Dental injuries in Norwegians aged 7-18 years

What are the Characteristics of Oral Injuries Caused by Playground Equipment?

PURPOSE

Studies regarding oral injuries from playground equipment in children remain limited. This study aimed to clarify the characteristics of oral injury caused by playground equipment and identify associations with concomitant head injury.

METHODS

Children treated between 2011 and 2021 at an oral surgery clinic for oral injuries from playground equipment were retrospectively investigated. The following factors were analyzed: demographic characteristics, mechanism of injury, type of equipment causing the injury, classification of oral injury, and whether the Department of Emergency and Critical Care Medicine was consulted regarding the head injury. The data collected were statistically analyzed using the Fisher-Freeman-Halton test with significance adopted at the 5% level.

RESULTS

This study analyzed data from 82 children. Injuries were concentrated in age groups of 2 to 3 years (32.9%), 4 to 5 years (28.0%), and 6 to 7 years (25.6%). Regarding the mechanism of injury, falls were more common (89.0%) than impact/striking (11.0%). The type of equipment most frequently causing injury was slides (29.3%), followed by swings (23.2%) and iron bars (18.3%). Injuries were classified as soft tissue injury alone (56.1%) or tooth injury and/or jaw fracture (43.9%). Consultation with the Department of Emergency and Critical Care Medicine for head injury was uncommon (13.4%), and all consultations for brain injury diagnosed minor injuries.

CONCLUSION

Oral injuries caused by playground equipment were frequent between 2 and 7 years old. The most common cause was falls, with most injuries caused by slides, swings, or iron bars. Approximately half of the oral injuries were soft tissue injuries only, while the other half were associated with tooth and/or jaw injuries. Department of Emergency and Critical Care Medicine consultations for head trauma were uncommon and consistently confirmed minor injuries.

Traumatic dental injuries among children attending the public after-hours emergency dental clinic in Bergen, Norway

OBJECTIVES

To investigate traumatic dental injuries (TDIs) among children who for 1 year attended a Norwegian public after-hours emergency public dental (EPD) clinic.

MATERIALS AND METHODS

The study included 7-18-year-olds (n = 312) who presented at the EPD clinic, underwent a clinical dental examination, and consented to the disclosure of clinical information. Recording of TDIs was restricted to anterior permanent teeth. Potential TDI predictors were also analysed.

RESULTS

Almost half (n = 148) of the children were assessed with TDIs in permanent teeth, showing a mean age of 11.0 (standard deviation [SD]: 3.5) years. Males constituted 54.7%. The children experienced TDIs often outside school hours (43.9%), and the majority (58.1%) were caused by falls/accidents. Sixty of them experienced only one TDI. The most common location was the maxillary central incisors. Assessment of TDIs according to severity, could only be done in 131 individuals, involving 253 TDIs. Of these, 81.8% were mild. The odds of visiting the emergency clinic for a TDI were higher (odds ratio [OR] = 2.64, confidence interval [CI]: 1.61-4.31) among children with previous TDIs and lower (OR = 0.28, CI: 0.12-0.68) among those with poor dental attendance.

CONCLUSIONS

Traumatic dental injuries were a common reason for seeking emergency care. Milder injuries dominated and involved mostly one maxillary central incisor. Previous episodes of TDIs and attendance patterns seemed to be associated with seeking care for TDIs.

Traumatic dental injuries: Knowledge assessment of dentists in the Norwegian Public Dental Service of Vestland

BACKGROUND/AIM

Most children and adolescents in Norway attend the Public Dental Service (PDS) where they are treated free-of-charge until the age of 19 years. Thus, general dentists employed in the PDS are the primary care providers for traumatic dental injuries (TDI) in young patients. This cross-sectional study assessed the knowledge of PDS general dentists on the acute management and follow-up of TDI and its socio-demographic and attitudinal covariates.

MATERIALS AND METHODS

All general dentists employed in the Vestland County PDS, Western Norway, (N = 170) received an online questionnaire. Socio-demographic and professional profiles of respondents as well as attitudinal indicators were queried. Clinical case scenarios on emergency treatment and further follow-ups of TDI were used to calculate a dental trauma knowledge score (DTKS; range: 0-21). Mann-Whitney U tests and Kruskal-Wallis tests determined differences between the demographic subgroups. Logistic regressions determined the potential of single factors in explaining the variability in dental trauma knowledge.

RESULTS

The response rate was 46%. Most participants (60.5%) had not participated in a TDI course after graduation but would like such a course (84.2%). Mean DTKS was 13.82 (±2.6). Knowledge scores differed significantly between age groups (p = .014) and years since graduation (p = .0018). Younger dentists and recently graduated dentists scored highest. Dentists under the age of 30 years scored higher than 30-39- and 40-49-year-old dentists in these areas: emergency treatment of crown fractures with pulp exposure, identification of complications after avulsion, and management of severe intrusive luxation injury.

