DENTAL INJURIES IN CHILDREN AGED 10 TO 12 AND

CONSEQUENCES

Landa Santiago Alexandra ¹

Nava Juárez Liliana Alejandra ¹
Vargas Chávez Sofia Monserrat ¹

¹ Clínica Odontológica Aragón, FES Iztacala, Estado de México, México.

__________________________________________________________________________________

ABSTRACT
Dental traumas (TDI) have a high prevalence in children and many times they are not given the importance
or proper management, so knowledge of TDI helps us to prevent and treat them promptly.
Objective: this article seeks to analyze the behavior of dental trauma in children from 10 to 12 years of age
and its possible consequences.
Method: an exhaustive search and compilation of articles that specifically study dental trauma in children was
carried out and the most relevant information was gathered for its broad knowledge, from its prevalence and
behavior to its consequences, prevention and treatment.
Results: it was possible to describe the behavior of dental trauma in children from 10 to 12 years old, as well
as its possible causes and consequences.
Conclusions: dental traumatisms affect not only the physiology and oral function, but also the aesthetics of
the child, so it is essential to have the necessary knowledge for its prevention and timely treatment.

Keywords: dental trauma, children, types of dental trauma, consequences of dental trauma.
______________________________________________________

INTRODUCTION

Among the main stomatological emergencies that occur in our services are dental trauma, which causes pain,
discomfort and sudden functional alteration, which make the patient go to the stomatology consultation. (1)
Children's physical activity, such as sports from an early age, the use of bicycles and activities in outdoor
camps, make them in permanent contact with risk factors. (2)

The loss of dental structures due to trauma has a great impact on the quality of life of infants, particularly
when it comes to incisors. Children with trauma to the anterior teeth experience a negative impact on their
psychological and social well-being. Knowing its characteristics contributes to prevention. (3) Dental trauma
can occur at any age, constituting one of the most unpleasant experiences for both children and their parents.
(4) Child accidents are a major public health problem. (5)

The TDI may range from a minor crack in the tooth, chipping off a part, to extensive dentoalveolar injuries,
which involve the supporting bone, tissues, and may lead to tooth displacement or avulsion.(6) Dental trauma
may also lead to dental injuries, impacting both maxillofacial structures and bone, resulting in functional,
aesthetic, mental, and social aspects.(7) In addition to the probable psychoemotional effects of this situation
on children and their parents, malocclusions can occur in a short time due to loss of proximal and incisal
contacts. (8) Unfortunately, parents and patients do not attach special importance to traumatic dental
injuries and tend to visit medical institutions only after a significant period of time or only after the patient
has acute symptoms of inflammation or aesthetic problems. (9)

Dental surgeons and physicians must work together as a team to educate the people regarding the prevention
and management of traumatic dental injuries(10).

Justification

We must delve into the research in order to guide future generations about dental trauma in pediatric patients,
because they require adequate treatment at the time of emergencies. Injuries that affect the temporary
dentition, especially those that compromise the frontal sector, are relatively common in children due to many
etiological factors such as falls, sports and, above all, the most alarming is child abuse. The greater
understanding of the importance of this dentition by parents stands out in a greater number of children taken
to the clinic for this reason.

Objectives

Analyze the behavior of dental trauma in children from 10 to 12 years of age. To identify the consequences
of dental trauma in children we will cover its prevention, treatment and consequences.

Materials and methods

When conducting an online search in BIDI UNAM, 561 articles on this subject are collected and appear.
After evaluation of their titles and abstracts, only 31 were finally selected for full review and data collection.
All the studies had been carried out during adolescence, especially in adolescents of 12 years of age.
Differences in estimation can be observed when using different evaluation criteria for dental trauma.

− TERMS

Avulsion dental (7), prevention (1), trauma in children (2). tooth fracture (3), malocclusion (2), luxation(1),
quality of life (1), children traumatic dental injuries (4), causes (2), treatment (3), prevalence (1).

