Increased lifetime prevalence of dental trauma is associated with previous non-dental injuries, mental distress and high alcohol consumption

Causes of dental trauma: Results of findings among patients in a secondary oral healthcare center, Jos, Nigeria

Background:

Dental trauma is a major type of traumatic dental injury (TDI) and a common presentation in many oral health facilities in Nigeria. Despite the high prevalence of TDIs, causes of dental trauma are yet to be fully investigated among Nigerians.

Aim:

The aim of this study is to determine the types of dental trauma, aetiology, and the causes of dental trauma as it relates with sociodemographic characteristics among dental patients.

Materials and Methods:

This was a cross-sectional study among patients attending a secondary oral healthcare facility in the North Central city of Jos between January 2019 and December 2020. The sociodemographic features of the patients include patients’ complaints, clinical and social history, result of simple clinical oral examinations, and diagnoses of dental trauma. The classification of Ellis and Davey (1970) was used to classify dental trauma for this study.

Results:

One hundred and seventy-six (6.7%) patients presented with dental trauma involving 281 teeth. The mean age was 37.54 ± 2.16 years. The most common cause of dental trauma in 48 (27.3%) patients was bone cracking, followed by falls in 33 (18.8%), road traffic accidents (RTAs) in 26 (14.8%), and bottle opening with teeth in 26 (14.8%). Bone cracking was the major cause of dental trauma in 18 (31.0%) educated and 2 (28.6%) non-educated patients. Among the patients, 118 (67.1%) presented with single traumatized tooth. Permanent anterior teeth 151 (53.74%) were more involved, and class 2 trauma involving enamel and dentinal structure was the most common presentation.

Conclusion:

Oral health awareness campaign on the damaging effect of bone cracking and use of tooth for opening metal caps of bottled drinks among adult population will reduce the prevalence of dental trauma among many adult Nigerians.

Health-Risk Behavior-, Mental Health-, and Physical Exercise-Related Risk Factors for Tooth Fractures in Korean Adolescents

We aimed to determine factors related to tooth fracture experience in Korean adolescents. This study used data from the 14th Korea Youth Risk Behavior Survey in 2018, a cross-sectional web-based survey of health-risk behaviors among a representative sample of Korean middle- and high-school students aged 12-17 years. A total of 60,040 participants were selected using a complex sampling design of the survey from 400 middle schools and 400 high schools. They answered a self-administered questionnaire survey in classrooms. Explanatory variables included those pertaining to health-risk behaviors, mental health, and physical exercise. Complex-sample multivariable logistic regression models were applied to identify factors related to tooth fracture experience in the past 12 months. The overall prevalence of dental fracture experience was 11.4%. Risk factors related to tooth fractures in Korean adolescents were unhealthy behaviors such as alcohol and tobacco consumption; mental health problems including stress, depression, and suicidal ideation; and intensive physical exercise. The major risk factor related to tooth fractures was depression. To prevent tooth fractures among adolescents, schools should strengthen mental health education, encourage mouthguard use during intensive physical exercise, and develop school environments to prevent orofacial injuries. Further studies on various risk factors related to tooth fractures are warranted.

Incidence of traumatic dental injury in Valencia, Spain

BACKGROUND

While traumatic dental injuries (TDI) are an increasingly frequent occurrence in everyday dental practice, little research on TDIs has been published in Spain. The aim of this study was to determine the incidence of TDIs in a population in Valencia (Spain) and investigate influential variables. In addition, a protocol for TDI data collection is proposed.

MATERIAL AND METHODS

This retrospective study compiled data from patients attending a private dental clinic between January 2003 and December 2014. The data were collected using a specially-elaborated protocol entitled "Emergency care of acute dental trauma". Patients responded to each item, and data was added from case radiographs and photographs. Data were entered in a Microsoft Office Excel spreadsheet and submitted for analysis by SPSS 15.0 software (Chicago, IL) applying 2-way analysis of variance (ANOVA) (p<0.01).

RESULTS

481 TDIs in 251 patients were examined at a private dental practice in Valencia. The population comprised 62.5% men and 37.5% women, aged 1 to 78 years. The highest frequency of tooth injuries occurred in children aged 9 years or younger. The most frequent injury was non-complicated crown fracture (43.2%). Upper central incisors were the most commonly affected teeth. The most frequent place where TDI was produced was in the street (28.7%), tripping over an immobile object being the most common cause (29%).

CONCLUSIONS

Thanks to the protocol elaborated for the purposes of this work, it was possible to compile a large quantity of data on TDI, facilitating future prevention and comparison with other regions. The results obtained concur with those published in the literature.

Depressive symptoms and traumatic dental injuries among adolescents

BACKGROUND/AIM

A previous cross-sectional study found that young adults with depression were more likely to have traumatic dental injuries (TDIs). The aim of this study was to determine the relationship between depressive symptoms during early and middle adolescence, and TDIs at age 15-16 years.

