Preventive strategies for traumatic dental injuries

Comparison of shock absorption capacities of three types of mouthguards: A comparative in vitro study

BACKGROUND/AIM

3D printing processes can be used to manufacture custom-made mouthguards for sports activities. Few studies have compared the impact performance of industrial-created mouthguards with that of custom-made mouthguards manufactured by thermoforming or 3D printing. The objective of this in vitro study was to compare the shock absorption capacities of custom-made mouthguards manufactured by 3D printing with industrial mouthguards and thermoformed ethylene vinyl acetate (EVA) mouthguards.

MATERIALS AND METHODS

For each type of mouthguard, eight samples were produced. 3D-printed mouthguards were manufactured using digital light processing technology. Each mouthguard was subjected to an impact performance test defined by the standard AFNOR XP S72-427, which evaluate maximum deceleration and force transmitted during impact. The thickness of each mouthguard before and after a series of five impacts was measured at the impacted inter-incisal area.

RESULTS

The mean maximum decelerations during impact ranged from 129 to 189 g for industrial mouthguards, 287 to 425 g for thermoformed EVA mouthguards, and 277 to 302 g for 3D-printed mouthguards. The mean reduction in mouthguard thickness at the impact zone after five tests was 1.2 mm for industrial mouthguards, 0.6 mm for 3D-printed mouthguards, and 2.2 mm for thermoformed EVA mouthguards.

CONCLUSIONS

Custom-made 3D printed mouthguards showed slightly better shock absorption ability than thermoformed mouthguards with respect to the indicator proposed in XP S72-427. They seemed to combine the practical advantages of thermoformed mouthguards in sports with better shock absorption capacity and lower cost. Furthermore, they had the least thickness variation during the test, and their shock absorption capacity was the least affected by repeated mechanical tests. Other types of 3D-printing resin materials that will become available must continue to be tested for shock absorption to provide the best protection to users at low cost.

Impacts of educational interventions on the knowledge of prevention and emergency management of traumatic dental injuries in 11-17-year-old martial arts athletes: a randomized controlled trial

PURPOSE

We compared the effect of an educational pamphlet and a mobile application regarding prevention and emergency management of sport-related traumatic dental injuries (TDIs) on knowledge and self-reported preventive practice of 11-17-year-old Karate and Taekwondo athletes.

METHODS

Participants were invited through an online link published by the Public Relations of the corresponding federations. They completed an anonymous questionnaire consisting of demographics, self-reported experience of TDIs, knowledge of emergency management of TDIs, self-reported preventive practice of TDIs, and the reason for not using mouthguard. The respondents were randomly allocated to pamphlet or mobile application group with the same content. Three months after the intervention, the questionnaire was completed by the athletes again. Repeated measures ANOVA and a linear regression model served for statistical analysis.

RESULTS

In pamphlet group, 51 athletes and in mobile application group 57 athletes completed both baseline and follow-up questionnaires. At baseline, the mean score was 1.98 ± 1.20 and 1.82 ± 1.24 (out of 7) for the knowledge and 3.70 ± 1.64 and 3.33 ± 1.95 (out of 7) for practice in the pamphlet and application group, respectively. In 3-month follow-up, the mean score of knowledge and self-reported practice was significantly higher compared to baseline in both groups (p < 0.001) with no statistically significant difference between the two groups (p = 0.83 and p = 0.58, respectively). Most of the athletes were very satisfied or satisfied with both types of the educational intervention.

CONCLUSION

Both pamphlet and mobile application seem to be useful to improve awareness and practice regarding TDI prevention in adolescent athletes.

Prevalence of Dental Trauma and Receipt of Its Treatment among Male School Children in the Eastern Province of Saudi Arabia

Background

Dental trauma is a common dental public health problem, and it affects 20% to 30% of permanent dentition worldwide.

Objective

To evaluate self-reported dental trauma to permanent anterior teeth and the receipt of dental treatment among male school children.

Materials and Methods

This cross-sectional study included grade 7 to 9 school children in Dammam/Al-Khobar, the Eastern Province of Saudi Arabia. The participants responded to a pilot-tested self-completion questionnaire which contained questions about experience, types, place, and reasons for dental trauma and the receipt of dental treatment. Bivariate and multiple logistic regression analyses were performed.

