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Traumatic oral injuries in children involve trauma to the dentition and the surrounding oral soft tissue structures. They usually present as an emergency hence their management poses a challenge globally. Treatment of a tooth fracture, displacement or loss is determined by the type and severity of the injury independent of the etiology. It necessitates the experience for behavior management in a child, ascertaining a patient centered diagnosis, formulating a definitive treatment plan, explanation and consent of oral care to the parents or carer with optimal operator skills. This article provides an overview on the types of oral injury in a child patient, their recognition, diagnosis and management based on credible, practical and readily understandable evidence.

Traumatic injuries to the primary dentition present special problems and the management is often different as compared with the permanent dentition. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialities were included in the task group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care for management of primary teeth injuries. The IADT cannot and does not guarantee favorable outcomes from strict adherence to the guidelines, but believe that their application can maximize the chances of a positive outcome. The Hebrew Edition is part of the IADT global effort to provide a worldwide accessibility to these guidelines. This third part will discuss injuries in the primary dentition.

Traumatic injuries to the primary dentition present special problems and the management is often different as compared with the permanent dentition. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialities were included in the task group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care for management of primary teeth injuries. The IADT cannot and does not guarantee favorable outcomes from strict adherence to the guidelines, but believe that their application can maximize the chances of a positive outcome., (© 2012 John Wiley & Sons A/S.)

Crown dilaceration of permanent teeth occurs due to the non-axial displacement of the already formed hard tissue portion of the developing crown at an angle to their longitudinal axis due to trauma to the primary predecessors. This is a rare condition, representing only 3% of the total of injuries to developing teeth and usually occurs in permanent maxillary incisors because of the close proximity of their tooth germs to the primary incisors, which are more susceptible to trauma. This alteration frequently results from the intrusion of a primary tooth when the child is around 2 years of age, at which time half of the crown of the permanent successor is already formed. Teeth with dilacerated crowns may either erupt with buccal or lingual displacement or remain impacted. The treatment may involve endodontic, orthodontic, restorative and prosthetic procedures. This paper reports the restorative treatment proposed to reestablish the esthetics and function of the affected teeth in three cases of crown dilaceration in permanent maxillary incisors after trauma to their primary predecessors.

This article overviews the diagnosis and management of traumatic injuries to primary teeth. The child's age, ability to cooperate for treatment, and the potential for collateral damage to developing permanent teeth can complicate the management of these injuries. The etiology of these injuries is reviewed including the disturbing role of child abuse. Serious medical complications including head injury, cervical spine injury, and tetanus are discussed. Diagnostic methods and the rationale for treatment of luxation injuries, crown, and crown/root fractures are included. Treatment priorities should include adequate pain control, safe management of the child's behavior, and protection of the developing permanent teeth.

Severe sequelae may result from trauma to the primary teeth. Since as many as 51% of infants under age 6 may present such lesions, it seems logical that all members of the medical team be aware of their importance and treatment. Prompt and appropriate treatment will allow, in the majority of cases, to preserve the primary teeth. This, in turn, is the safest way to allow proper growth of the maxillaries and the permanent teeth. The present article reviews the various lesions, their treatment and follow-up to bring this public health problem to the attention of all the medical profession.

The ever increasing number of injuries to deciduous teeth in children constitutes a serious problem in paedodontics. Among many factors that facilitate tooth injuries are malocclusions, and most specifically protrusions of upper incisors of Class II/1 according to Angle. This is a case report of a 6-year-old girl with irregularities of upper permanent incisors due to traumatic injuries to deciduous teeth. In view of the ongoing child development processes, medical check-ups following injuries to deciduous teeth should be undertaken once every two or three months. Since such injuries have an impact on the development of the masticatory organ, children should undergo medical inspection and observation immediately upon the completion of relevant post-trauma treatment.

Approximately half of children sustain some type of dental injury. Management of injuries to the anterior teeth of preschool children is directed toward minimizing potential damage to the developing permanent teeth; therefore, heroic measures to save primary teeth are not indicated. Crown fractures in the permanent dentition, even those exposing the dental pulp, can be successfully treated hours after an injury. Prompt referral for dental treatment is advisable. Displacement injuries to permanent teeth constitute genuine dental emergencies in which the prognosis is directly related to the timeliness of treatment. Avulsed permanent teeth should be immediately reimplanted by any capable person. If that is impossible, the teeth should be placed in cold milk and the child referred for immediate treatment by a dentist. Mouthguards prevent dental injuries but are not widely used outside of a few organized sports. Efforts should continue to promote mouthguard use in all contact sports.

An overview of the various possibilities for trauma to the primary and young permanent dentition has been presented. Appropriate treatment procedures have been described. Advances in dental science have been great, and dental materials have become superior to what they were just a few years ago. The dentist must never forget the variabilities of human responses to any of the treatment techniques, however, and the dentist must never be dogmatic in approach. The dentist should be able to diagnose, interpret, and alter any of the treatment techniques as more scientific evidence is obtained.

This article seeks to aid the busy dentist by providing a basic guide to treating fractured and traumatized primary teeth and soft tissues. Simple guidelines for a step-by-step approach to the efficient care of traumatized primary teeth are given.

Two hundred and eighty-seven children with a total of 545 traumatized primary upper incisors were followed using standardized procedures until the age of 10. Extraction was the only treatment offered when intervention was necessary. The immediate as well as the long-term consequences of trauma were studied on the basis of this material. Consequences in the primary dentition comprised: color changes (53%), pulp necrosis (25%), pulp canal obliteration (36%), gingival retraction (6%), permanent displacement after luxation (5-22%), pathological root resorption (1-10%) as well as disturbances in physiological root resorption (4%) and, lastly, premature tooth loss (46%). In a multivariate analysis of the development of pulp necross in primary teeth after trauma, the following decisive factors were found: age of the patient at the time of injury, degree of displacement of the tooth as well as the degree of loosening and presence of crown fracture. The factors found to influence development of pulp canal obliteration were: displacement of the tooth at time of injury as well as detectable physiologic root resorption at time of trauma. The presence of crown fracture seemed to decrease the risk of obliteration. The need for scientifically based treatment strategies for managing and reducting complications after trauma in the primary dentition is stressed.

The dental practitioner who has to examine a child who has suffered dental trauma also has to manage the parents, who are often as upset as the patient. This paper, the first in a short series of management of various types of dental trauma, presents the steps necessary to formulate a treatment plan for such patients in a logical, step-by-step sequence.

A review of the literature is presented to discuss anterior tooth trauma in the primary dentition. Studies show that the incidence ranges from 4 percent to 30 percent and varies depending upon the sex and age of the child. Classification of the type of trauma is subdivided into trauma to the tooth and trauma to the periodontium. Treatment modalities depend upon various factors and range from nontreatment to splinting to extraction. Possible sequelae of primary tooth trauma may include tooth discoloration, loss of vitality, root resorption and/or abscess formation. Careful follow-up is recommended following any type of trauma, because the ultimate goal in treatment is to prevent damage to the permanent successor.