Dental emergencies presenting to a dental teaching hospital due to complications from traumatic dental injuries

Assessment of artificial intelligence applications in responding to dental trauma

BACKGROUND

This study assessed the consistency and accuracy of responses provided by two artificial intelligence (AI) applications, ChatGPT and Google Bard (Gemini), to questions related to dental trauma.

MATERIALS AND METHODS

Based on the International Association of Dental Traumatology guidelines, 25 dichotomous (yes/no) questions were posed to ChatGPT and Google Bard over 10 days. The responses were recorded and compared with the correct answers. Statistical analyses, including Fleiss kappa, were conducted to determine the agreement and consistency of the responses.

RESULTS

Analysis of 4500 responses revealed that both applications provided correct answers to 57.5% of the questions. Google Bard demonstrated a moderate level of agreement, with varying rates of incorrect answers and referrals to physicians.

CONCLUSIONS

Although ChatGPT and Google Bard are potential knowledge resources, their consistency and accuracy in responding to dental trauma queries remain limited. Further research involving specially trained AI models in endodontics is warranted to assess their suitability for clinical use.

Traumatic Dental Injuries among 12-Year-Old Schoolchildren in the United Arab Emirates

AIMS

This study aimed to evaluate the prevalence of the factors related to traumatic injuries to the permanent incisors of 12-year-old children in the Emirate of Ajman, United Arab Emirates.

METHODS

A sample of 1008 12-year-old children (510 boys and 498 girls) participated in this study. A multi-stage randomized sampling technique was used to select children from public schools for their inclusion in the sample population. An oral examination was completed by a calibrated examiner after receiving training for traumatic dental injury (TDI) to permanent incisor teeth utilizing a modified version of Ellis's classification. Data that were related to sociodemographic factors, TDI causes, and where the TDI took place were recorded using a structured questionnaire.

RESULTS

Of all of the children that were examined, 9.8% of them had experienced dental trauma. The difference in TDI prevalence between boys (15.9%) and girls (3.9%) was statistically significant (p < 0.05). The children whose mothers had low levels of education experienced a higher prevalence of TDI (p = 0.001). The children with incisal overjets that were greater than 5 mm or with inadequate lip coverage tended to have experienced dental injuries (p < 0.01). The main causes of injury to permanent incisors were collision against an object or person (53.5%) and falling (42.4%). Most of the accidents happened at home (58.6%) and school (25.3%). The most prevalent injuries were enamel fractures (58.7%) and enamel-dentine fractures (34.3%).

CONCLUSIONS

This research highlighted many predisposing factors for traumatic dental injuries among children. There is an urgent need to initiate detailed public health policies to decrease the prevalence of dental trauma cases, especially in the identified risk group.

Evaluating the knowledge level, attitudes, and therapeutic approaches of Greek dentists for traumatic dental injuries

BACKGROUND/AIM

Greek dentists are facing a new era of a globally continuous effort to improve the first-aid management and long-term treatment outcome of traumatic dental injuries (TDI). In Greece, where the basic and clinical research in the field of dental trauma has been limited until recently, assessing the attitudes and therapeutic strategies of Greek dentists for dental trauma is of great importance. The aim of this study was to evaluate the knowledge attitudes and therapeutic approaches of Greek dentists in different clinical scenarios of TDI.

MATERIALS AND METHODS

A cross-sectional study was conducted among 448 dentists. A questionnaire-based survey of demographic characteristics, attitudes, and a scenario-based knowledge test, of TDI, which was used to formulate a "Dental Trauma Knowledge Score" with a 0-8 score range, was administered. Mann-Whitney U tests (for two categories variables) and Kruskal-Wallis tests (for more than two categories variables) were performed.

RESULTS

The median knowledge score was 5.0 (IQR: 4-7), a level considered as "Acceptable." Knowledge scores were found to significantly differ by age group, with the younger dentists presenting the highest scores. Dentists with a self-evaluation as "Acceptable" had significantly higher scores. Most of the dentists would refer for CBCT in severe trauma cases. A significant association was found between younger ages and on awareness of the mobile application ToothSOS. Female dentists had significantly higher scores compared to males when asked about avulsion management.

CONCLUSION

An acceptable level of knowledge on TDI management was revealed among dentists in Greece. Higher knowledge scores were observed among younger dentists.

