Addressing the Gaps: Education, Intervention, and Outcomes in Dental Traumatology

Intimate partner violence is a global health concern with alarming reports of prevalence around the world [1]. The head and neck region is often injured when physical abuse is present [2-8]. Dental professionals might be positioned in a key role when it comes to recognizing these injuries and approaching them properly [8-11]. In this issue, Lewer et al. provide a scoping review that explores the characteristics and effectiveness of current intimate partner violence interventions in dental settings [12]. Prompt and proper intervention of dental professionals in cases of domestic abuse can result in earlier intervention and better support for the victims and might even save lives. However, this requires proper education and knowledge for the dental professionals and should start early in dental schools with continuous support in the form of courses, workshops, and continuing education efforts [13]. A unique aspect of domestic abuse is child abuse and neglect, which poses various challenges in terms of identification and approach [6, 14]. Puranik et al. in this issue conducted an observational cohort study to investigate the impact of integration of problem-based learning on student performance and self-perceived benefits in a pediatric dental trauma curriculum with training on child abuse and neglect [15]. Ongoing efforts to increase awareness and knowledge of these issues and challenges are of utmost importance to our profession and patients. Continuous professional development is crucial for dental professionals to maintain and enhance the quality of their services. Various methods to increase knowledge, both theoretical and practical, have been tested and evaluated in relation to dental traumatology [16-18]. However, the overall knowledge of dental practitioners when surveyed across the world is sometimes limited [19-22]. In this issue, Cvijic et al. explored general dentists' experiences with and attitudes about two educational formats in dental traumatology: purely theoretical asynchronous webinars vs. webinars complemented by an in-person, interactive course [23]. Further in this issue, Péré et al. [16] compared the confidence levels of dental students and dentists in handling various traumatic injuries before and after a hands-on training session. Understanding the preferences and attitudes of dental professionals towards various types of continuing education courses is vital to improving the delivery and demand for further education among practitioners. Knowledge of dental traumatology is not only important for dental professionals, but due to the nature of the injuries and the significance of prompt and timely treatment, other professionals from the medical fields, parents, teacher coaches, etc., should have the basic knowledge in the emergency management of traumatic dental injuries. Previous studies have demonstrated a lack of knowledge among different populations [24-32], and efforts are being made to promote education within various stakeholder groups [18, 33-38]. In this issue, Avsar et al. evaluated the knowledge and attitudes of care staff in children's homes regarding the management of avulsed teeth [39]. Knowledge and first-aid abilities of care staff in various homes and health care facilities can significantly influence the prognosis of the affected teeth in cases of dental trauma. Promoting further education in these facilities will help improve the outcomes of dental trauma patients. The Internet and social media have become a main source of information for many people worldwide. The information provided on the various platforms with regard to the prevention, treatment, and management of traumatic dental injuries is not always accurate and precise [40-44]. In this issue, Başkan and Başkan investigated the quality, accuracy, and reliability of dental trauma videos posted on YouTube [45]. A search was performed on YouTube using the keywords “dental trauma,” “tooth injury,” “dental injury,” and “traumatic dental injury.” Their findings, together with previous studies, help to understand the trends and the overall accuracy of the publicly available information that may be both useful and misleading to our patient population. Trauma to primary teeth might have an influence on the development and health of the permanent tooth replacing it [46-49]. This is one of the reasons why prevention and proper management of injuries in the primary dentition is of utmost importance [50-53]. In this issue, da Costa et al. investigated the prevalence and severity of sequelae in anterior permanent teeth of children who suffered traumatic dental injuries in primary dentition [54]. Their findings revealed that nearly a third of the permanent teeth presented sequelae to the trauma in the primary tooth, highlighting the importance of close monitoring of children with traumatized primary teeth as well as the crucial role of prevention and proper management of these injuries. Oral and maxillofacial injuries are prominent among military personnel both during training and in combat or other service activities [55-59]. In this issue, Tsur et al. analyzed the epidemiology, severity, and outcomes of maxillofacial injuries during the Swords of Iron conflict using data from the Israeli National Trauma Registry [60]. Their findings highlight the important role of prevention in this high-risk population as well as the crucial need for specialized trauma care, particularly for fractures requiring surgical intervention and intensive care. Tooth avulsion is one of the most serious injuries to the dental complex and requires immediate treatment to improve prognosis and outcomes [61, 62]. The healing of the PDL following tooth replantation is the most important aspect in the success of the procedure over time and is influenced by numerous factors [63-65]. Overall, the exact mechanisms involved in repairing the periodontal ligament following dental avulsion remain unclear. In this issue, da Silva et al. investigated the repair process of periodontal tissues after tooth avulsion and immediate replantation in Wistar rats [66]. Understanding the specific biological processes that are involved in the healing of the PDL following avulsion and replantation can assist clinicians and researchers in advancing the field and promoting faster and more effective healing processes in cases of traumatic dental injuries that involve the PDL. This can also be helpful in improving the results of treatments like auto-transplantation and intentional replantation [67, 68]. Tooth auto-transplantation requires gentle and quick handling of the donor tooth to preserve the PDL cells' viability [67]. Various methods have been suggested to limit the handling time and manipulation of the donor tooth following the extraction [69-75]. In this issue, Li et al. introduced a guide plate designed to facilitate precise donor-tooth trimming while ensuring PDL preservation [76]. Furthermore, in this issue, Chi et al. evaluated an osteotomy guide, a morphology-adapted custom drill, and root-immersion containers to enhance the precision in dental auto-transplantation procedures [77]. Utilizing technological innovations such as CAD/CAM and others to make the procedure faster, more accurate, and less invasive will promote healing and improve the long-term complication-free outcomes. Following tooth fracture, fragment reattachment can provide an esthetic, morphological, and functional result [78-80]. Various techniques have been suggested and studied in the past with the aim of improving the durability and longevity of the procedure over time [81-83]. In this issue, Kidwai et al. compared various techniques of reinforcement in terms of the force required to fracture, using bovine incisor models with simulated uncomplicated crown fractures [84]. The techniques that were used included simple reattachment, external chamfer, over-contouring, and sound teeth. The method used was found to be correlated with the force required to fracture the teeth. This emphasizes the need for selecting the preferred method and technique for every procedure and the importance of continuous research and evaluation of novel techniques to improve long-term stability. Finally, an extremely important aspect of any medical and dental treatment, and especially traumatic dental injuries, is proper documentation and registration. This is crucial for long-term follow-up and for studying the outcomes and complications of trauma to the dento-alveolar complex [85-89]. In this issue, Eden et al. describe and validate a simple registration system for clinician-important traumatic dental injuries outcomes as an index [90]. They present a validation study for the Eden Dental Trauma Outcome Index that was developed to promote and enable accurate and systematic registration of long-term outcomes following traumatic dental injuries in an overarching goal to improve diagnosis, treatment, and prognosis of long-term healing complications. The authors have nothing to report. The authors declare no conflicts of interest.