Dentists Miss Multiple Injuries on Single Tooth, Study Finds
A new analysis of 30 international studies reveals that combination injuries—where one tooth sustains multiple types of damage simultaneously—occur far more often than clinicians typically recognize or report. The finding has implications for dental training, treatment protocols, and patient outcomes, as missed injuries can lead to costly complications and tooth loss.
Originaltitel: Prevalence and Patterns of Multiple Injuries Affecting a Single Permanent Tooth (Combination Injuries): A Systematic Review and Meta‐Analysis
**Kombinationskador på tänder utgör okänd del av tandtraumaprevalensen** Tandtraumapatienternas faktiska skadebörda är högre än statistiken visar — många drabbas av flera skador samtidigt på samma tand, men detta dokumenteras sällan i kliniken. En metaanalys från Karolinska Institutet samlade 30 observationsstudier från 20 länder för att kartlägga kombinationskadors omfattning bland 34 382 traumatiserade permanenta tänder. Resultatet visar att 14 procent av tandtrauman utgörs av kombinationsskador, med en spännvidd från 2 till 48 procent mellan studier. Danmark rapporterade högast prevalens. De vanligaste kombinationerna var emailj-dentinfraktur tillsammans med subluxation (25 procent) och emailj-dentinfraktur med commotio (17 procent). För inköpschefer och regionala tandvårdsprogram innebär detta att klassificeringssystem och behandlingsprotokoll måste uppdateras för att fånga denna ofta överseende skadekategori, vilket påverkar resurallokering och patientprognos.
ABSTRACT Background Combination injuries or multiple traumatic dental injuries (TDI) affecting a single permanent tooth are clinically significant but remain underrecognized. Although the global prevalence of TDI is well documented, the epidemiology of combination injuries has not been clearly established. This systematic review and meta‐analysis aimed to assess the prevalence and patterns of combination injuries in traumatized permanent teeth. Methods A review protocol was registered in PROSPERO (CRD1245967). Comprehensive searches of PubMed, EMBASE, Web of Science, and Scopus were conducted without language or date restrictions on December 4, 2025. Observational studies done in clinical settings involving patients older than 6 years with TDI in permanent teeth and reporting combination injuries were included. Two authors independently performed screening, data extraction, and risk of bias assessment using the Joanna Briggs Institute checklist. Random‐effects meta‐analyses were performed to estimate pooled prevalence and proportions of specific injury combinations. The certainty of evidence was evaluated using the GRADE framework. Results Thirty studies from 20 countries were included. Among 34,382 traumatized permanent teeth, 7161 presented with combination injuries. Reported prevalence ranged from 2.36% to 48.28%, with a pooled prevalence of 14% (95% CI: 11%–19%; I 2 = 98.2%). Denmark demonstrated the highest pooled prevalence among countries represented by multiple studies. The most frequently reported combinations were enamel‐dentin fracture with subluxation (25%) and enamel–dentin fracture with concussion (17%). Reporting terminology varied considerably, and many studies did not explicitly document combination injuries. While most studies had a low risk of bias, the overall certainty of evidence was very low. Conclusions The pooled prevalence of combination injuries was 14%, with the highest country‐specific prevalence reported in Denmark, and the most common pattern being enamel–dentin fracture combined with subluxation. Considerable variation in reporting terminology and the very low certainty of evidence highlight an urgent need for standardized nomenclature, calibrated diagnostic protocols, and well‐designed studies to accurately capture the complexity of these injuries.