Knowledge on Pre-Hospital Emergency Management of Tooth Avulsion among Croatian Students of the Faculty of Education

The purpose of this study was to evaluate the knowledge regarding tooth avulsion and dental first aid response among Croatian students of the Faculty of Education. A cross-sectional study was conducted among students. Participants (N = 235) were female with an average age of 21.9 ± 2.7 years. The questionnaire contained 10 close-ended questions with two to eleven possible answers. Every participant chose one correct answer. Statistical significance was determined using a Chi-square test. Majority of participants had never received any kind of information on management of a knocked-out tooth. Questions in the nature of tooth injuries, a knocked-out tooth, tooth replantation and whether the knocked-out tooth should be placed back were answered confirmatively by 40.43%, 83.40%, 57.02% and 62.55% of participants, respectively. The questionnaire showed that 18.78% of participants were aware that replantation should be performed within 30 min. The appropriate cleaning and transport medium was chosen by 40.85% and 35.31% of participants, respectively. A nearby dentist would be visited by 66.38% of students. Only 8.08% of participants provided a correct answer to all of the knowledge-based questions. The “I do not know” answer was chosen by 18.30% of participants whenever it was offered. This indicates that the majority (89.78%) were not aware of the fact that the procedure they chose would be inappropriate. The current study confirmed that future primary school teachers have a lack of knowledge for immediate response to tooth avulsion, leaving small chances for a successful prognosis of tooth replantation.

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.

A questionnaire-based survey for the evaluation of the knowledge level of primary school teachers on first-aid management of traumatic dental injuries in Athens, Greece

BACKGROUND/AIM

School teachers can play an important role in improving the prognosis of traumatized teeth of school children through immediate onsite management or on time referral to healthcare providers. In Greece where the research in the field of dental traumatology is very limited, this issue is of utmost importance. The aim of this study was to evaluate the knowledge level of Greek primary school teachers and their attitude with regard to emergency first-aid management of traumatic dental injuries (TDI) occurring in schools.

MATERIAL AND METHODS

A cross-sectional descriptive study among 276 school teachers was undertaken in Athens, Greece. This was done through a two-part questionnaire-based survey including demographic characteristics, attitude, and knowledge of first-aid management of TDI. Data were analyzed using non-parametric tests for differences. Log Poisson regression analysis was used to estimate relative risks of low or high knowledge of first-aid management.

RESULTS

The risk of lower knowledge score was almost double in teachers with <10 years of teaching experience and almost threefold higher in those reporting that they are not interested in being informed about dental trauma. In the case of luxation injury, 69.9% of the participants would not take any immediate action and would refer the child to a dentist. In case of permanent tooth avulsion, 52.2% knew that the tooth can be replanted in the socket, whereas only 17% believed that this should be performed within 30 minutes. Most of the participants would send the child to their own/family dentist, whereas only 4.7% would refer to an Endodontist.

CONCLUSION

The knowledge of primary school teachers in Greece about first-aid management of TDI is limited. However, a clear positive association was found between knowledge of first-aid management and teaching experience. Reliable information about dental trauma may result in improving the knowledge level of Greek primary school teachers.

Parental self-perceived knowledge and attitudes toward emergency management of avulsed permanent teeth in Imphal: A cross-sectional study

Introduction:

Dental avulsion is one of the dental traumatic injuries commonly affecting children aged between 6 and 12 years. One of the major limitations in obtaining a successful outcome while treating dental avulsions is the lack of knowledge on its first aid management among parents. The present study aims to assess the knowledge and attitude of parents in Imphal toward the emergency management of avulsed permanent tooth using a self-reported questionnaire method.

Materials and Methods:

The present cross-sectional study was undertaken among 777 parents of 6–12-year-old children who were recruited through 2 private schools in Imphal. A questionnaire consisting of 14 closed-ended questions used to assess the parental knowledge and attitude on emergency management of avulsed permanent teeth was distributed to the respondents after obtaining official consent from the respective schools and informed consent from the respondents.

Statistical Analysis:

Chi-square test was used to assess the association between the results and the educational status, gender, and geographical location of the respondents.

Results:

The study revealed that only a fraction of the respondents, i.e., 11.8% gave a positive response on attempting “self-replantation” and higher fractions (76.1%) of the respondents reported to have received no previous information on the emergency management of dental avulsion.

