Trends and associated factors in prevalence of dental trauma in Latin America and Caribbean: a systematic review and meta-analysis

Association between socioeconomic status and traumatic dental injury in permanent teeth: A systematic review with meta-analysis

OBJECTIVE

The aim of this study was to systematically review observational studies assessing the association between socioeconomic status (SES) and traumatic dental injuries (TDI) in permanent dentition.

METHODS

Electronic searches were performed in PubMed, EMBASE, Web of Science, LILACS, CINAHL, COCHANE Library and ScoINDEX databases for articles published up to February 2023. Two independent reviewers performed the search and critical appraisal of the studies. The inclusion criteria were observational studies that evaluated the association between individual-level socioeconomic indicators and TDI (clinically examined) in permanent teeth. Quality assessment of included articles was conducted using the Newcastle-Ottawa Scale. Global meta-analysis was performed with all studies and different subgroup analysis based on socioeconomic indicators (household income, educational level or any other indicator), age (children, early adolescents, late adolescents or young adults) and economic classification of the country (high, upper-middle or lower-middle). A random-effects model was used to estimate pooled prevalence ratios (PR) and respective 95% confidence intervals (CI) for each study.

RESULTS

The search strategy retrieved 11 315 publications. According to eligibility criteria, 17 articles were included in the meta-analysis. Individuals with low SES were 17% more likely to have TDI (PR 1.17; 95% CI 1.05-1.30). The subgroup analysis also revealed that the indicator (household income, PR 1.16; 95% CI 1.00-1.34) and the economic classification of the country (upper-middle, PR 1.19; 95% CI 1.07-1.33) influenced the association of SES with TDI occurrence.

CONCLUSIONS

Individuals with lower SES were more likely to present with TDI in permanent dentition than those with higher SES.

Contextual and individual factors associated with traumatic dental injuries in deprived 12-year-old schoolchildren: A cohort study

AIM

Traumatic dental injuries (TDIs) among children and adolescents have been acknowledged as of public health concern worldwide. The aim of the study was to assess the relationship between contextual and individual characteristics and TDIs in 12-year-old schoolchildren.

MATERIALS AND METHODS

A cohort study was conducted with 355 schoolchildren living in deprived communities in the city of Manaus, Brazil. Contextual factors (place of residence and socio-economic indicators) and individual characteristics, including sex, family income, parents/guardians years of schooling, overjet and open bite (Dental Aesthetic Index), self-esteem (Rosenberg Self-Esteem Scale), sense of coherence (Sense of Coherence Scale), oral health beliefs, social support (Social Support Appraisals) were assessed at baseline. TDIs were measured at baseline and at 2-year follow-up using the O'Brien Index. Data were analysed through confirmatory factor analysis and structural equation modeling.

RESULTS

The baseline prevalence of TDIs was 17.6% and the incidence of TDIs at 2-year follow-up was 26.8%. Better psychosocial status had a direct protective effect on the incidence of TDIs (β = -.184). Better contextual characteristics (β = -.135) and greater overjet (β = -.203) were directly associated with poor psychosocial status. Higher schooling of parents/guardians directly predicted better psychosocial status (β = .154). Psychosocial status mediated the relationship of greater overjet (β = .036), contextual factors (β = .024) and parental/guardian schooling (β = -.027) with TDIs.

CONCLUSIONS

Contextual factors and individual characteristics predicted TDIs. Psychosocial status was a relevant individual attribute in the causal network of TDIs, due to the direct effect on the incidence of TDIs as well as a mediator on the influence of contextual factors, overjet and parents/guardians schooling on the incidence of TDIs.

