Dental trauma in children: monitoring, management, and challenges—a narrative review

Introduction

Pediatric traumatic dental injuries (TDIs) represent a significant global public health concern, with epidemiological studies reporting prevalence rates ranging from 20% to 30% among children and adolescents worldwide (1,2). The maxillary central incisors are the most frequently affected teeth due to their anterior positioning and incomplete root development, which reduces bony support and increases vulnerability to fractures, luxations, and avulsions (3,4). TDI disproportionately impact preschool-aged children (1–3 years) owing to underdeveloped motor coordination and high fall rates, while school-aged children face trauma risks from sports, playground accidents, and vehicular collisions (e.g., bicycle or e-scooter-related injuries) (5,6).

The clinical and socioeconomic burden of TDI is profound. Complications such as pulp necrosis (PN), root resorption, and malocclusion can lead to long-term functional and aesthetic impairments, while untreated injuries negatively impact oral health-related quality of life (OHRQoL) and psychosocial well-being (7). Geographically, low- and middle-income countries (LMICs) and conflict-affected regions report higher TDI prevalence due to limited access to preventive care and delayed treatment (1,8). Socioeconomic disparities further exacerbate outcomes; children from marginalized communities experience higher injury severity and poorer follow-up rates (9).

The International Association of Dental Traumatology (IADT) guidelines provide a standardized framework for classifying and managing TDI (10). However, diagnostic challenges persist, particularly in differentiating transient pulp ischemia from irreversible necrosis during the acute post-trauma phase. Emerging technologies like laser Doppler flowmetry (LDF), pulse oximetry (PO), and ultrasound Doppler flowmetry (UDF) now enable real-time, non-invasive pulp vitality assessment, overcoming limitations of traditional cold/electric pulp testing (EPT) tests in pediatric patients (11,12).

This review synthesizes current evidence on:

• Classification systems for pediatric TDI (e.g., IADT criteria);
• Risk stratification by biological (e.g., obesity, neurodevelopmental disorders), behavioral (e.g., sports participation), and environmental factors [e.g., socioeconomic status (SES), access to care];
• Innovations in diagnostics [e.g., LDF, cone-beam computed tomography (CBCT)] and biomaterial-driven therapies [e.g., mineral trioxide aggregate (MTA) apexification, stem cell-based regeneration];
• Preventive strategies, including policy-led mouthguard mandates and artificial intelligence (AI)-assisted patient education.

By contextualizing recent advances in biomechanics, molecular biology, and digital health, this work aims to bridge gaps between research and clinical practice, ultimately improving outcomes for pediatric dental trauma patients. We present this article in accordance with the Narrative Review reporting checklist (available at https://tp.amegroups.com/article/view/10.21037/tp-2025-243/rc).

Methods

A comprehensive search was conducted in MEDLINE/PubMed, Scopus, and Web of Science up to May 2025 (initial search: 24 March 2025; final update: 4 May 2025). The search strategy combined MeSH terms and free-text keywords (Table 1). An initial search yielded 584 articles. Titles and abstracts were independently screened by two reviewers to exclude non-qualifying studies (e.g., non-TDI topics, reviews, case reports, non-English articles). The selection process is outlined in Figure 1.

Figure 1 The search strategy summary.

Quality assessment

In order to enhance the transparency and reliability of the studies, a brief assessment of the quality of the included studies was conducted, and the evidence was categorized into the following three levels based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework (13): high quality, moderate quality, and low quality. Concurrently, given the heterogeneity of study designs, particular attention was devoted to the randomization of trials, the sample size, the configuration of control groups, and the objectivity of outcome assessment.

• High quality: randomized controlled trials (RCTs) and repeated experimental studies, with pediatric dental trauma populations as the research subjects.
• Moderate quality: small sample-size experiments or non-RCTs, involving research subjects that are non-pediatric dental trauma populations.
• Low quality: uncontrolled trials, studies using mismatched cell types or cells of unknown origin, animal experiments, or research that does not fully meet the criteria for high or moderate quality.

Clinical classification and risk factors

The clinical manifestations of pediatric dental trauma are defined by standardized classification criteria established by the IADT (14), summarized in Table 2. This review adopts a hierarchical framework categorizing injuries into minor, moderate, and severe levels, encompassing diverse types from enamel fractures to complex avulsions and alveolar bone fractures.