Conclusion:

About 96.1% of the respondents showed interest on acquiring knowledge on the emergency management of dental avulsion. This warrants the urgent need on educating the parents on the first aid emergency management of avulsed tooth.

Alkaline Material Effects on Roots of Teeth

The aim of this review was to identify and analyse all studies related to the effects of alkaline materials used in dentistry on roots of teeth. The first part of the review focused on mechanical property alterations of root dentine due to sodium hypochlorite (SH) used as an irrigant solution based on MeSH (Medical Subject Heading) terms from a previous study by Pascon et al in 2009. The second part reviewed literature on calcium hydroxide (CH), mineral trioxide aggregate (MTA) and other alkaline materials used as root canal dressings or filling materials. Additional MeSH terms used included "compressive strength", "elastic modulus" "flexural strength", "fracture strength" and "fracture resistance". The language filter was English. Of the initial 205 articles identified, 49 were included in this review, of which 29 were on SH, 21 on CH/MTA, and 1 relating to both. Many in vitro studies indicated a strong link between reduced mechanical properties of roots of teeth or radicular dentine treated with SH, and when sealers or root fillings with CH- or MTA-based materials were placed in contact with roots or radicular dentine. Recent literature indicates that the association between reduced mechanical properties and alkaline sealers and/or root-filling materials is not as straightforward as previously assumed, and requires further investigation using more valid experimental models.

Etiologic factors and clinical evaluation of restored fractured anterior teeth: an observational study

Purpose:

The aims of this study were to investigate the etiologic factors and to evaluate performance of composite resin on fractured crown in permanent anterior teeth at 6 and 12 months.

Subjects and Methods:

Records from 51 patients were retrieved from a Dental School Clinic, comprising 73 fractured anterior teeth directly restored with a submicron hybrid composite (Spectrum TPH) resin and respective adhesive system (Prime and Bond NT) were evaluated. The United States Public Health Service criteria were used to assess the clinical evaluation. Data were analyzed using the Wilcoxon Signed Rank, Kruskal–Wallis, Mann–Whitney U, and Siegel and Castellan tests.

Results:

Seventy-two maxillary incisors and one canine of 51 patients were evaluated. The patient’s age at the time of therapy ranged from 14 to 64 years old (mean 25.47). Mostly observed crown fracture was seen in upper incisors (84.9%) and due to falls (58.8%). At the 6-month follow-up, one patient lost one restoration and at the 12-month, one patient lost one and one lost two restorations. A statistically significant difference was found in terms of marginal adaptation between 6 and 12 months.

Conclusion:

In this short-term observation period, remaining tooth structure was conserved and good patient compliance was achieved. Factors such as esthetic and/or cost should be considered to indicate the direct composite restorations.

Pulp prognosis following conservative pulp treatment in teeth with complicated crown fractures-A retrospective study

BACKGROUND/AIM

Complicated crown fractures are relatively common in children where the maintenance of the pulp is especially important in young permanent teeth. The aim of this study was to analyze the pulp prognosis of permanent teeth with complicated crown fractures treated with conservative pulp treatment in adolescents.

MATERIAL AND METHODS

Complete dental records of teeth with complicated crown fractures treated with conservative pulp treatment were obtained. The risk of pulp necrosis and infection was evaluated by the Kaplan-Meier method and Cox regression (P<.05). Risk factors included gender, age, time interval between dental injury and treatment, stage of root development, type of pulp treatment, and coronal restoration.

RESULTS

The study involved 375 teeth treated with direct pulp capping, partial or coronal pulpotomy, and direct pulp capping retreated by pulpotomy (partial or coronal). The frequency of pulp necrosis and infection was 10.1% (11/109) for partial pulpotomy and 9.8% (22/205) for coronal pulpotomy. There was no difference between partial and coronal pulpotomy (P=.673). The risk of pulp necrosis and infection was not significantly different between pulpotomy (partial and coronal; 33/314, 10.5%) and retreatment by pulpotomy (partial or coronal) after direct pulp capping (2/33, 6.1%; P=.436). However, the frequency of pulp necrosis and infection after direct pulp capping (16/28, 57.1%) was significantly higher than that with pulpotomy (partial or coronal; odds ratio=8.216, P<.001). The time interval between dental injury and treatment did not significantly influence pulp survival after pulpotomy (partial or coronal; P=.312), but the stage of root development had a significant impact (P<.001).

