ORAL HEALTH

Health Evidence Bulletins - Wales
Team Leader: Mr Tony Glenn

Date of completion: 8/3/1998

The contents of this bulletin are likely to be valid for approximately one year, by which time significantly new research evidence may become available


Dental Injuries

(Users are advised to consult the supporting evidence for a consideration of all the implications of a recommendation)

The Statements The Evidence
7a. A major risk factor in the aetiology of trauma to incisors is protruding upper incisors.
In 1993, the proportions of 12-13 year-old children in the United Kingdom with fractured incisors was as followsi:

overjet under 5mm = 16%

overjet over 5mm = 24%

Odds ratio = 1.66 for overjets over 5mm.

i. O’Brien M. Children’s dental health in the United Kingdom 1993. HMSO London, 1994 p.81

(Type IV evidence - observational studies)

7b. Mouthguards used during sports reduce oral injuriesi,ii,iii.

(Health gain notation - 2 "likely to be beneficial")

i. Scott J, Burke FJT, Watts DC. A review of dental injuries and the use of mouthguards in contact team sports. British Dental Journal 1994; 176: 310-314
(Type V evidence - expert opinion);
ii. Jennings DC. Injuries sustained by users and non-users of gum shields in local rugby union. British Journal of Sports Medicine 1990; 24: 159-164
(Type IV evidence - observational studies);
iii. McNutt T, Shannon SW, Wright JT, et al. Oral trauma in adolescent athletes: a study of mouth protectors. Paediatric Dentistry 1989; 11: 209-213
(Type IV evidence - observational studies)
7c. Measures to prevent dental injuries in addition to mouth protection include head protection and seat belts at the appropriate timesi.
(Health gain notation - 1 "beneficial")
See also the Injury Prevention Bulletin in this series
i. Welsh Health Planning Forum. Oral Health. Protocol for Investment in Health Gain. Cardiff: Welsh Office NHS Directorate, November 1992
(Type V evidence - expert opinion)
7d. Parents/school and sports staff should be educated in first aid measures for dental injuriesi.
(Health gain notation - 1 "beneficial")
i. Welsh Health Planning Forum. Oral Health. Protocol for Investment in Health Gain. Cardiff: Welsh Office NHS Directorate, November 1992
(Type V evidence - expert opinion)
7e. Avulsed permanent teeth should be stored in isotonic media (eg milk) if instant replantation is not possible (over 80% periodontium healed in 8 weeks in an animal experiment where pre-implantation storage time was up to 3h) i.
(Health gain notation - 1 " beneficial")
i. Bloml f L, Lindskog S, Hammarstr m L. Periodontal healing of exarticulated teeth stored in milk or saliva. Scandinavian Journal of Dental Research 1981; 89: 231-239
(Type II evidence - randomised controlled trial)
7f. The following information sources contribute to diagnosis and assessment i
  • history
  • visual examination
  • palpation
  • X-rays

(Health gain notation - 1 "beneficial")

  • transillumination

(Health gain notation - 2 "likely to be beneficial")

i. Welsh Health Planning Forum. Oral Health. Protocol for Investment in Health Gain. Cardiff: Welsh Office NHS Directorate, November 1992
(Type V evidence - expert opinion)

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7g. Avulsed permanent teeth should be replanted within 15 minutes. (Radiographic follow up for 5 years showed that 14/21 teeth were stable at the end of the study) i.
(Health gain notation - 1 " beneficial")
i. Andersson L, Bodin I. Avulsed human teeth replanted within 15 minutes - a long term clinical follow-up study. Endodontics and Dental Traumatology 1990; 6: 37-42
(Type III evidence - well designed non-randomised trial)
7h. On reimplantation there should be a short period of splinting to allow re-establishment of a periodontal ligament) i.
(Health gain notation - 2 "likely to be beneficial")
i. Oikarinen K. Tooth splinting: a review of the literature and consideration of the versatility of a wire-composite splint. Endodontics and Dental Traumatology 1990; 6: 237-250
(Type V evidence - expert opinion)
7i. In the event of pulp death occuring before the root apex has formed, calcium hydroxide pastes may promote formation of the apex or of a calcified barrier. (Bone healing and apical closure was noted in 50/55 cases) i.
(Health gain notation - 1 " beneficial")
i. Cvek M. Treatment of non vital permanent incisors with calcium hydroxide. Odontologisk Revy 1972; 23: 27-44
(Type III evidence - well designed non-randomised trial)
7j. Root resorption can be arrested by inserting calcium hydroxide paste into the root canal followed by obturation with gutta percha.
(Healing was obtained in 192/197 teeth) i.
(Health gain notation - 1 " beneficial")
i. Cvek M. Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha. A retrospective clinical study. Endodontics and Dental Traumatology 1992; 8: 45-55
(Type III evidence - well designed non-randomised trial)
7k. The etch retained composite technique is now the accepted clinical standard for repairing an uncomplicated crown fracture, providing aesthetically pleasing restoration with acceptable longevity i.
(Health gain notation - 1 " beneficial")
i. Andreasen J O, Andreasen FM. Essentials of traumatic injuries to the teeth. Copenhagen: Munksgrd,1990
(Type V evidence - expert opinion)

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7l. Regular follow-up is recommended after treatment of dental trauma i.
(Health gain notation - 1 "beneficial")
i. Welsh Health Planning Forum. Oral Health. Protocol for Investment in Health Gain. Cardiff: Welsh Office NHS Directorate, November 1992
(Type V evidence - expert opinion)
7m. Orthodontics, if indicated, is beneficial after treatment of dental trauma i.
(Health gain notation - 1 "beneficial")
i. Welsh Health Planning Forum. Oral Health. Protocol for Investment in Health Gain. Cardiff: Welsh Office NHS Directorate, November 1992
(Type V evidence - expert opinion)
7n. The dental team should be educated as to their role in the detection of non-accidental injury i.
(Health gain notation - 2 "likely to be beneficial")
i. Welbury RR, Murphy JM. The dental practitioner's role in protecting children from abuse 3. Reporting and subsequent management of abuse. British Dental Journal 1998; 184(32): 115-119
(Type V evidence - expert opinion)
7o. Guidelines on the treatment of avulsed permanent teeth and traumatically intruded permanent incisor teeth in children are availablei. i. Faculty of Dental Surgery. National Clinical Guidelines 1997. London: Royal College of Surgeons, 1997
(Recommendations classified according to type of evidence)
7p. There is some evidence in the United Kingdom that primary care services for the treatment of dental trauma are inadequate, as dentists have insufficient knowledge. The situation should be reviewed locally and steps taken to address the problem if detected i,ii. i. Hamilton FA, Hill FJ, Holloway PJ. An investigation of dento-alveolar trauma and its treatment in an adolescent population. Part 1: the prevalence and incidence of injuries and the extend and adequacy of treatment received. British Dental Journal 1997; 182(3): 91-95
(Type IV evidence - observational studies);
ii. Hamilton FA, Hill FJ, Holloway PJ. An investigation of dento-alveolar trauma and its treatment in an adolescent population. Part 2: dentists’ knowledge of management methods and their perceptions of barriers to providing care. British Dental Journal 1997; 182(4): 129-133
(Type IV evidence - observational studies)
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Health Evidence Bulletins: Wales, Duthie Library, UWCM, Cardiff CF14 4XN. e-mail: weightmanal@cardiff.ac.uk