Unusual approach to treat malocclusion with traumatically missing and hopeless maxillary unilateral incisors: A case report

Orthodontic cases requiring tooth extraction sometimes involve post-traumatic incisors. For adolescent cases in which trauma causes the maxillary unilateral incisors to be missing or have poor prognoses, it is worth considering these teeth as candidates for extraction, and this unusual approach is seldom reported in the literature. An adolescent patient with a missing maxillary left lateral incisor and an ankylosed maxillary left central incisor sought treatment for dental protrusion and crowding. An unusual orthodontic approach was used, which involved the extraction of the maxillary left central incisor and mandibular first premolars. After treatment, the maxillary right central incisor was successfully translocated across the midpalatal suture and transformed into the left central incisor. Additionally, well-aligned teeth and enhanced smile aesthetics were achieved, and the treatment outcomes remained stable throughout the follow-up period.

Prevalence of Dental Trauma and Their Relationship to Risk Factors among 8-15-Year-Old School Children

Background

Tooth injuries lead to functional, aesthetic, and psychological disorders, accompanied by the great concern of the child, the parents, and the dentist.

Aim

(a) To assess the prevalence of traumatic dental injury (TDI) and its relationship to risk variables among 8-15-year-old school children in Mahbubnagar, India. (b) To collect baseline data as there are limited reports of TDI studies in South India to date.

Methods

A cross-sectional study was conducted among 6643 children from 78 schools in Mahbubnagar using a multilevel random sampling method. The permanent incisors were examined according to the WHO classification using a standard oral mirror and probe. Individuals with clinical evidence of trauma were asked about the details of the injury event using a structured questionnaire. The chi-square test analyzed the distribution of all measurements in this study with a statistical significance of 0.05.

Results

Among the 6643 children from the 78 schools surveyed, 9.3% experienced TDI. TDI occurred in 68% of boys, which was about twice as high in girls at 32%. The most commonly affected teeth were the maxillary central incisors. A higher number of children with an incisal overjet more significant than 3 mm had TDI than the children less than 3 mm, although this difference was not statistically significant. The lip closure incompetence was more common in children with TDI. The most frequent causes of TDI were falls, and the site of occurrence was school. Type I fractures were the most prevalent and most went untreated.

Conclusion

The high level of dental trauma and the low percentage of children with trauma seeking treatment emphasize the need for greater awareness among the Mahbubnagar children.

Does the school environment exert influence on quality of life related to traumatic dental injury in children?

The aim of this cross-sectional study was to assess whether favorable factors related to school characteristics have a positive effect on the impact of traumatic dental injury (TDI) on oral health-related quality of life (OHRQoL). An epidemiological survey of oral health was conducted with 12-year-old schoolchildren from Quito, Ecuador. Children were examined for TDI, dental caries, and malocclusion. Individual socioeconomic data were also collected. Information on the physical environment, health practices, and occurrence of negative episodes at school was collected from the school coordinators. The Child Perceptions Questionnaire 11-14 (CPQ11-14) was used to evaluate the OHRQoL (outcome variable). Multilevel Poisson regression analysis was conducted. Severe TDI was associated with higher CPQ11-14 scores, even in the multiple model adjusted for oral health conditions, sex, individual socioeconomic variables, and school-related variables. Children from schools that had an appropriate tooth-brushing environment for their students exhibited a lower impact on OHRQoL, even after adjustment for the occurrence of TDI and other variables. A favorable school environment may exert a positive effect on OHRQoL, independent of the occurrence of TDI.

Lip incompetence and traumatic dental injuries: a systematic review and meta-analysis

Background/aim Traumatic dental injury is an impact injury to the teeth and/or other hard and soft tissues severity of which can lead to pain, as well as aesthetic, psychological, behavioural and functional problems among children. Lip incompetence directly exposes teeth increasing the risk of traumatic dental injuries. This review aimed to assess the existing evidence regarding association of lip incompetence and dental trauma.Methods The review protocol was registered with PROSPERO with Protocol number: CRD42020163069. Electronic searches of grey literature and three databases were performed. Cross sectional studies conducted between the years 2009-2019 on children aged 0-15 years were selected. Studies were evaluated with the help of NIH quality assessment scale. Data on research question, study population, inclusion and exclusion criteria, sample size justification, exposure and outcome clearly defined and adjustment for confounding variables were assessed. All analyses were performed using Review Manager 5.4.Results The study identified 10,223 articles, 33 were included. Among these 20 identified articles reported 'Good' quality with 13 studies reporting 'Fair' quality post assessment. Subject with lip incompetence were at 2.44 (1.59-3.75) times the risk of developing traumatic injuries during primary dentition. This risk increases to 3.26 (2.21;4.53) times in mixed and permanent dentition. At 12 years of age the OR for dental trauma is 3.77 (2.06;6.91) in subjects with incompetent lips.Conclusions The results confirm the association between lip incompetence and dental trauma.

