Management of dental trauma in children and adolescents

Maxillofacial injuries in the pediatric patient

Approximately 22 million children are injured in the United States annually. Children are uniquely susceptible to craniofacial trauma because of their greater cranial-mass-to-body ratio. The pediatric population sustains 1% to 14.7% of all facial fractures. The majority of these injuries are encountered by boys (53.7% - 80%) who are involved in motor vehicle accidents (up to 80.2%). The incidence of other systemic injury concomitant to facial trauma is significant (10.4% - 88%). The management of the pediatric patient with maxillofacial injury should take into consideration the differences in anatomy and physiology between children and adults, the presence of concomitant injury, the particular stage in growth and development (anatomic, physiologic, and psychologic), and the specific injuries and anatomic sites that the injuries affect. This comprehensive review, based on the last 25 years of the world's English-speaking surgical literature, presents current thoughts on the anatomic and physiologic differences between adults and children, a synopsis of childhood growth and development, and an overview of state-of-the-art management of the pediatric patient who has sustained maxillofacial injury.

Fractures of the facial skeleton in children

Among 3,908 patients with fractures of the facial skeleton hospitalized in a 25-year period, 202 were children. 69% were boys and 31% girls. A child is most active at the age of fourteen. Fractures of the upper alveolar bone and the condyle were the most common. We compared the pattern of fractures in children and those in adults recorded at the same period of time.

Prophylactic penicillin for intraoral wounds

We conducted a prospective, double-blind, placebo-controlled study in adult patients to determine whether prophylactic penicillin prevents infection in intraoral lacerations secondary to minor trauma or seizures. Uninfected full-thickness, mucosal-only, or through-and-through wounds presenting within 24 hours of injury were considered. Management consisted of cleansing, irrigation, debridement, and closure as indicated: no topical antibiotics were applied. Patients were randomly assigned to receive penicillin VK 500 mg or identically appearing placebo four times daily for five days. Home wound care was standardized and patients were followed for a minimum of four or five days. Infection was assessed clinically. Seventy-six patients were enrolled and 62 completed the study. Penicillin (30) and placebo (32) groups were similar in all parameters except wound etiology; assault was more common in the placebo group (P = .02). Two infections occurred in patients receiving penicillin, and six infections were seen among placebo-treated patients (P = .05, beta = 0.17). When patients poorly compliant with therapy were eliminated from analysis, none of the penicillin-treated patients and five of the placebo-treated patients developed infections (P = .027). Our data suggest that patients with intraoral wounds may benefit from prophylactic penicillin if compliant with their therapy. More studies are needed to further delineate the usefulness of prophylactic antibiotics for these wounds.

Mouthguards and the role of sporting team dentists

With the increased popularity of contact sports and encouragement to participate at an early age, the role of the dental profession in relation to prevention of dental and other orofacial sporting injuries has become more important. Provision of professionally-fitted (custom) mouthguards for persons involved in contact sports, recognition of the 'injury prone dentition', and expertise in immediate management of dental injuries form the basis of sports dentistry. The aim of this review paper is to increase professional awareness and interest. Additionally, it is hoped to stimulate dentists to become involved as sporting club consultants.