Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Evaluation and management of dental injuries in children

Dennis J McTigue, DDS
Section Editors
Ann Griffen, DDS, MS
Richard G Bachur, MD
Deputy Editor
James F Wiley, II, MD, MPH


Nearly one-half of children sustain some type of dental injury during childhood. Many of these injuries are preventable. The injuries that result in the loss of permanent teeth may have long-lasting cosmetic, functional, economic, and psychosocial effects [1-5]. The outcome for a number of dental injuries, which may be uncertain until the permanent dentition is established, is improved by prompt, appropriate treatment and referral.

This topic will cover injuries of the teeth. The anatomy and development of the teeth; intra-oral, lip, and tongue lacerations; and the assessment and management of jaw injuries are discussed separately:

(See "Anatomy and development of the teeth".)

(See "Assessment and management of intra-oral lacerations".)

(See "Assessment and management of lip lacerations".)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Aug 11, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Häyrinen-Immonen R, Sane J, Perkki K, Malmström M. A six-year follow-up study of sports-related dental injuries in children and adolescents. Endod Dent Traumatol 1990; 6:208.
  2. Kaste LM, Gift HC, Bhat M, Swango PA. Prevalence of incisor trauma in persons 6-50 years of age: United States, 1988-1991. J Dent Res 1996; 75 Spec No:696.
  3. Zadik D, Chosack A, Eidelman E. The prognosis of traumatized permanent anterior teeth with fracture of the enamel and dentin. Oral Surg Oral Med Oral Pathol 1979; 47:173.
  4. Gutmann JL, Gutmann MS. Cause, incidence, and prevention of trauma to teeth. Dent Clin North Am 1995; 39:1.
  5. Robertson A, Norén JG. Subjective aspects of patients with traumatized teeth. A 15-year follow-up study. Acta Odontol Scand 1997; 55:142.
  6. Andreasen JO, Ravn JJ. Epidemiology of traumatic dental injuries to primary and permanent teeth in a Danish population sample. Int J Oral Surg 1972; 1:235.
  7. Andreasen, J, Andreasen, F. Textbook and Color Atlas of Traumatic Injuries to the Teeth, 3rd ed, Munksgaard, Copenhagen 1994.
  8. Forsberg CM, Tedestam G. Traumatic injuries to teeth in Swedish children living in an urban area. Swed Dent J 1990; 14:115.
  9. Andreasen JO. Challenges in clinical dental traumatology. Endod Dent Traumatol 1985; 1:45.
  10. Wilson S, Smith GA, Preisch J, Casamassimo PS. Epidemiology of dental trauma treated in an urban pediatric emergency department. Pediatr Emerg Care 1997; 13:12.
  11. Becker DB, Needleman HL, Kotelchuck M. Child abuse and dentistry: orofacial trauma and its recognition by dentists. J Am Dent Assoc 1978; 97:24.
  12. da Fonseca MA, Feigal RJ, ten Bensel RW. Dental aspects of 1248 cases of child maltreatment on file at a major county hospital. Pediatr Dent 1992; 14:152.
  13. Jessee SA. Orofacial manifestations of child abuse and neglect. Am Fam Physician 1995; 52:1829.
  14. Galea H. An investigation of dental injuries treated in an acute care general hospital. J Am Dent Assoc 1984; 109:434.
  15. Roberts, G, Longhurst, P. The problem: Classification, epidemiology and aetiology. In: Oral and Dental Trauma in Children and Adolescents, Oxford University Press, Oxford 1996. p.8.
  16. Stockwell AJ. Incidence of dental trauma in the Western Australian School Dental Service. Community Dent Oral Epidemiol 1988; 16:294.
  17. von Arx T. Developmental disturbances of permanent teeth following trauma to the primary dentition. Aust Dent J 1993; 38:1.
  18. Järvinen S. Fractured and avulsed permanent incisors in Finnish children. A retrospective study. Acta Odontol Scand 1979; 37:47.
  19. Keels MA, Section on Oral Health, American Academy of Pediatrics. Management of dental trauma in a primary care setting. Pediatrics 2014; 133:e466.
  20. Baccetti T, Antonini A. Dentofacial characteristics associated with trauma to maxillary incisors in the mixed dentition. J Clin Pediatr Dent 1998; 22:281.
  21. Forsberg CM, Tedestam G. Etiological and predisposing factors related to traumatic injuries to permanent teeth. Swed Dent J 1993; 17:183.
  22. Ogunbodede EO, Adamolekun B, Akintomide AO. Oral health and dental treatment needs in Nigerian patients with epilepsy. Epilepsia 1998; 39:590.
