Traumatic dental injuries in primary teeth

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Traumatic dental injuries are common in both primary and permanent teeth although more focus is typically place on those in the permanent teeth. An increase in injuries is seen as the child passes from crawling to walking and recently there has been increased interest in predisposing factors such as increased overjet, lip competency, and malocclusion.

The aim of this review was to evaluate the prevalence of traumatic dental injuries (TDI) in primary teeth and to evaluate the different factors associated with TDI in primary teeth.


Searches were conducted in the PubMed, Embase, Cochrane Central Register of Controlled Trials. (CENTRAL) and Google Scholar databases. Epidemiological studies, cross sectional studies, cohort studies and case control studies reporting the prevalence of traumatic dental injuries in primary teeth between 1990 and 2020 were considered. Two reviewers independently selected studies extracted data and assessed risk of bias using the Newcastle-Ottawa scale adapted for cross-sectional studies. The effect estimates and 95% confidence intervals (CI) of the prevalence of TDI in primary teeth were calculated for each included study. A random-effect model was used for meta-analysis and meta-regression analysis with the overall quality of evidence was assessed using GRADE.


  • 24 studies involving 4876 TDI in 22,839 children were included.
  • The overall prevalence of traumatic dental injuries in primary teeth was 24.2%
  • Boys were more prone to traumatic dental injuries than girls.
  • Falls contributed to the highest number of traumatic dental injuries.
  • Maxillary central incisors were the most commonly injured teeth and enamel fracture the most common type of injury.
  • Children with incompetent lip closure were more prone to TDI (followed by children with increased overjet, miscellaneous reasons, and children with anterior open bite.
  Prevalence (95%CI)
Overall 24.2% (18.24 to 31.43%)
Boys 30.0% (18.7 to 42.81%)
Girls 26.8% (15.75 to 39.70%)
Falls 59.3% (41.05 to 76.40%)
Maxillary central incisors 73.9% (65.4 to 81.59%)
Enamel fractures 61.9% (47.29 to 75.47%)
Anterior open bite 33.3% (25.17 to 42.04%)
Incompetent lip closure 49.4% (39.9 to 58.92%)
Increased over jet 44.1% (36.1 to 52.33%)
  • The evidence was assessed as of very low certainty using the GRADE approach.


The authors concluded: –

The prevalence of TDI in cross-sectional studies of primary teeth was 24.2% with very low quality of evidence. Falls contributed the highest number of TDI in primary teeth, accounting for 59.3%. Children with incompetent lip closures have the highest prevalence (49.4 %) of TDI in primary teeth.


The reviewers have searched a good range of databases focusing their attention on studies published in the past 30 years. Of the included studies 15 (67%) were from Brazil with 2 from India and one each from Ireland, Jordan, Saudi Arabia, South Africa, Sudan and Taiwan. There was a large degree of heterogeneity within the studies linked with variation in sample sizes, geographic region, type of schools and the diagnostic criteria used. In all 8 different diagnostic criteria were used in the studies with a majority (14) using Andreasen’s classification. The estimate for overall prevalence of 24.2% (95 %CI; 18.24 to 31.43%)  is similar to a 2018 study by Petti et al looking at the prevalence of traumatic dental injury in both dentitions (Dental Elf – 15th May 2018) which produced a very similar figure for the prevalence of TDI in primary teeth of 22.7% (95 %CI; 17.3% to 28.7%) from a sample of 59,436 individuals.


Primary Paper

Patnana AK, Chugh A, Chugh VK, Kumar P, Rao V Vanga N, Singh S. The prevalence of traumatic dental injuries in deciduous teeth: A systematic review and Meta-analysis. Dent Traumatol. 2020 Dec 1. doi: 10.1111/edt.12640. Epub ahead of print. PMID: 33289328.

Review protocol on PROSPERO

Other references

Dental Elf – 15th May 2018

Traumatic dental injuries affect around 1 billion people




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