Initial management of paediatric dento-alveolar trauma in the permanent dentition: a multi-centre evaluation

Key Points There is a recognised delay in presentation to tertiary centres following paediatric dental trauma. There is a need for paediatric dentistry staff to be proactive in providing regular dental trauma related teaching for their local A&E personnel. Priority should be given to more effective teaching to increase knowledge and confidence in dental trauma management. Objective To investigate the time lapse prior to provision of emergency dental care and appropriateness of earliest treatment provided for children with dental trauma. Design A multi-regional prospective and cross-sectional survey. Setting Paediatric dental departments of Liverpool, Manchester and Sheffield. Subjects One hundred and fifty referred or emergency paediatric patients with trauma to the permanent incisors. Results One hundred and fifty subjects were recruited. Mean age of the subjects was 11.1 years (SD = 2.6; range = 6.2-16.6); 100 were male and 50 were female. The mean time interval from injury until initial presentation to a health care professional was 22.6 hours (SD = 76.1; range = 0-672). Thirty-six percent of children (n = 54) first presented to a general dental practitioner whilst 30% (n = 45) presented to accident and emergency medical staff. Following initial assessment, a further mean time lapse of 8.1 hours (SD = 43.7; range = 0-504) was incurred in 25% of cases prior to dental referral. In 39% of subjects (n = 58/150), treatment was considered inappropriate. The most frequent example of inadequate management was failure to protect exposed dentine, which was found for 71% (n = 24/34) of complicated crown fractures and 40% (n = 25/62) of uncomplicated crown fractures. Conclusion This study identified marked delays in the management of some paediatric dental trauma to permanent incisor teeth which, in itself, could be suboptimal. Greater educational and clinical support would seem to be warranted in this area of service provision.