An evaluation of after-office-hour dental trauma in Singapore

The purpose of this study was to assess the post-traumatic sequelae and treatment outcome and the corresponding prognostic factors at the initial emergency visit. Over a 5-year period, the authors collected case records from 129 dental trauma patients. These patients had been referred subsequent to receiving emergency treatment after office hours at the Accident and Emergency Department of Singapore General Hospital. After the exclusion of 31 cases with concomitant fracture of maxilla and/or mandible and cases with insufficient documentation, the final study sample consisted of 98 patients (41 males, 57 females) who had sustained injuries to 264 permanent teeth. The main cause of dental trauma was falls (56%), and the main type of injuries was periodontal tissue injuries with or without concomitant injuries to hard tissue, including root fracture (73%). For the final evaluation, teeth with insufficient recall period were excluded before univariate and multivariate stepwise logistic regression analysis. It was found that for 100 teeth with luxation type of injuries, the presence of concomitant hard tissue injuries retained prognostic significance for pulpal outcome (p < 0.001) after adjusting for severity of luxation, while the severity of luxation was the only significant factor for periodontal outcome (p < 0.001). For 34 avulsed teeth, the stage of root development was the major factor associated with the pulpal outcome (p = 0.003), while extra-alveolar storage media were found to be significantly related to the periodontal outcome (p < 0.001). For 72 teeth with hard tissue injuries, first-visit interval played a significant role in the outcome (p = 0.03). Although the sample size in the root fracture group was too small for such statistical analysis, the results indicated that patient education on dental trauma was an important factor. Thorough standardized documentation was also recommended to facilitate optimal follow-up management and future research as well as medico-legal purposes.