ORIGINALARTICLE

FREQUENCY, PATTERN, AND MANAGEMENT OF DENTOALVEOLAR TRAUMA IN PEDIATRIC

PATIENTS

Fareeha Fatima¹, Muhammad Tariq Khan², Shahkar Zaman², Mehran Khan¹, Hanif Ullah³, Ismail³

How to cite this article

ABSTRACT

OBJECTIVES

Fatima F, Khan MT, Zaman S, Khan

M, Ullah H, Ismail. Frequency,

Pattern, and Management of

Dentoalveolar Trauma in Pediatric

Patients. J Gandhara Med Dent Sci.

2026;13(3):35-40.

This study aimed to determine the frequency, pattern, and management of

dentoalveolar trauma in pediatric patients.

METHODOLOGY

This descriptive cross-sectional study was conducted at the Oral and

Maxillofacial Surgery department of Saidu Dental Hospital, Swat. A total of

166 pediatric patients aged 2 to 12 years with maxillofacial trauma were

included through non-probability consecutive sampling. Patients with jaw

fractures, epilepsy, mental disabilities, or delayed presentation beyond 12

hours were excluded. Clinical and radiographic assessments conrmed

dentoalveolar trauma. Data on trauma patterns and management strategies

were collected and stratied by age and gender. Post -stratication chi-

square tests were used to assess associations.

https://doi.org/10.37762/jgmds.13-3.859

Date of Submission: 30-01-2026

Date Revised:

Date Acceptance:

08-06-2026

09-06-2026

²Professor, Department of Oral and

Maxillofacial Surgery, Saidu College of

Dentistry, Swat

RESULTS

The mean age of participants was 7.47 years (SD ± 2.95), with 57 females

(34.34%) and 109 males (65.66%). Dentoalveolar trauma was observed in

50% of cases. Luxation was the most common injury (25.9%), followed by

crown infraction (10.2%) and avulsion (9.0%). The most frequent

management approach was splinting (31.3%), followed by conservative

management (9.6%). Closed and open reduction with xation were less

common. There was no signicant dierence in trauma type or treatment

method between genders (p=0.66 and p=0.98, respectively) or age groups

³Assistant Professor, Department of Oral

and Maxillofacial Surgery, Saidu

College of Dentistry, Swat

Correspondence

¹Fareeha Fatima, Postgraduate Resident,

Department of Oral and Maxillofacial

Surgery, Saidu College of Dentistry,

Swat

(p=0.81

CONCLUSION

and

p=0.63,

respectively).

Half of the pediatric patients with facial trauma presented with dentoalveolar

injuries. Luxation was the most common injury pattern, and splinting was the

most commonly used treatment. No signicant gender- or age-based

dierences were found in trauma patterns or management approaches.

KEYWORDS: Adolescent, Child, Facial Bones Injuries, Maxillofacial

Injuries, Splints, Tooth Luxation, Wounds and Injuries

+92-346-9362730

Fareehafatima1155@gmail.com

INTRODUCTION

damage are more common than bone fractures. Soft

Dentoalveolar trauma refers to damage involving the tissues and developing teeth in children make them

dentition, supporting alveolar structures of the upper

and lower jaws, and adjacent oral tissues. Frequently

more prone to cuts, bruises, and tooth injuries. Bone

fractures, while less frequent, usually aect the more

seen in children due to accidents or physical activities, flexible parts of the face, like the maxilla and

such injuries may result in complications like pulpal mandible.³It is reported that males are more likely to

death, tooth displacement, and growth disturbances. experience trauma than females. Common causes

They can also impair articulation, oral function, and include falls, altercations, sports, accidents, and

collisions with objects or people.^4,5The most common

psychological well-being, highlighting the importance

places for dental injuries are the home, school, and

of timely assessment and eective treatment in

pediatric dental practice.¹This can cause pain and street, with enamel fractures and enamel-dentin

discomfort that makes it hard for kids to eat, talk, or fractures without pulp involvement being the most

even sleep properly. On top of that, they might start common types.⁵Dentoalveolar injuries commonly

feeling embarrassed or self-conscious about how they occur due to accidents and violence and may involve

tooth avulsion, tooth fractures, fractures of the alveolar

look, which can make them avoid smiling or laughing

around others. Over time, this can aect their

process, and soft tissue tears. Unlike other hard tissue

confidence and make it harder for them to connect with injuries, tooth enamel cannot regenerate or heal. The

friends or enjoy social situations.²In pediatric Andreasen dental trauma classication system oers a

maxillofacial trauma, soft tissue injuries and dental structured approach to categorize these injuries, ranging