CONCLUSION

Younger dentists had a higher theoretical knowledge of TDI. Continuing professional development among dentists in the Norwegian PDS is needed for emergency treatment and complication management after TDI.

The impact of COVID-19 pandemic on the epidemiological characteristics of permanent dental injury in Xi'an of China: A retrospective study

The coronavirus disease 2019 (COVID-19) has become a major global concern, seriously affecting the lives and health of the population. This retrospective study aimed to investigate changes in permanent tooth injury in the Xi'an area of China influenced by the COVID-19 pandemic. The medical records of 466 dental emergency patients in 2019 and 2020 were retrospectively analyzed. The number of injured teeth in a single patient, the number of injury types, the time from injury to hospital visit and follow-up visits within 1 year before and after the pandemic were analyzed using the chi-squared test and the paired t-test. There was significant difference in the number of emergency patients and trauma types before and during COVID-19 pandemic (P < .05). The time from injury to hospital visit and the interval between the trauma event and visit showed longer during the COVID-19 pandemic (P < .05). The rate of on-time follow-up in the following year was significantly decreased, and the rates of delayed visits and patients lost to follow-up were significantly increased (P < .05). The outbreak of the COVID-19 pandemic brought a certain change in the epidemiological characteristics of dental injury in the Xi'an area of China. Dental emergency departments should provide even more timely and effective treatments. It is also necessary to strengthen public education, with emphasis on the importance of timely medical treatment and regular follow-up for dental trauma.

Survival of immediate implants replacing traumatised teeth in the anterior maxilla

Aim The provision of implants following traumatic dental injuries can hold many challenges, primarily in higher aesthetic regions. The purpose of this retrospective study was to assess the clinical outcomes of immediate implants placed in fresh extraction sites in the anterior maxilla following dental trauma.Materials and methods In total, 60 patients requiring teeth replacement with dental implants in the anterior maxilla were included in the study. Following a delayed loading protocol, the implants were restored with definitive single crowns or bridges. Implant and prosthetic survival, complications and periodontal health were recorded during follow-up.Results A total of 70 implants were placed in the anterior maxilla with three failures reported, resulting in an implant survival rate of 95.7% over a follow-up period of three years. No additional bone augmentation was undertaken and prosthetic survival recorded was 100%, with favourable periodontal outcomes achieved overall.Conclusion This study showed that implants immediately inserted into fresh extraction sites following dental trauma can constitute a predictable treatment strategy, presenting high implant survival rates over the follow-up period observed. Further well-designed controlled clinical trials are required to evaluate longer-term outcomes for this technique.

A retrospective study of emergent traumatic dental injuries in permanent teeth in Xi'an, China

Traumatic dental injury is one of the common injuries seen in the emergency department. To determine the distribution features of emergency traumatic dental injuries in Xi'an, China, data from the medical records of 623 patients (aged 6-78 years) were evaluated and analyzed according to age, gender, etiology, factors predisposing teeth to injury, and types of teeth traumatized. The patient records of 397 males (63.7%) and 226 females (36.3%), with a 1.8:1 male-to-female ratio, were included. The total number of traumatized teeth was 1475. The highest frequency of dental trauma was found in the 19- to 30-year age group (30.7%). The greatest frequency of dental trauma injuries was in May (13%). Over one-third of patients with traumatic injuries to permanent teeth (n = 218, 35%) injured 2 permanent teeth. The most commonly affected teeth were the maxillary central incisors (59.3%). The most common type of trauma was concussion (20.4%). There was statistically significant difference among the type composition ratio of age groups (P < .05). The most common causes of dental trauma were falls (50.2%). There was statistically significant difference among the etiological composition ratio of age groups (P < .05). Combined injuries were present in 120 teeth in 103 patients (16.5%). The epidemiological characteristics of dental trauma in Xi'an shows that the occurrence of dental trauma is closely related to the age, sex, time, type of injury, and cause of injury. There exists cross-correlation among the epidemiological factors. The most common type of trauma is concussion and the most common cause of dental trauma is fall. High incidence of combined injuries needs extra attention.

Implant treatment after traumatic tooth loss: A systematic review

BACKGROUND/AIMS

Treatment after traumatic tooth loss is challenging and is currently guided by expert opinion and the individual patient situation. The aim of this study was to provide an overview on the outcome of dental implant treatment in the anterior maxilla after traumatic tooth loss, based on a systematic review of the existing evidence.

MATERIALS AND METHODS

A systematic search of the literature was performed on PubMed, Cochran Library and Web of Science following the PRISMA guidelines based on a structured research question (PICO). All clinical studies of five patients or more with follow-up of at least 1 year after implant loading were included. Patients were at least 18 years of age. Cohen's Kappa-coefficient was calculated. The Newcastle-Ottawa Scale was applied to assess the quality of the included studies. Descriptive statistical methods were applied.