EPIDEMIOLOGY

1. Enamel fracture
2. Enamel-dentin fracture (with no pulp exposure)
3. Complicated crown fracture (with pulp exposure)
4. Crown-root fracture
5. Root fracture
6. Alveolar fracture
7. Concussion
8. Sublaxation
9. Extrusive luxation
 10. Lateral luxation
11. Intrusive luxation
12. Avulsion
13. Preventiv

RESULTS

The study was carried out in 2022 for research purposes, information was collected from various articles on
the prevention, treatment, and consequences of dental and ATM trauma, in children and adolescents from
various countries.
The injuries are most frequently observed between 2 and 5 years of age, more prevalent in boys than in girls
but the increases again in the age range of 8-13 years because of sports and physical recreational activities
(riding a bicycle or a soccer, skateboarding, roller-skating, playground activities, etc.)
Clinical and radiographic examinations were performed on the patients. Some predetermining factors are age,
sex, time of injury, cause of the injury, number of affected teeth and the type of trauma that was identified as
well as its classification.
Enamel fracture
Clinical findings: Fracture involves enamel only.
Treatment. Smooth any sharp edges;
Parent/patient education: Exercise care when
eating not to further traumatize the injured tooth
while encouraging a return to normal function as
soon as possible. Encourage gingival healing and
prevent plaque accumulation by parents cleaning
the affected area witha soft brush or cotton swab
combined with an alcohol-free 0.1 to 0.2%
chlorhexidine gluconate mouth rinse applied
topically twice a day for 1 wk.
Followup: No dinical or radiographic follow up
recommended.
https://i0.wp.com/www.aliem.com/wp-content/uploads/2021/08/102-2-1-
e1630007603436.png?fit=383%2C644&ssl=1
Enamel-dentin fracture (with no pulp exposure)
Clinical findings: Fracture Involves enamel and
dentin. The pulp is not exposed. The location of
missing tooth fragments should be explored
during the trauma history and examination,
especially mouth, there is a risk that they when the
accident was not witnessed by an adult or there
was a loss of consciousness.
- Note: While fragments are most of ten lost out of
the can be embedded in the soft tissues, ingested,
or aspirated.
Treatment: Cover all exposed dentin with glass
ionomer or composite. Lost tooth structure can
be restored using composite Immediately or at a
later appointment. Parent/patient education.
Unfavorable outcomes: Asymptomatic and pulp
healing with: Normal color of the remaining
crown, No signs of pulp necrosis and infection
continued root development in immature leeth.
Unfavorable outcomes: Symptomatic; crown
discoloration; no further root development of
immature teeth; signs of pulp necrosis and
infection-suchas: Sinus tract, gingival swelling
abscess, or increased mobility, Persistent dark gray
discoloration with one or more other signs of
infection radiographic signs of pulp necrosis and
infection.
Follow up: Clinical examination after 6-8 wk.
Radiographic follow up indicated only when
clinical findings are suggestive of pathosis. Parents
should watch for any unfavorable outcomes. If
seen, the child needs to return to the clinic as son
as possible.
Favorable outcome: Asymptomatic. Pulp healing
with: Normal color of the remaining Crown. No
signs of Pulp necrosis and infection. Continued
root development in immature teeth.
Unfavorable outcome: Symptomatic. Crown
discoloration. Signs of pulp necrosis and
infection-such as. No further root development
of immature teeth.
Complicated crown fracture (with pulp exposure)
Clinical findings: Fracture involves enamel and
dentin plus the pulp is exposed. The location of
missing tooth fragments should be explored
during the trauma history and examination,
especially when the accident was not witnessed by
an adult or there was a loss of consciousness.
-Note: While fragments are most often lost out of
the mouth, there is a risk that they can be
embedded in the soft tissues, Ingested, or
aspirated.
Treatment: Preserve the pulp by partial
pulpotomy. Local anesthesia will be required. A
non-setting calcium hydroxide paste cover this
with a glass ionomer cement and then a composite
resin. Cervical pulpotomy is Indicated for teeth
with large pulp exposures. The evidence for using
other biomaterials such as non- staining calcium
silicate-based cements k emerging. Clinicians
should focus on appropriate case selection rather
than the material used .
Treatment depends on the child's maturity and
ability to tolerate procedures. Therefore, discuss
