**4. Etiologic factors for traumatic dental injuries**

There are many studies that have been conducted that provide the epidemiology of maxillofacial trauma throughout the world [12–15]. This is important as they provide etiological factors which vary, depending on the age of the patient in question, as well as cultural and socio-economic factors [12, 16].

Among the most common causes of the TDIs are: traffic accident involving motor vehicle, motorcycle, or bicycle; day-to-day activities and sports; as well as a fall from a height [17, 18]. Knowing the etiology of the maxillofacial trauma provides an understanding of people's behavior in a region and the need for adoption of preventive policies [12, 13, 16].

Traumatic dental and facial injuries are frequent in sports and often cause esthetic, functional, psychological, and economic problems [3–20]. Dental injuries are the most frequent orofacial injury related to participation in sports activities [19, 20].

The main causes of traumatic dental injuries are falls and collisions with people or objects, which are very common in contact sports [19, 20]. Participation in sports, especially contact sports, greatly increases the risk of traumatic dental injury.

#### **5. Classification systems for dental trauma**

Dental Therapists and Oral Hygienists need to be aware of how TDI are classified so that they can provide treatment for patients presenting with the conditions. Many classifications of TDI have been presented over the years [21].

The currently accepted system is based on the Application of International Classification of Diseases to dentistry and stomatology by the WHO (1995), and was modified by Andreasen and Andreasen (2011) [22–24].

The conditions to be observed in the two classifications include the following: crown infraction; uncomplicated and complicated crown fracture; uncomplicated and complicated crown-root fracture; root fracture; concussion; luxation; avulsion; and lacerations.

The modified Andreasen classification is more comprehensive and contains and explains more conditions to be observed when studying dental trauma. **Table 1** indicates the differences in the two classification systems and will prepare us to review and formulate a structure to guide dental professionals.

Based on the classification described in **Table 1** detailed descriptions of the injuries is provided. The injuries are categorized into soft tissue injuries (**Table 2**); Dento-alveolar Injuries (**Table 3**); and Oro-Facial Bony Injuries


#### **Table 1.**

*Andreasen and Andreasen (2011) and WHO classification (1995) of TDI.*

*The Role of the Dental Therapists and Oral Hygienists in the Immediate Response… DOI: http://dx.doi.org/10.5772/intechopen.99631*


#### **Table 2.**

*Summary describing common soft tissue injuries and their management (Patel* et al*., 2014).*



#### **Table 3.**

*Summary describing common dento-alveolar injuries and their management (Patel et al., 2014).*


#### **Table 4.**

*Summary describing common oro-facial bony injuries and their management (Patel et al., 2014).*

(**Table 4**). The tables will also include the management to be provided for the TDIs as guidelines for dental professionals.

#### **6. Discussion**

The information compiled above shows that it is very crucial for Dental Therapists and Oral Hygienist to have a clear ability to formulate a diagnosis and oral hygiene care plan based on the assessment of the oral cavity [22–24]. Literature

#### *The Role of the Dental Therapists and Oral Hygienists in the Immediate Response… DOI: http://dx.doi.org/10.5772/intechopen.99631*

available tends to focus on TDI being diagnosed and managed by dentists and dental specialists [2, 3]. This is not always feasible as the first in line for the provision of oral health services are Dental Therapists and Oral Hygienists. The future of oral health services shows a need to empower all oral health professionals in the provision of TDI so that patients get optimal oral health services. With the number of auxiliary oral health professionals increasing, it is very important that their role in providing critical and emergency oral health services as emphasized.

Dental Therapist and Oral Hygienists provide treatment in a Primary Health Care setting and could therefore be the first in line to provide treatment when patients present in developing countries [6, 7, 9]. Hence it is crucial that they be provided with clear guidelines and information to diagnose and manage TDI. This will be done through the ability to classify the various TDI indicated in **Table 1**. The scope of practice for Dental Therapists and Oral Hygienists indicates that there should be a focus on dental trauma when clinical services are provided (**Tables 2**–**4**).

**Table 5** provides a brief schematic template that indicates that during practice the Dental Therapists and Oral Hygienists should be able to identify whether patients present with soft tissue, dento-alveolar or oro-facial bony injuries when they provide dental treatment for adults and pediatric patients [25, 26]. This is important as they will be able to monitor the patient's progress towards achieving desired oral health outcomes.

When the patients present in the clinical environment there should be adequate clinical reasoning skills to know how to manage the TDI. The information provided in the middle column of **Tables 2**–**4** provides detailed descriptions of the TDI so that the Dental Therapists and Oral Hygienists can have clear guidelines of what to expect in practice. The middle circle of **Table 5** provides a relevant scheme to be

**Table 5.** *Applying the clinical findings in dental therapist and Oral hygiene practice.*

followed that they should use to have a clear description of the possible lesions. This is essential for the provision of evidence of adequate consultation when needed and leads the clinicians to have adequate and clear written responses should the information be requested by other members of the dental team or health team [25–28]. This is a key factor to be considered as they also need to refer the lesions to the appropriate dental team members based on the scope of practice [27, 29, 30].

Clinical service and oral hygiene patient care is improved if the TDI are managed efficiently and effectively [31, 32].

The crucial step to be followed during all the phases is to ensure that there is appropriate documentation of self-care education, status of patient compliance, failed or canceled appointments, postoperative instructions provided, modification made in care plan and supportive facts, referrals and continued care schedule when the TDI are managed [4, 33].

The appropriate management will assist all clinicians to ensure that the individual patients' potential state of oral health and maintenance is achieved [33]. This leads to optimum oral health service that is crucial for the patients.

## **7. Conclusions**

Ultimately, knowing how to effectively diagnose and start treating dental emergencies early will lead to better clinical outcomes and greater patient satisfaction. Availability of easily accessible dental emergency manual/guidelines provide an overview of effective management strategies for dental emergencies which is essential for Dental Therapists and Oral Hygienist [34].

It is very important to select appropriate clinical responses when patients present with dental trauma as discussed [35, 36]. It is also crucial to note as discussed, that relevant approaches to diagnostic testing and evaluation when treating dental emergencies will build confidence and enable Dental Therapists and Oral Hygienists to effectively manage dental trauma.

A recommendation for developing protocols for the different categories of patients such as pediatric patients is suggested for further development. There is further room for a broader schematic template that shows how the inter and multi-disciplinary team can play a role in providing oral health services for patients presenting with TDI.

### **Conflict of interest**

The authors declare no conflict of interest.

*The Role of the Dental Therapists and Oral Hygienists in the Immediate Response… DOI: http://dx.doi.org/10.5772/intechopen.99631*