Prevalence of dental trauma in Brazilian children and adolescents: a systematic review and meta-analysis

This study aimed to investigate the prevalence of dental trauma in Brazilian children and adolescents. A systematic review was conducted considering eight databases: MEDLINE (via PubMed), LILACS, BBO, Scopus, Embase, Web of Science, Open Access Theses and Dissertations, and OpenThesis. Only prevalence studies that used a probabilistic sampling method were included, without restriction on year or language of publication. The JBI critical appraisal tools for prevalence studies were used to assess the individual risk of bias. The individual studies were combined in the meta-analysis using the random-effects model. The heterogeneity between the studies was analyzed by Cochran's Q and the I-square statistics. A meta-regression analysis was performed to evaluate the sources of heterogeneity. The GRADE approach assessed the certainty of evidence across included studies. The search resulted in 2,069 records, of which 36 were included in the study. The eligible studies were published from 2000 to 2021, with a total sample of 40,194 children and adolescents. Most studies (75%) had a low risk of bias. In permanent teeth, the prevalence of dental trauma was 21% (95%CI: 16.0; 26.0) and in deciduous teeth; 35% (95%CI: 26.0; 44.0). The prevalence of dental trauma among boys was higher than among girls for both dentitions. Based on a low certainty, the prevalence of traumatic dental injuries in Brazilian children and adolescents is higher than that found worldwide both in deciduous and permanent teeth. Also, the prevalence of dental trauma among boys is higher than among girls.

Multi-state outcome analysis of treatment interventions after failure of non-surgical root canal treatment: a 13-year retrospective study

Objective

To examine the factors affecting the transitions through treatment interventions after failure of non-surgical root canal treatment (NS-RCT).

Methodology

Insurance enrollment and claim information for enrollees of Delta Dental of Wisconsin (DDWI), USA were analyzed for 438,487 initial NS-RCT procedures to determine the effect of initial provider type and other covariates on additional treatments (no additional treatment, nonsurgical retreatment, surgical retreatment and extraction). A multi-state model was created using the “mstate” R package. Transitions between the four states identified by Code on Dental Procedures and Nomenclature were analyzed. Cox proportional Hazards regression stratified by transition type was used to estimate the effect of provider type on the risk of each transition, adjusting for covariates.

Results

The overall survival rates for all teeth that were treated by NS-RCT was 82.8% [95% CI 82.57%, 83.11%] at 10 years. Approximately, 7% of cases changed from the first state of initial NS-RCT during the 13-year study period with ultimately 0.9%, 0.4% and 5% of cases receiving non-surgical retreatment, surgical retreatment or extraction, respectively. Teeth are more likely to be retreated non-surgically than surgically, and to be extracted than retreated. In general, the probability of a tooth having non-surgical retreatment was higher if the initial provider was not an endodontist (Hazard Ratio (HR)=3.2). Molars were more likely to be non-surgically retreated (HR=2.0) or extracted (HR=2.8) when compared to anterior teeth. The probability of non-surgical retreatment (HR=0.93) or extraction (HR=0.50) was lower when a crown was placed within 90 days after NS-RCT.

Conclusion

Most teeth remained in the same state after treatment with no additional treatment transitions. When a transition occurred, it was more likely to be an extraction. Type of provider, age, location of the tooth, gender, and time to placement of final restoration significantly influence treatment transitions.

