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Preface
Sami M.A. Chogle, BDS, DMD, MSD Gerald A. Ferretti, DDS, MS,
MPH
Guest Editors
In this issue of Dental Clinics of North America devoted to
orofacial trauma and emer-
gency care, we present current understanding of the nature of
dental trauma, preven-
tive strategies, and subsequent healing and treatment
modalities.
As Drs J.O. Andreasen, F.M. Andreasen, and L. Andersson prefaced
in their Text-
book and Color Atlas of Traumatic Injuries to the Teeth, The
study and understanding
of healing in hard and soft tissues after trauma is probably one
of the most serious
challenges facing the dental profession. That this task
presently rests with only
a handful of researchers is out of proportion with the fact that
perhaps half of the
worlds population today has suffered oral or dental trauma.
Furthermore, suchpatients presenting with acute dental trauma
report to the dental clinic unexpectedly.
As dental clinicians, we need to be prepared and current on
dental trauma and its
emergent care.
Thanks to brilliant inquisitive minds and their published
research, we have come
a long way since the early 1970s in understanding dental trauma
and defining treat-
ment strategies. Several events first deemed as requiring
aggressive treatment have
not been supported by thorough current research. All the
contributors to this issue
share a commitment to the principles and practice of
evidence-based health care.
They approach this subject from a variety of viewpoints. There
are examples of best
practices based on a high level of evidence, and there are also
examples of how toproceed when high-quality evidence is lacking.
Due to the fact that the treatment
approach in itself is usually traumatogenic, treatment
principles for traumatized teeth
become critical. In the case of some trauma entities, such as
concussion, subluxation,
and some injuries to the primary dentition, observation and
follow-up is the only treat-
ment needed. In other situations, repositioning and splinting
procedures characterize
treatment. Techniques for the reduction of tooth dislocations
include immediate digital
repositioning and orthodontic or surgical repositioning. Recent
research suggests that
the selection of treatment modality should be very specific and
related to preinjury or
injury factors to optimize healing.
The purpose of this issue is to provide the clinician, whether
in a dental practice oremergency service of a hospital, with an
understanding of acute dental trauma,
Orofacial Trauma and Emergency Care
Dent Clin N Am 53 (2009) ixxidoi:10.1016/j.cden.2009.08.002
dental.theclinics.com0011-8532/09/$ see front matter 2009 Elsevier
Inc. All rights reserved.
http://dental.theclinics.com/http://dental.theclinics.com/
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preventive strategies, and current treatment approaches. In that
regard, the articles in
this issue follow a sequence of medical and physical evaluation,
classification and
biology of traumatic injuries to the primary and permanent
dentition and their support-
ing structures, preventive strategies, and acute and long-term
treatment modalities. In
most cases, a traumatic event involves more than the dentition
and its supporting
structures. Therefore, the dental clinician must be able to
evaluate systemic effects
of the injury. In the past decade, better understanding of the
biology of the dental
pulp and the use of new materials and techniques have opened new
possibilities for
management of pulpal exposures. Injuries to the alveolus,
maxilla, and/or mandible
complicate healing and need longer and more customized treatment
plans. These
topics are fully covered in articles in this issue.
Acute dental trauma implies severe pain and psychological impact
for many
patients. The choice of treatment may be different for injuries
to primary and perma-
nent dentition depending on several factors, including type of
injury, age, and tooth
type. In the likely event that most dentists will end up
treating traumatic injuries onan emergency basis, the astute
clinician will develop a dental trauma kit for such situ-
ations. The dental clinicians must also provide information as
to the prevention of
dental injuries, including accident-prone sports activities
where mouth guards could
be of value. Several articles in this issue deal with these
subjects.
In the wake of esthetically and functionally successful implant
therapy, information
has been included on implants as part of oral rehabilitation,
with a discussion of the
primary biologic principles and the use of implants after dental
trauma. This is impor-
tant as a much longer treatment solution because these patients
are often young chil-
dren in whom the placement of an implant is contraindicated
because it interferes with
growth and development of the jaw.We thank the authors for their
time and effort in making this issue of the Dental
Clinics of North America a current and comprehensive aid to the
dental clinician
and providing the rationale and methods of optimal care to the
acutely traumatized
patient. It is also hoped that these articles will provide the
stimulus for further reading
in the field. Those interested in an in-depth discussion of the
epidemiology, psycho-
logical and biological impact of the various trauma entities on
the pulp and periodon-
tium, the pathogenesis of the various healing complications, and
long-term effects and
treatment of oral trauma are referred to the Textbook and Color
Atlas of Traumatic
Injuries to the Teeth, 4th edition.
Sami M.A. Chogle, BDS, DMD, MSD
Department of Endodontics
School of Dental Medicine
Case Western Reserve University
10900 Euclid Avenue
Cleveland, OH 44106, USA
Department of Endodontics
Henry M. Golden School of Dental Medicine
Boston University100 East Newton Street G-305
Boston, MA 02118, USA
Prefacex
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Department of Endodontics
Institute for Dental Research and Education
Boston University
Dubai Health-Care City
Building #34, Al-Zahrawi ComplexPO Box 505097, Dubai, UAE
Gerald A. Ferretti, DDS, MS, MPH
Rainbow Babies and Childrens Hospital
Cleveland, OH, USA
School of Dental Medicine
Case Western Reserve University
10900 Euclid Avenue
Cleveland, OH, USA
E-mail addresses:
[email protected] (S.M.A. Chogle)
[email protected] (G.A. Ferretti)
Preface xi
mailto:[email protected]:[email protected]:[email protected]:[email protected]