different treatment options including
pulpotomy) with the parents. Each option is
invasive and has the potential to cause long- term
dental anxiety. Treatment is best performed by a
child-oriented team with experience and expertise
in the management of pediatric dental injuries.
Often no treatment may be the most appropriate
option in the emergency situation, but only when
https://i0.wp.com/www.aliem.com/wp-content/uploads/2021/08/102-
4.png?resize=400%2C442&ssl=1
there is the potential for rapid referral (within
several days) to the child-oriented team.
Follow up: Clinical examination after: 1 wk, 6-8
wk, 1 y. Radiographic follow up at 1 y following
pulpotomy or root canal treatment. Other
radiographs are only Indicated where clinical
findings are suggestive of pathosis (eg, an
unfavorable outcome). Parents should watch for
any unfavorable outcomes. If seen, the child needs
to return to the clinic as soon as possible. Where
unfavorable outcomes are identified, treatment is
often required. The follow-up treatment, which
frequently requires the expertise of a child-
oriented team, is outside the scope of these
guidelines.
Favorable outcome: Asymptomatic. Pulp healing
with: Normal color of the remaining Crown. No
signs of pulp necrosis and infection. Continued
root development in immature teeth.
Unfavorable outcome: Symptomatic. Crown
discoloration. No further root development of
immature teeth. Signs of pulp necrosis and
infection-such as: Sinus tract, gingival swelling,
abscess, or increased mobility. Persistent dark gray
discoloration with one or more signs of root canal
Infection. Radiographic signs of pulp necrosis and
Infection.
Crown-root fracture
Clinical findings: Fracture involves enamel
dentin, and root: the pulp may or may not be
exposed (ie. complicated or uncomplicated).
Additional findings may include loose, but still
attached, fragments of tooth.
Treatment: Often no treatment may be the most
appropriate option in the emergency situation,
but only when there is the potential forrapid
referral (within several days) to a child-oriented
team. If treatment is considered at the emergency
appointment, local anesthesia will be required
Remove the loose fragment and determine if the
crown can be restored.
Option A: If restorable and no pulp exposed, cover
the exposed dentine with glass ionomer If
restorable and the pulp is exposed. perform a
pulpotomy (see crown fracture with exposed
pulp) orroot canal treatment. depending on the
stage of root development and the level of the
fracture.
Option B: If unrestorable, extract all loose
fragments taking care not to damage the
permanent successor tooth and leave any firm root
fragment in situ, or extract the entire tooth.
-Treatment depends on the child's maturity and
ability to tolerate the procedure. Therefore,
discuss treatment options (including extraction)
with the parents. Each option is invasive and has
the potential to cause long-term dental anxiety.
Treatment is best performed by a child-oriented
team with experience and expertise in the
management of pediatric dental injuries.
http://www.tri-cityendo.com/wp-content/uploads/dentaltraumafig4.jpg
Parent/patient education: Exercise care when
eating not to further traumatize the injured tooth
while encouraging a return to normal function as
soon as posible. To encourage gingival healing and
prevent plaque accumulation, parents should
clean. the affected area with a soft brush or cotton
swab combined with an alcohol-free 0.1% to 0.2%
chlorhexidine gluconate mouth rinse applied
topically twice a day for 1 wk.
Follow up: Clinical examination after: 1 wk, 6-8
wk, 1 y. Radiographic follow up at 1 y following
pulpotomy or root canal treatment. Other
radiographs are only Indicated where clinical
findings are suggestive of pathosis (eg, an
unfavorable outcome). Parents should watch for
any unfavorable outcomes. If seen, the child needs
to return to the clinic as soon as possible. Where
unfavorable outcomes are identified, treatment is
often required.
Favorable outcome: Asymptomatic. Pulp healing
with: Normal color of the remaining Crown. No
signs of pulp necrosis and infection. Continued
root development in immature teeth.
Unfavorable outcome: Symptomatic. Crown
discoloration. No further root development of
immature teeth. Signs of pulp necrosis and
infection-such as: Sinus tract, gingival swelling,
abscess, or increased mobility. Persistent dark gray
discoloration with one or more signs of root canal
Infection. Radiographic signs of pulp necrosis and
Infection.
Root fracture
Clinical findings: Depends on the location of