RESULTS

Nine hundred and ninety-nine articles were identified through the systematic search. Finally, six articles were eligible for inclusion. The studies comprised prospective and retrospective cohort studies and case series. From these, 96 patients with 120 implants were included. The age ranged from 18 to 59 years. The survival rates of implants and superstructures were 97% and 95%, respectively, after a mean follow-up of 3.5 years. Mean marginal bone resorption was 0.56 mm (range 0.21-1.30 mm). Complication rates were 7% and 11% on implant and superstructure level, respectively. Patient-reported outcome measures and objective evaluations showed a high level of satisfaction with the aesthetic outcome. Bone augmentation was performed in 60 implant sites. Three patients underwent pre-surgical orthodontic treatment. The maxillary central incisor was the most frequently replaced tooth (70%).

CONCLUSIONS

This systematic review revealed a low level of evidence on the outcome of dental implant treatment after traumatic tooth loss. Systematic reporting of treatment outcomes of tooth replacements after dental trauma is highly encouraged to further guide dentists for the benefit of these challenging patients.

Introduction of an interactive tool (the Dental Trauma Guide) in the undergraduate dental teaching to manage traumatic dental injuries

BACKGROUND/AIMS

Traumatic dental injuries (TDI) are complex problems where lack of proper care may result in serious complications. The need to improve the management of TDI is a frequently addressed concern. Methods of improvement in their diagnosis and management are continuously evolving. The interactive Internet tool, the Dental Trauma Guide (DTG), helps to simplify diagnostic and management dilemmas. However, it is not a freely available tool. The aim of the current study was to assess the knowledge and diagnostic skills of undergraduate dental students with access to the DTG compared with students without such access, in order to validate and promote this tool in dental education.

MATERIALS AND METHODS

Two groups of students were randomly selected where one group of final year dental undergraduate students were exposed to lectures, demonstrations, discussions and tutorials on the management of TDI according to the standard undergraduate curriculum in Sri Lanka. Another test group of 21 students were provided with access to DTG during their training in paediatric dentistry. At the end of the study period, students were assessed on their knowledge of TDI using MCQs (Multiple Choice Questions) and OSCEs (Objective Structured Clinical Examination), based on the DTG.

RESULTS

The students with access to the DTG were more knowledgeable in providing the correct answers to three out of the seven OSCE questions. Evaluation based on the MCQs did not reveal a significant difference (p = .913). However, users of the DTG showed a statistically significant difference with better overall knowledge based on their answers (p = .028). Following this period of evaluation, all of the students were provided with access to the DTG to supplement their learning experience.

CONCLUSION

The Dental Trauma Guide is a useful supplementary tool for undergraduate students to arrive at a correct diagnosis and treatment plan for TDI.

A 5-year data report of traumatic dental injuries in children and adolescents from a major dental trauma center in Greece

BACKGROUND/AIM

Prevalence and demographic characteristics of traumatic dental injuries (TDI) differ in different countries. The aim of this retrospective study was to assess TDI in primary and permanent teeth among children and adolescents who presented to the Department of Paediatric Dentistry, National and Kapodistrian University of Athens, Greece, during the last 5 years.

MATERIAL AND METHODS

Dental records of 236 new patients who presented with dento-alveolar trauma to the Postgraduate Dental Clinic from 1/1/2014 to 31/12/2019 were reviewed. Data recorded were gender, age, month of the year the injury occurred, type of trauma, and number of traumatized teeth. Injuries were classified as fracture, luxation, or combination injuries. Descriptive statistics, chi-squared (x² ), and Fisher's exact tests were used to evaluate the results. Level of significance was set at 5%.

RESULTS

The age of the patients ranged from 1 to 18 years old, with a mean of 8.63 years (SD: 3.52). There were 395 anterior traumatized teeth and 2 cases with traumatized posterior teeth. Children suffered trauma more often at the ages of 5 years, 7 years, and 11 years. In this cohort, 60% were boys who had a higher chance of having trauma than girls (odds ratio = 1.418 95% CI = 0.724, 2.777). Most TDI occurred in March and May, followed by June and February, and most traumatized teeth were permanent (80%). Maxillary central incisors in both dentitions were injured most often and significantly more compared to lateral incisors (p < 0 .01). The most common type of injury was a fracture in the permanent dentition (60%) and luxation injuries (69%) in the primary dentition.

CONCLUSIONS

Traumatic dental injuries in this cohort occurred mostly in spring, affected boys more than girls, permanent teeth more than primary teeth, maxillary incisors more than mandibular incisors, and central incisors more than lateral incisors, while children aged 5, 7, and 11 years old had the most injuries.

Prevalence of orofacial injuries in wheeled non-motor sports athletes: A systematic review and meta-analysis

BACKGROUND/AIMS

As the popularity of sports activities grows, so do the number of sport-related injuries. Furthermore, sports that use equipment or vehicles that modify the speed of the player can present more serious injuries. The aim of this systematic review was to identify the overall prevalence of orofacial trauma in wheeled non-motor sports athletes.

