Traumatic and non-traumatic dental presentations to the paediatric emergency departments of two UK children's hospitals: A multi-centre evaluation

Endodontic implications of dental trauma: useful tips for primary dental care

Dental trauma is the fifth most common condition affecting human beings worldwide. The dental team can expect to encounter traumatic dental injuries in everyday practice. Dental trauma guidelines guide practice and should be available to the dental team faced with an acute presentation of injury in a patient of any age. The management of dental trauma and the endodontic materials available for intervention of its complications are rapidly evolving. This paper provides an important update for the primary dental care team regarding the endodontic management of dental trauma.

Pediatric non-traumatic dental presentations to the emergency department: a ten year retrospective study in an Australian tertiary hospital

BACKGROUND

Non-traumatic dental conditions (NTDC) that present to the emergency department of a tertiary hospital tend to be related to dental caries, including facial cellulitis, abscess and toothache. This study aimed to report the types of dental conditions and the characteristics of children that presented to an urban tertiary hospital emergency department for NTDC.

METHODS

Medical records were reviewed for children less than 19 years of age who presented to the emergency department over a 10-year period with a NTDC. Principal diagnosis, sociodemographic data and source of referral was obtained with treatment and investigations collated for those who were subsequently admitted.

RESULTS

Across the total 4483 dental presentations, 2481 were NTDC. The most common age group was from 0 to 3 years of age (average 6.3) and 57.2% of children were male. Dental caries related diagnoses were the most common reasons for emergency department presentations. A total of 297 children were admitted for investigations and treatment.

CONCLUSIONS

Children present to emergency departments with caries related conditions more often than traumatic injuries. Targeted interventions are needed to ensure adequate oral health care access for children to avoid overburdening the emergency services in tertiary hospitals with NTDC.

Specialists' management of permanent dentition traumatic dental injuries in 7-16-year-olds: A qualitative study

BACKGROUND/AIM

Specialist paediatric dentists are integral to dental trauma care pathways. General dentists rely on specialist input, more so in complex cases. Little is known about specialists' role in these pathways or the perceived barriers they face. The aim is to explore specialists' role in managing traumatic dental injuries in the permanent dentition in children.

MATERIAL/METHODS

Face-to-face (remote video) online semi-structured interviews were undertaken. All UK specialists were invited by email. Purposeful sampling aimed to investigate representation from the devolved nations, presence/absence of working within a managed-clinical network and level of care provision. Interviews were audio-recorded and transcribed verbatim. Transcripts were thematically analysed.

RESULTS

Data saturation was reached after nine interviews. Three main themes established were: inconsistent access to care; the need to formalise traumatic dental injuries care pathways; educationally upskilling general dentists. Geographical variation in provision of specialist and out-of-hours/emergency department care meant patients risked not receiving care by the most appropriate individual. Formalizing care pathways by clearly defining the role of each stakeholder (specialist, dentist, medical professionals and parents) and developing a method to assess complexity was perceived to be essential to improving treatment outcomes. Upskilling general dentists in trauma management appeared essential. A potential lack of engagement was raised, with a suggestion that trauma management education should become core continuing-professional development.

CONCLUSIONS

Specialist input should be available in the management of traumatic dental injuries. Current access to specialist care is inequitable across the UK. Formalizing care pathways and upskilling general dentists could ease inconsistencies.

Hospital usage for oral and dental conditions in Hawaii: A cross-sectional study using the 2021 Hawaii statewide hospital data

OBJECTIVE

To investigate the frequency of emergency department (ED) usage primarily for oral/dental conditions in Hawaii and to examine social-demographic factors associated with the identified ED visits.

METHODS

This was a cross-sectional study of the 2021 Hawaii Statewide Hospital data. We identified records indicating ED usage and a primary diagnosis of non-traumatic dental conditions (NTDC) and other oral dental conditions (OODC). Descriptive analyses of ED visits for NTDC and OODC were performed to identify vulnerable individuals based on age, sex, race/ethnicity, primary source of payment, county of residence, and total charges per hospital record. A multivariable negative binomial regression model included age, sex, and county of residence was used to obtain adjusted rate ratios (aRR) and 95% confidence intervals (CI) of ED visits for NTDC.

RESULTS

Among hospital records with diagnoses for oral or dental conditions (n = 12,336), 97% indicated ED, of which half had an NTDC diagnosis, and the remaining half had an OODC diagnosis. Distinct differences in the characteristics of ED visits were observed between NTDC and OODC. The median total charges per record indicating ED for NTDC and OODC were $1439 and $2439, respectively. A higher rate of ED visits for NTDC was found for those aged 21-44 (aRR [95%CI] = 3.02 [2.41, 3.80], reference: 0-9 years) and those living in a less populous county (Hawaii: 1.73 [1.43, 2.07]; Kauai: 1.78 [1.45, 2.19], reference: Honolulu).

CONCLUSIONS

Continued effort to improve dental health is required to reduce ED visits for oral and dental conditions among Hawaii residents, especially for vulnerable individuals.

Management of traumatic dental injuries: a survey of paediatric emergency department health professionals

OBJECTIVE

To assess paediatric emergency department (PED) health professionals' confidence, experience and awareness in managing traumatic dental injuries (TDIs).

DESIGN

A cross-sectional online survey.

SETTING

PED at Alder Hey Children's Hospital and Birmingham Children's Hospital.

RESULTS

94 ED health professionals responded. One-third of responders (n=26) encounter children with dental trauma daily or weekly. TDI teaching during undergraduate training was received by 13% (n=12) of responders, and 32% (n=30) had never received training. Responders thought they would benefit from online resources and regular teaching on paediatric TDIs, in addition to an easy-to-use decision-making tool to signpost families.ED health professionals' confidence in giving advice to families following a TDI, and in recognising types of TDIs, was notably low; -79 and -76 Net Promotor Score, respectively.Responders' awareness of how to recognise and manage TDIs was varied. Majority were aware of the need to attempt to reimplant an avulsed permanent tooth, and the need to refer a child presenting with a complex permanent tooth injury to the oncall dentist. However, very few responders commented on the importance of follow-up. Responders also raised concerns about the lack of dental services to treat TDIs in children.

CONCLUSIONS

There is a need to enhance dental trauma teaching for all ED health professionals who encounter TDIs to increase their confidence and enable them to triage and advise patients appropriately. Additionally, increased signposting for families to the appropriate service could in turn improve outcomes and experience for children who experience a TDI.

Variations in temporal trends in non-traumatic dental condition related emergencies

OBJECTIVE

The objective of the study was to investigate temporal trends in non-traumatic dental condition (NTDC) related emergency visits at Emergency Department (ED), urgent care (UC), and at a Federally Qualified Health Center (FQHC) that providing dental services to a mid-sized rural community.

METHODS

Temporal trends over a 9-year period (2008-2016) in NTDC rates at ED, UC, FQHC and in a region around the FQHC were determined. Statistically significant changes (α = 0.05) in the proportion of NTDC visits between FQHC and UC across each of the time points were investigated.

RESULTS

Proportion of NTDC ED visits was relatively stable over the study period; whereas those at FQHC exceeded those at UC site beginning 2012 and were significantly (α = 0.05) higher than that of UC subsequently (2015-2016).

CONCLUSIONS

NTDCs are preventable dental conditions and the care provided in treating NTDCs in emergency settings is palliative and does not address the underlying conditions resulting in poor outcomes. The results presented elucidate the critical role of FQHCs in significantly reducing NTDC visits. These might be precursors to a potential shift in NTDC care seeking behavior and expected to favorably impact oral health outcomes.