CONCLUSIONS

Partial or coronal pulpotomy, employed either as a primary pulp treatment or secondary to emergency pulp capping, had similarly satisfactory pulp survival rates.

The future of pediatric dentistry education and curricula: a Chilean perspective

BACKGROUND

A meeting was organised to consolidate a network of researchers and academics from Australia, Brazil, Chile, the UK and the USA, relating to Early Childhood Caries (ECC) and Dental Trauma (DT). As part of this meeting, a dedicated session was held on the future of paediatric dental education and curricula. Twenty-four paediatric dentistry (PD) academics, representing eight Chilean dental schools, and three international specialists (from Brazil and Latvia) participated in group discussions facilitated by five members of the ECC/DT International Collaborative Network. Data were collected from group discussions which followed themes developed as guides to identify key issues associated with paediatric dentistry education, training and research.

DISCUSSION

Participants discussed current PD dental curricula in Chile, experiences in educating new cohorts of oral health care providers, and the outcomes of existing efforts in education and research in PD. They also, identified challenges, opportunities and areas in need of further development. This paper provides an introspective analysis of the education and training of PD in Chile; describes the input provided by participants into pediatric dentistry education and curricula; and sets out some key priorities for action with suggested directions to best prepare the future dental workforce to maximise oral health outcomes for children. Immediate priorities for action in paediatric dentistry in Chile were proposed.

Microbiological Aspects and Inflammatory Response of Pulp Tissue in Traumatic Dental Lesions

Traumatic dental lesions are more frequently found in the pediatric population, with a major involvement, in 80% of the cases, of the superior central incisors. The exposure of the dental pulp leads to major morphological changes in dental tissue, such as discolouring, acute pulp inflammation, chronic inflammation and necrosis. This article reviews the various studies published on the different types of inflammatory response of the pulp tissue following traumatic events, from the microbiological and histological point of view of various techniques.

Prevalence and Etiology of Traumatic Injuries to the Anterior Teeth among 5 to 8 Years Old School Children in Mathura City, India: An Epidemiological Study

Objectives: To assess the prevalence of traumatic injuries to the anterior teeth among the 5 to 8 years old children attending the schools in Mathura city.

Study design: A total of 1657 children of the age groups: 5, 6, 7 and 8 years from 20 schools situated in various parts of Mathura city were included in this study, utilizing stratified cluster random sampling method.

Results: The prevalence of traumatic injuries to the anterior teeth in 5 to 8 years old age group was found to be 2.7%. Males accounted for 3.1% whereas females accounted for 2.3%. Overall, males experienced more traumatic injuries than the females with male to female ratio of 1.8:1. The etiology of traumatic injuries was mostly due to falls, followed by bicycle accidents, collisions, violence and bike accidents in that order.

How to cite this article: Gojanur S, Yeluri R, Munshi AK. Prevalence and Etiology of Traumatic Injuries to the Anterior Teeth among 5 to 8 Years Old School Children in Mathura City, India: An Epidemiological Study. Int J Clin Pediatr Dent 2015;8(3):172-175.

Knowledge of Emergency Management of Traumatized Teeth among Schoolteachers in Mashhad, Iran

Background and aims. Dental trauma is an important oral health problem in children that requires immediate and appropriate management for long term success. The aim of this study was to evaluate the knowledge of elementary school teachers about emergency management of traumatic dental injuries in children.

Materials and methods. A total of 163 teachers from 21 elementary schools from Mashhad, Iran participated in this study. Data were collected using a two-part questionnaire comprised of questions regarding demographic data and participants' knowledge about dental trauma.

Results. The level of the teachers' knowledge was moderate (53.3%). Of the 163 participants, 104 (63.8%) were females and 59 (36.2%) were males. Among several predictors that were surveyed in this study, only the age of respondents signifi-cantly impacted the teachers' knowledge (P = 0.004).

Conclusion. The results of this study showed the moderate level of knowledge of teachers regarding emergency manage-ment of traumatized teeth. Adding dental trauma management courses in the teacher training curriculum and requiring teachers to be updated in regards to this issue can improve their knowledge and thus led to better management of traumatic dental injuries in children.

