Long-Term Management of Dental Trauma, Mitigating Risk Factors, and Optimizing Treatment Outcomes

Abstract

The importance of protective equipment in sports cannot be overstated, as orofacial injuries remain a significant concern among athletes. These injuries, which occur across a wide range of sports, have increasingly been recognized for their immediate and long-term impact on the health and well-being of athletes [1, 2]. This highlights the urgent need for effective preventive measures, such as mouthguards, which have been shown to reduce the risk of dental and soft tissue injuries significantly [1]. By prioritizing orofacial injury prevention, athletes can be better protected not only from short-term injuries but also from long-term complications, fostering a safer and more sustainable approach to sports participation [2, 3]. As digital platforms continue to shape healthcare communication, the quality of available information becomes ever more crucial [4-8]. In this issue, Gezer et al. analyzed the quality and reliability of YouTube videos related to mouthguards in sports dentistry [9]. Their study highlights the marked differences in content quality between videos produced by dental professionals and non-professionals. By examining 300 videos, the authors categorize their findings based on publisher credibility and video types, shedding light on the role of online educational resources in informing athletes about protective measures. This research offers valuable insights into the potential of digital media to both educate and misinform, pointing to the need for better oversight and guidance in online healthcare content.

Furthermore, in this issue, de Bessa et al. present a scoping review that synthesizes data on orofacial injuries resulting from intense physical practices, with a particular focus on dental damage and temporomandibular joint disorders [10]. Understanding the types and prevalence of these injuries is vital for developing effective preventive strategies. Their findings underscore the need for further investigation into preventive measures and for increasing awareness among athletes about the risks associated with high-intensity physical training. The study highlights the growing recognition of these injuries in non-traditional sports and the importance of tailored prevention programs.

The integration of advanced technologies in the design and production of mouthguards holds significant promise for enhancing athlete safety [3]. In this issue, Rondon et al. compared the adaptation, thickness, and shock absorption properties of mouthguards made from conventional plaster models versus three-dimensional printed models [11]. As personalized healthcare continues to gain traction, the authors examine the effectiveness of new manufacturing methods in improving the protective quality of mouthguards. The findings suggest that 3D printing technology could offer enhanced customizations, potentially reducing the risk of dental injuries during sports activities and improving overall performance.

Dental trauma, particularly in immature teeth, presents unique challenges in both immediate management and long-term outcomes. The developing dentition in children is highly vulnerable, and injuries can disrupt future tooth development and function, given the delicate nature of these teeth and the risk of complications that can affect both primary teeth and their permanent successors [12, 13]. In this issue, Kevci et al. explored the complications arising from alveolar bone process fractures in preschool children [14]. This retrospective cohort study examined healing complications in primary teeth and the potential long-term effects on permanent dentition. The findings underscore the importance of early recognition and appropriate management of these injuries, contributing to improved clinical outcomes and the development of preventive strategies in pediatric dentistry.

A variety of studies have examined risk factors for dental and orofacial trauma, investigating elements such as age, gender, behavior, and environmental factors to better understand their impact on injury occurrence and severity [15-19]. In this issue, Ju et al. investigated the relationship between ear health and the incidence of traumatic dental injuries among Indigenous Australian children, a group that faces unique healthcare challenges [20]. Using data from a longitudinal cohort study, the authors explored how ear health, including recurrent ear infections or hearing loss, may influence the likelihood of dental trauma in this population. Their findings offer valuable insights into the complex interplay of health issues that can increase the risk of dental injuries, highlighting the need for integrated healthcare approaches that address both dental and general health [21-23]. This study emphasizes the importance of a multifaceted approach to preventing and managing dental trauma, particularly in communities where access to healthcare may be limited and health disparities are more pronounced [24].

The developing roots of immature teeth are more susceptible to complications, making it essential to explore effective treatment options that support healing and promote proper root maturation [25-27]. In this issue, Maree et al. examined the dynamics of morphological changes following regenerative endodontic treatment over a 60-month period [28]. Using a retrospective cohort design, the study evaluated periapical status and root dimensions in traumatized immature teeth, shedding light on the long-term effects of this treatment. By understanding how root morphology evolves over time, the findings have the potential to refine clinical follow-up protocols and improve long-term treatment outcomes for patients with immature traumatized teeth.