METHOD

This study used longitudinal data from phases 1 and 3 of the Research with East London Adolescents Community Health Survey (RELACHS), a school-based survey following a representative, multi-ethnic sample of adolescents attending public schools in East London (England). Information on depressive symptoms was collected using the Short Moods and Feelings Questionnaire (SMFQ) during early (age 11-12 years) and middle adolescence (age 15-16 years). TDIs were identified during clinical examinations in phase 3 when pupils were 15-16 years old. Logistic regression was used to test the association between depressive symptoms at different stages of adolescence and TDIs adjusting for confounders (age, gender, ethnicity, parental employment and overjet).

RESULTS

Depressive symptoms were reported by 24% and 32% of adolescents in early and middle adolescence, respectively. Evidence of TDIs was found in 18% of adolescents at age 15-16 years. Adolescents with depressive symptoms, either in early or middle adolescence, had greater odds of experiencing TDIs. However, these estimates were not statistically significant. In regression models adjusted for confounders, the odds of having TDIs were 1.23 (95% CI: 0.77-1.96) and 1.23 (95% CI: 0.76-1.95) among pupils with depressive symptoms in early and middle adolescence, respectively.

CONCLUSION

There was no association between depressive symptoms and TDIs in early and middle adolescents.

Prevalence of traumatic crown injuries in German adolescents

OBJECTIVES

Although dental trauma and its unfavorable sequelae are considered major public health problems worldwide, the published data on the prevalence of traumatic crown injuries (TCIs) in Germany are lacking. Therefore, the present study assessed the prevalence of TCIs among adolescents in Bavaria, Germany.

MATERIAL AND METHODS

Ethical approval and parental consents were obtained, and population-based information from 10- (N = 1158), 12- (N = 416), and 15-year-olds (N = 1302) from two different cohort studies performed in Bavaria (GINIplus/LISA and LAGZ) were examined for the presence of TCIs, dental caries, and restorations. Statistical comparisons were made using Mann-Whitney U test and Wilcoxon signed-rank test.

RESULTS

The prevalence of TCIs was 6.3% in the 10- and 12-year-old children and 14.0% in 15-year-old children, and a higher prevalence was observed in boys than in girls. Most (87.5%) of the traumatized teeth were maxillary incisors. The caries prevalence was low in all three populations.

CONCLUSION

The prevalence of TCIs in Bavarian adolescents at a low risk for caries was found to be low.

CLINICAL RELEVANCE

Dental trauma is a prevalent event in children and adolescents, and incisors are the most affected teeth. Therefore, dental practitioners should be able to manage the spectrum of traumatic injuries.

Are traumatic dental injuries greater in alcohol or illicit drugs consumers? A systematic review and meta-analysis

INTRODUCTION AND AIMS

Traumatic dental injuries (TDI), alcohol and illicit drugs consumption are highly-prevalent public health concerns. The aim of this study was to evaluate the association between alcohol and/or illicit drugs consumption and the presence of TDI.

DESIGN AND METHODS

This review was performed in accordance with MOOSE and PRISMA guidelines. Electronic searches were performed to found observational studies that investigated subjects that consumed alcohol and/or illicit drugs associated with TDI. Data extraction and a risk of bias assessment were performed. Three meta-analyses (MA) were performed to evaluate the association between TDI and alcohol consumption (1^stMA), subgrouping the studies into alcohol intake and binge-drinking, alcohol-related problems (2^ndMA), and drugs (3^rdMA). The odds ratio (OR) were calculated (p ≤ 0.05) for all analyses. The evidence was certainty-tested using the GRADE approach.

RESULTS

Twelve articles met the eligibility criteria. Nine studies were methodologically sound, while three had some confounding factors. In the pooled MA, an association between alcohol consumption and TDI (OR 1.57[1.33,1.85],p = 0.00001) was determined with moderate certainty of evidence, confirmed in the subgroups of alcohol intake (OR 1.49[1.17,1.90],p = 0.001) and binge-drinking (OR 1.68[1.30,2.18],p = 0.0001). No associations were found between TDI and risk for alcohol-related problems and drug use (OR 0.75[0.50,1.14],p = 0.18, and OR 1.20[0.82,1.75],p = 0.27, respectively), with both analyses having a very low certainty of evidence.

DISCUSSION AND CONCLUSIONS

There is moderate evidence concerning the association between alcohol use and TDI. Despite the absence of an association between illicit drugs use, alcohol-related problems and the presence of TDI, these results should be viewed with caution, since they had very low-certainly-evidence.