Traumatic dental injuries among 12-year-old Jordanian schoolchildren: an investigation on obesity and other risk factors

BACKGROUND

Traumatic dental injury (TDI) is an important public dental health problem among schoolchildren. The aim of the study was to investigate the relationship between TDIs, obesity, and other possible associated factors like gender, overjet, lip coverage, parents' education level and family income among 12-year old Jordanian schoolchildren.

METHODS

A cross-sectional population-based study examined a total of 1015 schoolchildren attending 34 schools randomly selected from urban and rural areas of Amman-the capital city of Jordan. The epidemiological classification adopted by WHO and modified by Andreasen et al. was used to classify TDIs. Obesity was defined according to the international cut-off points of body mass index for boys and girls between 2 and 20 years old.

RESULTS

The prevalence of TDIs was 16.3%. Enamel fracture was the most common type of TDIs (65%). Neither parents' education level nor family income had a significant effect on TDI occurrence (P > 0.05). Results of multiple logistic regression showed that TDIs were significantly more prevalent among males (OR = 1.42, CI; 1.01-2.01, P < 0.05), and children with inadequate lip coverage (OR = 1.95, CI; 1.35-2.81, P < 0.05). The relationship between TDIs and obesity was not statistically significant (P > 0.05).

CONCLUSIONS

Being a male with inadequate lip coverage was associated with higher probability of having a TDI. Obesity had no significant effect on the occurrence of TDIs.

Massachusetts emergency departments' resources and physicians' knowledge of management of traumatic dental injuries

BACKGROUND

Hospital emergency departments (ED) are confronted with triaging and managing dental emergencies of both traumatic and non-traumatic origin. However, the literature suggests that there exists inadequate knowledge of the management of traumatic dental injuries (TDI) among medical professionals who must be knowledgeable and have the appropriate resources needed to triage or treat patients presenting with TDI.

AIM

The aims of this study were to (i) evaluate the resources of Massachusetts emergency departments (MEDs) for TDI, (ii) determine the knowledge of management of TDI among MED physicians, and (iii) investigate potential factors that affect their knowledge.

MATERIALS AND METHODS

Surveys were mailed to MED directors and their physicians. The director survey contained questions regarding institutional information for each emergency department (ED). The physician survey contained questions about physician characteristics and tested their knowledge of managing dental trauma.

RESULTS

A total of 72 surveys (16 MED directors and 56 physicians) were returned and included in the analysis. Only 50% of the MEDs had on-site dental coverage, 43.8% had 24-h off-site dental coverage, and none had a formal written dental trauma protocol. MED physician's knowledge of the appropriate management of luxations and avulsions was generally good, but poor for dental fractures. The MED physician's knowledge for the emergent nature of the various injuries was generally good with that of avulsions being the best. Physicians were more likely to have a better knowledge of managing dental trauma if they were specialists in pediatric emergency medicine (P = 0.001) or their hospitals had an academic affiliation (P = 0.05).

CONCLUSIONS

Based on the findings from this study, educational campaigns must be undertaken to improve both the resources available to the ED, and the knowledge of physicians regarding emergency management of TDI. In addition, efforts should be made by local dental organizations to provide ED with lists of dentists who are knowledgeable and willing to be available 24 h day⁻¹ to consult with and, if necessary, treat TDI. These efforts would enhance the long-term outcomes for patients sustaining dental trauma who present to hospital ED.

A retrospective study of traumatic dental injuries

AIM

The prognosis of dental trauma cases varies depending on the time elapsed after the trauma before treatment started. The aim of this study was to examine epidemiological and dental data from traumatic injuries to primary and permanent teeth during the period from 2005 to 2010.

MATERIAL AND METHODS

The examinations aimed to determine the age and sex distributions of patients, the causes of tooth injury, the type of teeth injured, the monthly distribution of the trauma, the time elapsed between injury and treatment, and the classification of the traumatized teeth and their treatments.

RESULTS

The dental trauma records of patients with an average age of 9 years, including 120 girls (35.3%) and 220 boys (64.7%), were evaluated. The most commonly affected teeth were the maxillary central incisors (66.24%). The main cause was falls (70.1%). In primary dentition, subluxation (36.4%) was observed in the highest percentage of injured teeth, and in permanent dentition, the most common observation was uncomplicated crown fractures (44.9%). Only 18 patients (2.9%) were referred to the clinic within 1 h following the injury. The most frequent treatment for primary teeth was examination and follow up (63.9%). Restoration with composite resin (26.3%) and root canal treatment (28.6%) were the most common procedures for permanent teeth.