fracture. The coronal fragment may be mobile
and may be
Displaced. Ocdusal interference may be present.
Treatment: If the coronal fragment is not
displaced, no treatment is required. If the coronal
fragment is displaced and is not excessively
mobile, leave the coronal fragment to
spontaneously reposition even if there is some
occlusalinterference. If the coronal fragment is
displaced, excessively mobile and interfering with
occlusion, two options are available, both of
which require local anesthesia.
-Option A: -Extract only the loose coronal
fragment. The apical fragment should be left in
place to be resorbed.
-Option B: -Gently reposition the loose coronal
fragment. If the fragment is unstable in its new
position. stabilire the fragmentwith a flexible
splint attached to the adjacent uninjured teeth
Leave the splint in place for 4 wk.
The treatment depends on the child's maturity
and ability to tolerate the procedure. Therefore,
discuss treatment options with the parents. Each
option is invasive and has the potential to cause
long-term dental anxiety. Treatment is
bestperformed by a child-oriented team with
experience and expertise in the management of
pediatric dental injuries. Often no treatment may
be the most appropriate option in the emergency
scenario, but only when there is the potential for
rapid referral (within several days) to the child-
oriented team.
https://i0.wp.com/www.aliem.com/wp-content/uploads/2021/08/102-5-
e1630007942438.png?resize=400%2C365&ssl=1
Follow up: If coronal fragment has been extracted,
clinical examination after 1 y. Where there are
concerns that an unfavorable outcome is likely,
then continue clinical follow up each year until
eruption of permanent teeth. Radiographic
follow up only indicated where clinical findings
are suggestive of pathosis (eg, an unfavorable
outcome). Parents should be informed to watch
for any unfavorable outcomes and the need to
retum to the clinic as soon as possible. Where
unfavorable outcomes are identified, treatment is
often required. The follow-up treatment, which
frequently requires the expertise of a child-
oriented team, is outside the scope of these.
Favorable outcome: Asymptomatic. Pulp healing
with: Normal color of the crown or transient
red/gray or yellow discoloration and pulp canal
obliteration. No signs of Pulp necrosis and
infection. Continued root development in
immature teeth.
Realignment of the root- fractured tooth. No
mobility. Resorption of the apical fragment.
Unfavorable outcome: Symptomatic. Signs of pulp
necrosis and infection-such as: -Sinus tract.
gingival swelling, abscess or increased mobility. -
Persistent dark gray discoloration with one or
more signs of root canal infection. Radiographic
signs of pulp necrosis and infection. -
Radiographic signs of infection-related
(inflammatory) resorption.
No further root development of immature teeth.
No improvement in the position of the root-
fractured tooth.
Alveolar fracture
Clinical findings: The fracture involves the
alveolar bone Blabial and palatal/lingual) and may
extend to the adjacent bone. Mobility and
dislocation of the segment with several teeth
moving together are common findings. Occlusal
interference is usually present.
Treatment: Reposition (under local anesthesia)
any displaced segment which is mobile and/or
causing occlusal interference. Stabilize with a
flexible splint to the adjacent uninjured teeth for 4
wk. Treatment should be performed by a child-
oriented team with experience and expertise in the
management of pediatric dental injuries.
Follow up: Radiographic follow up at 4 wand 1 y
to assess impact on the primary tooth and the
permanent tooth germs in the Ine of the alveolar
fracture. This radiograph may indicate a more
frequent follow-up regimen is needed. Other
radiographs are indicated only where clinical
findings are suggestive of pathosis (eg, an
unfavorable outcome).
If the fracture line is located at the level of the
primary root apex, an abscess can develop. A
periapical radiolucency can be seen on the
radiograph. Parents should be informed to watch
for any unfavorable outcomes and the need to
return to the clinic as soon as possible. Where
https://i0.wp.com/www.aliem.com/wp-
content/uploads/2021/08/Alveolar-fx.png?resize=400%2C377&ssl=1
unfavorable outcomes. are identified, treatment is
often required.
The follow-up treatment, which frequently
requires the expertise of a child-oriented team, is
outside the scope of these guidelines.
Favorable outcome: Asymptomatic. Pulp healing
with: Normal crown color or transient red/gray or
yellow discoloration and pulp canal obliteration.