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J Gandhara Med Dent Sci

Frequency, Pattern, and Management of Dentoalveolar Trauma in Pediatric Patients

from minor enamel fractures to more complicated cases tissue changes obscured the diagnosis of dentoalveolar

involving exposure of the dental pulp. For example, injuries. To minimize selection bias, all consecutive

uncomplicated crown fractures and crown infractions eligible patients presenting during the study period

include fractures of the enamel and dentin with varying were enrolled regardless of age, gender, injury

degrees of pulp involvement, while complicated crown- mechanism, or injury severity. Both clinical and

root fractures extend injury to both the cementum and radiographic assessments were done to conrm

dental pulp. The International Association of Dental eligibility. Children were excluded if they had epilepsy,

Traumatology (IADT) suggests a clear and organized as it would make assessment harder, and they are more

approach to handling dentoalveolar trauma. It starts likely to experience falls and trauma. Mentally disabled

with quickly assessing the injury, classifying it, taking children were also excluded, along with those who

X-rays, and stabilizing the tooth with a splint. presented late and showed facial swelling during the

Treatment, such as apexogenesis or root canal therapy, clinical exam, as this would make it dicult to assess

depends on whether the pulp is exposed and on the the injury properly. Approval from the research and

tooth's maturity. Regular check-ups are important to

monitor healing, ensure the tooth is still alive, and

confirm the splint is holding. The IADT also stresses

ethics committee of the hospital (119-ERB/023, dated:

06/10/023) and CPSP was obtained. All patients

presenting with dental-alveolar fractures and meeting

our inclusion and exclusion criteria were included in

this study from the OPD of oral and maxillofacial

surgery. Informed consent was obtained from the

patients after explaining the study protocol and research

purpose. They were assured of the condentiality of

their personal and other data collected. A detailed

history was taken from the patients, followed by an

appropriate relevant clinical examination. The clinical

examination began with a visual inspection of the face

and surrounding structures to identify any obvious

deformities, asymmetries, swelling, bruising, or

lacerations. Palpation was conducted gently to detect

any tenderness, crepitus (grating sensation), instability,

or abnormal movement suggestive of fractures or

dislocations. The nasal examination evaluated the nasal

airway patency, septal deviation, and presence of any

deformity or tenderness over the nasal bones, which

the

importance

preventive

care,

thorough

documentation, and working with other specialists

when dealing with more complex cases to achieve the

best results.⁸A previous study reported that out of 303

teeth, the most prevalent type of injury observed was

enamel fracture, accounting for 220 cases (72.60% of

total). Enamel and dentine fractures were the second

most common, with 58 instances (19.14% of total).

Injuries involving pulp, indicating more extensive

damage, were observed in 14 cases (4.62% of total).

Additionally, 11 cases (3.63% of the total) were

missing due to trauma.⁹The pattern of pediatric

dentoalveolar trauma and its management is dierent

from that of adults. The study of the frequency, pattern,

and management of dentoalveolar trauma in pediatric

patients is crucial due to its impact on public health and

children's well-being. Dental injuries are common in

children, and understanding their prevalence and causes

helps prevent them. Ultimately, it addresses knowledge

gaps and contributes to evidence-based practices in

pediatric dental trauma care. The objective of this study

was to determine the frequency, pattern, and

management of dentoalveolar trauma in pediatric

patients.

may have indicated

nasal fracture. Intraoral

examination involved inspecting the oral cavity,

including the teeth, gums, palate, and mucosa, for

lacerations, avulsions, fractures, or other injuries.