  23. Kvittem B, Hardie NA, Roettger M, Conry J. Incidence of orofacial injuries in high school sports. J Public Health Dent 1998; 58:288.
  24. Perez R, Berkowitz R, McIlveen L, Forrester D. Dental trauma in children: a survey. Endod Dent Traumatol 1991; 7:212.
  25. Sheps SB, Evans GD. Epidemiology of school injuries: a 2-year experience in a municipal health department. Pediatrics 1987; 79:69.
  26. Schatz JP, Joho JP. A retrospective study of dento-alveolar injuries. Endod Dent Traumatol 1994; 10:11.
  27. World Health Organization. Application of the International Classification of Diseases to Dentistry and Stomatology, 3rd ed, Geneva 1995.
  28. Malmgren B, Andreasen JO, Flores MT, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Dent Traumatol 2012; 28:174.
  29. Nelson LP, Shusterman S. Emergency management of oral trauma in children. Curr Opin Pediatr 1997; 9:242.
  30. Wilson CF. Management of trauma to primary and developing teeth. Dent Clin North Am 1995; 39:133.
  31. Bertolami CN, Kaban LB. Chin trauma: a clue to associated mandibular and cervical spine injury. Oral Surg Oral Med Oral Pathol 1982; 53:122.
  32. Clark JC, Jones JE. Tooth fragments embedded in soft tissue: a diagnostic consideration. Quintessence Int 1987; 18:653.
  33. Fried I, Erickson P, Schwartz S, Keenan K. Subluxation injuries of maxillary primary anterior teeth: epidemiology and prognosis of 207 traumatized teeth. Pediatr Dent 1996; 18:145.
  34. Harding AM, Camp JH. Traumatic injuries in the preschool child. Dent Clin North Am 1995; 39:817.
  35. Brin I, Fuks A, Ben-Bassat Y, Zilberman Y. Trauma to the primary incisors and its effect on the permanent successors. Pediatr Dent 1984; 6:78.
  36. Moss SJ, Maccaro H. Examination, evaluation and behavior management following injury to primary incisors. N Y State Dent J 1985; 51:87.
  37. Fried I, Erickson P. Anterior tooth trauma in the primary dentition: incidence, classification, treatment methods, and sequelae: a review of the literature. ASDC J Dent Child 1995; 62:256.
  38. Cvek M, Cleaton-Jones P, Austin J, et al. Effect of topical application of doxycycline on pulp revascularization and periodontal healing in reimplanted monkey incisors. Endod Dent Traumatol 1990; 6:170.
  39. Emerich K, Wyszkowski J. Clinical practice: dental trauma. Eur J Pediatr 2010; 169:1045.
  40. Andersson L, Andreasen JO, Day P, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol 2012; 28:88.
  41. Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM. Replantation of 400 avulsed permanent incisors. 4. Factors related to periodontal ligament healing. Endod Dent Traumatol 1995; 11:76.
  42. Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM. Replantation of 400 avulsed permanent incisors. 1. Diagnosis of healing complications. Endod Dent Traumatol 1995; 11:51.
  43. Lekic P, Kenny D, Moe HK, et al. Relationship of clonogenic capacity to plating efficiency and vital dye staining of human periodontal ligament cells: implications for tooth replantation. J Periodontal Res 1996; 31:294.
  44. Layug ML, Barrett EJ, Kenny DJ. Interim storage of avulsed permanent teeth. J Can Dent Assoc 1998; 64:357.
  45. Trope M, Friedman S. Periodontal healing of replanted dog teeth stored in Viaspan, milk and Hank's balanced salt solution. Endod Dent Traumatol 1992; 8:183.
  46. Krasner P, Rankow HJ. New philosophy for the treatment of avulsed teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995; 79:616.
  47. Blomlöf L, Otteskog P, Hammarström L. Effect of storage in media with different ion strengths and osmolalities on human periodontal ligament cells. Scand J Dent Res 1981; 89:180.
  48. Belmonte FM, Macedo CR, Day PF, et al. Interventions for treating traumatised permanent front teeth: luxated (dislodged) teeth. Cochrane Database Syst Rev 2013; :CD006203.
  49. Diangelis AJ, Andreasen JO, Ebeleseder KA, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dent Traumatol 2012; 28:2.
  50. Cvek M. A clinical report on partial pulpotomy and capping with calcium hydroxide in permanent incisors with complicated crown fracture. J Endod 1978; 4:232.
  51. Cvek M, Cleaton-Jones PE, Austin JC, Andreasen JO. Pulp reactions to exposure after experimental crown fractures or grinding in adult monkeys. J Endod 1982; 8:391.