World traumatic dental injury prevalence and incidence, a meta-analysis-One billion living people have had traumatic dental injuries

Traumatic dental injuries (TDIs) account for a considerable proportion of bodily injuries. Nevertheless, global TDI frequency is unknown, probably because TDI diagnosis is not standardized. This study estimated world TDI frequency. A literature search (publication years 1996-2016) was aimed at covering as many countries, communities, ethnic groups as possible, thus achieving high generalizability. In particular, non-specific keywords, no language restrictions, and large databanks were used. Observational studies reporting proportions of individuals with at least one TDI (prevalence) and who developed TDI (incidence rate) were considered. Prevalence rates to permanent dentition, primary dentition and in 12-year-olds, incidence rate to any tooth for any age, male-to-female prevalence ratio (PR) in 12-year-olds, with 95% confidence intervals (95 CIs), were extracted/calculated. Study quality, Z-score distribution, funnel plot symmetry analysis, between-study heterogeneity, sensitivity, and subgroup analyses were performed. Selected primary studies were 102 (permanent dentition; 268 755 individuals; median age, 13.8 years), 46 (primary dentition; 59 436 individuals; median age, 3.4 years), 42 (12-year-olds; 33 829 individuals), 11 (incidence rate; 233 480 person-years; median age, 7.8 years), and 31 (PR; 16 003 males, 16 006 females). World TDI frequency resulted as follows: permanent dentition prevalence 15.2% (95 CI, 13.0%-17.4%); primary dentition prevalence 22.7% (95 CI, 17.3%-28.7%); 12-year-olds prevalence 18.1% (95 CI, 15.3%-21.0%); incidence rate, 2.82 (95 CI, 2.28%-3.42%) per 100 person-years; PR, 1.43 (95 CI, 1.34%-1.52%). Differences between WHO Regions were found. This study shows that more than one billion living people have had TDI. TDI is a neglected condition which could rank fifth if it was included in the list of the world's most frequent acute/chronic diseases and injuries.

The relevance of alcohol to dental practice

Alcohol is a very widely used drug which can cause dental disease and influence dental treatment. It is therefore important that dental professionals take an alcohol history from all patients and are aware of how to give alcohol reduction advice. This article discusses the impact of alcohol on oral health, including oral cancer, trauma, halitosis, tooth wear, periodontal disease and caries, with reference to the available literature. It also outlines current alcohol risk level advice and guidance regarding giving alcohol reduction advice in a dental setting.

Clinical Performance and Epidemiologic Aspects of Fractured Anterior Teeth Restored with a Composite Resin: A Two-Year Clinical Study

PURPOSE

To investigate the etiologic factors, effect of age and gender on dental trauma, and to evaluate the performance of composite resin on the fractured crown of permanent anterior teeth.

MATERIALS AND METHODS

Over a 2-year period, 73 permanent teeth from 51 patients with dental trauma were treated with direct composite resin restoration. Informed consent and standardized trauma forms were completed by the patient; teeth were restored with a submicron hybrid composite resin (Spectrum TPH) and respective adhesive system (Prime&Bond NT). Sixty-nine teeth were directly restored without fiber posts, while four were treated with fiber posts. Two experienced clinicians, besides the operator, evaluated each restoration at 6-, 12-, and 24-month follow-ups according to US Public Health Service (USPHS) criteria for the following characteristics: anatomical form, marginal adaptation, color match, marginal discoloration, surface roughness, and caries. Data were analyzed using the Wilcoxon Signed Rank, Kruskal-Wallis, Mann-Whitney U, and Siegel and Castellan tests.

RESULTS

A total of 73 traumatized teeth in 51 patients aged from 14 to 64 years (mean age 25.47 ± 14.058 years) were assessed according to the Ellis classification and restored over a 2-year period. Crown fractures were more common in the maxilla (84.9%) and caused by falls (58.8%). At the end of 24 months, a total of ten restorations were lost. The survival rate after 24 months was 82.14%. There were statistically significant differences in marginal adaptation between the 6-, 12-, and 24-month follow-ups. Although changes in marginal discoloration over time were not significant (p = 0.194), changes in color match were significant (p = 0.029).

CONCLUSION

Within the limitations of this study, direct composite restorations were accepted as clinically satisfactory.