No signs of pulp necrosis and infection.
Continued root development in immature teeth.
Periodontal healing Realignment of the alveolar
segment with the original occlusion restored. No
disturbance to the development and/ or eruption
of the permanent successor.
Unfavorable outcome: Symptomatic. Signs of pulp
necrosis and infection-such as: -Sinus tract.
gingival swelling, abscess or increased mobility. -
Persistent dark gray discoloration with one or
more signs of root canal infection. Radiographic
signs of pulp necrosis and infection. -
Radiographic signs of infection-related
(inflammatory) resorption.
No further root development of immature teeth.
Limited or no improvement in the position of
the displaced segment and the original occlusion
is not re-established. Negative impact on the
development and/or eruption of the permanent
successor.
Concussion
Clinical findings: The tooth is tender to touch but
it has not been displaced .It has normal mobility
and no sulcular bleeding.
Treatment: No treatment is needed. Observation.
Parent/patient education: Exercise care when
eating not to further traumatize the injured tooth
while encouraging a return to normal function as
soon as posible. To encourage gingival healing and
prevent plaque accumulation, parents should
clean. the affected area with a soft brush or cotton
swab combined with an alcohol-free 0.1% to 0.2%
chlorhexidine gluconate mouth rinse applied
topically twice a day for 1 wk.
Follow up: Radiographic follow up only indicated
where clinical findings are suggestive of pathosis
(eg, an unfavorable outcome). Parents should be
informed to watch for any unfavorable outcomes
and the need to return to the clinic as soon as
possible. Where unfavorable outcomes are
identified. Treatment is often required. The
https://i0.wp.com/www.aliem.com/wp-content/uploads/2021/08/102-
Concussion.png?resize=400%2C274&ssl=1
Subluxation
Clinical findings: The tooth is tender to touch
and it has increased mobility, but it has not been
displaced. Bleeding from gingival crevice may be
noted.
follow-up treatment, which frequently requires
the expertise of a child-oriented team, is outside
the scope of these guidelines.
Favorable outcome: Asymptomatic. Pulp healing
with: Normal color of the crown or transient
red/gray or yellow discoloration and pulp canal
obliteration. No signs of pulp necrosis and
infection.
Continued root development in immature teeth.
No disturbance to the development and/or
eruption of the permanent successor.
Unfavorable outcome: Symptomatic. Signs of pulp
necrosis and infection-such as: Sinus tract,
gingival swelling, abscess, or increased mobility.
Persistent dark gray discoloration plus one or
more other signs of root canal infection.
Radiographic signs of pulǝ necrosis and infection.
No further root development of immature teeth.
Negative impact on the development and/or
eruption of the permanent successor.
Treatment: No treatment is needed. Observation.
Parent/patient education: Exercise care when
eating not to further traumatize the injured tooth
while encouraging a return to normal function as
soon as posible. To encourage gingival healing and
prevent plaque accumulation, parents should
clean. the affected area with a soft brush or cotton
swab combined with an alcohol-free 0.1% to 0.2%
chlorhexidine gluconate mouth rinse applied
topically twice a day for 1 wk.
Follow up: Where there are concerns that an
unfavorable outcome is likely, then continue
clinical follow up each year until eruption of the
permanent teeth. Radiographic follow up only
indicated where clinical findings are suggestive of
pathosis (eg. an unfavorable outcome). Parents
should be informed to watch for any unfavorable
outcomes and the need to return to the clinic as
soon as possible. Where unfavorable outcomes are
identified. treatment is often required. The
follow-up treatment, which frequently requires
the expertise of a child-oriented team, is outside
the scope of these guidelines.
Keels, M. A. (2014). Management of Dental Trauma in a Primary Care
Setting. PEDIATRICS, 133(2), e466–e476. https://doi.org/10.1542/peds.2013-3792
Extrusive luxation
Clinical findings: Partial displacement of the
tooth out of its socket. The tooth appears
elongated and can be excessively mobile. Occlusal
interference may be present.
Treatment: Treatment decisions are based on the
degree of displacement, mobility, Interference
with the occlusion, root formation, and the ability
of the child to tolerate the emergency situation. If
the tooth is not interfering with the occlusion-let
