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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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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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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, ...