The etiology of pediatric dental trauma can be systematically categorized into biological predispositions, behavioral-risk patterns, and environmental hazards. Biologically, elements including anterior positioning of maxillary central incisors with inadequate bony support (15), neurodevelopmental disorders, such as autism spectrum disorder (ASD) and cerebral palsy (CP) impairing motor coordination (16,17), obesity [body mass index (BMI) ≥25 kg/m²] increasing impact force during falls, and the high fall rates in preschoolers (1–3 years) due to underdeveloped protective reflexes all elevate trauma susceptibility (18).

Environmentally, factors including inadequate parental supervision and household hazards at home (19), the lack of mouthguards in athletes at risk of trauma despite awareness (20), the riding of electric scooters (which caused a higher crown fracture/avulsion rate compared to bicycles, 45% vs. 28%) in sports contexts, and low SES delaying dental intervention collectively contribute to the incidence and severity of pediatric dental trauma (21).

Main complications

TDI in children often give rise to complications affecting the dental pulp, periodontal tissues, and tooth roots (Figure 2). The initial stage of pulp-related complications is pulp hyperemia, characterized by the dilation and congestion of dental pulp blood vessels, representing an early physiological response to injury without irreversible damage (22). The next stage involves pulp shock, a state of transient functional inhibition that may yield false-negative results in vitality tests, necessitating dynamic clinical observation to distinguish it from irreversible pulp damage (23). Moderately advanced cases may develop pulpal calcification, including pulp canal obliteration (PCO), which occurs in 4.9% of traumatized primary teeth and shows a significant association with subluxation injuries (24). This process involves the progressive narrowing or obliteration of root canals, complicating future endodontic access and potentially masking underlying PN or infection. The most critical pulp-related complication is PN, defined by the complete loss of pulp vitality, diagnosed clinically through no response to cold/EPT, greyish-black crown discoloration, and delayed periapical swelling or fistulas (25). While subluxated primary teeth exhibit an 8.3% [95% confidence interval (CI): 4.8–11.8%] 1-year PN risk (26), permanent teeth with alveolar process fractures carry a higher risk of 56% (95% CI: 48.1–63.9%) over 10 years (27). Severe cases often require extraction due to infection, underscoring the need for timely intervention in TDI.

Figure 2 Main complications of pediatric dental trauma.

Root complications primarily include resorptive changes and fractures. Inflammatory external root resorption (IER) manifests radiographically as “moth-eaten” lesions with adjacent periapical radiolucencies, directly associated with post-traumatic inflammation (28). In contrast, replacement resorption (RR), a process in which dental tissue is progressively replaced by bone, occurs more frequently in immature teeth with open apices or in cases of delayed treatment. A retrospective study by Yamashita et al. [2017] reveals that RR occurs in 8% of luxation injuries, and their binomial logistic regression analysis further indicates that male gender [P=0.0392, odds ratio (OR) =2.79], avulsion injury (P=0.0009, OR =12.27), and a delay of more than 16 days from trauma to the initiation of endodontic treatment (P=0.0450, OR =7.53) significantly increase the risk of posttrauma complications, including RR (29).

Periodontal complications involve varying degrees of periodontal ligament (PDL) injury. Concussion presents with mild mobility and occlusal pain, while subluxation is marked by increased mobility and gingival bleeding (30).

Trauma to primary teeth indirectly risks permanent tooth development through inflammatory mediators from infected primary roots or direct injury to developing tooth germs (31). Case-control studies show a 4.1-fold (OR =5.388) increased risk of sequelae in permanent successors (SPS) (32). These findings underscore the need for longitudinal clinical and radiographic monitoring to detect early developmental abnormalities.

Clinical diagnosis

Clinical examination

Accurate diagnosis of TDI in children requires systematic integration of clinical evaluation and imaging modalities. Clinical examination forms the foundation, involving meticulous documentation of injury details (e.g., timing, mechanism) and inspection of soft tissues for lacerations, swelling, or signs of infection. Intraoral assessment focuses on identifying dental fractures, displacement, pathologic mobility (indicating PDL injury), and greyish-black discoloration of the tooth crown (suggestive of PN) (33).

Isolated clinical assessment may miss occult injuries. A cohort study of 674 preschool children revealed radiographic findings such as PCO and root fractures in 2.5% of TDI cases without clinical symptoms. Conversely, 275 cases (40.8%) showed clinical signs without radiographic evidence, highlighting the diagnostic limitations of periapical radiographs (34). Given children’s heightened radiation susceptibility, imaging must strictly adhere to the as low as reasonably achievable (ALARA) principle (35). For primary tooth trauma, standard periapical radiography is preferred, avoiding the routine use of CBCT (36).