Results

There were 258 students in the study with a mean age of 14.29 ± 1.11 years. Dental trauma was experienced by 39.5% of the participants. Tooth fracture (22.7%) was the most common type of dental trauma followed by tooth displacement (8.7%) and complete tooth removal (8%). The most common reason of dental trauma included fall (9.3%) and accidental hit by some objects (8.9). Home (19.8%), school (5%), and playground (4.2%) were reported as common places of dental trauma. Dental treatment was received by 20.5% of the samples. Most participants visited a dental clinic (10.8%) and used self-care at home (7.2%) after dental trauma. Nearly 4.7% of the participants received dental treatment immediately, 5% on the next day, and 2.7% after a month. Multiple logistic regression analyses showed a significant association of monthly family income (odds ratio = 0.44) with dental trauma (P = 0.008).

Conclusion

Dental trauma was highly prevalent among school children; however, few of them received care/dental treatment. Participants frequently experienced dental trauma due to a fall in their homes. Preventive measures should be taken to prevent dental trauma, reduce its burden, and improve quality of life.

Associations and risk factors for dental trauma: A systematic review of systematic reviews

OBJECTIVE

We sought to revise, qualify and summarize the body of evidence based on current information on the known associations and risk factors for traumatic dental injury (TDI) occurrence with an overview of systematic reviews.

METHODS

Electronic searches were performed with no language nor date restrictions.According to the PECO strategy, systematic reviews that investigated participants (P) with (E) and without (O) the presentation of factors relating to TDI and these factors' association with TDI episodes (O) as primary or secondary outcomes were included. Quality assessment and bias control were carried out according to the AMSTAR 2 checklist. In cases of systematic review results of discordance, the Jadad decision algorithm was applied.

RESULTS

After titles, abstracts and full texts were read, 19 systematic reviews were included in this overview. Four were classified with critically low, eleven with low and four with moderate methodological quality, respectively. In all studies, 249 cross-sectional, 34 epidemiological surveys, 22 cohort, 9 case-control, 4 longitudinal, 3 ecological and 30 unspecified studies were included. Male gender, child age, greater overjet, inadequate lip coverage, anterior open bite, caries in the permanent dentition, overweight, a previous history of TDI, tongue piercing, the use of alcoholic beverages and participation in sports were all associated with a greater chance of suffering TDI.

CONCLUSIONS

Sociodemographic, clinical and environmental factors are associated with a greater chance of TDI occurrence. However, most of the systematic reviews included were of a low quality and may not provide an accurate and comprehensive summary of the available research that addresses the question of interest. Well-designed primary studies on different aspects of TDI are encouraged to provide higher quality scientific evidence.

Orofacial trauma and mouthguard use in Brazilian rugby union players

BACKGROUND/AIM

Rugby union represents a high-risk sport for orofacial trauma due to its impact collisions and repetitive tackles. The aim of this study was to investigate the prevalence of orofacial trauma according to mouthguard use among a sample of Brazilian rugby union players.

METHODS

An online questionnaire was sent to the 16 best rugby union clubs in Brazil. The questionnaire contained questions about the training history of each athlete, prevalence of orofacial trauma, and details about mouthguard use. Only participants who reported using a mouthguard were selected for this analysis.

RESULTS

A total of 244 individuals were included. The prevalence of orofacial trauma was 34.4%, and 61.9% of them did not wear a mouthguard at the time of the incident. The only type of mouthguard reported was the pre-fabricated ("boil and bite" and "ready-to-wear") type. A stronger association was observed between the reason for using a mouthguard and the outcome, whereas a lower proportion of trauma was observed among individuals who claimed mandatory mouthguard use at the gym/sport (20.0%). Time since the respondent started playing rugby union and who instructed them to use a mouthguard were not associated with orofacial trauma.

CONCLUSION

Prevalence of orofacial trauma was high among this sample of rugby union players from Brazil, even with the use of pre-fabricated mouthguards. This study encourages further investigation on the use of custom-made mouthguards in rugby union and the role of coach/physical educators to reduce the prevalence of orofacial trauma.

Crystallization and hardening of poly(ethylene-co-vinyl acetate) mouthguards during routine use

Mouthguards (MGs) made from poly(ethylene-co-vinyl acetate) (EVA) are widely used in contact sports to prevent injuries such as breaking teeth and lip lacerations and to reduce brain concussion. However, the changes in morphology and the molecular mobility of EVA, which can affect its physical properties during practical usage, have not been precisely examined. Therefore, we attempted to determine the main factors which lead to changes in MG performance after one season of practical use by high school rugby players. Solid-state nuclear magnetic resonance (NMR) and pulse NMR measurements showed the hardening of MGs, which was associated with an increased crystallinity of the EVA resulting from prolonged usage. Furthermore, our data indicated that the increase in the relative amount of the crystalline phase may be primarily attributed to temperature fluctuations and repeated changes in pressure, which could cause the hardening of EVA and eventually diminish the protective ability of MGs.