Radiological examination was carried out in the form of

periapical, panoramic, and computed tomography scans

to assess the presence of dentoalveolar fractures. The

pattern of dentoalveolar trauma was assessed clinically,

with fractures of the alveolar bone being palpable with

a nger and/or tooth luxation in any direction,

confirmed by plain radiographs such as panoramic

radiographs. In selected cases, the consultant

maxillofacial surgeon advised a CT scan to conrm the

diagnosis. The patterns included the following: Crown

infraction, which involved an incomplete fracture of the

enamel; uncomplicated crown fracture, where the

dentin and/or enamel were fractured, but the pulp

remained unaected; complicated crown fracture,

METHODOLOGY

This descriptive cross-sectional study used

nonprobability, consecutive sampling technique at the

Oral and Maxillofacial Surgery department of Saidu

Dental Hospital, Swat, from September 21, 2024, to

April 5, 2025. The sample size was determined using

OpenEpi software, yielding 166 participants with a 95%

confidence interval and a 6% margin of error. The

sample size calculation was based on a previous study

that reported a 19.14% proportion of enamel and which extended through the enamel and dentin,

dentine fractures among dentoalveolar fractures.⁹Only

exposing the pulp; uncomplicated crown-root fracture,

where the fracture extended through the enamel, dentin,

and cementum, but the pulp remained unexposed;

children presenting within 12 hours of injury were

included to allow standardized clinical and radiographic

evaluation before signicant swelling or secondary

complicated crown

-root fracture, similar to the previous

July - September 2026

J Gandhara Med Dent Sci

Frequency, Pattern, and Management of Dentoalveolar Trauma in Pediatric Patients

Dentoalveolar trauma was found in 50% among all

type but with pulp exposure; root fracture, which

affected the dentin, cementum, and pulp; avulsion,

which was the complete dislodgement of a tooth from

its socket during trauma; and luxation, where the tooth

was displaced from its original position in the alveolus

without complete avulsion, resulting from acute trauma

in either a lateral or vertical direction. The management

facial fractures (Fig 1). The most common pattern of

dentoalveolar trauma was luxation (n = 43, 25.9%),

followed by crown infraction (n = 17, 10.2%). Avulsion

occurred in (n = 15, 9.0%), while 83 subjects (50.0%)

had other facial fractures, not dentoalveolar trauma.

The most common management approach was splinting

options for dentoalveolar injuries included conservative (n = 52, 31.3%), followed by conservative management

treatment and splinting. Conservative management was (n = 16, 9.6%). Closed reduction and xation were used

used for minor injuries such as crown infractions and in (n = 11, 6.6%), and open reduction and xation were

uncomplicated crown fractures that did not require

stabilization. Splinting was performed for dentoalveolar

fractures, luxation injuries, and selected root fractures

to stabilize the aected teeth and alveolar segment and

facilitate healing. Additional treatment, including

repositioning of displaced teeth and appropriate

restorative procedures, was provided based on the type

and severity of the injury. Splinting was performed for

dentoalveolar fractures, luxation injuries, and selected

root fractures requiring stabilization. The splint was

used to immobilize the aected teeth and alveolar

segment to facilitate healing and restore function.

Management of dentoalveolar injuries included

conservative treatment and splinting, depending on the

type and severity of injury. Splinting was used to

stabilize luxated teeth, dentoalveolar fractures, and

selected root fractures, facilitating healing and restoring

function. Conservative management was done for stable

fractures, such as zygomatic fractures. Closed reduction

and xation were done for fractures such as those in the

mandibular body or symphysis. The fractured or

dislocated bone was manipulated back into its normal

position without an open incision. Open reduction and

fixation were done for grossly displaced fractures that

could not be reduced without an incision. An incision

was made to access the fractured or dislocated bone

directly. Data was analyzed using SPSS version 20.0.

Frequencies and percentages were obtained for all

categorical variables, including gender, dentoalveolar

(yes/no), and management options, while age was

presented as mean ± standard deviation (or median with

IQR for skewed data assessed using the Shapiro test or

histogram). Age groups and gender stratied the

frequency of dentoalveolar fractures and management

performed in (n = 4, 2.4%). (Table 1). There was no

significant dierence between females and males in

trauma type (p=0.66) or management approach

(p=0.98). Luxation was the most common injury in

both groups (24.6% in females, 26.6% in males).

Avulsions and crown infractions were similarly

distributed, while complicated crown fractures occurred

only in males. Splinting was the most frequent

treatment in both sexes (33.3% in females, 30.3% in

males). Conservative and closed reduction methods

were used at similar rates. About half of both groups

had facial fractures without dentoalveolar trauma.

