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RESEARCH PRODUCT

The Treatment of Anterior Dental Trauma

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Anterior dental trauma is a common injury pattern of the dentoalveolar system in which appropriate first aid is important. When children and adolescents suffer an anterior dental trauma, the challenge is to preserve the tooth in this esthetically important area and minimize subsequent damage. Lack of treatment or improper treatment can lead to a lifelong need for dental care. There are many causes of anterior dental trauma. At the age of one and two years, it is mainly caused by falls when learning to walk. At preschool age, between two and six years, many such injuries are caused by falls resulting from lack of attention when engaging in physical play. The highest incidence of anterior dental trauma occurs between seven and twelve years of age (1– 4). The leading cause is the increase in sporting activities and in confrontations with others of the same age. After traffic accidents and physical fights, sporting injuries are one of the main causes of anterior dental trauma (5, 6), and the prevalence of these injuries varies between different types of sport (7– 10). Anterior dental trauma during school sports classes accounts for 2.3% of all sports accidents in Germany (7). Because of the high frequency of dental trauma and the expensive, lengthy care it can require, the German Dental Association (BZAK, Bundeszahnarztekammer) recommends that all kindergartens, schools, sports centers, dental practices, and medical institutions should keep a stock of tooth rescue boxes (5). Because anterior dental trauma is often caused by accidents that also cause limb fractures, concussion, or life-threatening injuries (11), it is frequently overlooked, as emergency care initially concentrates on more important issues. As a result, it often becomes impossible to provide appropriate treatment that would allow the affected front tooth to be saved. At the same time, the preservation of an intact permanent tooth, which unlike deciduous teeth will not be naturally replaced by the body, is extremely important to the further psychological development of the affected person (12). Various studies involving surveys have shown that the loss of a front tooth in children and adolescents is evaluated unfavorably in both psychological and social terms. These problems include both exclusion by peers because of the visible flaw, which can lead to social deprivation (13), and a feeling of embarrassment when laughing and avoidance of contact with peers (13, 14). However, there are also practical reasons for providing immediate care for anterior dental trauma in order to avoid subsequent interventions: If a front tooth is lost before the jaw has finished growing, it cannot be replaced with an artificial implant, as implants heal ankylotically. This would lead to the alveolar process developing further around the implant as the jaw grew, leading to an esthetically unpleasing result in the long term following crown treatment. If left untreated, the loss of a permanent tooth causes severe damage to the alveolar process that subsequently requires extensive surgeries to repair, in order to achieve an esthetically and functionally satisfactory result.