Frequency of root resorption following trauma to permanent teeth

This retrospective study evaluated the frequency of development of root resorption in dental trauma cases involving supporting tissue. For 249 traumatized teeth of 125 patients aged between 7 and 51 years, we collected data on the gender and age of the patient, the teeth involved, the type of trauma, and the period between dental injury and initial examination. Radiographic parameters examined in relation to root resorption included the presence of inflammatory external root resorption, internal root resorption, replacement resorption, and canal calcification. Data were analyzed by chi-squared test, Fisher's exact test, and mult iple logistic regression (P < 0.05). The results indicated that there was a significant relationship between the period from the date of injury until initial examination and the occurrence of inflammatory external resorption (P = 0.0199), as well as the type of injury (P = 0.0406). Furthermore, external resorption was most frequently associated with intrusive luxation (92.8%), followed by avulsion (89.0%), lateral luxation (80.2%), and extrusive luxation (77.4%). Among the types of dental injury, replacement resorption was observed more frequently in cases of avulsion (87.2%). The only factor that was significantly associated with this type of resorption was the type of injury (P < 0.0001). Root resorption is observed more frequently and its risk of development is higher in cases of severe trauma, especially avulsion and intrusive luxation.

Obesity, physical activity and traumatic dental injuries in adolescents from East London

BACKGROUND/AIMS

Evidence on the interplay between obesity, physical activity and traumatic dental injuries (TDIs) is still inconclusive and heavily based on cross-sectional studies. The aim of this study was to explore the interrelationship of obesity and physical activity at age 11-12 years with TDI at age 15-16-years among schoolchildren from East London.

MATERIALS AND METHOD

Data were analysed regarding 598 adolescents who participated in phases I and III of the Research with East London Adolescents Community Health Survey (RELACHS), a longitudinal, school-based study of adolescents in East London. Participants reported their level of physical activity and their height and weight were measured to estimate body mass index Z-scores (according to the UK growth reference) when they were 11-12 years old. Oral clinical examinations were conducted to assess TDI, overjet and lip coverage when participants were 15-16 years old. The associations of obesity and physical activity with TDI were evaluated in crude and adjusted models using binary logistic regression.

RESULTS

Overall, 22.6% of adolescents were obese and 7.2% exercised for 7 h or more a week at baseline, while 18.1% of adolescents had experienced TDI by age 15-16 years. Physical activity (7+ hours per week) was significantly associated with TDI (odds ratio: 2.19; 95% confidence interval: 1.08-4.43) in the crude model. However, no significant associations were found between obesity and TDI (1.18; 95% CI: 0.72-1.93) or physical activity and TDI (1.96; 95% CI: 0.94-4.07) in adjusted models.

CONCLUSION

This study found no evidence of any associations of obesity and physical activity with TDI among adolescents from East London.

Alcohol consumption at age 11-12 years and traumatic dental injuries at age 15-16 years in school children from East London

AIM

To explore the association between alcohol consumption at age 11-12 years and traumatic dental injuries (TDI) at age 15-16 years.

METHODS

Data of 635 adolescents who participated in phases I and III of the Research with East London Adolescents Community Health Survey (RELACHS), a longitudinal school-based survey of a representative sample of adolescents from East London, were used for this study. Information on socio-demographic characteristics and alcohol consumption was obtained from questionnaires in phase I when adolescents were 11-12 years of age. Data on TDI and clinical characteristics (incisor overjet and lip coverage) were taken from clinical examination in phase III when adolescents were 15-16 years of age. The association between (lifetime and last month) alcohol consumption and TDI was assessed in crude and adjusted logistic regression models.

RESULTS

Overall, 14.5% of adolescents had ever consumed alcohol and 3.5% had consumed alcohol the month before the baseline survey, whereas 17% of adolescents had experienced TDI by age 15-16 years. No significant association of alcohol consumption with TDI was seen in these adolescents for either lifetime (adjusted odds ratio [OR]: 0.87; 95% confidence interval [CI]: 0.45-1.67) or last month consumption of alcohol (adjusted OR: 0.86; 95% CI: 0.28-2.69).

CONCLUSION

This study did not support the association between alcohol use and TDI in adolescents.

Pattern of traumatised anterior teeth among adult Nigerians and complications from late presentation

Background

The objectives of this study were to determine the prevalence and pattern of traumatic dental injury (TDI) among adults presenting in a tertiary health care facility in Nigeria, the time interval between injury and presentation in the hospital, the reasons for seeking treatment, and the complications arising due to late presentation.

Methods

Information obtained from history taking and clinical examination included Patient’s demographics, the when, where, and how of the injury, previous history of trauma, time elapsed between injury and presentation at the hospital, reason for seeking treatment, tooth/teeth involved, sensibility, tenderness to percussion, mobility, presence of discolouration, swelling, sinus tract, and mobility. Radiographic findings such as periapical radiolucency, pulp canal obliteration, and root resorption were also documented. TDI was classified using the Andreasen’s classification.