METHODS

The search strategy was applied in eight electronic databases (Embase, LILACS, Livivo, PEDro, PubMed, Scopus, SportDiscus, and Web of Science). Additionally, a complementary search of the gray literature (Google Scholar, OpenGrey, and ProQuest Dissertations & Theses Global), reference lists of included articles, and studies indicated by experts on the subject was done. The included articles were observational studies with sufficient data of orofacial trauma (type and anatomical site) in wheeled non-motor sport athletes, regardless of the competition level. Risk of bias was assessed by using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. The meta-analysis was performed using R Statistics software, and the strength of cumulative evidence was assessed by The Grading of Recommendations Assessment, Development, and Evaluation.

RESULTS

From 4042 identified studies, after the removal of duplicates and phase one of selection (title and abstracts screening), 251 studies remained for phase two (full-text screening). Five articles were finally included. One study was considered to have a low risk of bias and four had a moderate risk of bias. The cumulative prevalence of orofacial injuries in wheeled non-motor sport athletes was 21.7% (CI: 8.7-34.7; I² :97.6%) and the prevalence of dental injuries in these sports was 7.5% (CI:4.3-10.7; I² :61.9%). The certainty in cumulative evidence was considered to be very low.

CONCLUSION

About 22% of the wheeled non-motor sport athletes have suffered orofacial injuries. The most prevalent type of injury was classified as dental trauma.

Educational Impact of Notebook Covers on the Knowledge of Sixth-Grade Primary Pupils About Tooth Avulsion and Replantation: A Randomized Trial

BACKGROUND

Tooth avulsion is a common cause of tooth loss. However, there is a significant lack of knowledge about dental trauma and the appropriate emergency procedures to handle these cases.

AIM

The aim of this study was to evaluate the educational effect of notebook covers illustrated with figures and informative texts about tooth avulsion and replantation in sixth-grade primary school pupils.

MATERIAL AND METHODS

Sixth-grade pupils of two public school participated in this study. An experimental group consisting of 134 pupils received notebook covers illustrated with figures and informative texts about tooth avulsion and replantation, while a control group of 108 pupils received notebooks with neutral covers. An assessment of the educational effects on pupils was performed after 9 months, with a standardized questionnaire normally used to evaluate dental trauma. Statistical analysis was conducted with SPSS 21.0 (α = .05) for group description and comparison using chi-square and Student t tests.

RESULTS

Compared with the control group, the experimental group showed statistically significant improvements in correct meaning of dental trauma (38% vs. 58.2%); procedures to follow in the case of dental avulsion (2.8% vs. 70.9%); storing the avulsed tooth in milk (18.5% vs. 76.9%); general knowledge about dental anatomy (61.1% vs. 95.5%); and the ideal time for the tooth to remain outside the mouth prior to replantation (20.4% vs. 59.7%).

CONCLUSION

The use of notebook covers illustrated with figures and informative texts about dental trauma led to a significant increase in the knowledge of schoolchildren about tooth avulsion, first aid, and replantation.

Web-based dental trauma database using Eden Baysal dental trauma index: a turkish multicenter study

Purpose

To describe the prevalence and pattern of traumatic dental injuries (TDIs) among Turkish children in a web-based and multicenter design using Eden Baysal Dental Trauma Index (EBDTI).

Materials and methods

The study sample consisted dental trauma patients aging 1-15 years and a webbased form was developed and used to record the information of the patients' clinical and radiographic findings including EBDTI. The obtained data also included patient gender, age at the initial date of trauma, date of trauma, cause of injury and emergency treatment. Data were analyzed using Pearson Chi-square and Fisher's exact tests.

Results

A total of 280 traumatized teeth in 252 patients were evaluated. Dental trauma was seen more in boys and 7-10 years age group (p<0.05). There were significant differences between permanent and deciduous teeth with regard to uncomplicated and complicated crown fracture rate (p<0.05). The root fractures were mostly located at the apical third of the root in both dentitions.

Conclusion

TDI was associated with age, gender, and type of dental trauma. EDBTI provided easy and proper recording of multiple dental injuries and maturity of the apex and it was found to be a very useful tool to facilitate online recordings of dental injuries.

Traumatic dental injuries presenting to a paediatric emergency department in a tertiary children's hospital, Adelaide, Australia

BACKGROUND/AIM

There is a scarcity of data regarding paediatric traumatic dental injuries (TDI) in tertiary teaching hospitals. Therefore, the aim of this study was to review the TDI presenting to the Women's and Children's Hospital in Adelaide (Australia) on an emergency basis and to identify the characteristics of the presenting patient cohort, their accident, injuries and management.

METHODS

Medical health records of 337 paediatric patients attending the Paediatric Emergency Department (PED) for the management of TDI over 18 months were prospectively reviewed.

