Occurrence of dental avulsion and associated injuries in patients with facial trauma over a 9-year period

Random forest algorithm to identify factors associated with sports-related dental injuries in 6 to 13-year-old athlete children in Hamadan, Iran-2018 -a cross-sectional study

Background

Traumatic dental injuries are one of the most important problems with major physical, aesthetic, psychological, social, functional and therapeutic problems that adversely affect the quality of life of children and adolescents. Recently the development of methods based on machine learning algorithms has provided researchers with more powerful tools to more accurate prediction in different domains and evaluate the factors affecting different phenomena more reliably than traditional regression models. This study tries to investigate the performance of random forest (RF) in identifying factors associated with sports-related dental injuries. Also, the accuracy of the RF model for predicting sports-related dental injuries was compared with logistic regression model as traditional competitor.

Methods

This cross-sectional study was applied to 356 athlete children aged 6 to 13-year-old in Hamadan, Iran. Random forest and logistic regression constructed by using sports-related dental injuries as response variables and age, sex, parent’s education, child’s birth order, type of sports activity, duration of sports activity, awareness regarding the mouthguard, mouthguard use as input. A self-reported questionnaire was used to obtain information.

Results

Fifty-five (15.4%) subjects had experienced a sports-related dental injury. The mean age of children with sports injuries was significantly higher than children without the experience of injury (p = 0.006). The prevalence of injury was significantly higher in boys (p = 0.008). Children with illiterate mothers are more likely to be injured than children with educated mothers (p = 0.045). Awareness of mouthguard and its use during exercise has a significant effect on reducing the prevalence of injury among users (p < 0.001).

Random forest model has a higher prediction accuracy (89.3%) for predicting sports-related dental injuries compared to the logistic regression (84.2%). The results of the relative importance of variables, based on RF showed, mouthguard use, and mouthguard awareness has more contributed importance in dental sport-related injuries’ prediction. Subsequently, the importance of sex and age is in the next position.

Conclusions

Using predictive models such as RF challenges existing inaccurate predictions due to high complexity and interactions between variables would be minimized. This helps to achieve more accurate identification of factors in sport-related dental injury among the general population of children.

Complex Dentoalveolar Fractures: Main Clinical Variables Description and Analysis

AIMS AND OBJECTIVES

To analyze and evaluate clinical features that define complex dentoalveolar trauma.

MATERIALS AND METHODS

Forty-five patients, with a mean age of 36.1 years, were included in the study; most patients were male (82.2%). The main clinical features defining dentoalveolar fractures were evaluated, including the status of the tooth, alveolar socket and adjacent soft tissues and their relationships with tooth loss. The relationship between splinting and tooth loss was also studied. The data were analyzed using descriptive and statistical methods.

RESULTS

A significant relationship was observed between the different clinical variables and tooth loss, in particular the status of the alveolar socket as the most relevant clinical factor; there was also a significant relationship between splinting and tooth loss, as this was the main protective factor.

CONCLUSIONS

Tooth loss prognosis following complex dentoalveolar trauma is related to the clinical features of the fracture, particularly the status of the alveolar socket and the possibility of using splinting as treatment.

Complications after osteosynthesis of craniofacial fractures-an analysis from the years 2015-2017

BACKGROUND

Complications mean a recurring problem in everyday clinical practice. Complication rates between 6 and 13% are described for the treatment of bony injuries to the head and neck area. This paper aims to provide a detailed analysis of the complications after osteosynthesis in facial skull fractures.

MATERIAL AND METHOD

In this retrospective study, we reviewed all patient records of injured treated in the Department of Cranial and Maxillofacial Surgery at the Dortmund General Hospital between 2015 and 2017.

RESULTS

Of the 22,031 head and neck injuries, 685 were treated with osteosynthesis. A clinically significant complication was reported in 32 patients (4.76%). The number of total complications was 63. In total, 66.7% of all complications have been identified in the paramedian mandible (44%), median mandible, mandibular angle, and in the collar area (each 12.7%). Eleven implants (in 5 patients) showed a cancellous bone impaction. Broken implants have been recognized in two cases. In 8 cases, there was a pseudarthrosis in the fracture area; in one case, there was a broken implant and pseudarthrosis in combination.

CONCLUSION

Osteosynthesis is a safe method of treating facial skull fractures, which is why we consider it the gold standard of therapy. The complication rate is well below 5%. The 3-dimensional adaptation (bending) and shortening of the osteosynthesis implants do not lead to an increase in complications.

Evaluation of Dentoalveolar Trauma in Children and Adolescents: a Modified Classification System and Surgical Treatment Strategies for Its Management

OBJECTIVE

To retrospectively analyze dentoalveolar trauma in pediatric patients, propose a modified classification, and delineate an approach for its urgent care from the surgeon's perspective.

PATIENTS AND METHODS

Clinical records of patients, attended at the 'A. and P. Kyriakou' Children's Hospital Department of Oral and Maxillofacial Surgery from 2000 to 2015, were retrieved and data were analyzed.

RESULTS

A total of 365 cases of dentoalveolar trauma, affecting 363 children and adolescents (221 males and 142 females), with an age range from 1 to 15 years, were treated in the authors' department. The most common injury mechanism was falls. The trauma was graded as class II in most patients (41.65%). The anterior maxilla was injured in the majority of the patients (78.35%). In 230 patients (63%) the trauma involved the primary dentition. Two hundred eighty-nine of the patients were treated with local anesthesia on an emergency basis, while in the rest 76 patients general anesthesia was considered mandatory.