Results

Out of the 2645 adult patients that attended the outpatient clinic, 184 Presented with TDI giving a prevalence of 6.96 %. Their age range and mean age were 17–69 years and 30.6 ± 11.2 years respectively. Falls accounted for most (26.4 %) of the trauma to anterior teeth followed by motor cycle accidents (18.4 %) and domestic accidents (12.9 %), while opening bottle cork accounted for 1.2 %. The most common type of injury was enamel-dentine fracture accounting for 28.8 %, followed by complicated crown fracture 18.6 %, and avulsion 11.7 %. The maxillary central incisors were the most commonly affected followed by the maxillary lateral incisors and canines. More than half (51.5 %) of the patients presented in the hospital more than 1 year after injury. Majority of patients in the age groups ≤20 and 51–60 sought treatment because of pain, while more of those in the age groups 21–30 and 31–40 sought treatment because of aesthetic considerations. Seventy three (45.3 %) of the patients presented with complications involving 138 teeth. Majority of the complications were in teeth with enamel-dentine fracture (93.4 %), followed by concussion injury (55.6 %).

Conclusions

The prevalence of TDI in this study falls within previously reported figures. However, the high number of teeth developing complications may have resulted from late presentation for care.

Childhood dental injuries: a resiliency model of adaptation

BACKGROUND

There is a paucity of research examining how children and their families adapt to traumatic dental injuries.

AIM

This study examined how clinical and psychosocial factors influence adaptation to this oral stressor using a theoretical framework of resiliency and adaptation.

DESIGN

Children with traumatised permanent teeth, who were attending a UK dental hospital, completed questionnaires at baseline and at a 6 month follow-up. Child questionnaires assessed coping styles, social support, and quality of life outcomes. Parents were also asked to complete questionnaires, which assessed previous stressors/strains on the family, social support, healthcare satisfaction, and family impacts. Data related to the child's dental injury were collected from clinical notes. Structural equation modelling and regression analyses were employed to analyse data.

RESULTS

One hundred and eight children and 113 parents participated at baseline. Children's gender, coping style, social support, and family functioning significantly predicted children's oral health-related quality of life. Parents' satisfaction with their children's dental care significantly predicted parental quality of life outcomes. Children's close friend support and healthcare satisfaction remained significant predictors of positive outcomes at follow-up.

CONCLUSIONS

The findings revealed important psychosocial factors that influence child and family adaptation to childhood dental trauma.

Are overweight/obese children at risk of traumatic dental injuries? A meta-analysis of observational studies

BACKGROUND/AIM

Observational studies which investigated the association between overweight/obesity and traumatic dental injuries (TDI) reported contrasting results. Thus, this meta-analysis was designed to investigate such an association with the highest possible levels of internal and external validities.

MATERIAL AND METHODS

A comprehensive literature search was performed through PubMed, ISI Web of Science, Cochrane Library, Scopus, Google scholar to ensure generalizability. Eligible studies reported clear case and control definitions, exposure assessment. Where possible, odds ratio (OR) adjusted for covariates was extracted. Study quality was assessed through Newcastle-Ottawa Scale (NOS). Only fair-to-good quality studies with NOS scores ≥4 were selected. The method to assess the pooled OR was based on the level of between-study heterogeneity, estimated through the Cochran's Q. Reliability of the pooled OR was improved by controlling for publication bias, sensitivity analysis to study inclusion, and subgroup analyses according to tooth type (permanent vs primary teeth) and country where the study was performed (Brazilian studies vs studies from other countries).

RESULTS

Seventeen studies were selected from America, Asia, and Europe, their NOS scores ranged between 4 and 8. Overall, there were almost 28,000 patients, 7400 of them with TDI. The level of publication bias was minimal, and no adjustment was necessary. Between-study heterogeneity was high, and the random-effects method was used to assess the pooled OR, which resulted 1.30 (95% confidence interval, 1.11-1.53; P < 0.05). Sensitivity and subgroup analyses corroborated this estimate.

CONCLUSION

The choice to increase internal and external validity levels decreased the precision of the pooled OR (i.e., confidence intervals were relatively wide). The statistically significant overweight/obesity-TDI association, together with the so-called counterfactual condition (i.e., TDI prevalence was higher among overweight/obese children than among lean children), suggests that causal association between these two conditions is plausible.

A study of sports related occurrence of traumatic orodental injuries and associated risk factors in high school students in north India

Background:

Oral and dental injuries contribute to a major part of sports related injuries in children. Trauma occurring in developing years disrupts normal social functioning and brings about a major impact on quality of life due to their cumulative effect.

Objectives:

To assess the prevalence and causes of various sports related traumatic orodental injuries among 8 to 16 year school students along with identifying the associated risk factors in North India.

Patients and Methods:

A cross sectional study consisting of high school students of different organized sports teams aged 8-16 years was carried out in geographical area of north India. The students were selected by multistage cluster sampling methodology. 1105 students from 19 school teams (sports teams) and sports academies participated in study through structured interview and clinical examination in different sports situations.