  52. Murchison DF, Worthington RB. Incisal edge reattachment: literature review and treatment perspectives. Compend Contin Educ Dent 1998; 19:731.
  53. Trushkowsky RD. Esthetic, biologic and restorative considerations in coronal segment reattachment for a fractured tooth: a clinical report. J Prosthet Dent 1998; 79:115.
  54. Fuks AB, Gavra S, Chosack A. Long-term followup of traumatized incisors treated by partial pulpotomy. Pediatr Dent 1993; 15:334.
  55. American Academy of, Pediatrics. Tetanus (lockjaw). In: Red Book: 2009 Report of the Committee on Infectious Diseases, 28th ed, Pickering, LK (Eds), American Academy of Pediatrics, Elk Grove Village 2009. p.655.
  56. Hammarström L, Blomlöf L, Feiglin B, et al. Replantation of teeth and antibiotic treatment. Endod Dent Traumatol 1986; 2:51.
  57. Sae-Lim V, Wang CY, Choi GW, Trope M. The effect of systemic tetracycline on resorption of dried replanted dogs' teeth. Endod Dent Traumatol 1998; 14:127.
  58. Ben-Bassat Y, Brin I, Zilberman Y. Effects of trauma to the primary incisors on their permanent successors: multidisciplinary treatment. ASDC J Dent Child 1989; 56:112.
  59. Cole B, Welbury R. Malformation in the primary and permanent dentitions following trauma prior to tooth eruption: a case report. Endod Dent Traumatol 1999; 15:294.
  60. Brin I, Ben-Bassat Y, Zilberman Y, Fuks A. Effect of trauma to the primary incisors on the alignment of their permanent successors in Israelis. Community Dent Oral Epidemiol 1988; 16:104.
  61. Tronstad L. Root resorption--etiology, terminology and clinical manifestations. Endod Dent Traumatol 1988; 4:241.
  62. Holan G, Fuks AB. The diagnostic value of coronal dark-gray discoloration in primary teeth following traumatic injuries. Pediatr Dent 1996; 18:224.
  63. Sonis AL. Longitudinal study of discolored primary teeth and effect on succedaneous teeth. J Pedod 1987; 11:247.
  64. Soxman JA, Nazif MM, Bouquot J. Pulpal pathology in relation to discoloration of primary anterior teeth. ASDC J Dent Child 1984; 51:282.
  65. Borum MK, Andreasen JO. Sequelae of trauma to primary maxillary incisors. I. Complications in the primary dentition. Endod Dent Traumatol 1998; 14:31.
  66. American Dental Association and Academy for Sports Dentistry. Protect your smile with a mouthguard, 1999.
  67. Woodmansey KF. Athletic mouth guards prevent orofacial injuries. J Am Coll Health 1997; 45:179.
  68. Nowjack-Raymer RE, Gift HC. Use of mouthguards and headgear in organized sports by school-aged children. Public Health Rep 1996; 111:82.
  69. Position Statement: A properly fitted mouthguard. Academy for Sports Dentistry Newsletter 1998; 15:10.
  70. Ranalli DN. Prevention of sports-related traumatic dental injuries. Dent Clin North Am 2000; 44:35.
  71. Chaconas SJ, Caputo AA, Bakke NK. A comparison of athletic mouthguard materials. Am J Sports Med 1985; 13:193.
  72. Hoffmann J, Alfter G, Rudolph NK, Göz G. Experimental comparative study of various mouthguards. Endod Dent Traumatol 1999; 15:157.
  73. Oikarinen KS, Salonen MA, Korhonen J. Comparison of the guarding capacities of mouth protectors. Endod Dent Traumatol 1993; 9:115.
  74. DeYoung AK, Robinson E, Godwin WC. Comparing comfort and wearability: custom-made vs. self-adapted mouthguards. J Am Dent Assoc 1994; 125:1112.
  75. McNutt T, Shannon SW Jr, Wright JT, Feinstein RA. Oral trauma in adolescent athletes: a study of mouth protectors. Pediatr Dent 1989; 11:209.
  76. Flanders RA, Bhat M. The incidence of orofacial injuries in sports: a pilot study in Illinois. J Am Dent Assoc 1995; 126:491.
  77. Maestrello-deMoya MG, Primosch RE. Orofacial trauma and mouth-protector wear among high school varsity basketball players. ASDC J Dent Child 1989; 56:36.
  78. Holmes C. Mouth protection in sport in Scotland--a review. Br Dent J 2000; 188:473.
  79. Rodd HD, Chesham DJ. Sports-related oral injury and mouthguard use among Sheffield school children. Community Dent Health 1997; 14:25.
  80. Ranalli DN. Prevention of craniofacial injuries in football. Dent Clin North Am 1991; 35:627.
  81. Hamilton FA, Hill FJ, Mackie IC. Investigation of lay knowledge of the management of avulsed permanent incisors. Endod Dent Traumatol 1997; 13:19.