The Modern Landscape of Dental Traumatology: From Clinical Precision to Social Responsibility

Ana Beatriz Cantao Liran Levin Intrusion is a complex traumatic dental injury that can present with different severities and result in various outcomes and potential complications 1-3. The nature of the injury might possibly damage several surrounding tissues like the bone, PDL, cementum, pulp, and blood supply. The consequences of intrusion injuries could range from pulp necrosis to ankylosis and tooth loss 4. In this issue, Schweiger et al. evaluated the risk of pulp necrosis, ankylosis, and tooth loss and their associations with the degree of the intrusion, the stage of root development, and the initial treatment administered in a retrospective chart review of hospital records 5. Their study provides further information on prognostic factors that might influence the outcome of permanent teeth who underwent intrusion. Ankylosis presents an important challenge following various types of traumatic dental injuries 6-8. This fusion of the cementum or dentin with the alveolar bone, mainly as a result of an injury to the PDL, poses serious consequences and should be diagnosed and treated accordingly 9, 10. Moreover, ankylosed teeth often present with progressive resorption, commonly referred to as external replacement root resorption, and both are considered irreversible processes 11. In this issue, Kaufman et al. present an observational study assessing the eruption patterns and progression of external replacement root resorption of eight teeth that were avulsed and had delayed replantation treated by regenerative endodontic treatment 12. Their preliminary findings provide some encouraging evidence with regard to the overall prognosis of ankylosed teeth with external inflammatory root resorption. Alveolar bone injuries might result in trauma to the teeth and surrounding tissues and are not uncommon in emergency room visits and hospital admission reports 13-17. These complex injuries often require a multi-disciplinary team to treat the different aspects of the injury 13. In this issue, Xavier et al. describe the epidemiological characteristics of patients with alveolar bone injuries treated at a specialized dental trauma center between 1998 and 2023 18. Understanding the etiology, risk factors as well as the prognostic characteristics of alveolar bone injuries is crucial for future treatment planning and for the decision-making process of these complex injuries. Athletes and other participants in sports activities are known to be more prone to traumatic dental injuries and the prevention of such injuries in this high-risk population has been advocated for by various associations and research groups 19-29. In this issue, Hamdan and Dashash, in a cross-sectional study, report on the prevalence and characteristics of orofacial-dental trauma among athletes aged 6–16 years in Damascus, Syria 30. Their results show a very high prevalence of traumatic dental injuries and highlight the urgent need for education, regulation, and enforcement of the use of mouthguards and other protective measures to prevent or reduce the risk of dental trauma among athletes. Domestic abuse is a serious world-wide concern with extremely important public health implications 31. Injuries to the teeth, head and neck areas are seen in many of the victims 32-36 and thus, dental professionals might often be well-positioned and play a crucial role in identifying and supporting victims of domestic abuse 37, 38. In this issue, Berger et al. explored how domestic abuse, particularly its physical, psychological, and social impacts, were represented, perceived, and discussed on social media 39. The study used web-scraping methods to reveal the perception of the victims and survivors of domestic abuse, and the findings highlight the need for further education for health and dental care professionals on the topic of domestic violence and abuse 38, 40, 41. The ToothSOS mobile app was developed and introduced by the International Association of Dental Traumatology (IADT) in 2018 and gained awareness and users gradually during the years since its inauguration 42-47. The app contains information on the emergency management and prevention of dental injuries for the lay public, as well as treatment guidelines for dental practitioners 42. This issue presents two papers related to the awareness and the efficacy of the app in improving knowledge on traumatic dental injuries' emergency management. Ozdemir et al. evaluated the effectiveness of the ToothSOS mobile application in enhancing undergraduate dental students' knowledge of the emergency management of dental trauma cases 48. They demonstrated that both the professional and the patient-facing section of the ToothSOS app were able to improve the dental students' knowledge and decision-making accuracy regarding traumatic dental injuries 48. Further in the issue, Cagay Sevencan et al. in a cross-sectional study, revealed a lack of awareness among family physicians, highlighting the importance of keeping them updated and educated with regard to the latest advances and guidelines in dental traumatology 49. Limited awareness and knowledge with regard to emergency management of dental trauma and mouthguard use was also reported among youth basketball players in a cross-sectional study by Comert et al. published in this issue 50. This emphasizes the urgent need for further educational efforts both within the dental field and out of it, in the inter-disciplinary community of health care professionals 51-55. As technology, social media, and web-based information resources are rapidly developing, there is the constant question and concern about the reliability and accuracy of information available online with regard to dental trauma treatment and prevention 56-60. In this issue, Gupta et al. assessed the quality, accuracy, and reliability of YouTube and Vimeo videos in terms of the information regarding the management of tooth fractures 61. Despite the prevalence of professionally authored content on tooth fracture management, the qualitative output was reported to be significantly subpar. Consequently, the dissemination of inaccurate or incomplete data might pose a substantial risk to clinical outcomes in emergency dental scenarios. Vital pulp therapy is commonly used in cases of traumatic pulpal exposure in permanent teeth 62-64. In this issue, Sharma et al. performed an evaluation of the existing systematic reviews to assess the success of vital pulp therapy for managing traumatic pulpal exposures in permanent teeth 65. Continuous improvement of our understanding of the biological healing processes together with thorough documentation and publication of data from large cohorts of patients with long-term follow-ups will increase our ability to provide better guidelines and a high level of treatment to our patients. The use of energy drinks is gaining attention and popularity in the last years with various reports on adverse effects of their regular usage 66, 67. One of the potential effects of energy drinks is the development of enamel erosions due to repeated contact between the teeth and acidic beverages along with mechanical stress seen on athletes' teeth 68. In this issue, Elias et al. evaluated the erosive potential of commercially available energy and sports drinks on human enamel and assessed the protective effects of three toothpaste formulations 69. Educating athletes and others on the effects related to energy drinks as well as follow-up and assessment of oral health among them is an integral part of our duties to our patients and the communities we serve 70. This includes prevention not only of traumatic dental injuries but also of other oral diseases and conditions like caries and enamel erosion. Protective faceshields are recommended to prevent injuries to the face and mouth, but they can also be used as a protective device while recovering from an injury 28. They can reduce injuries to the teeth, mouth, eyes, nose, and bones of the face 28, 71, 72. With the development of new materials and technologies, there is a constant effort to improve the efficacy, comfort, and usability of faceshields 73, 74. In this issue, Gonçalves et al. investigated the influence of raster angles on the mechanical properties of 3D-printed facial protectors using polylactic acid and thermoplastic polyurethane materials 75. An important aspect of the growing body of knowledge with regard to novel techniques and materials is the thorough and constant evaluation of the results in order to make sure we are using these advances in the optimal way. Lastly, in this issue, Puranik et al. report on two cases of cemental tears in pediatric patients secondary to traumatic dental injuries 76. They also suggest a radiographic classification of cemental tears secondary to traumatic dental injuries to help achieve timely diagnosis and management 76. Enhanced diagnostic vigilance regarding cemental tears among pediatric and general dental practitioners is imperative to facilitate early detection, optimize therapeutic management, and improve long-term clinical outcomes for this frequently underdiagnosed phenomenon. The authors have nothing to report.