The association of inadequate lip coverage and malocclusion with dental trauma in Brazilian children and adolescents - A systematic review and meta-analysis

BACKGROUND/AIM

Dental trauma (DT) occurs frequently in children and adolescents. Therefore, understanding the factors associated with its occurrence in these age groups is important to establish specific preventive measures. The aim of this study was to investigate the relationships of lip coverage, overjet, and open bite to dental trauma in Brazilian children and adolescents.

MATERIAL AND METHODS

The review protocol was registered in the PROSPERO database (CRD42020156290) and the bibliographic search was performed in nine electronic databases until July 2020. The studies included were observational, performed in Brazil, with healthy children and adolescents (0-19 years old), and without the restriction of date or language. Two reviewers assessed the individual risk of bias of the eligible studies with a standardized checklist. The meta-analyses were stratified by dentition stage and age range using fixed or random effects, odds ratio (OR) as the effect measure, and 95% confidence interval. The heterogeneity across studies was assessed with the I² test and the GRADE approach assessed the certainty of evidence.

RESULTS

The search presented 2493 initial results, from which 55 met the eligibility criteria and were included. Most studies (67%) presented a low risk of bias and were published between 2000 and 2019. Children and adolescents with inadequate lip coverage are 1.86-2.36 times more likely to suffer from DT, while those with increased overjet are 1.94-3.11 times more likely. Children with primary dentitions and anterior open bites are 1.76 (95% CI: 1.20-2.59) times more likely to suffer from DT. The certainty of evidence varied from very low to moderate.

CONCLUSIONS

Inadequate lip coverage, increased overjet, and anterior open bite are associated with the occurrence of dental trauma in Brazilian children and adolescents.

Influence of school environment on occurrence of traumatic dental injuries in 12 years old children

BACKGROUND/AIM

Since children spend most of their time in school, some environmental characteristics of the schools may influence the occurrence of traumatic dental injuries (TDI). Therefore, the aim of this cross-sectional study was to assess the prevalence of TDI in 12 years old children in Quito, Ecuador, and its association with some school environmental aspects.

MATERIAL AND METHODS

Six calibrated examiners evaluated 998 children from 31 public schools of Quito, to evaluate the occurrence of TDI in anterior teeth. School coordinators answered questionnaires on school physical conditions, promotion of health practices and the occurrence of negative episodes in school. The occlusion and socioeconomic status of the participants were also evaluated. Prevalence of TDI, unadjusted and adjusted by the design effect was calculated. Association between individual and contextual explanatory variables and presence of TDI were evaluated using multilevel Poisson regression analysis (P < .05).

RESULTS

TDI prevalence adjusted by design effect was 20.7%. Children studying in schools with patio floor of grass and with access ramps had significantly lower prevalence of TDI than children studying in schools with patio floor of cement and with only stairs, respectively. The prevalence of TDI was also lower in children from schools that offered healthy meals or that had a proper place for oral hygiene.

CONCLUSIONS

Schools with adequate physical structures and that promote health practices to their students have a lower prevalence of TDI.

Risk factors and patterns of traumatic dental injuries among Indian adolescents

Background/purpose

Dental injuries in children have functional, esthetic, and psychological effects, with consequences for the child, parent, and dentist. This study assessed the pattern of traumatic dental injuries and their relationship with predisposing factors among 12- and 15-year-old school children in Kanpur, India.

Materials and methods

A cross-sectional study was conducted on 1100 boys and girls aged 12 or 15 years. Anterior permanent teeth were examined based on the modified Ellis classification. Type of damage, size of incisal overjet, and adequacy of lip coverage were also recorded. Chi-square tests and multiple regression analysis were used for statistical analysis.

Results

The prevalence of traumatic dental injuries to anterior teeth was 10.9%. Age and gender distribution indicated that most injuries occurred in 15-year-old age group (11.3%) and among boys (11.5%). The gender-related difference was statistically significant (p < 0.024). Maxillary central incisors (83.7%) were frequently involved. The predominant injury type was enamel fracture (68.3%) mainly due to falls (52.5%). Increased overjet, inadequate lip coverage, type of school, and gender were significant contributing factors for traumatic dental injuries.