(Table 2). No signicant dierences were found

between the age groups in trauma pattern (p=0.81) or

management (p=0.63). Luxation was the most common

injury in both groups, occurring in 20.8% of 2-5-year-

olds and 28.0% of 6-12-year-olds. Avulsion was more

frequent in the younger group (12.5% vs 7.6%), while

crown infractions were slightly more common in the

older group (11.0%). Splinting was the most frequent

treatment in both age groups, particularly among 6-12-

year-olds (33.9%). Conservative and closed reduction

approaches were used at similar rates. Over half

(56.3%) of the younger group and nearly half (47.5%)

of the older group presented with other facial fractures

without dentoalveolar trauma. (Table 3)

Figure 1: Frequency of Dentoalveolar Trauma

options to

observe

eect

modication. Post-

stratication chi-square tests were used, with P≤0.05

considered signicant. When the chi-square assumption

was violated, Fisher's exact test was used.

RESULTS

The study sample (n = 166) had a mean age of 7.47

years and a standard deviation of 2.95. Regarding

gender distribution, 57 subjects (34.34%) were female,

and 109 subjects (65.66%) were male, with the most

common age group being 6-12 years (n=118, 71.08%).

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Frequency, Pattern, and Management of Dentoalveolar Trauma in Pediatric Patients

Table 3: Pattern and Management Approaches in Dentoalveolar

Trauma Stratied By Age Groups

Table 1: Pattern and Management Approaches in Dentoalveolar

Trauma

Characteristic

N = 166

Characteristic

Pattern of dentoalveolar trauma

Avulsion

2-5 yr,

6-12 yrs,

P-Value

N = 48

N=118

Pattern of

dentoalveolar

trauma

Avulsion

(9.04)

(1.81)

Complicated Crown-Root Fracture 03

06 (12.50)

Complicated Crown-Root 00 (0.00)

09 (7.63)

03 (2.54)

Complicated Crown Fracture

Crown Infraction

03(1.81)

(10.24)

43(25.90)

(50.00)

Fracture

Complicated Crown

Fracture

01 (2.08)

02 (1.69)

Luxation

No dentoalveolar trauma

0.81

Crown Infraction

Luxation

04 (8.33)

10 (20.83)

00 (0.00)

13 (11.02)

33 (27.97)

01 (0.85)

(other facial fracture )

Uncomplicated Crown-Root Fracture 01(0.60)

Uncomplicated Crown-

(0.60)

(6.63)

(9.64)

Uncomplicated Crown Fracture

Closed reduction and xation

Conservative

Open reduction and xation

Splinting

Root Fracture

Management

of dento-alveolar

trauma

Uncomplicated Crown

Fracture

00 (0.00)

01 (0.85)

04(2.41)

(31.33)

No dentoalveolar trauma 27 (56.25)

56 (47.46)

83(50.00)

(other facial fracture )

No dentoalveolar trauma

(other facial fracture )

Management of dento-alveolar trauma

Closed reduction and

02 (4.17)

09 (7.63)

xation

Conservative

06 (12.50)

10 (8.47)

03 (2.54)

40 (33.90)

56 (47.46)

0.63

Open reduction and xation 01 (2.08)

Splinting

12 (25.00)

No dentoalveolar trauma 27 (56.25)

Table 2: Pattern and Management Approaches in Dentoalveolar

(other facial fracture )

Trauma Stratied by Gender

Characteristic

Female, Male,

P-

Value

N = 57

N = 109

DISCUSSION

Avulsion

06 (10.53) 09(8.26)

Complicated Crown- 02 (3.51) 01(0.92)

Root Fracture

In our study, males accounted for 65.66% of cases,

consistent with the ndings of Patidar et al., who

reported a male-to-female ratio of approximately 2:1 in

Complicated

00 (0.00) 03(2.75)

Crown Fracture

Crown Infraction

Pattern of

dento-alveolar

trauma

06 (10.53) 11

(10.09)

29(26.61)

0.66

pediatric

dental

trauma

cases.²

This

male

(24.56)

