Trauma
Kyle Edmonds, DDS (he/him/his)
Dental Resident
Boston Children’s Hospital, Boston, MA
Harvard University School of Dental Medicine
Cambridge, Massachusetts, United States
Zameera Fida, DMD
Pediatric Dental Attending
Boston Children's Hospital
Boston Children's Hospital
Boston, Massachusetts, United States
Zameera Fida, DMD
Pediatric Dental Attending
Boston Children's Hospital
Boston Children's Hospital
Boston, Massachusetts, United States
Isabelle Chase, DDS, FRCD(C)
Program Director
Boston Children's Hospital
Harvard School of Dental Medicine
Boston, Massachusetts, United States
Purpose:
Dental trauma is a commonly occurring injury, especially among children and young adults. Intervention is vital for the functionality of traumatized teeth and the social and physiological well-being of the patient. The purpose of this study is to evaluate if current clinical practices in the Boston Children’s Hospital Emergency Department (BCH ED) are resulting in optimal outcomes for the patient.
Methods:
Review was conducted of initial traumatic complicated fractures of permanent incisors in the absence of luxation injury, and therapies rendered from January 2015 to January 2021. Time to treatment, pulpal therapy, materials, and treatment rendered were evaluated. Pulpal vitality was also assessed over time. Treatment rendered in the BCH ED was considered a failure if endodontic treatment was needed in the future. Binary logistic regressions were completed for predictor variables to assess statistical significance for future treatment failure.
Results:
Three hundred and eighty-one cases were reviewed with 56 instances of pulpal exposure. The average time to treatment was 5.6 hours after trauma. Of the 56 instances, 11 needed root canal treatment at a later date (19.6%). All of these treatment failures were associated with increased time to treatment (7.4 hours), calcium hydroxide use, and cotton roll isolation. Binary logistical regressions found statistical significance for increased time to treatment, and calcium hydroxide use as predictors for treatment failure. There was no statistical significance with isolation method.
Conclusions:
This evidence shows correlation of treatment failure with increased time to treatment, and calcium hydroxide use. This is helpful to inform current treatment protocols for emergency dental services.