Conclusion

Study reveals the frequency and cause of traumatic injuries to anterior teeth, which assists in identifying risk groups and treatment needs in order to establish effective preventive strategies.

Oral health of 12-year-old children in Quito, Ecuador: a population-based epidemiological survey

BACKGROUND

There is a paucity of population-based surveys on oral health conditions in Ecuador. Thus, the aim of this study was to conduct an epidemiological survey with a representative sample of children aged 12 years from public schools of Quito, Ecuador. The aim of this initial report was to describe the methodology used in the survey, as well to present results regarding calibration procedures and prevalence of oral-health related outcomes.

METHODS

We invited 33 public schools' coordinators from the urban area of Quito, and 1100 children (12 years old) to take part in this study. Six trained and calibrated examiners conducted clinical examinations using oral mirrors and ball-ended probes to assess: dental caries, traumatic dental injuries, malocclusion, gingival bleeding, presence of calculus and fluorosis. Children also responded a questionnaire on Oral Health-Related Quality of Life (OHRQoL). Individual sociodemographic data was collected through a questionnaire sent to parents. Moreover, some contextual data on school environment (infrastructure conditions, promotion of health practices and negative episodes) were also evaluated. Prevalence values, crude and weighted by sampling weights, and 95% confidence intervals (95%CI) were calculated.

RESULTS

Nine hundred and ninety-eight children from 31 schools were examined from March to May 2017. The adjusted prevalence values (95%CI) for the six outcomes evaluated were: dental caries = 60.3% (55.3 to 65.0%); traumatic dental injuries = 20.7% (17.2 to 24.8%); dental fluorosis = 63.7% (58.5 to 68.5%); gingival bleeding = 92.0% (87.1 to 95.2%); presence of calculus = 69.9 (60.5 to 77.9%); and malocclusion = 25.8% (21.8 to 30.3%). Adjusted mean of number of decayed, missed or filled permanent teeth (DMF-T) was 1.61 (1.37 to 1.84). Results on OHRQoL and other contextual variables will be reported in other articles.

CONCLUSION

The prevalence of the majority of oral health problems in 12-year-old children from public schools in Quito-Ecuador was compatible with those observed in other similar cities. However, periodontal health and fluorosis seem to be highly prevalent in children from Quito.

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.

Cross-cultural adaptation and psychometric evaluation of the early childhood oral health impact scale (ECOHIS) in chilean population

Background

The Early Childhood Oral Health Impact Scale (ECOHIS) measures the impact of dental diseases on Oral Health-Related Quality of Life both in children and their families. The aim of this study was to develop a Chilean Spanish version of the ECOHIS that is conceptually equivalent to the original and to assess its acceptability, reliability and validity in the preschool population of Chile.

Methods

The Chilean version of the ECOHIS was obtained through a process including forward and back-translation, expert panel, and cognitive debriefing interviews. To assess metric properties, a cross-sectional study was carried out in Carahue, Southern Chile (April–October 2016). Children younger than six years old without systemic diseases, disabilities or chronic medication from eleven public preschools were included. Parents were invited to complete the Chilean version of the ECOHIS, PedsQL™4.0 Generic Core and PedsQL Oral Health scales, and to answer global questions about their children’s general and oral health. A subsample was administrated ECOHIS a second time 14–21 days after. A clinical examination was performed to assess dental caries, malocclusion, and traumatic dental injuries. Reliability was evaluated using measures of internal consistency (Cronbach’s alpha) and reproducibility (Intraclass correlation coefficient - ICC). Construct validity was assessed by testing hypotheses based on available evidence about known groups and relationships between different instruments.