the tooth spontaneously reposition itself. If the
Favorable outcome: Asymptomatic. Pulp healing
with: Normal color of the crown or transient
red/gray or yellow discoloration and pulp canal
obliteration. No signs of pulp necrosis and
infection.
Continued root development in immature teeth.
No disturbance to the development and/or
eruption of the permanent successor.
Unfavorable outcome: Symptomatic. Signs of pulp
necrosis and infection-such as: Sinus tract,
gingival swelling, abscess, or increased mobility.
Persistent dark gray discoloration plus one or
more other signs of root canal infection.
Radiographic signs of pulǝ necrosis and infection.
No further root development of immature teeth.
Negative impact on the development and/or
eruption of the permanent successor.
tooth is excessively mobile or extruded > 3 mm,
then extract under local anesthesia. Treatment
should be performed by a child-oriented team
with experience and expertise in the management
of pediatric dental injuries. Extractions have the
potential to cause long-term dental anxiety.
Follow up: Where there are concerns that an
unfavorable outcome is likely, then continue
clinical follow up each year until eruption of the
permanent teeth. Radiographic follow up only
indicated where clinical findings are suggestive of
pathosis (eg, an unfavorable outcome).
Parents should be informed to watch for any
unfavorable outcomes and the need to return to
the clinic as soon as possible. Where unfavorable
outcomes are identified, treatment is often
required.
The follow-up treatment. which frequently
requires the expertise of a child-oriented team, is
outside the scope of these guidelines.
Favorable outcome: Asymptomatic. Pulp healing
with: Normal color of the crown or transient
red/gray or yellow discoloration and pulp canal
obliteration. No signs of pulp necrosis and
infection.
Keels, M. A. (2014). Management of Dental Trauma in a Primary Care
Setting. PEDIATRICS, 133(2), e466–e476. https://doi.org/10.1542/peds.2013-3792
Lateral luxation
Clinical findings: The tooth is displaced, usually
in a palatal/lingual or labial direction. The tooth
will be immobile. Occlusal interference may be
present.
Treatment: If there is minimal or no occlusal
interference, the tooth should be allowed to
spontaneously reposition itself. Spontaneous
repositioning usually occurs within 6 mo. In
situations of severe displacement. two options are
available, both of which require local anesthesia:
-Option A: Extraction when there is a risk of
ingestion or aspiration of the tooth.
Continued root development in immature teeth.
No disturbance to the development and/or
eruption of the permanent successor.
Unfavorable outcome: Symptomatic. Signs of pulp
necrosis and infection-such as: Sinus tract,
gingival swelling, abscess, or increased mobility.
Persistent dark gray discoloration plus one or
more other signs of root canal infection.
Radiographic signs of Pulp necrosis and
infection. No further root development of
immature teeth. Negative impact on the
development and/or eruption of the permanent
successor. No improvement in the position of the
extruded tooth.
-Option B: Gently reposition the tooth .If unstable
in its new position, splint for 4 wk using a flexible
splint attached to the adjacent uninjured teeth.
Treatment should be performed by a child-
oriented team with experience and expertise in the
management of pediatric dental injuries.
Extractions have the potential to cause long-term
dental anxiety.
Follow up: Clinical examination after: 1 wk, 6-8
wk, 6 mo, 1y.
If repositioned and splinted. review after: 1 wk, 4
wk for splint removal, 8 wk, 6 mo, 1 y.
Where there are concerns that an unfavorable
outcome is likely, then continue clinical follow up
each year until eruption of the permanent teeth.
Radiographic follow up only indicated where
clinical findings are suggestive of pathosis (eg. an
unfavorable outcome). Parents should be
informed to watch for any unfavorable outcomes
and the need to return to the clinic as soon as
possible. Where unfavorable outcomes are
identified. treatment is often required. The
follow-up treatment.
Favorable outcome: Asymptomatic. Pulp healing
with: Normal color of the crown or transient
red/gray or yellow discoloration and pulp canal
obliteration. No signs of pulp necrosis and
infection.
Keels, M. A. (2014). Management of Dental Trauma in a Primary Care
Setting. PEDIATRICS, 133(2), e466–e476. https://doi.org/10.1542/peds.2013-3792
Intrusive luxation
Clinical findings: The tooth is usually displaced
through the labial bone plate, or it can impinge on
