Trauma in Young Permanent Teeth: Factors Associated with Adverse Outcomes

Thesis (Master's)--University of Washington, 2013University of Washington Abstract Trauma in Young Permanent Teeth: Factors Associated with Adverse Outcomes Ahmed Rozi Chair of the Supervisory Committee: Assistant Professor: Ana Lucia Seminario Department of Pediatric Dentistry Purpose: To determine variables associated with adverse outcomes for dental trauma in young anterior permanent teeth in a university dental clinic setting. Methods: Electronic charts (AXIUM) of patients at a university-based dental clinic who experienced dental trauma between July 1, 2009 and June 30, 2012 were included. Variables such as demographics (age, gender, American Society of Anesthesiologists classification, and insurance type), affected teeth distribution, trauma characteristics, type of dental trauma using Andreasen's classification, elapsed time between trauma and immediate treatment, elapsed time between the immediate and final treatment, immediate treatment type, immediate and final restoration type, and number of follow-up visits were evaluated. Adverse outcomes were defined as root canal treatment, decoronation, and extraction. The association between adverse outcomes and each variable of interest was calculated using the Chi Square test, Fisher's Exact Test, and logistic regression. Results: A database of approximately 1265 charts was screened and 50 patients; [age range 7-18 years (mean, 11 years (SD, 3.13)); 32 (64 %) males and 18 (36%) females] were included in this study. The maxillary central incisors were most commonly affected by dental trauma (90%). Adverse outcomes were significantly associated with the type of dental trauma (P = 0.001), presence of luxation injury (P = 0.048), immediate dental treatment (P < 0.001), immediate dental restoration type (P = 0.019), and number of follow-up visits (P < 0.001). Teeth with complicated crown fractures had a greater than 8-times increase in the odds of future adverse outcomes (OR: 8.56; 95% CI: 1.48, 49.35) compared with uncomplicated crown fractures, while the odds for adverse outcomes for teeth without fracture was14 times higher than teeth with uncomplicated crown fractures (OR: 14.67; 95% CI: 1.54, 139.79). The odds of an adverse event when placing a dental restoration at the emergency visit is 0.08 times that of no dental treatment (OR: 0.08; 95% CI: 0.01, 0.54). Specifically, the odds of an adverse event when placing a filling at the emergency visit is 0.21 times the odds of an adverse event with no dental treatment (OR: 0.21; 95% CI: 0.06, 0.75). Patients who come back for more than three times for follow-up visits showed more than nine times higher odds of having an adverse outcome compared with patients who come back for two visits or less (OR: 9.17; 95% CI: 2.00, 42.04). Conclusions: Not treating dental trauma in a timely manner in young permanent teeth might severely impact a good prognosis for the injured tooth. In a university dental clinic setting, the factors associated with adverse outcomes in young permanent teeth after dental trauma were the type of dental trauma, presence of luxation injury, type of immediate dental treatment, type of immediate dental restoration, and number of follow-up visits