Results

The content comparison of the back-translation with the original ECOHIS showed that all items except one were conceptually and linguistically equivalent. The cognitive debriefing showed a suitable understanding of the Chilean version by the parents. In the total sample (n = 302), the ECOHIS total score median was 1 (IQR 6), floor effect was 41.6%, and ceiling effect 0%. Cronbach’s alpha was 0.89 and the ICC was 0.84. The correlation between ECOHIS and PedsQL™4.0 Generic Core was weak (r = 0.21), while it was strong-moderate (r = 0.64) with the PedsQL Oral Health scale. In the known groups comparison, the ECOHIS total score was statistically higher in children with poor than excellent/very good oral health (median 11.6 vs 0, p < 0.01), and in the high severity than in the caries-free group (median 8 vs 0.5, p < 0.01). No differences were found according to malocclusion and traumatic dental injuries groups.

Conclusions

These results supported the feasibility, reliability and validity of the Chilean version of ECOHIS questionnaire for preschool children through proxy.

Risk factors for traumatic dental injuries in the Brazilian population: A critical review

BACKGROUND/AIMS

Strategies for the prevention of traumatic dental injuries (TDI) should consider the risk factors involved for each population studied. The aim of this study was to perform a critical review regarding the risk factors for TDI in the Brazilian population.

MATERIALS AND METHODS

A systematic literature search was performed in the MEDLINE, Scopus, Web of Science, Lilacs, and BBO databases using MeSH terms, synonyms, and keywords, with no language or date restrictions. In the first step, all relevant studies identified, regardless of the type of statistical analysis performed, were grouped according to their geographic location. In a second step, the studies using Andreasen's criteria to classify the injuries and multivariate analysis to identify the risk factors for TDI in Brazilian subjects were included for data extraction.

RESULTS

The search strategy initially identified 3373 articles. However, only 108 articles assessed TDI with predisposing factors and were included in the first step. From those, 28 were deemed eligible for inclusion in the second step. No consensus related to the relationship between gender and TDI in the primary dentition was achieved. Nonetheless, males were found to be more prone to trauma in the permanent dentition. Overjet, inadequate lip sealing and anterior open bite increased the risk for TDI, both in primary and permanent dentitions. Social environment was related to trauma only in primary dentition. For permanent dentition, dental caries, obesity, binge drinking, and drug use were identified as considerable risk factors for TDI.

CONCLUSION

The risk factors for TDI in the Brazilian population are similar to those found worldwide. However, some differences can be observed, such as gender and socioeconomic indicators as predisposing factors.

Exploring the impact of malocclusion and dentofacial anomalies on the occurrence of traumatic dental injuries in adolescents

OBJECTIVE

To investigate the association between malocclusion/dentofacial anomalies and traumatic dental injuries (TDI) in adolescents.

MATERIALS AND METHODS

The sample of this cross-sectional study comprised 509 adolescents aged 11 to 14 years enrolled at public schools in the city of Osório, southern Brazil. Parents answered a structured questionnaire addressing demographic and socioeconomic characteristics. An examiner who had undergone a training and calibration exercise recorded malocclusion/dentofacial anomalies (Dental Aesthetic Index, DAI), TDI (Andreasen), and dental caries (World Health Organisation). Statistical analyses (SPSS software) involved Poisson regression with robust variance.

RESULTS

The prevalence of TDI was 11.6%, and the prevalence of defined, severe, and handicapping malocclusion was 24.0%, 21.6%, and 22.0%, respectively. The multivariate analysis demonstrated that the probability of TDI was approximately twofold higher among adolescents with severe malocclusion (prevalence ratio [PR] 2.22; 95% confidence interval [CI] 1.14-4.31) and handicapping malocclusion (PR 1.95; 95% CI 1.01-3.85) in comparison to those with normal occlusion or minor malocclusion. Defined malocclusion was not significantly associated with the outcome. Among the dentofacial anomalies evaluated, the probability of TDI was nearly twofold higher among adolescents with overjet greater than 3 mm (PR 1.96; 95% CI 1.14-3.37) and 2.2-fold higher among those with an abnormal molar relationship (PR 2.24; 95% CI 1.17-4.32), after controlling for confounding variables.