the permanent tooth bud. The tooth has almost or
completely disappeared into the socket and can be
palpated labially.
Treatment: The tooth should be allowed to
spontaneously reposition itself, irrespective of the
direction of displacement. Spontaneous
improvement in the position of the intruded
tooth usually occurs within 6 mo. In some cases, it
can take up to 1y. A rapid referral (within a couple
of days) to a child-oriented team that has
Continued root development in immature teeth.
Periodontal healing realignment of the laterally
luxated tooth. Normal occlusion. No disturbance
to the development and/or eruption of the
permanent successor.
Unfavorable outcome: Symptomatic. Signs of pulp
necrosis and infection-such as: Sinus tract,
gingival swelling, abscess, or increased mobility.
Persistent dark gray discoloration plus one or
more other signs of root canal infection.
Radiographic signs of Pulp necrosis and infection.
Ankylosis. No further root development of
immature teeth. No improvemen: in position of
the laterally luxated tooth. Negative impact on the
development and/ or eruption of the permanent
successor.
experience and expertise in the managemensof
pediatric dental injuries should be arranged.
Follow up: Clinical examination after: 1 wk, 6-8
wk, 6 mo, 1y.
Further follow up at 6y of age is indicated for
severe intrusion to monitor eruption of the
permanent tooth. Radiographic follow up only
indicated where clinical findings are suggestive of
pathosis (eg, an unfavorable outcome). Parents
should be informed to watch for any unfavorable
outcomes and the need to return to the clinic as
soon as possible. Where unfavorable outcomes are
identified. treatment is often required. The follow
up treatment. which frequently requires the
expertise of a child-oriented team, is outside the
scope of these guidelines.
Favorable outcome: Asymptomatic. Pulp healing
with: Normal color of the crown or transient
red/gray or yellow discoloration and pulp canal
obliteration. No signs of pulp necrosis and
infection.
Continued root development in immature teeth.
Periodontal healing. Re-eruption/realignment of
the intruded tooth. No disturbance to the
Keels, M. A. (2014). Management of Dental Trauma in a Primary Care
Setting. PEDIATRICS, 133(2), e466–e476. https://doi.org/10.1542/peds.2013-3792
Avulsion
Clinical findings: The tooth is completely out of
the socket. The location of the missing tooth
should be explored during the trauma history and
examination, especially when the accident was not
witnessed by an adult or there was a loss of
consciousness.
While avulsed teeth are most often lost out of the
mouth, there is a risk that they can be embedded
in soft tissues of the lip. cheek, or tongue.pushed
into the nose, ingested or aspirated.
If the avulsed tooth is not found the chid should
be referred for medical evaluation to an emergency
room for further examination especially where
there are respiratory symptoms.
Treatment: Avulsed primary teeth should not be
replanted. Parent/patient education: Exercise care
when eating not to further traumatize the injured
development and/ or eruption of the permanent
successor.
Unfavorable outcome: Symptomatic. Signs of pulp
recrosis and infection-such as: Sinus tract.gingival
swelling, abscess, or increased mobility. Persistent
cark gray discoloration with one or more signs of
infection.
Radiographic signs of pulp necrosis and infection.
No further root development of immature teeth.
Ankylosis. Negative impact on the development
and/ or eruption of the permanent successor.
soft tissues.To encourage gingival healing and
prevent plaque accumulation parents should
clean the affected area with a soft brush orcotton
swab combined with an alcohol-free 01%-0.2%
chlorhexidine gluconate mouth rinse applied
topically twice a day for 1 wk.
Follow up: Cincal examination alter: 6-8 wk.
Further follow up at 6 y of age is the permanent
tooth indicated to monitor eruption of the
permanente tooth.
Radiographic follow up only indicated where
dinical findings are suggestive of pathosis (eg, an
unfavorable outcome).
Parents should be informed to watch for any
unfavorable outcomes and the need to return to
the clinic as soon as possible. Where unfavorable
outcomes are identified, treatment is often
required. The follow-up treatment, which
frequently requires the expertise of a child-
oriented team is outside the scope of these
guidelines.
Favorable outcome: No signs of disturbance to
development and/oreruption of the permanent
Successor.
Unfavorable outcome: Negative impact on the
development and/or eruption of the permanent
successor.