Prevalence and risk factors associated with traumatic dental injury among 12-year-old schoolchildren in Montes Claros, MG, Brazil

The scope of this study was to determine the prevalence of trauma in the permanent dentition of 12-year-old schoolchildren and assess associations with demographic factors such as gender and socioeconomic status and overjet and lip coverage clinical factors. A cross-sectional analysis was conducted using a representative sample of 638 students. Data were gathered by means of clinical examinations and self-administered questionnaires. Descriptive analysis was performed, followed by the use of the chi-square test and Poisson logistic regression model for the determination of significant associations. The prevalence of traumatic dental injury was 34.9%. Falls constituted the main etiological factor (49.7%), and occurred in the home (48.2%). The results of the Poisson regression analysis revealed that accentuated overjet (> 5 mm) remained associated with traumatic dental injury irrespective of the other variables [PR = 1.50 (95% CI: 1.41 to 1.61); p = 0.003]. Moreover, a statistically significant association was found between accentuated overjet and dental trauma. No significant associations were found between TDI and socioeconomic status. These findings highlight the need for prevention strategies and orthodontic correction at the onset of the permanent dentition.

Traumatic dental injuries among 12-15-year-old-school children in panchkula

Background:

Traumatic dental injury (TDI) in children and adolescents has become one of the most serious dental public health problems. Despite such a high prevalence of dental trauma, very less attention has been paid to TDI, its etiology, and prevention.

Objectives:

To determine the prevalence of anterior tooth traumatic dental injuries in 12-15-year-old school children of Panchkula district, India, and to find any correlation with the cause, gender, extent of overbite as well as over-jet, and previous treatment.

Patients and Methods:

A multistage sample of 12-15-year-old school children (n = 810) in Panchkula district, Haryana, was selected. The children were screened using WHO criteria for oral examination and a trained dental surgeon examined the children. Those with clinical TDI were examined further for the type of traumatic injuries using Elis classification modified by Holland. Overjet and overbite were recorded. After examination, questions regarding the cause of trauma and its treatment were asked. Data were subjected to statistical analysis using the Chi square and Mantel-Haenszel tests by SPSS version 20.0.

Results:

The results showed that out of 810 children, 86 (10.2 %) had TDI. Males had higher prevalence of trauma than females (P < 0.05). The common cause of trauma was fall (51.11%) followed by sports injuries (41.86%). Enamel-dentin fracture without pulpal involvement was the most common type of trauma and the most frequent involved teeth were maxillary central incisors. A significant association was observed between overjet and overbite and trauma. Only 3.5% of the children affected with trauma had received treatment.

Conclusions:

The prevalence of traumatic injuries to permanent incisors in 12-15-year-old Panchkula school children was relatively high. TDI was associated with gender, overjet, and lip competence. There was a great unmet treatment need.

Oral health-related quality of life and traumatic dental injuries in Brazilian adolescents

OBJECTIVES

To evaluate the impact of traumatic dental injuries (TDI) on oral health-related quality of life (OHRQoL) among Brazilian adolescents.

METHODS

A population-based case-control study was carried out, which was nested to a cross-sectional study with a sample of 1215 adolescents aged 11-14 years from Belo Horizonte, Brazil. OHRQoL was measured using the Brazilian version of the Child Perceptions Questionnaire (CPQ11-14 )--Impact Short Form (ISF:16). Two-step cluster analysis was performed to define cases and controls based on CPQ11-14--ISF:16 scores. This method considers the pattern of responses for each item separately and how important each item is to the formation of clusters. The case group included those adolescents who presented higher negative impact on OHRQoL (n=405), while the control group included those with lower negative impact (n=810). Two controls for each case were individually matched from the same school and gender. The main independent variable was TDI, diagnosed by the Andreasen's classification. Untreated dental caries, malocclusion, and age were confounding variables. Conditional logistic regression analysis was performed with the significance level set at 5%.

RESULTS

A multiple conditional logistic regression model demonstrates that adolescents diagnosed with fracture involving dentin and/or pulp had a 2.40-fold greater chance of presenting high negative impact on QHRQoL [95% CI=1.26-4.58; P=0.008] than those without evidence of fractures. Enamel fracture only [P=0.065] and restored fractures [P=0.072] were not statistically associated with OHRQoL.