For complex cases of permanent tooth trauma, CBCT serves as a crucial three-dimensional diagnostic tool. A retrospective analysis of 190 pediatric patients with maxillary anterior tooth trauma demonstrated that low-dose CBCT significantly outperformed periapical radiography in diagnosing root fractures, alveolar bone fractures, and tooth resorption (37). Another study on 35 traumatized maxillary anterior teeth confirmed that CBCT exhibited significantly higher sensitivity (99%) and accuracy (91%) for TDI compared to conventional radiography (84%, 70%) (38). This suggests that CBCT can serve as an important supplement to conventional imaging in complex permanent tooth trauma.

Pulp vitality testing

Accurate pulp vitality assessment remains critical yet challenging in pediatric dental trauma management. Traditional methods such as cold tests and EPT are frequently compromised in children due to psychological factors and physiological limitations. Heightened anxiety often leads to test refusal or unreliable responses, while incomplete root development in young permanent teeth disrupts electrical circuit formation, reducing EPT reliability (39). Although cold testing is widely adopted, it risks false-negative readings during acute post-traumatic phases owing to transient neuronal suppression (40). These constraints have accelerated the adoption of pulpal blood flow (PBF) monitoring technologies, which provide objective, non-invasive vitality assessment through hemodynamic evaluation.

LDF quantifies real-time perfusion by analyzing Doppler frequency shifts in laser light reflected from moving erythrocytes, with spectral changes correlating directly with blood flow velocity (41) (Figure 3A). Clinical evidence underscores its diagnostic superiority (Table 3): Belcheva et al. documented significantly elevated LDF values in traumatized teeth compared to healthy counterparts across 88 split-mouth cases, enabling early vital pulp detection (42). Ersahan et al. further demonstrated LDF’s efficacy in tracking revascularization (>4.5 perfusion units) in extrusively luxated immature incisors over 6 months (43). Crucially, Roeykens et al. reported that LDF reclassified 43% (12/28) of teeth initially diagnosed as necrotic to vital status, accurately differentiating transient apical breakdown from true necrosis (44).

Figure 3 Overview of three distinct techniques used to detect blood flow patterns in dental pulp. (A) LDF detection of pulp blood flow pattern: when the laser beam penetrates the dental pulp blood vessels in a hemispherical manner, it is scattered by the flowing red blood cells. Before the beam reaches the receiver, part of the laser is absorbed. (B) PO detection of pulp blood flow pattern: a diode emits red light (~660 nm) and another emits infrared light (~940 nm). Oxyhemoglobin absorbs less red light, while deoxygenated hemoglobin absorbs less infrared light. The photoreceptor analyzes these absorption changes to determine blood oxygen saturation in the dental pulp. a: oxyhemoglobin. b: deoxygenated hemoglobin. (C) UDF detection of pulp blood flow pattern: ultrasound waves interact with moving red blood cells, causing frequency changes. When red blood cells move away from the probe, frequency decreases; when they move closer, frequency increases. By measuring these changes, the speed of red blood cells is calculated, indicating blood flow velocity. IR LED, infrared light emitting diode; LDF, laser Doppler flowmetry; PO, pulse oximetry; RED LED, red light emitting diode.

PO evaluates pulp vitality by measuring pulp oxygen saturation (SpO₂) through differential light absorption at two wavelengths, calculating the oxyhemoglobin/deoxyhemoglobin ratio (50) (Figure 3B). This technical advantage has positioned PO as a valuable adjunct in trauma management protocols, particularly for guiding timely intervention decisions in pediatric populations (Table 3). Bargrizan et al. established higher physiological SpO₂ baselines in immature incisors with open apices (mean 86.77% in central incisors, n=329 teeth), correlating with revascularization potential (45). Caldeira et al. subsequently defined prognostic thresholds: SpO₂ ≤77% predicted PN, while ≥90% indicated recovery in 59 luxated teeth (46). Most recently, Bux et al. achieved 100% diagnostic accuracy using PO across 40 traumatized teeth, surpassing conventional tests in objectivity (47).

UDF adapts the Doppler principle to high-frequency sound waves to assess vascular dynamics (51) (Figure 3C). Its real-time monitoring capability allows for immediate assessment of treatment response, filling a critical gap in post-traumatic follow-up protocols (Table 3). In a comparative analysis of 246 traumatized teeth, Ahn et al. observed significantly higher pulp survival rates at 1 year with UDF-guided treatment (90%) versus EPT-based management (74%), highlighting its enhanced sensitivity (48). Complementarily, Cho et al. established normative PBF velocity benchmarks (0.5–0.6 cm/s) through evaluation of 359 healthy anterior teeth, providing critical reference values for trauma assessment (49).