Results:

30.3% (n = 335) of students suffered from orodental injuries. A higher number of girls had injury (32%) than boys (29%), though the difference was not significant. Most of the students suffered from soft tissue injuries (48%) followed by tooth fractures (43%). Maximum numbers of injuries were reported in high velocity (44.1%) and medium intensity sports (46.6%) (P < 0.001) Maximum injuries occurred in basketball (50%) and lowest in the field of badminton (6.1%) (P < 0.05). Amateurs (52%) suffered the most from injuries as per level of coaching. Only 6% of boys and 2% of girls used mouthguards.

Conclusions:

The result of the present study confirmed that students participating in different organized sports at high school level are at a very high risk of getting orodental injury. Hence knowledge and education regarding prevention of traumatic injuries is of paramount importance.

Nutritional status and physical activity level as risk factor for traumatic dental injuries occurrence: a systematic review

AIM

To systematically review epidemiological articles assessing traumatic dental injuries (TDI) rates according to the physical activity habits and nutritional status.

METHODS

A search was conducted using PubMed, ISI, Scopus, SciELO, LILACS, and gray literature in Brazilian Theses Databank. We searched for dental trauma, traumatic dental injuries, tooth injuries, tooth fractures, physical activity, motor activity, exercise, sedentary lifestyle, sports, obesity, body mass index (BMI), overweight, and fatness. Databases were searched in duplicate from their earliest records until 2012. Additional studies were identified by searching bibliographies of the articles. Two reviewers performed data extraction and analyzed study procedural quality using the Newcastle-Ottawa scale. PRISMA guidelines for reporting systematic reviews were followed.

RESULTS

We found 1159 articles, of whom 14 reports involving 13 studies were selected. One article was a birth cohort, one had a case-control design, and the others were cross-sectional. The quality of evidence varied across the studies and was high (9) in 3. Eleven of the studies included assessed influence of nutritional status: five show a positive association between dental trauma and overweight and six do not show any association. Regarding physical activity level, five studies assessed its effect on trauma occurrence: two detected that physical activity acts as a protective factor and two that physical active increases the risk of dental injuries, and one showed no differences in TDI occurrence. Physical activity estimated from questionnaires and BMI were the most frequently used measures, but methodological differences prevent the comparison of results.

CONCLUSION

The results suggest that no truly causal relationship exists between dental trauma and physical activity and nutritional status. Due to the relatively low level of evidence currently present, studies with more robust design, for example, prospective cohort should address this question, especially in view of the epidemic of obesity.

Dental traumas during the military service

BACKGROUND

Dental traumas are most frequent during the first three decades of life and more frequent among males than females. Approximately 80% (n = 28 000) of the male age cohort performs military service annually in Finland. As little is known of dental, head, and neck traumas during the military service, our aim was to study the etiology, number and occurrence of traumas of the Finnish conscripts during one calendar year. Our hypothesis was that above-mentioned traumas comprise a remarkable proportion of military accidents.

MATERIALS AND METHODS

The data comprised of all the Finnish conscripts' trauma cases in the year 2009 (mean age 20.1 years, SD 1.1). The frequency, mechanism, and time of the incidences were analyzed.

RESULTS

Of the total 1432 trauma cases, 303 (23%) involved head, neck, or dentition. The occurrence rate of dental traumas was 6.5 cases/1000 persons/year. Dental traumas comprised 14.3% of all traumas. The most common mechanism for dental traumas was a blow-type force. First 4 months of the service and winter time were periods of increased risk of dental traumas. Two-thirds of the dental traumas, one-third of the body traumas and a quarter of the head and neck traumas occurred during military field exercises. Most dental traumas required a visit to a military dental clinic and also needed follow-up care.

DISCUSSION AND CONCLUSION

Head, neck, and dental injuries are common during the military service in Finland. Prevention of dental traumas and need for first aid dental skills of the personnel should be emphasized.

A review of the oral health-related evidence that supports the orthodontic treatment need indices

BACKGROUND AND OBJECTIVES

To date, there is no evidence-based method of quantification for malocclusion. Consequently, how deviant occlusal traits should be scored and weighted relative to one another is a matter of serious debate. Orthodontic Treatment Need Indices (OTNI) use the subjective opinion of the experts, as their foundation, to define the pathological boundaries (cut-offs) of occlusal traits. This paper reviews the evidence relating malocclusions or deviated occlusal traits to oral health problems, and investigates if this evidence supports the cut-off points and the rationale used for OTNI.

MATERIALS AND METHODS

The relevant cited studies and reviews from the MEDLINE, Web of Science, Scopus, Cochrane databases, and scientific textbooks were used. The citation rate was confirmed by using the Google Scholar.

