Our duty to promote local emergency services for traumatic dental injuries.

Traumatic dental injuries (TDI) are very frequently occurring in the society. Different studies show that about 30–40% of a county's population has sustained trauma to the primary teeth at the age of five and 20–30% have sustained TDI to the permanent dentition already at the age of 12.[1]

Luckily 2/3 of the TDIs are uncomplicated but about one-third of the TDIs to the permanent teeth are complicated cases where the pulp is exposed and the tooth is dislocated out of its position, which requires repositioning or replantation to avoid later complications and tooth loss.[2]

Examples of such complications are ankylosis and loss of the tooth, which results in serious negative consequences to the development of the alveolar process, usually in the esthetically sensitive anterior region of the maxilla if the child is still growing.

Whereas, fractures of the jaws and some soft tissue injuries in the oro-facial region may wait hours to be treated without affecting the prognosis, some dental injuries have to be treated immediately the 1st h and others within the 1st h after the injury to have a successful outcome.[3] We all know that an avulsed tooth has to be replanted as soon as possible or the tooth be placed in a suitable storage medium such as milk or in the mouth before the patient reaches a dentist who can replant the tooth. Moreover dislocated teeth with exposed periodontal ligament will be subjected to drying and the prognosis of such teeth is affected if the teeth are not repositioned within the 1st h after trauma. The research published over several decades[1] show that we have all the knowledge to do the correct clinical management in the emergency situation and we know that what has to be done is not difficult, but fairly simple actions, but unfortunately in many places emergency services are not always available for the injured child and they have to wait until the next day clinic are open and resources are available, which for many injuries will be too late for optimum treatment.

In a recent study of emergency management in 42 countries worldwide it was shown that the availability of emergency services vary considerably between cities in the world.[4] One may think that good emergency services would always be found in rich countries. However, this was not the case. In many cities in economically very well-developed countries, no emergency services were found and in many cities in less economically developed countries excellent emergency services could be found.[4]

A more important factor than the economy seems to be the ability of dentists in a society to locally organize emergency management outside office hours among themselves. During daytime and week days there is usually no problem to get in contact with a dentist competent in managing TDIs and even specialist are available. However, outside office hours, when dental clinics are closed, it was shown that in many places in the world, good emergency services were not existing, whereas in other places a good local organization could always provide emergency services for TDI, also outside office hours.[4] We know that a majority of TDI occur during evenings and weekends when the dental clinics are closed.[5]

We should remember that when we are talking about TDIs we are in most cases dealing with injured young children, which should be a prioritized patient category, where simple actions in the emergency phase could have saved the avulsed tooth if advice, consultations and treatments options would have been available in the emergency phase.

Hence please have a look locally in your own city. Do you have an optimal emergency situation for TDIs? If not, ask yourself how it can be improved. This can make a huge difference for many injured children and adolescents.