CONCLUSION

It was revealed that although the most frequent type of injury in permanent dentition was uncomplicated crown fracture, the root canal treatment was the most common treatment in permanent dentition. This finding suggests that when the checkup time after the injury was delayed, the pulp could lose vitality. This finding reveals that it is important to inform the parents about dental trauma and the importance of bringing their children fast to a dentist in trauma cases.

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.

Investigation of mothers' knowledge of dental trauma management in United Arab Emirates

AIM

To assess, by means of a structured questionnaire, mothers' level of knowledge with regards to the immediate emergency management of dental trauma in the Emirate of Ajman, United Arab Emirates (UAE).

METHODS

A cross-sectional study using anonymous structured questionnaires was employed for mothers chosen at random from child care centres. The questionnaire surveyed mothers' background, knowledge and management of tooth fracture, avulsion, and also investigated mothers' self-assessed knowledge of the availability and priority of emergency services of trauma in UAE.

RESULTS

The sample consisted of 676 mothers (response rate 96.6%) who attended mother and child care centres in Ajman over a period of two months (January-February 2011). More than half of the mothers participated in this study were in their twenties and 69.4% had university qualifications. Around 61.5% of the mothers had previous direct or indirect experience of dental trauma. Mother's knowledge of dental trauma seemed to be inadequate. Chi-square test indicated that there was no significant difference in the number of correct responses in relation to age, level of education, or number of observed trauma cases. Most mothers were unaware of the availability of after working hours emergency services. They were dissatisfied with their level of knowledge of dental trauma and the majority were interested in having further education on the topic.

CONCLUSIONS

The level of knowledge of dental trauma management (especially tooth avulsion) among mothers in Ajman was inadequate and education campaigns are necessary to improve the emergency management of dental injuries. Therefore it is important to educate the public of the availability of after hours dental emergency services to overcome any delay in seeking professional help in cases of dental trauma.

The association between orthodontic treatment need and maxillary incisor trauma, a retrospective clinical study

OBJECTIVES

Identifying risk factors for dental trauma in children is important. The main aim of this retrospective study was to investigate the association between maxillary incisor trauma (MIT) and variables such as gender, malocclusion complexity, and orthodontic treatment need (OTN).

STUDY DESIGN

ICON (Index of Complexity, Outcome and Need) scores were calculated in 502 schoolchildren (253 girls and 249 boys, aged 11-14-years). Subjects were categorized into 5 ICON complexity groups (easy to very difficult) and into 2 groups according to OTN (ICON >43, ICON <44). Logistic regression was performed to test for any differences in risk of MIT among subjects in different ICON complexity groups and to estimate the predictive value of gender, OTN, and ICON scores for MIT.

RESULTS

Nine percent experienced incisor trauma (93.4% maxilla, 6.6% mandible). Enamel fracture was the most common type (6.2%) of dental trauma. Boys had greater odds of MIT compared with girls (odds ratio [OR] 2.16, 95% confidence interval [CI] 1.11-4.21). Subjects with OTN showed greater odds of MIT compared to those without (OR 2.37, 95% CI 1.21-4.64). Only subjects presenting with difficult complexity grade (64 < ICON < 77) showed significantly higher odds of experiencing MIT (OR 3.16, 95% CI 1.25-8.01) compared with the easy complexity group (ICON <29).

CONCLUSION

The higher risk of experiencing MIT in malocclusions with difficult complexity warrants more vigilant screening of this group before and during dental or orthodontic treatment.

Knowledge of elementary school teachers in Tel-Aviv, Israel, regarding emergency care of dental injuries

BACKGROUND

Immediate management of traumatized teeth is often critical to the prognosis of the teeth. Most of the traumatic dental injuries occur at home, followed by school. There is a high probability that first aid would be given by lay people such as parents, teachers, or coaches. Knowledge of those people regarding emergency management of dental trauma is crucial for better prognosis.

AIM

To investigate: (i) the knowledge of elementary school teachers regarding traumatic dental injuries to permanent teeth and emergency treatment, (ii) their source of information, and (iii) the demand for more education in dental trauma.

