Radiographic evidence of traumatic injuries to primary incisors without accompanying clinical signs

In epidemiological studies, traumatic dental injuries in children are usually determined from clinical signs or parents' reports. Radiographs are used in dental trauma centers but not in field surveys. The aim of this study was to evaluate the proportion of patients who present with radiographic evidence of trauma without any clinical signs of a history of TDI.

The prevalence of traumatic dental injuries was assessed from the records of 674 preschool children at their first visit to a private dental practice. Evidence of the history of traumatic dental injuries was based on clinical and radiographic signs. Clinical signs consisted of enamel fracture, crown fracture with dentin exposure (with or without pulp exposure), internal coronal discoloration, and the presence of a draining sinus. Radiographic signs were as follows: root fracture, pulp canal obliteration, tube-like mineralization, internal resorption, arrested dentin deposition, external inflammatory root resorption, and a periapical radiolucency.

Of the 674 children, 408 (60.5%) presented with clinical evidence of traumatic dental injuries. This included 195 (28.9%) with enamel fracture as the sole sign. Seventeen (2.5%) had radiographic signs of traumatic dental injuries without any clinical evidence of trauma, increasing the prevalence of traumatic dental injuries by 2.5-63.0%. Fifteen of these were pulp canal obliteration, one root fracture, and one with arrested dentin deposition. Clinical signs of traumatic dental injuries without radiographic evidence of trauma were present in 275 (40.8%) patients.

Traumatic dental injuries based on both clinical and radiographic evidence are more prevalent than when based on clinical examination only.