibular injuries annually. Depending on the stage of the child’s dentition, 2 types of mouthguards are recommended. The “boil and bite” mouthguard (Fig. 370-1), which is inexpensive and can be adapted to the child’s mouth by the parent, is especially helpful during mixed dentition when primary teeth are exfoliating and permanent teeth are erupting. The custom-made mouthguard (Fig. 370-2) is ...