RESULTS

TDI were more frequent in children under 5 years of age (56.1%) with a predominance of injuries sustained by males (63.8%). The accident characteristics included weekend occurrence (35.6%), the most common aetiology was falls (64.4%) and many incidents occurred at home (48.5%). Overall, 654 teeth were injured with the majority affecting deciduous teeth (58.4%) and the maxillary central incisors (69.9%). The most frequent injury was lateral luxation (27.5%). The majority of patients were referred to the Paediatric Dentistry Department (60.8%). However, almost half of presenting patients did not require further management locally and were subsequently discharged to their dental practitioners (39.2%). Most patients receiving treatment were managed under general anaesthetic (36.9%), and there was often a delay of 3-12 hours before treatment commenced (49.1%). Similarly, more severe injuries in the permanent dentition (avulsion, extrusion, root fracture, intrusion, alveolar fracture) were more frequently managed between 3 and 12 hours following the accident.

CONCLUSION

The patient, accident, injury and management characteristics are comparable to what has previously been reported in other studies in paediatric populations. Injuries affecting the permanent dentition are more likely to be managed within 3 and 12 hours in an outpatient setting, whereas injuries affecting the deciduous dentition had a delay in management between 12 and 24 hours under general anaesthetic.

Diagnosis and Management of Transverse Root Fractures

BACKGROUND

Root fractures are not a common injury, but a thorough understanding of their etiology, healing responses, diagnosis, management, and prognosis is essential.

REVIEW

The prognosis is largely related to the patient's age; degree of displacement, if any, of the coronal fragment; and the location and orientation of the fracture. The more apical the fracture is located, the better the prognosis. Teeth with root fractures located supracrestally may have the worst prognosis, but their management and outcome depend on many factors, with the most influential factor being the ability to restore the tooth because the coronal fragment usually needs to be removed. In contrast, root fractures located in the apical and middle thirds and those subcrestally in the coronal third of the root have a good prognosis and usually require little, if any, treatment apart from immediate repositioning (if the coronal fragment has been displaced) and stabilization. Monitoring of root-fractured teeth over time is essential to determine the healing response and to assess whether the pulp survives or not. In some cases, the pulp in the coronal fragment may necrose and become infected, thus requiring root canal treatment, but this should only be done to the fracture line. Pulp necrosis and infection typically occur within the first 3-4 months if it is a direct result of the trauma. However, pulp necrosis and infection can also occur many years later, in which case it is likely to be a result of bacterial penetration via cracks or breakdown of restorations.

CONCLUSION

Overall, root fractures should be managed conservatively unless they are located supracrestally.

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.

Traumatic dental injuries and experiences along the life course - a study among 16-yr-old pupils in western Norway

The study assessed risk factors for traumatic dental injuries (TDI) using experiences along the life course. A retrospective longitudinal study, including historical clinical data, was conducted on 16-yr-old pupils in western Norway. All first-grade pupils born in 1997 and attending public high schools were invited to participate (n = 5,184). Participants responded to an electronically administered closed-ended questionnaire (39.6%, n = 2,055). Information on the occurrence of TDI and events during the life course (categorized as socio-economic, biological, psychosocial, and behavioural indicators) was collected. Variables with a significant bivariate association with three different dependent variables (TDI, severity of TDI, and multiple episodes of TDI) were tested in a hierarchical logistic regression analysis. Traumatic dental injuries were more frequent among boys, adolescents of higher socio-economic status, and adolescents with adverse psychosocial and behavioural scores. Moderate and severe TDIs were more frequent among adolescents with adverse psychosocial and behavioural scores and among adolescents participating in the sport of wrestling. Multiple episodes of TDI were more frequent among adolescents with adverse psychosocial and behavioural scores and among adolescents participating in sports activities. Incorporation of different life-course indicators is important in evaluating TDI severity and repeated incidents.

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.

Timing of implant placement after traumatic dental injury

Dental implants are reliable to replace teeth lost because of traumatic dental injury. However, dental implants behave like ankylosed teeth and should not be placed in growing individuals because of the risk of infraposition. This risk may be reduced by ensuring arrested skeletal growth and ideal incisal support. The timing of implant placement may be immediate, early, conventional, or late and is determined by the extent of the trauma, remaining growth, and conditions of the hard and soft tissues. Timing should allow an observation period to properly evaluate the prognosis of concomitantly traumatized neighboring teeth. Orthodontic alignment is often necessary after traumatic dental injury in young individuals to provide symmetric dental conditions around the facial midline, to allow implant placement in the correct 3-dimensional position for the later prosthetic reconstruction, and to ensure sufficient mesiodistal space that leaves a minimum of 1.5 mm of healthy alveolar bone between the future implant and neighboring teeth. Space and stable occlusion should be maintained by bonded retainers and a splint used during the night. A partial prosthesis is usually recommended as a temporary replacement. If a fixed provisional prosthesis is required, it is crucial that it does not interfere with the remaining growth and incisal support and allows proper oral hygiene.