Emerging modalities continue to expand diagnostic frontiers. Transmitted-light plethysmography demonstrated higher baseline PBF in mature versus immature teeth (52) and detected reversible flow fluctuations during thermal provocation (53). Magnetic resonance imaging (MRI) exhibits particular promise in pediatric applications, achieving up to 90% sensitivity for early necrosis detection and excelling in identifying initial degenerative changes (54,55).

Treatment methods

Clinical practitioners should tailor diagnostic interventions to both the severity of dental injuries and the root maturity stage in children, comprehensively assessing post-traumatic pulp damage to formulate rational treatment plans. Generally, the treatment process comprises three phases: emergency management, transitional therapy, and definitive restoration. The core therapeutic principle emphasizes preserving vital pulp to facilitate continued root development.

Primary tooth management

The management of primary tooth trauma requires a balance between preserving dental function and minimizing risks to the developing permanent tooth. Given the unique anatomical characteristics of primary dentition—such as open apices and close proximity to the underlying developing permanent buds—treatment protocols must prioritize conservative strategies while anticipating potential long-term sequelae. Therefore, during diagnosis, clinicians should assess the risk of permanent successor injury and, based on the child’s cooperation level, provide parents with detailed instructions on treatment considerations to optimize outcomes.

For intruded primary teeth, conservative observation is preferred due to the high likelihood of spontaneous re-eruption, as a retrospective cohort study of 238 teeth found 68% re-erupted within 6 months (56). Lateral luxation or fractures typically require 4-week splinting (57,58). Replantation of avulsed primary teeth is contraindicated, and long-term monitoring of the underlying developing permanent tooth is crucial for detecting potential complications, as trauma to primary teeth may cause enamel discoloration, developmental abnormalities, or damage to the permanent tooth bud (59,60).

Young permanent tooth management

The core objective in managing immature permanent teeth is to preserve pulp vitality to support continuous root development, as pulp viability is the physiological prerequisite for guiding root maturation. For crown fractures with pulp exposure, direct pulp capping or partial pulpotomy is indicated, while non-exposed fractures with intact pulp can be restored using composite resin (61). A retrospective study of 99 immature teeth with crown fractures confirmed that cervical pulpotomy achieved a 90.4% success rate, attributed to vital pulp therapy reducing complication risks (62).

In luxation injuries, intrusive luxation mandates urgent pulp intervention due to its high failure rate—Antipovienė et al. reported a 75% risk of PN (63), and a multicenter study of 230 intruded teeth by Tsilingaridis et al. revealed 75% PN, 25% infectious root resorption, and 22% RR, with root maturity and intrusion severity identified as key risk factors (64). By contrast, partially displaced luxations require standard protocols of repositioning, splinting, and regular pulp vitality assessment.

Avulsed teeth demand replantation within 30–60 minutes ideally; if delayed, storage in Hank’s balanced salt solution or milk is recommended to maintain PDL viability (65). For root fractures, flexible splinting with stainless steel wire and composite resin is essential, with splinting duration tailored to injury severity (23). Notably, Isaksson et al.’s study of 512 root-fractured teeth showed that prolonged splinting (81–110 days) promoted hard tissue (dentin/cementum) healing compared to shorter periods (18 days) (66), while a comparative study in 60 children demonstrated that 0.7 mm wire splints provided superior pain relief than 0.4 mm wire without compromising healing outcomes (67).

Pulp therapy and tooth reimplantation

In pulp treatment for traumatized teeth, bioceramic materials play a core role, with MTA and Biodentine being the most widely used (Table 4). MTA achieves a 93.6% success rate in pulpotomy for complicated crown fractures with pulp exposure, significantly higher than 76.9% for indirect pulp capping (68). In apexification, MTA extends the median tooth survival time to 16.1 years, which represents approximately a 60% increase relative to calcium hydroxide—with the latter showing a median survival period of around 10 years (69). Furthermore, using MTA as a coronal barrier ≥3 mm thick significantly reduces the root fracture risk to 9.8% after root canal treatment by optimizing stress distribution (70). Biodentine reinforced with glass fibers exhibits a 23% increase in fracture resistance, making it more suitable for traumatized teeth requiring mechanical support (71). Functional materials like aspirin/poly (lactic-co-glycolic acid) (ASP/PLGA) composite membranes promote pulp repair through anti-inflammatory and mineralization effects (10), while growth factors such as human β-defensin 4 provide new directions for pulp regeneration (72).