Keels, M. A. (2014). Management of Dental Trauma in a Primary Care

Setting. PEDIATRICS, 133(2), e466–e476. https://doi.org/10.1542/peds.2013-3792

After carrying out the analysis, we determined that the following sub-themes are those that cover the objective
of this work:

➢ Injuries to primary teeth

➢ Simple crown fracture with little or no affected dentin
➢ Extensive crown fracture significantly involving dentin but not pulp
➢ Extensive crown fracture with considerable affected dentin and pulp exposure
➢ Traumatized tooth with devitalization with or without loss of coronary structure
➢ Teeth lost as a result of treatment
➢ Tooth displacement without crown and root fracture
➢ Post-traumatic sequelae
➢ Prevention of dental injuries

DISCUSSION

Regarding sex and age, we agree with results that are similar to those found by several authors, who suggest a
predilection for the male sex. It may be because boys play violent sports and games more intensely and
frequently than girls.⁴

However, similar studies show that the most affected age group is 12-14 years old followed by the 5-11 year
old group, arguing the frequency of accidents in these and that games and sports are more active and are not
able to anticipate dangerous situations. With the rapid incorporation of girls into sporting life, it is possible
that in the future both sexes will be in equal proportion.
Most of these studies state that the prevalence of dental lesions increases in parallel with the protrusion of the
incisors; Similarly, they argue that bilabial incompetence limits the natural protection that the lips offer to
the teeth, which is why early diagnosis and treatment of these alterations is necessary to contribute to the
prevention of dental trauma. ⁴

One in five children suffers some type of dental trauma during school age, these results are related to the
psychomotor development of the child and the activities of each age group.
Dental traumas are characterized by the fact that they are not governed by a single etiopathogenic mechanism,
nor do they follow a predictable pattern in terms of intensity or extension.⁴

We believe that the high incidence of trauma can mostly be associated with a low level of information on the
part of parents and educators about prevention measures for dental trauma, hence the importance of carrying
out educational interventions that involve both teachers As tutors, and more intentional should be done in
Physical Education teachers, it is very important to transmit values of equality between both genders at all
levels of society. Doing prevention is the main and most important task, but if the fact of trauma to the teeth
is consummated, no matter how slight the injury may appear, it is imperative to go immediately to the dentist,
and receive the proper assessment and appropriate treatment. It should not be forgotten that leaving it for
later could become a fatal event for the life of the teeth. ⁴
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