Eden baysal dental trauma index

 “Learning is a lifetime process, but there comes a time when we must stop adding and start updating.” – Robert Breault

Traumatic dental injuries (TDI) are unwanted outcome of violence, sports, traffic, school and domestic accidents. These can affect teeth, periodontium and surrounding supporting hard and soft tissues of both primary and permanent dentition. They rarely involve just a single tooth, thus untreated traumatic dental injuries can have a negative social, functional, and emotional effect on any individual and their family.1

Even though TDI are the fifth most prevalent disease or injury, still both, the oral health sections of the CDC (Centers for Disease Control and Prevention) and WHO considered only dental caries, periodontal diseases, and oral cancer as oral diseases.2

Poor reporting of TDI and less recognition by the public health organization is one of main cause of the neglection of TDI. Teaching of dental trauma to undergraduate dental students is minimal in their 5-year curriculum and non-existent in medical training. 3 Education in dental trauma is extremely important to promote knowledge on the assessment and treatment of a traumatized tooth.

Andreasen’s classification is accurate, most widely used and relates to treatment and prognosis regarding dental injuries. However, there is a risk for underestimation of multiple dental injuries with Andreasen’s classification. In 2020 a new attempt was done to create a simple index based on Andreasen's classification, that could be simple to use in the emergency setting and facilitate later data processing. Due to the fact that treatment and prognosis of traumatic injuries are profoundly influenced by the maturity of the root and involvement of the fracture affecting the alveolar bone, this new system also included these two parameters along with other categories of Andreasen.

This new ‘Eden Baysal Dental Trauma Index’, was developed by Prof. Dr. Ece Eden a pedodontist and her 4th grade student Mehmet Baysal of Turkey and was published in 2020. It is a five-digit index that defines the type of the injury of the hard-dental tissues (crown in relation with the pulp and root), periodontal ligament, alveolar process and also records the maturity of apex.4 The tooth injured is indicated by the two-digit FDI numbering system in parenthesis, and can easily be used for both primary and permanent dentitions.

The index contains five digits following FDI tooth code. The coding of the traumatic injury is divided into 3 groups as injuries of the crown (1st digit), injuries of the root (2nd digit) and the luxation injuries (3rd digit), maturity of apex (4^th digit) and fracture of alveolar process (5^th digit).

It was observed that dental trauma not only affects the teeth and the neighbouring dental hard tissues but may also damage the soft tissues extra and/or intra-orally e.g. the skin on the face and the lips, gingiva, lingual or labial frenulum and the tongue. Thus, in 2021 the modified version of Eden Baysal indexing was introduced. 5

'Modified Eden Baysal Dental Trauma Index ' aims to record the soft tissue injuries together with the information of injured tooth or teeth and alveolar process. Four different types of soft tissue injuries are coded for both skin/lip and gingiva/tongue. The total of nine codes starts with ‘0’ indicated no injury and followed by extraoral soft tissue injuries (1 to 4) and 5 to 8 are used to record the intra-oral soft tissue injuries affecting gingiva, frenulum or the tongue. The codes used to record soft tissue injuries as superscript numbers. 5

A simple table which shows the summary of the codes used in ‘Eden Baysal Dental Trauma Index’, can be included in the patient record form to remind the clinician about the index codes and may enable the recording. As well as, it is also suitable for computer registration.

Training of all the stakeholders is necessary before collecting data or recording trauma cases in dental clinics as well as for trauma centers. If one is uncertain about the codes to select, the severe code that will affect the treatment plan should be chosen. If there is more than one code at the same digit, always the most severe code that will affect the treatment should be recorded.

The good news is that the IADT has recently included Eden Baysal Dental Trauma Index for recording dental injuries in ‘Dental Trauma Guide’ which is an evidence-based treatment guide.