Replantation of avulsed primary or permanent teeth in children necessitates a multidisciplinary approach integrating root surface treatment, biomaterial application, and regenerative strategies to optimize periodontal healing and pulp vitality (78). Key strategies to optimize reimplantation outcomes, spanning root surface management and regenerative interventions, are summarized in the following evidence-based approaches (Table 4). For delayed replantation (≥60 minutes extraoral time), effective root surface decontamination is critical: Vendrame Dos Santos et al.’s 2020 rat model study showed that papain enzymatic cleaning reduced resorptive lacunae by 45% at 4 weeks post-replantation compared to untreated controls, while enhancing PDL fibroblast colonization (73). Regenerative therapies have emerged as game-changers: Guo et al. reported that deciduous dental pulp stem cell (DPSC) aggregate transplantation achieved 90% tooth revitalization with functional angiogenesis in a rat avulsion model, outperforming the 30% success rate in untreated groups (74). A platelet-rich fibrin (PRF)-based construct with bone marrow mesenchymal stem cells (BMMSCs) further demonstrated that PRF scaffolds significantly induced BMMSCs proliferation (increasing MTT assay values from days 1 to 7) and enabled tight cell adhesion, holding promise for improving replantation outcomes (75). Basualdo Allende et al.’s 2024 clinical trial in 50 pediatric patients added that low-level laser therapy reduced post-replantation pain by 41% at 7 days and improved PDL healing scores by 29% versus sham treatment (76).

For teeth with immature apices, innovative solutions like Ko et al.’s 2024 doxycycline-loaded nitric oxide-releasing nanogel showed a 58% reduction in periapical inflammation and 34% increase in hard tissue formation versus conventional antibiotics (77). Collectively, these findings establish a triage protocol: prioritize immediate replantation within 60 minutes, apply fluoride/enzymatic root cleaning for delays, and integrate stem cell-based therapies or PRF to promote vascularization and bone regeneration. While some methods are not trauma-specific, their translational applications have improved traumatized tooth prognoses, with potential materials summarized in Table 4.

Psychological impact

Dental trauma in children imposes significant psychosocial burdens and compromises their quality of life. A cross-sectional study by Elizabeth et al. on 8–13-year-old with maxillary incisor trauma revealed that 80% experienced impaired smiling ability, with accidental falls as the primary cause. Notably, a gender disparity existed in treatment delay: 34.8% of males had delays exceeding 1 year, whereas 41.7% of females received treatment within 1 year (79). Using the German version of the Early Childhood Oral Health Impact Scale (ECOHIS-G), Lembacher et al. found trauma-induced dental pain nearly doubled the reduction in OHRQoL among 0–6-year-old, with significant correlations observed between the decayed, missing, filled teeth (dmft) index, plaque accumulation, and child impact scale (CIS) scores (7). Kvesić et al. identified parental knowledge gaps, female gender, poor oral hygiene, and recent pain as risk factors for dental fear and anxiety (DFA) in traumatized children, with their model explaining 54.5% of DFA variance via the Child Fear Survey Schedule-Dental Subscale (CFSS-DS) scale (80).

Procopio et al. focused on familial impacts, noting that dental caries and trauma significantly reduced OHRQoL in children with ASD, highlighting heightened vulnerabilities in special needs populations (81). Collectively, these findings demonstrate that dental trauma erodes multidimensional quality of life through aesthetic disruptions triggering social anxiety, treatment-related fear, and familial stress.

Preventive strategies and interventions

Preventive strategies for pediatric dental trauma require multi-level, interdisciplinary approaches to mitigate incidence and improve outcomes. Educational interventions form the foundational pillar: Al Sari et al. demonstrated that training programs for school nurses and PE teachers significantly enhanced their competence in TDI management, with correct response rates to avulsion emergencies increasing from baseline to 3 months post-training (82). Similarly, Sulistyarsi et al. showed that an electronic book intervention elevated primary school teachers’ TDI knowledge scores from a median of 6 (poor) to 13 (good) (P<0.05), underscoring the efficacy of digital educational tools (83). Policy-led initiatives aim to bridge awareness-practice gaps. Despite 43% awareness of mouthguards’ protective role among sports academy children (Pranitha et al.) (20), usage remained negligible (0%), with discomfort (26.1%), perceived unnecessity (26.1%), and accessibility issues (8.0%) cited as barriers (14). Technological innovations offer scalable solutions: the ToothSOS mobile app garnered 91.7% willingness among pediatricians for TDI guidance, though awareness remains low (84). AI tools like ChatGPT show promise in patient education (76.7% accuracy for TDI queries), though validation is needed (85).