Vertical root fractures in endodontically treated teeth are often challenging to detect and may require advanced imaging techniques for precise identification. In this issue, Hilgert et al. investigated the impact of different acquisition protocols and artifact reduction filters in cone beam computed tomography (CBCT) on diagnosing vertical root fractures in endodontically treated teeth [29]. Their detailed analysis of tomographic images aimed to enhance diagnostic accuracy by evaluating how these imaging parameters influence the detection of fractures, ultimately improving clinical decision-making. The study underscores the importance of optimizing imaging protocols to increase the reliability of CBCT in diagnosing complex endodontic conditions. Integration of advanced imaging technology is essential for advancing endodontic care, improving diagnostic practices, and enabling practitioners to more effectively manage challenging cases, ultimately leading to better long-term outcomes for patients.

Tooth avulsion, the complete displacement of a tooth from its socket, is a serious dental emergency that requires immediate intervention to preserve both the tooth and its surrounding structures. Successful replantation depends on several critical factors, including the timing of replantation, the condition of the periodontal ligament, and the methods used to store the avulsed tooth prior to replantation [30-32]. Despite advancements in treatment techniques, challenges remain in standardizing protocols and improving outcomes, particularly with delayed replantation. In this issue, Tewari et al. addressed the longstanding issue of inconsistent terminology used to describe the time intervals associated with tooth avulsion and replantation [33]. The study included a comprehensive scoping review of 92 studies, followed by a Delphi survey with 20 global experts in dental traumatology to refine and agree upon the most accurate and descriptive terms. The findings offer a potential solution to this persistent issue, which could improve communication and lead to better clinical outcomes in the management of avulsed teeth. Moreover, in this issue, Doiphode and Kalaskar investigated the effects of citric acid and EDTA on the viability of human periodontal ligament cells on dehydrated root surfaces of avulsed teeth [34]. Delayed replantation often leads to complications that compromise long-term success, which has prompted research into treatments that enhance periodontal healing. This in vitro study provides valuable insights into potential therapies that could improve healing outcomes following tooth avulsion. In another in vitro study published in this issue, Harjai and Shanbhog compared the efficacy of amniotic fluid at various gestational stages with Hank's Balanced Salt Solution (HBSS) in preserving periodontal ligament cell viability [35]. Their findings suggest that both types of amniotic fluid can sustain cell viability over time, raising important questions about the best practices for managing avulsed teeth. The selection of an appropriate storage medium is critical for maintaining periodontal vitality and maximizing the chances of successful replantation. Together, these studies contribute to a deeper understanding of how to improve the management of tooth avulsion through better terminology, enhanced periodontal healing, and optimal storage media. Addressing these key aspects enables dental professionals to more effectively navigate the complexities of tooth avulsion, leading to better clinical interventions and improved long-term prognosis for patients.

Dental professionals often lack sufficient knowledge and training in managing dental trauma, which can hinder their ability to provide effective care for patients suffering from traumatic dental injuries [36, 37]. Given the urgency and complexity of TDI management, understanding the specific challenges faced by dental professionals is crucial for improving both clinical outcomes and patient care [38]. In this issue, Cvijic et al. explored the perceived challenges encountered by general dentists in managing TDI within the public dental service in Norway [39]. Through a series of focus group discussions, the study identified key issues such as inadequate proficiency in diagnosing and treating TDIs and the need for more comprehensive training in this area. The findings underscore the critical need for targeted educational programs and continuing professional development to ensure that dentists are fully equipped with the knowledge and skills required to manage traumatic dental injuries effectively [38, 40]. By addressing these gaps in education and training, we can improve the quality of care provided to TDI patients and promote better clinical outcomes across diverse healthcare settings.

In recent years, the experiences of families undergoing pediatric dental procedures have garnered increasing attention, particularly regarding how treatment decisions impact both children and their caregivers [41, 42]. In this issue, Williams et al. examined the experiences of families regarding tooth autotransplantation as a treatment for missing maxillary incisors [43]. Using semi-structured interviews, the study explores the motivations, concerns, and barriers that families encounter when considering this procedure for their children. The findings provide valuable insights into the emotional and practical factors that influence treatment decisions, such as concerns about the procedure's success, recovery, and long-term benefits. By highlighting the perspectives of patients and their families, the study emphasizes the importance of incorporating these viewpoints into treatment planning. It advocates for dental professionals to consider not only clinical factors but also the psychological and emotional needs of families when making decisions about pediatric dental care.