Luxation

predominance is often attributed to higher engagement

in physical activities and risk-prone behaviors among

boys. The majority of trauma cases (71.08%) occurred

in the 6-12-year age group, which corresponds with the

mixed dentition phase. This is consistent with Patidar et

al.’s observation that the permanent dentition group (12-

16 years) had the highest frequency of dental trauma.¹⁰

The increased mobility and participation in outdoor

activities during these developmental stages likely

contribute to the higher incidence.¹¹Half of the facial

fractures were dentoalveolar trauma - this is how

common these injuries are in children. Luxation injuries

were the most frequent (25.9%), followed by crown

infractions (10.2%) and avulsions (9.0%) of the

dierent types. This is quite dierent than what was

found by Patidar et al., in which he noted Ellis class IV

fractures were the most common.²There may be

dierences between the two studies in how dental

injuries were diagnosed and classied. Dierent

findings were reported as found by Azami-Aghdash et

al.'s review, in which enamel fractures were the most

common dental trauma in children and teens.⁴These

dierences may be due to a combination of participants'

age range, environmental inuences, and how active

Uncomplicated

Crown-Root Fracture

Uncomplicated

Crown Fracture

No dentoalveolar

trauma (other facial

fracture )

01 (1.75) 00

(0.00)

00 (0.00) 01(0.92)

28 (49.12) 55

03 (5.26) 08

(50.46)

Closed reduction

and xation

(7.34)

(10.53)

01 (1.75) 03

(2.75)

Conservative

10(9.17)

Management

of dento-alveo

lar trauma

Open reduction

0.98

and xation

(33.33)

28 (49.12) 55

(50.46)

Splinting

33(30.28)

No dentoalveolar

trauma (other facial

fracture )

^*Fisher's exact test

the children had been. All of which can aect the type

and frequency of visible dental injuries. In our cases,

splinting treatment was used in 31.3%, while

July - September 2026

J Gandhara Med Dent Sci

Frequency, Pattern, and Management of Dentoalveolar Trauma in Pediatric Patients

conservative techniques were selected in 9.6%. Our

excluded, which may have introduced selection bias.

Finally, information regarding the mechanism of injury,

socioeconomic factors, and long-term follow-up was

preference for splinting teeth follows recognized injury

treatment protocols that protect damaged roots, support

periodontal healing, and help save the tooth. The not evaluated, limiting

International Association of Dental Traumatology understanding

more comprehensive

risk

factors and treatment

recommends that dentists use exible splints on teeth

with subluxation or extrusion injuries for up to 2 weeks,

as this setup helps natural tooth movement heal

properly.¹²A case series by Goswami and Eranhikkal

effectiveness.

CONCLUSIONS

demonstrates how dierent splints can repair traumatic This study demonstrates that midline laparotomy

tooth damage in children by keeping injured teeth wound closure with Prolene is associated with fewer

correctly positioned and supported.¹³According to Cho

post-operative wound complications, including wound

et al.'s retrospective study, splints eectively healed

root fractures but did not yield good outcomes for

patients who suered lateral or extrusive luxation

dehiscence and surgical site infection, compared to

closure with Vicryl suture. Using a standardized

continuous small-bite closure with a consistent suture-

injuries in their primary teeth. Patidar et al. found that to-wound length ratio of 4:1 shows that the type of

endodontic treatment became the standard approach for

saving permanent teeth, yet doctors mostly continued to

watch and provide simple wound care for injured

primary teeth.²The dierences in injury treatment plans

are linked to variations in injury type and depth, as well

suture, rather than the closure technique, aects

outcomes.

CONFLICT OF INTEREST: None

as between tooth groups. Permanent teeth with FUNDING SOURCES: None

developed root canals become more likely to need root

canal treatment as a result of traumatic injuries.

Lembacher et al. found that the chance of pulp tissue

death goes up as traumatic dental injuries get worse,

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AUTHORS CONTRIBUTION

Fareeha Fatima - Concept & Design; Data Acquisition;

Data Analysis/Interpretation; Drafting Manuscript;

Critical Revision; Final Approval

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Trauma: Expert Strategies. Cham: Springer Nature; 2025. p.

77–92.

https://doi.org/10.1007/978-3-031-XXXXX-X_11.

(Verify chapter DOI before submission).

Muhammad Tariq Khan - Concept & Design; Data

Acquisition; Data Analysis/Interpretation; Drafting

Manuscript; Critical Revision; Supervision; Final

Approval

Shahkar Zaman

Manuscript; Final Approval

Mehran Khan - Concept & Design; Data Acquisition;

Data Analysis/Interpretation; Drafting Manuscript;

Critical Revision; Final Approval

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