In conclusion, integrating educational empowerment, policy mandates, and technological adjuncts creates a synergistic framework. This evidence-based, multi-domain approach is essential for addressing pediatric dental trauma across social, educational, and clinical contexts.

Existing challenges and future directions

Pediatric dental trauma management has advanced, yet significant challenges persist. Gregorczyk-Maga et al. identified interleukin markers in gingival crevicular fluid as predictors of inflammatory root resorption (86), driving the need for molecular-level innovations—future rapid diagnostic kits based on these biomarkers could enable point-of-care risk assessment, allowing immediate intervention with anti-inflammatory agents to block resorptive pathways. Therapeutically, Basualdo Allende et al.’s validated anti-inflammatory effects of low-level laser therapy are evolving toward intelligent precision (76). Next-generation devices may auto-adjust laser parameters based on real-time inflammatory marker feedback, while combining with bioceramic materials (e.g., MTA pulpcapping with concurrent laser irradiation) to accelerate dentin bridge formation. Cross-sectional studies like Elizabeth et al.’s on avulsed teeth show limitations in long-term prognosis, spurring the development of longitudinal research frameworks (79). Future multi-center cohorts may integrate 3D oral scanning and pulp vitality monitors to track long-term trajectories, with AI algorithms generating personalized prognosis models from real-time occlusal pressure data. In essence, future advancements will blend molecular diagnostics (e.g., interleukin marker-based alerts) with precision therapies. This integrated model—where biomarker tests trigger personalized laser and biomaterial interventions—holds promise to redefine trauma management, fundamentally improving outcomes for pediatric patients.

Conclusions

This comprehensive review synthesizes current insights into pediatric dental trauma, spanning clinical classification, pathogenesis, diagnostic advancements, therapeutic strategies, psychosocial impacts, and preventive interventions.

Pediatric dental trauma is a multifaceted challenge, with biological vulnerabilities (e.g., maxillary incisor positioning, neurodevelopmental disorders), behavioral risks (oral habits, malocclusions), and environmental hazards (inadequate supervision, sports injuries) collectively contributing to its etiology. Complications such as PN, root resorption, and developmental sequelae in permanent teeth underscore the need for precise and timely management. Innovations in diagnostic tools, including LDF, PO, and UDF, have revolutionized pulp vitality assessment, enabling non-invasive, real-time monitoring and improving diagnostic accuracy.

Treatment paradigms emphasize personalized strategies: conservative management for primary teeth to avoid permanent tooth bud damage, and vital pulp therapy for immature permanent teeth to support root development. Bioceramic materials (e.g., MTA, Biodentine) and regenerative approaches (stem cells, platelet-rich fibrin) have significantly advanced pulp repair and replantation outcomes, though challenges in managing immature apices and delayed replantation cases persist. Psychosocial impacts, including dental anxiety and quality of life impairment, highlight the necessity of integrating psychological support into comprehensive care.

Preventive efforts, ranging from school-based educational programs and policy-driven mouthguard mandates to AI-powered mobile health tools, demonstrate promise in reducing trauma incidence and improving emergency response. However, gaps remain in translating evidence-based interventions to low-resource settings and addressing special-needs populations. Future research should prioritize long-term outcomes of regenerative therapies, interdisciplinary models for trauma care, and culturally adapted preventive strategies to achieve optimal oral health for children worldwide. Figure 4 visually encapsulates the key themes discussed, integrating the framework for pediatric dental trauma.

Figure 4 Pediatric dental trauma: classification, causes, treatments, and preventions. BP, bioceramic paste; CBCT, cone-beam computed tomography; MTA, mineral trioxide aggregate.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the Narrative Review reporting checklist. Available at https://tp.amegroups.com/article/view/10.21037/tp-2025-243/rc

Peer Review File: Available at https://tp.amegroups.com/article/view/10.21037/tp-2025-243/prf

Funding: This study was supported by the 2022 Post Graduation Education and Teaching Reform Project (No. F015010042230602806 to L.Z.), The National Natural Science Fund (No. 81700946 to J.Z.) and the Natural Science Fund of Hubei Province (No. 2024AFB1007 to J.Z.).

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-2025-243/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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