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Standardization of Terminology for Multiple Traumatic Dental Injuries Affecting a Permanent Tooth in a Single
Nitesh Tewari1,2, Alina Wikstrom3,4, Eva Lauridsen5
1Division of Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
Background/Aims:
Inconsistent terminology in dental traumatology limits comparability between clinical, epidemiological, and prognostic studies. This is particularly relevant for traumatic dental injuries in which two or more distinct injuries affect a single permanent tooth during the same traumatic episode. Such injury patterns have been described using several overlapping terms, resulting in conceptual and reporting heterogeneity. This study aimed to establish a standardized term and corresponding definition for multiple traumatic dental injuries affecting a single permanent tooth in one traumatic episode using a mixed-methods consensus approach.
Methods:
A sequential mixed-methods design was used. First, terminology identified in a previous systematic review was analyzed to identify conceptual patterns. These findings informed the development of candidate terms and definitions. Subsequently, a modified Delphi consensus process was conducted with international experts in dental traumatology, following CREDES and ACCORD guidance. Experts rated the suitability of proposed terms and definitions on a 10-point Likert scale. Items rated > 7 by more than 70% respondents were considered to have reached consensus. A subsequent feedback exercise among practicing dentists and postgraduate students assessed broader acceptability of the proposed terminology.
Results:
Twenty-six terms describing multiple injuries affecting a single permanent tooth were identified in the literature and grouped into four conceptual categories: general terminology for multiple injuries, specific pairings of trauma types, tissue-level classifications, and expanded descriptive phrases. Following two Delphi rounds, the term "combination injury" reached the highest level of expert agreement (76.9%). The feedback exercise showed acceptability by 70.5% among a broader group of dentists and highlighted the need for further dissemination and clarification before widespread implementation.
Conclusion:
The term "combination injury," supported by a refined clinically relevant definition, achieved expert consensus. Adoption of this terminology may improve consistency in clinical documentation, research reporting, and future prognostic studies. Further studies should evaluate its usability in clinical records and epidemiological datasets.