Retrospective evaluation of patients admitted to Karadeniz Technical University Pediatric Dentistry clinic due to trauma

Purpose:

Traumatic dental injuries are among the commonly observed problems in the primary and permanent teeth. The rate of prevalence of dental trauma varies globally. In this study, we investigated the type of dental trauma, related factors, and treatment procedures in children.

Subjects and methods:

During a 5-year period (January 2011–January 2016), 416 children aged in the range of 1–15 years were admitted to our clinic with dental trauma. The cause and type of the dental trauma in the primary and permanent teeth and their relation with gender and age were evaluated using the chi-square test, and their distribution by age was evaluated using regression analysis.

Results:

Overall, girls and boys comprised 37% and 63% of the study population, respectively. The mean age was 8.5 years. Falls (61.1%) were the most common cause of traumatic dental injuries, and enamel–dentin fracture (26%) was the most common dental trauma type.

Conclusion:

Traumatic dental injuries in children are common. A large proportion of patients without any clinical symptoms (15.8%) did not seek any treatment after the trauma. Teachers, parents, and children should be informed about the action to be taken when dental trauma occurs and about the importance of immediately taking the child to a dentist after the trauma to ensure an accurate diagnosis, an optimal treatment plan, and positive outcome.

A Short Time Period in the Treatment of an Open Apice Intruded Tooth: An 8-year Follow-up

AIM

Among traumatic dental injuries, intrusive dislocation is considered to be one of the most serious injuries. Despite the high success rate in complacent patients, the traditional technique of calcium hydroxide inoculation has drawbacks. The good antimicrobial and sealing properties combined with excellent biocompatibility and high success rates of the mineral trioxide aggregate (MTA) encourage its use.

BACKGROUND

The objective of this study was to report a successful case of intrusive dislocation in a short time with a follow-up of eight years.

CASE DESCRIPTION

A patient, seven years of age, presented intrusive dental dislocation, confirmed by radiographic examination, which revealed besides axial displacement of the central incisor towards the bone, incomplete root development. The passive repositioning was chosen as the treatment modality. After cleansing of the root canal, therapy with hydroxide paste was performed for 30 days, and then the apex was closed using an artificial barrier made with apical MTA buffer to facilitate root canal obturation.

CONCLUSION

Clinical and radiographic signs at 6 months and 8 years of preservation evidence the success of the therapy.

CLINICAL RELEVANCE

Teeth with incomplete root formation when traumatized may have their development process interrupted; consequently their root canals remained ample with thin and fragile walls and the open apex which represents a great challenge to the accomplishment of endodontic therapy. The process of apexification with MTA as in this case is an alternative to traditional therapy based on calcium hydroxide, conferring a faster treatment and a decrease in the odds of fracture of the tooth since from the confection of the apical barrier there is a possibility of being the same restored at an early stage.

HOW TO CITE THIS ARTICLE

de Sá MAB, Nunes E, et al. A Short Time Period in the Treatment of an Open Apice Intruded Tooth: An 8-year Follow-up. Int J Clin Pediatr Dent 2019;12(2):160-163.

[Outcomes of traumatic dental injuries in children]

The aim of the study was to review literature data on incidence and outcomes of traumatic dental injuries (TDI) in pediatric population. A systematic search was conducted using Elibray, Pubmed/Medline, Scopus databases in October 2018. Reference lists were also hand-searched to identify additional literature. The most prevalent complication of TDI is pulp necrosis (PN) which triggers inflammatory root resorption (IRR). PN and IRR are however much more specific for mature permanent teeth. In immature teeth pulp revascularization may occur even after avulsion. Pulpectomy timing is well defined for mature teeth only. It is accepted that pulp extirpation should be performed in the first 10 days after trauma. In immature teeth no criteria exist with pulp electrosensitivity having very low negative prognostic value as drop of pulp sensitivity because of trauma not necessary indicate PN. Follow-up protocol for immature teeth with various TDI would be useful for proper timing of pulpectomy and prevention of IRR.

Profile of intrusive luxation and healing complications in deciduous and permanent teeth - a retrospective study

OBJECTIVE

This retrospective study analyse the profile of intrusion in deciduous (DT) and permanent teeth (PT), the occurrence of healing complications (HC), type of treatments and predisposing factors.

METHODS

The records of patients attended from 2005 to 2011 were analysed. Records of patients who had one or more intruded DT or PT were included in the study. Data collected from dental records included age, gender, attendance (immediate/mediate), healing complications and type of treatment. A Chi-square test and Logistic regression (p ≤ .05) were performed to evaluate the associations between the type of teeth and presence of HC, as well as to explore the interactions between predisposing factors.

RESULTS

The intrusion prevalence was 9.98% in DT and 2.45% in PT. Partial intrusion (57.3%) with palatal direction of the crown (61.8%) was most prevalent in DT, while complete intrusion (56.7%) with buccal direction of the crown (58.1%) was predominant for PT. Mobility was the most common HC in DT compared to root resorption in PT. Minimally invasive treatments were the most common therapy for DT compared to invasive treatments for PT. PT demonstrated increased HC when compared to DT (p = .004). A logistic regression illustrated that the level of intrusion and crown direction during the trauma did not influence the occurrence of HC (p > .05).