CONCLUSIONS

Adolescents with more severe untreated TDI, such as fractures involving dentin and/or pulp, were more likely to self-report a higher negative impact on their OHRQoL than those without TDI.

Knowledge and attitude of dental trauma among mothers in Iraq

AIM

To evaluate the knowledge and attitude of Iraqi mothers regarding dental trauma prevention and management.

STUDY DESIGN AND METHODS

Mothers (n = 231) that visited two professional dental centres in Mosul, Iraq, were interviewed and asked to answer a three-part questionnaire containing questions about demographic variables, attitudes and knowledge of dental trauma.

STATISTICS

The relationships of the demographic variables with the total knowledge score of the correct responses were analysed using two-sample t tests. The number of correct responses regarding management of avulsed teeth compared to that of fractured teeth was evaluated using a paired t test. A 5 % level of statistical significance was applied for the analyses.

RESULTS

The mean knowledge score was 5.2 (on a scale of 0-10). No significant differences were found in knowledge score with respect to mothers' age, educational level, working status, personal experience with dental trauma or first aid training (p > 0.05). Mothers with either at least a high school education or previous experience with dental trauma were more likely to recommend that their children wear mouth guards during sports (p = 0.02 and p = 0.03, respectively). Mothers who were 35 years of age and older were more likely to know how to correctly carry an avulsed tooth to a dentist. Mothers' knowledge regarding management of fractured teeth was significantly higher than that of avulsed teeth (p < 0.0001).

CONCLUSIONS

Mothers in Mosul, Iraq, did not have sufficient knowledge about the prevention and management of traumatic dental injuries. Intervention programmes should be considered to increase mothers' awareness regarding dental injuries.

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

INTRODUCTION

This retrospective study aimed to assess the occurrence of dental avulsions in patients with facial trauma over a 9-year period.

MATERIALS AND METHODS

Data was collected from records of patients attended to at the Division of Oral and Maxillofacial Surgery at Piracicaba Dental School-State University of Campinas, Piracicaba (SP), Brazil.

RESULTS

Two hundred three patients with 387 avulsed teeth were evaluated, the central incisors being the most common teeth involved (42 % of permanent and 61 % of primary teeth). Thirty-four percent of the cases occurred on weekends, mainly on Saturdays (20 %) and the distribution in relation to the time of year was similar with slight peaks in January. The most prevalent associated dentoalveolar injury was lateral luxation (26 %) and 19 % of the patients presented with an associated facial fracture. The most common sign presented was laceration (23 %), and the main symptoms found were pain (58 %). Associated general trauma was present in 139 patients (68 %), and the most prevalent was the upper limb (41 %).

DISCUSSION

Special emphasis should be given not only to diagnosis and treatment of dental avulsion but for prevention, too. An understanding of the etiology, severity, and distribution of associated traumatic injuries can help for future studies and for an effective prevention of these injuries.

Product related adult genitourinary injuries treated at emergency departments in the United States from 2002 to 2010

PURPOSE

We describe the epidemiological features of adult genitourinary injuries related to consumer products and determined the patient cohorts, products and situations associated with increased genitourinary injury risk.

MATERIALS AND METHODS

The National Electronic Injury Surveillance System, a data set validated to provide a probability sample of injury related emergency department presentations in the United States, was analyzed to characterize genitourinary injuries from 2002 to 2010. We analyzed 3,545 observations to derive national estimates.

RESULTS

An estimated 142,144 adults (95% CI 115,324-168,964) presented to American emergency departments with genitourinary injuries from 2002 to 2010. Of the injuries 69% occurred in men. A large majority of injuries involved the external genitalia. The most common categories of products involved were sporting items in 30.2% of cases, clothing articles in 9.4% and furniture in 9.2%. The highest prevalence of injury was at ages 18 to 28 years (37.5%), which was most often related to sports equipment, such as bicycles. Older cohorts (age greater than 65 years) more commonly sustained injuries during falls and often in the bathroom during use of a shower or tub. Of all patients 88% were evaluated and treated in the emergency department without inpatient admission, although the admission rate increased with increasing patient age.

CONCLUSIONS

Acute genitourinary injury is often associated with common consumer items and with identifiable high risk cohorts, products and situations. Consumers, practitioners and safety champions can use our epidemiological data to prioritize and develop strategies aimed at the prevention, limitation and informed treatment of such injuries.