MATERIALS AND METHODS

A three-part questionnaire comprised of questions regarding demographic data, attitude, and knowledge about dental injuries was distributed to teachers in 12 elementary schools in the Tel-Aviv area, Israel.

RESULTS

The average knowledge score was 4.59 (in a scale of 0-10). Three individual predictors significantly improved the respondents' knowledge: being in the 35-49-year age group (P-value = 0.042), those who had children themselves (P-value = 0.002) and those who had previous experience with trauma (P-value = 0.049). There was no correlation between the demand for further education in dental trauma and knowledge score.

CONCLUSIONS

The knowledge regarding management of traumatic dental injuries in a group of teachers in the Tel-Aviv area is inadequate. Educational programs as well as addition to the curriculum are necessary to improve their emergency management of traumatic dental injuries and provide better protection to the students.

An investigation into the association between facial profile and maxillary incisor trauma, a clinical non-radiographic study

OBJECTIVES

To explore the association between maxillary incisor trauma (MIT) and facial skeletal forms (sagittal and vertical), overjet (OJ), lip coverage, and gender.

SUBJECTS AND METHODS

Five hundred and two subjects (253 females and 249 males, aged 11-14 years) were examined. Sagittal (Class I, II or III) and vertical skeletal pattern (average, increased or decreased Frankfort-Mandibular Plane Angle (FMPA)) were recorded. Samples were categorized into four groups according to OJ severity: OJ ≤ 3.5 mm, 3.5 mm < OJ ≤ 6.0 mm with competent lips, 3.5 mm < OJ ≤ 6.0 mm with incompetent lips and OJ > 6 mm. Samples were also subdivided into two groups: OJ ≤ 3.5 mm and OJ > 3.5 mm. Chi-square test was performed to determine any gender differences in trauma experience. Logistic regression was performed to test for any differences in risk of MIT in different groups, and to estimate the predictive value of facial skeletal pattern (sagittal), FMPA, gender, OJ, and lip competence for MIT.

RESULTS

Nine percent had incisor trauma (8.4% MIT). Boys had greater odds of receiving MIT than girls (OR = 2.16; 95% CI, 1.11-4.21). Subjects with Class II skeletal patterns had greater odds of MIT than those with Class I skeletal patterns (OR = 3.98; 95% CI, 1.98-8.00). Subjects with decreased FMPA had greater odds of MIT than subjects with average FMPA (OR = 4.55; 95% CI, 2.28-9.06). Lip competence was not associated with MIT (P > 0.05). Subjects with OJ > 3.5 mm had greater odds of MIT than subjects with OJ ≤ 3.5 mm (OR = 2.83; 95% CI, 1.49-5.37).

CONCLUSION

Compared with children with normal OJ (≤3.5 mm), Class I skeletal pattern (Straight profile) and average FMPA, the odds of MIT increased significantly in children with OJ > 3.5 mm (OR = 2.83), Class II skeletal pattern (OR = 3.98) and decreased FMPA (short face profile) (OR = 4.55), respectively.

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.

Pattern of traumatic dental injuries in children attending the University Dental Hospital, Sri Lanka

AIM

The aim of this study was to determine the pattern of traumatic dental injuries in children seeking care at the Division of Paediatric Dentistry, the Dental Hospital, University of Peradeniya, Sri Lanka.

MATERIAL AND METHODS

The sample consisted of patients attending the Division Paediatric Dentistry, University Dental Hospital for traumatic dental injuries between February 2003 and May 2006. The data were collected by means of an interviewer administered questionnaire to parent/guardian and a clinical examination.

RESULTS

A total of 197 children aged between 2 and 17 years had sought treatment for 304 traumatized teeth. Half of the patients had sought treatment more than 1 month after the trauma occurred. The most frequent cause for dental trauma was a fall (89%) whilst compromised aesthetics was the most common reason for seeking care (48%). Maxillary central incisors were the most affected teeth. Of the permanent teeth, 49% had sustained uncomplicated fractures involving only the enamel and dentine. Pulp therapy ranging from pulpotomy to root canal treatment was the treatment of choice for most of the traumatized permanent teeth (46%). In the deciduous teeth, a fracture involving enamel, dentine and the pulp was the most common (35%).