CONCLUSION

Intrusion's profile in DT and PT are different. PT showed more HC than DT, however the level of intrusion and crown direction were not associated with the presence of HC.

Periodontal Diseases and Traumatic Dental Injuries in the Pediatric Population

This article provides an overview of periodontal diseases and traumatic dental injuries (TDIs) in children and adolescents, which are serious public health problems worldwide. Periodontal diseases, including gingivitis and periodontitis, commonly affect the oral soft tissues and teeth and often co-occur with other chronic diseases. TDIs are prevalent from an early age and carry high treatment costs. Behavioral and environmental factors contribute to both TDIs and periodontal diseases, but their etiology varies according to population characteristics and case definition. Both conditions may lead to pain, function impairment, esthetic problems, and psychosocial effects, with major consequences on quality of life.

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.

Evaluation of Knowledge, Awareness, and Occurrence of Dental Injuries in Participant Children during Sports in New Delhi: A Pilot Study

Aim

To evaluate the occurrence of dental injuries in children, the level of knowledge of the participants about preventive measures, and management of dental trauma during sports, in New Delhi.

Materials and methods

A cross-sectional study was carried out among 450 children aged 6 to 16 years. A structured interviewer-guided questionnaire was used to determine the prevalence of oral injuries sustained during sport activities, the use of mouthguard as well as the athlete’s awareness regarding use of mouthguard. The respondents consisted of 313 males (69.6%) and 137 females (30.4%) with a mean age of 12.6 years.

Results

Out of the total participants, 27 (6%) had chipping or fracture of teeth, 25 (5.6%) had soft-tissue laceration, 24 (5.4%) had avulsion of teeth, and 18 (4%) had suffered fracture of jaw/bones. Out of the total participants, 263 (58.4%) knew that it was possible to replant the teeth and 187 (41.6%) did not know that it was possible to replant the teeth. Out of the total participants, 203 (45.1%) did not know what is the best time to put the teeth back in the mouth and 247 (54.9 %) answered in affirmative with variable answer. Of the total participants, 223 (49.6%) answered that they would carry avulsed tooth in water, 94 (20.8%) wrapped in cloth, 57 (12.6%) in mouth/saliva, 9 (2%) in Hanks’ balanced salt solution (HBSS), and 67 (14.8%) answered others. Of the total participants, 321 (71.3%) were aware that mouthguards prevent injury and 129 (28.7%) did not know about mouthguards. Out of the total participants, 94 (20.9%) used mouthguards and 356 (79.1%) had never used mouthguards.

Conclusion

Level of awareness and knowledge about sports-related orofacial injury is very poor among children in New Delhi. Education on prevention of orofacial trauma should be given to the coaches and children. Wearing of mouthguards during sport activities should be compulsory during practice and competition events.

How to cite this article: Goswami M, Kumar P, Bhushan U. Evaluation of Knowledge, Awareness, and Occurrence of Dental Injuries in Participant Children during Sports in New Delhi: A Pilot Study. Int J Clin Pediatr Dent 2017;10(4):373-378.

Autotransplantation and Orthodontic Treatment after Maxillary Central Incisor Region Trauma: A 13-Year Follow-Up Case Report Study

The anterior maxilla is the most prone region to the trauma during childhood, and tooth loss sometimes happens due to trauma. Replacing the missing teeth has always been one of the dentists' challenges in children and adolescents, since their dentofacial growth is not complete. Autotransplantation of mandibular premolars with two-thirds or three-quarters of root formation provides the best prognosis for the tooth survival. This case report describes the management of a 10-year-old boy suffering a severe dental injury who received the autotransplantation of the premolars from mandible to restore the space caused by trauma in maxillary central incisor region and a 13-year follow-up of the autotransplantation.

Prevalence of Dental Caries and Traumatic Dental Injuries among 6- to 12-year-old Children in Bhopal City, India

Introduction

Dental caries and trauma are the most common oral health problems for many decades. There is need for prevalence data to analyze the nature of the problems and to take necessary steps in improving public health.

Aim and objectives

To assess the prevalence of dental caries and traumatic dental injuries among schoolchildren of age 6 to 12 years in Bhopal city.

Settings and design

Cross-sectional study design was selected. Universal sampling method was followed in this study.

Materials and methods

A total of 1,204 children were examined. The distribution of samples was done based on age, gender, residing area, and type of school.

Statistical analysis

Data were collected and statistically evaluated under chi-square test and analysis of variance.

Results

The overall caries experience (73.17%) was found to be higher than that of traumatic injury experience (20.9%). There was age-related correlation between age and decay, missing, and filled teeth score.

Conclusion

Since most injuries occur at home or at school, educating the individual is the key that will have a great impact on the prognosis of traumatic injuries. Also good food habits need to be instilled in children from a tender age with the help of parents, which is the ultimate solution to fight caries.