RESULTS

So far, the evidence for harmful effects of deviated occlusal traits on oral health is either lacking or exists as cross-sectional (mostly) and longitudinal (a few and primarily short-term) studies. When an association was reported between a deviated occlusal trait and an oral health problem, either the strength of that association was weak, or due to methodological issues, findings were not conclusive. Consequently, establishing a cause and effect relationship is difficult. Further, commonly used OTNI do not record a full spectrum of occlusal traits, and relating their ranking or scoring systems to the available evidence is difficult. Therefore, there is little evidence to suggest that individuals with a high need (high score), as measured by OTNI, will necessarily put at risk their oral health if they turn down orthodontic therapy.

CONCLUSION

OTNI have a role in the epidemiology and can be used for resource planning, but their predictive value to detect the future objective functional deficits or oral health problems is questionable. OTNI will need revalidation over time with emerging research findings.

Quality of life impacts following childhood dento-alveolar trauma

BACKGROUND

Dental injuries occur commonly in childhood and may necessitate demanding courses of treatment. The aim of this study was to investigate a variety of clinical and demographic factors that may influence the quality of life impacts experienced by children after a dental injury.

METHOD

A total of 244 children who attended a UK dental hospital, for management of traumatised permanent incisors, were invited to participate in the study. Clinical, demographic and psychosocial variables were collected at baseline, and outcome variables were assessed again at a 6-month follow up. Clinical variables included number of teeth injured; severity of the dental injury; visibility of the injury; time since injury; and number of dental appointments attended within the hospital. Psychosocial outcomes assessed included children's oral health-related quality of life (OHRQoL) and health-related quality of life (HRQoL).

RESULTS

One hundred and eight children participated in the baseline study (44% response rate), and of this group of children, a total of 70 children completed follow-up questionnaires (65% response rate). The results indicated that the most affected areas of children's OHRQoL and HRQoL were functional limitations and school-related activities, respectively. Of all the demographic and clinical variables, which were investigated within the current study, the only variable that significantly predicted OHRQoL and HRQoL for children was gender. Boys were found to report fewer impacts on their OHRQoL and HRQoL than girls. Interestingly, over two-thirds of children reported fewer impacts at the 6-month follow up.

CONCLUSIONS

The results revealed that girls were more likely to report higher level of impacts on their OHRQoL and HRQoL than boys following traumatic injury to their permanent incisors. Clinical variables were not significant predictors of child quality of life outcomes following dento-alveolar trauma at baseline or at the 6-month follow up.

A retrospective study of 889 injured permanent teeth

The aim of this study was to investigate pre-injury factors, causes of dental injuries and healing complications after traumatic injuries to permanent teeth. The analysed sample comprised 889 permanent teeth of 384 patients, who were treated in the Dentistry Department in Faculty Hospital in Pilsen. Enamel-dentin fractures [233 teeth (26.2%)] and lateral luxations [207 teeth (23.3%)] were the most frequent injuries. The age of the patients at the time of injury varied between 7 and 65 years. Predominantly, children were affected [587 injured teeth (66.0%)]. The most frequent causes of injuries in patients older than 11 years were various sport activities, predominantly bicycling. Pulp necrosis was observed in 239 teeth (26.9%). It was the most frequent post-traumatic complication in all types of dental traumas. Teeth with a completed root formation demonstrated a higher prevalence of pulp necrosis than teeth with an incomplete root formation in all types of luxation injuries. External root resorption was observed in 144 teeth. The rate of inflammatory resorption differed between the various types of luxation injuries (extrusive luxation 5.6%, lateral luxation 11.6%, intrusive luxation 33.3%). Following avulsion and replantation, active inflammatory resorptions were diagnosed in 13 (26.5%) of 49 replanted teeth and ankylosis/replacement resorptions were observed in 21 (42.9%) of 49 replanted teeth. After avulsion, primarily, immature teeth were affected by these complications. Within the observation period of 5 years, 39 teeth (4.4%) had to be removed (16 teeth with root fractures, 19 avulsed and replanted teeth, 3 luxated teeth, 1 tooth with crown-root fracture).

Oral aspects of obesity

Obesity (Body Mass Index > or = 30 kg/m2) has a high prevalence of 15-30% among European and American populations. It is an incurable chronic disease with a considerable mortality and co-morbidity. The co-morbidity can be reduced substantially by a moderate weight loss of 5-15%. The main cause of obesity is an imbalance between energy intake and energy expenditure. Therefore, the treatment starts with an energy restricted diet, a reduction of sedentary lifestyle, increased physical activity, and behavioural therapy to change eating habits. When necessary, this treatment can be followed by pharmacotherapy or surgery. Obesity is related to several aspects of oral health, such as caries, periodontitis and xerostomia. In addition, obesity may have implications for the dental treatment plan.

Traumatic dental injuries and attention-deficit/hyperactivity disorder: is there a link?