CONCLUSIONS

As there was a considerable delay in seeking care for these injuries, it is recommended that educational programs be conducted for parents to create awareness about the importance of immediate management of traumatized teeth.

Case series: a clinical study of 27 cases of dentoalveolar root fractures in children and adolescents

AIM

This was to assess fracture type, treatment delay, splinting periods and various treatment methods on periradicular healing of root fractures in a group of patients attending a Paediatric Dentistry clinic.

METHODS

Records and radiographs of children with root-fractured teeth, referred during 1999-2003, were assessed.

STATISTICS

Correlation analysis was performed using Spearman rank test.

RESULTS

There were 27 root-fractured teeth in 20 patients aged between 8-18 years. One root-fracture occurred in 13 patients (65%) and 7 (35%) had two root-fractured teeth; all maxillary teeth and the most affected teeth were central, followed by lateral, incisors. Only 4 patients were seen on the day of the trauma. The commonest cause of injury was a fall (12 patients), followed by collisions, bicycle and motorcycle accidents. Treatments consisted of: splinting, splinting+pulp therapy, extraction of coronal fragment accompanied with orthodontic interventions and restorative procedures, and surgical operations. Healing was related to treatment delay, location and type of fracture, and splinting time. Statistical analysis showed significant correlations only between healing type and splinting time.

CONCLUSIONS

Preventive educational programs concerning traumatic dental injuries are needed in Turkey and mandatory use of mouthguards and preventive use of helmets with bicycles and motorcycles.

Determinação social da odontalgia em estudos epidemiológicos: revisão teórica e proposta de um modelo conceitual

A literatura epidemiológica se caracteriza por limitada abordagem teórica acerca dos mecanismos complexos de determinação das doenças e condições de saúde. No campo da epidemiologia da saúde bucal, isto não tem sido diferente, uma vez que a cárie dentária a doença bucal mais investigada no mundo é comumente vista sob um ponto de vista biologicista/reducionista. Uma das mais importantes conseqüências da cárie é a dor de origem dentária ou odontalgia, a qual tem recebido pouca atenção em investigações com refinamento teórico e delineamento de maior capacidade para inferência causal. O objetivo deste trabalho foi rever a literatura científica sobre os determinantes da odontalgia e colocar em debate teorias pertinentes à explicação do fenômeno. São revistos modelos de determinação e correntes de pensamento emergentes no estudo de morbidades bucais, estabelecendo-se interface com o modelo biopsicossocial da dor e almejando-se a elaboração de um modelo conceitual abrangente da odontalgia. Sugere-se que a ligação entre estrutura social e saúde bucal se dá por meio de vias materiais, comportamentais e psicossociais. Aspectos da estrutura social são levantados na tentativa de relacioná-los com o desfecho de interesse, destacando sua importância nas discussões acerca da causalidade dos fenômenos de saúde bucal.

A retrospective evaluation of crown-fractured permanent teeth treated in a pediatric dentistry clinic

A retrospective study was carried out on the dental trauma records of 93 patients (55 boys, 38 girls) with 129 crown-fractured teeth. The patients' average age was 9.57 years (SD 1.57), ranging between 7 and 15 years. Uncomplicated crown facture (comprising enamel-dentin) was the most observed type of injury (n = 107, 83%). Only 15 patients (16.13%) sought treatment in less than 24 h following the injury. Of 41 injured teeth (31.79%) the apices were open at the time of presentation at the clinic. The initial treatment of these injured teeth were interim restoration with acid-etch and composite (69%), Cvek amputation (2.33%), fragment reattachment (1.55%), apexification (APX, 10.07%), and root-canal treatment (RCT, 17.05%). Out of 94 teeth, which were diagnosed as vital on admittance, 23 (24.46%) later developed pulp necrosis and required APX or RCT depending on their apical status. In 66 teeth (51.16%) definitive treatment was provided with only esthetic restoration (ER), while in 15.50% and 26.68% of injured teeth ER was carried out following APX and RCT, and RCT, respectively. Definitive treatment was provided in 3-6 months for 29.45% of the injured teeth, while 27.13% and 20.16% of teeth received definitive treatment within 1-3 months and 6 months to 1 year, respectively. Type of crown-fracture, elapsed time following injury, and vitality of the tooth on admittance and pulp necrosis observed were significantly related to the total time spent for definitive treatment (P < 0.05).