How to cite this article

Maran S, Shashikiran ND, Ahirwar P, Maran P, Kannojiya PR, Niranjan B. Prevalence of Dental Caries and Traumatic Dental Injuries among 6- to 12-year-old Children in Bhopal City, India. Int J Clin Pediatr Dent 2017; 10(2): 172-176.

Dental Pulp Revascularization in a Replanted Avulsed Immature Maxillary Permanent Central Incisor

An 8-year-old girl sustained an accidental traumatic avulsion of her right maxillary permanent central incisor. She arrived with her mother at a hospital dental clinic with the right maxillary central incisor tooth wrappe in a wet paper towel over 1 hour after the injury. Replantation was accomplished without root surface alteration or root canal intervention. Clinical and radiographic follow-up examinations for over 1 year revealed continued root growth and apical development of the replanted avulsed immature maxillary central incisor with no signs or symptoms of pulpal or periapical pathosis. Excellent outcomes were achieved for periodontal ligament reattachment without removal of the periodontal membrane and pulp revascularization without endodontic intervention.

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.

Lip and tooth injuries at public swimming pools in Austria

BACKGROUND/AIMS

There is an increased risk of orofacial injuries in swimming pool facilities. Nevertheless, only a few studies have addressed this issue. The aim of this study was to identify the frequency of lip and tooth injuries at public swimming pools in Austria. A further aim was to examine which gender and age groups were affected, where and why these injuries occurred, and whether pool attendants had sufficient knowledge of dental first-aid measures.

MATERIAL AND METHODS

A total of 764 pool attendants in Austria were contacted by telephone and 689 participated in the study (90.2%). The attendants were interviewed retrospectively about accident occurrences in 2014 by a standardized questionnaire. Responses to the provision of first aid and choice of storage medium for avulsed teeth were subsequently evaluated.

RESULTS

The frequency of lip injuries was 19.0%, and tooth injuries were 11.3%. Male bathers (P < .05) and children under 12 years (P < .001) most frequently suffered injuries. The waterslide was the most common accident site. The most common cause of lip injuries was slipping on wet surfaces (39.0%), and for tooth injuries it was collisions with other persons or objects (each 28.1%). The pool attendants' responses were predominantly good or sufficient on first aid, with the exception of what storage medium to choose. Tooth rescue boxes were available in only 8.6% of all pool facilities.

CONCLUSION

Orofacial injuries are a frequently occurring problem in swimming pool facilities. The pool attendants' knowledge on first-aid care of tooth injuries could still be improved.

Prevalence and family structures related factors associated with crown trauma in school children resident in suburban Nigeria

BACKGROUND

Multiple risk factors have been identified for traumatic dental injuries, including crown fractures, in various age groups and various populations. The objective of this study was to determine the prevalence, risk factors and family related factors for crown trauma among 8 to 16 year-old children in a suburban population, Nigeria.

METHODS

This is a secondary analysis of a data of 2107 children collected through a school-based survey. Study participants were 8 to 16 year-old resident in suburban Nigeria. The independent variables for the study were age, sex, socioeconomic status, and birth rank, family size and parenting status (one parent, step parent, both parents, and guardians). Details were collected using an interviewer administered questionnaire. Intraoral examination was conducted to identify presence of crown fracture. The independent variables associated with and predictors of crown trauma were determinedusing chi-square and logistic regression analysis respectively.

RESULTS

Only 167 (7.9 %) of the 2107 study participants had crown trauma. The teeth level prevalence of crown trauma was 0.33 %. Children with middle socioeconomic status had reduced odds of having crown trauma when compared with children with low socioeconomic status (AOR 0.50; CI 0.32-0.80). The odds of having crown traumawas more than doubled in males when compared with females (AOR 2.41; CI 1.72-3.39) and almost doubled in children living with single parents when compared with children living with both parents (AOR 1.94; CI 1.29-3.05).

CONCLUSIONS

The prevalence of crown traumawas low in this study population. Being a female and having lowsocioeconomic status significantly reduced the risk factors for crown traumawhile living with single parents increased risk for crown trauma.

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.

Surgical management of mandibular central incisors with dumbbell shaped periapical lesion: a case report

Dental traumatic injuries may affect the teeth and alveolar bone directly or indirectly. Pulpal necrosis and chronic and apical periodontitis with cystic changes are the most common sequelae of the dental traumatic injuries, if the teeth are not treated immediately. This case report focuses on the conventional and surgical management of mandibular central incisors. A twenty-four-year-old male patient presented with pain in the mandibular central incisors. Radiographic examination revealed mandibular central incisors with dumbbell shaped periapical lesion. After root canal treatment, parendodontic surgery was performed for mandibular central incisors. After one-year recall examination, the teeth were asymptomatic and periapical lesion had healed.

Influence of different post-core systems on impact stress: a pilot study

This pilot study compared impact strain at the core and root surfaces between two different post-core systems.