Traumatic dental injuries (TDIs) constitute a major cause of morbidity among children worldwide. Both TDIs and attention-deficit/hyperactivity disorder (ADHD) are prevalent conditions with similar male-to-female predominance and similar age of presentation. While the commonest causes of TDIs have been identified as playground or sports accidents, a well-known feature of ADHD is accident proneness. Violence, another significant risk factor for TDIs, is more likely to be observed in conduct disorder, a common comorbidity of ADHD. Also, both TDIs and ADHD have been found to be associated with left-handedness. The presence of multiple dental trauma episodes (MDTE), as well as increased risk for non-dental injuries in children with TDIs indicates an underlying persistent condition, which resembles ADHD. Higher point prevalence of mental distress at age 30, found to be associated with increased lifetime prevalence of TDIs, may also be taken as an evidence of a background developmental disorder persisting into adulthood with various comorbidities. In conclusion, this review combines the results of several studies and explains the significance of ADHD as an underlying and predisposing factor for TDIs. Increased awareness and close collaboration between different disciplines involved are essential.

Neighborhood social capital and dental injuries in Brazilian adolescents

OBJECTIVES

Evidence suggests that communities with higher levels of social capital have better health, but this association has not been explored specifically in relation to dental injury. We investigated the association between social capital and dental injury.

METHODS

We conducted a multilevel study assessed individual and neighborhood effects on dental injury of 1302 14- to 15-year-old adolescents in 39 schools of Distrito Federal, Brazil. Children underwent a dental examination and, with their parents, answered a questionnaire about their local environments. Our data analysis used logistic multilevel modeling of students and neighborhood (the latter defined by catchment areas of schools).

RESULTS

The prevalence of dental injury was significantly lower in neighborhoods with higher levels of social capital, especially among boys. After control for individual and neighborhood variables, the adjusted odds ratio for a 1-unit increase in the standardized social capital index was 0.55 (95% confidence interval=0.37, 0.81; P=.002) among boys.

CONCLUSIONS

Social capital may explain inequalities in rates of dental injury, especially among boys.

Prevalence and handedness correlates of traumatic injuries to the permanent incisors in 13-17-year-old adolescents in Erzurum, Turkey

The objectives of the present study were to explore the relationship between dental trauma and handedness, and to assess the prevalence of traumatic injuries to the permanent incisors of 13-17-year-old patients, seeking treatment for various dental conditions in Erzurum, Turkey. A questionnaire focusing on handedness was administered to these patients. Handedness was assessed by the Edinburgh Handedness Inventory (Oldfield, 1971). Hand preference was divided into two classes for convenience in data analysis: (i) right-handers (GSc from 80 to 100); and (ii) left-handers (GSc from -80 to -100). This study included the 13-17-year-old group patients who had GSc as described above. Thus, the present study was carried out on 2180 (1252 male and 928 female, with a mean age of 14.9 years) out of 2392 patients. The clinical examinations and radiographic assessments were performed in full-designed dental chairs. Preliminary analysis showed no differences in rates of handedness with respect to sex and age. Overall, 10.4% of the patients were left-handers. A total of 292 (13.4%) of 2180 patients examined had one or more traumatized permanent incisors. The proportion of dental trauma was significantly higher in males than in females, 17.41% in males as compared to 7.97% in females; and ratio of the affected males to females was about 2.18. Sex difference in the prevalence of traumatized permanent incisors was statistically significant (P < 0.001). That is, males had a significantly higher risk of dental trauma than females (P < 0.001; odds ratio: 2.49; 95% confidence interval (CI) 1.88, 3.23). There was a higher level of traumatized permanent incisors among left-handers than among right-handers. 28.3% of left-handers and 11.7% of right-handers had dental trauma. This difference in the prevalence of traumatized permanent incisors for handedness was statistically significant (P < 0.001). Indeed, left-handers had a significantly higher risk on dental trauma than right-handers (P < 0.001; odds ratio: 3.09; 95% CI 2.23, 4.29). The primary causative factor in the occurrence of trauma was the fall (27.7%). Then came violence and fight as the second most frequent cause of trauma (24%), followed by sports injury (18.8%). Trauma resulting from collisions and traffic accidents were accounted as 13.7 and 11.3% of all cases, respectively. The other causes were 4.5%. In conclusion, the present study suggests that left-handed adolescents have more frequent permanent incisor tooth trauma than right-handed adolescents. Left-handedness, therefore, appears to be a risk factor for trauma in 13-17-year-old adolescents.

Risk factors for major injuries to the face and teeth

Hyperactivity in children was significantly associated with the occurrence of major injuries affecting the face and/or teeth. Other important risk factors included being male, from lower social class and single-parent households, and scoring high for conduct disorder. The behavioural risk factors were significantly more common in children living in families receiving benefits, lower social classes and non-nuclear families.