CONCLUSIONS

Accurate diagnosis, timely treatment, and follow-up are critical for the management of dentoalveolar trauma in pediatric patients. A modified more detailed and severity-specific classification and guidelines for its surgical management may assist practitioners in decision making and effective treatment planning.

A 12-Year Retrospective Study of Avulsion Cases in a Public Brazilian Dental Trauma Service

Abstract This study assessed the epidemiological characteristics and management of the permanent teeth avulsion cases attended in a Brazilian dental trauma service from December 2005 to August 2016. A retrospective study was conducted of case records of 93 patients involving 139 avulsed teeth. Data included sex, age, trauma etiology, location of the accident, number and position of avulsed teeth, and presence and type of associated traumatic lesions. Management of the avulsed teeth was addressed as: time elapsed until teeth were retrieved from the accident’s location; teeth’s cleaning method and storage media; time elapsed until seeking treatment and replantation. The majority of the patients were children from 6-10 (31.2%) and 11-15 years old (26.9%). Male patients were more affected than female. Bicycle accident was the main etiological factor (31.2%). In 56 (60.2%) cases, traumatic lesions to neighboring teeth were present. In 55 (59.1%) cases, lesions to adjacent soft tissues were reported. In 82 (88.2%) cases, patients requested treatment at the same day of the accident. Sixty-four teeth (46.0%) were immediately retrieved and 28 (20.1%) were not found. Forty-two teeth (30.2%) were kept dry. Only one tooth (0.7%) was immediately replanted at the accident’s site, while 51 teeth (36.7%) were not replanted. Numerous avulsed teeth were inappropriately managed and immediate replantation was not frequent. Public policies must be created to raise awareness towards the particularities of avulsion cases.

Brazilian primary school teachers' knowledge about immediate management of dental trauma

OBJECTIVE:

To assess the level of knowledge of primary school teachers in the public school network of Northeastern Brazil with respect to management of dental trauma and its relationship with prognosis.

METHODS:

A questionnaire was applied to 195 school teachers of public schools in Northeastern Brazil. The questionnaire comprised 12 objective questions about dental trauma and methods for its prevention and management. Data were submitted to chi-square test and Poisson regression test (P > 0.05).

RESULTS:

Out of the 141 teachers who responded the questionnaires, the majority were women (70.2%) and most of them had experienced previous dental accidents involving a child (53.2%). The majority (84.4%) had incomplete college education and few were given some training on how to deal with emergency situations during their undergraduate course (13.5%) or after it (38.3%). Their level of knowledge about dental trauma and emergency protocols showed that unsatisfactory knowledge level was associated with the male sex: 46% higher for men in comparison to women (P = 0.025).

CONCLUSIONS:

Approximately half of teachers evaluated had unsatisfactory knowledge about dental trauma and emergency protocols, with female teachers showing more knowledge than men.

Unusual transalveolar and transmuco-gingival root avulsion of a fractured primary central incisor: a case with an 8-year follow-up

The purpose of this unique case report is to describe a very unusual dentoalveolar fracture associated with avulsion of the near-complete root. A 3-year-old male patient came for consultation after a dentoalveolar trauma with a “fragment that looks like canine” found in his mouth by his mother. This boy suffered root fracture of the upper primary central right incisor, accompanied by transalveolar and transmuco-gingival avulsion of the tooth root fragment, leaving the crown in its position in the dental arch. Clinical and radiological examinations were performed in order to follow up the case: 15 days, one month, and three months after trauma, the crown had a slight mobility without other clinical or radiological signs. After six months, the upper primary central right incisor's crown was exfoliated. Open bite due to the persistence of the pacifier habit favored the crown retention in the mouth. This case emphasizes the importance of primary diagnosis and follow-up of trauma cases. To the best of our knowledge, this kind of dental injury has not been previously described in the literature nor in the current Dental Trauma guidelines for the management of traumatic dental injuries in the primary dentition.

Concomitant dental injuries in maxillofacial fractures - a retrospective analysis of 1219 patients

BACKGROUND/AIM

Traumatic dental injuries are frequently combined with maxillofacial fractures, but literature addressing this topic is rare. In a retrospective study, the frequency of dental lesions in inpatients with traumatic facial injuries was analyzed.

MATERIAL AND METHODS

All patients referred to the Department of Oral and Maxillofacial Surgery of the University Medical Center of the Johannes Gutenberg-University Mainz for inpatient treatment due to facial fractures between January 2001 and December 2007 were analyzed regarding the type of fracture, its localization, and potential concomitant dental injuries. In addition a systematic review was performed to compare the findings of this study with existing data.

RESULTS

Altogether 1219 facial trauma patients underwent inpatient treatment. 184 (15.87%) out of those had 451 injured teeth, and 4.9% were edentulous. The most frequent causes were assaults (25.1%), followed by falls (19.6%) and bike accidents (10.1%). Avulsion, especially of the upper incisors, occurred in most cases (27.9%). Assaults caused 1.29 dental fractures per patient, while traffic-related accidents led to three to four times higher injury-rates.

CONCLUSIONS

With almost every sixth patient having at least one kind of dental injury, this study shows that a thorough anamnesis and examination of the dental status are absolutely necessary, especially in patients who suffered from high-speed impacts or collisions with low-resilience surfaces.