# Dental Trauma Epidemiology in Primary Dentition: A Cross-Sectional Retrospective Study
## 4 Discussion
Health care providers should be aware of when and how to document suspicious injuries and how to obtain laboratory evidence, photo documentation, and/or consultation with experts when appropriate [19]. In accordance with the literature, our data highlight that multiple DT is present during a single traumatic event; the child's smaller mouth and the developing supporting tissues contribute to a higher exposed surface and impact severity [20; 21]. Due to their exposed position during impact, central and lateral incisors are most frequently involved. One case of DT involved a primary molar because of trauma to the chin. Most cases affected the tooth-supporting tissues, in agreement with previous studies [14; 21; 22]. Lesions to the tooth-supporting tissues are more frequent than mineralized tissues due to a lower mineralization and higher elasticity of infant bone structure [23]. In accordance with a Chinese study [24], root fracture was the most frequently affected mineralized structure; contrarily to our findings, and [PERSON] [13] reported crown fracture as the most frequent. Root fracture frequently entails displacement of the coronal fragment causing occlusion interference and pain. On the contrary, crown fracture is frequently asymptomatic. For this reason, we may hypothesize a larger prevalence of dental visits due to root fractures rather than crown fractures, the latter resulting in being underdiagnosed. It is fundamental that clinicians are able to diagnose and treat DT correctly as these events frequently occur in insurance-covered places and on the grounds that a correct clinical approach influences both the primary and permanent tooth prognoses. In 2020, the International Association of Dental Traumatology updated its previous DT guidelines (2012) [25; 26]. The main novelties concerned the most frequent lesions in primary teeth: intrusive luxation and lateral luxation. With regards to intrusive luxation, the previous guidelines suggested immediate extraction whenever the root was found dislocated toward the developing permanent tooth bud. In absence of signs and symptoms of infection, novel guidelines indicate a watch-and-wait approach for up to 1 year irrespective of the direction of the displacement and be left for spontaneous repositioning, thus avoiding the risk of iatrogenous trauma to the developing crown. Regarding lateral luxation in minimal or the absence of occlusal interference, new guidelines suggest a watch-and-wait approach, allowing for the tooth to reposition itself. However, to avoid ingestion/aspiration in cases of severe dislocation, two possible options are suggested: tooth extraction or, if the child's level of cooperation allows it, manual repositioning and a flexible splint for four weeks if unstable. Tooth avulsion is more frequent in primary dentition than permanent dentition due to the higher elasticity of infant bone structure. The treatment guidelines between the two dentitions are completely different. While in permanent dentition, immediate tooth replantation is strongly recommended, in primary dentition, avulsed teeth should not be replanted. The IADT Guidelines consider primary tooth replantation a significant treatment burden (replantation, splint placement and removal, and root canal treatment) for a young child and emphasize the potential of further iatrogenic damage to the permanent tooth bud due to an inaccurate procedure. Furthermore, even in cases of correct replantation, the absence of a splint could lead to a medical emergency resulting from aspiration of the tooth [27]. The major limitations of the present study were the monocentric setting, the retrospective nature of the study, and the sample size. Despite these limitations, the data provide a contribution to the epidemiological profile of primary teeth dental traumatology. Multicenter study data would make the results more objective.