CONCLUSIONS

Severe and handicapping malocclusion, accentuated overjet, and abnormal molar relationship were strongly associated with the occurrence of TDI. Future studies should investigate whether the treatment of these conditions can help reduce the occurrence of TDI in adolescents.

Remote diagnosis of traumatic dental injuries using digital photographs captured via a mobile phone

BACKGROUND

Intra-oral photographs have been aided diagnosis of several pathologies in teledentistry. Mobile phone cameras may produce high-quality photographs, presenting itself as a viable tool for remote diagnosis of traumatic dental injuries.

AIM

To evaluate the levels of interexaminer agreement in cases of traumatic dental injuries when comparing diagnoses conducted in person and remotely.

MATERIAL AND METHODS

The sample included 40 patients with 73 traumatized teeth, and a total of 90 diagnoses, who had presented to two dental clinics, one private, and the other public, in Brazil's Federal District. The dental history and clinical examination data were registered in electronic forms, and digital photographs were captured with a mobile phone camera and uploaded to a cloud drive. Six remote examiners formulated their diagnoses based solely on photographic analysis. Thereafter, they were provided with additional clinical data and asked to provide a second round of diagnoses. These diagnoses were compared to those conducted in person, which were considered the gold standard. The data were analyzed with Gwet's AC1 interexaminers' measure to evaluate the agreement between the in-surgery and remote diagnoses.

RESULTS

The levels of interexaminer agreement between the in-surgery and remote diagnoses formulated exclusively with images were 0.83 or higher (95% confidence interval: 0.73-0.91), and 0.93 or higher (95% confidence interval: 0.88-0.97), when clinical information was available.

CONCLUSION

The precision of the remote diagnoses was comparable to the diagnoses conducted in person. The levels of interexaminer agreement were higher when clinical data were included with the images. Mobile phones may be an effective tool for capturing images that assist in the remote diagnosis of traumatic dental injuries.

Income inequality and traumatic dental injuries in 12-year-old children: A multilevel analysis

BACKGROUND/AIM

Contextual socio-economic factors have been associated with traumatic dental injuries (TDIs). However, evidence concerning the role of income inequality on TDIs in children is scarce. The aim of this study was to investigate the association between contextual income inequality over a 10-year period and TDIs in Brazilian children.

SUBJECTS AND METHODS

The study population comprised a representative sample of 5027 children aged 12 years who participated in the Brazilian oral health survey in 2010. City-level Gini Index was used to measure contextual income inequality in the years 2000 and 2010, as well as the variation in income inequality between 2000 and 2010. Covariates were gender, ethnicity, family income, number of people per room and incisal overjet. Clinical examinations were used to assess TDIs. Multivariable multilevel ordered multinomial logistic regression was used to estimate cumulative Odds Ratio (OR) and 95% confidence intervals between income inequality and TDIs.

RESULTS

The prevalence of children who had one tooth with TDI and two or more teeth with TDIs was 15.2% and 6.4%, respectively. The maxillary central and left lateral incisors were the teeth most affected by TDIs. Gini coefficient reduction between the years 2000 and 2010 decreased the odds of TDIs even after adjustment for demographic and socio-economic characteristics, and incisal overjet. The likelihood of more TDIs decreased 21% for each 0.05 unit decrease in the Gini coefficient between the years 2000 and 2010. Boys, brown skin colour, overcrowding and incisal overjet greater than 5 mm remained statistically associated with TDIs in the final model.

CONCLUSIONS

The decrease in income inequality over a 10-year period was inversely associated with TDIs among Brazilian children aged 12 years.

Trend of traumatic crown injuries and associated factors in preschool children

The aim of this study was to assess trends in traumatic crown injuries (TCIs), their prevalence, and association with socioeconomic and clinical factors in preschool children over a 5-year period. A series of cross-sectional surveys was conducted in Santa Maria, Brazil, on children attending a National Day of Children's Vaccination. The same protocol was used in all surveys conducted in 2008, 2010, and 2013. Clinical examinations were performed to evaluate types of traumatic crown injuries using the O'brien index. A semi-structured questionnaire was answered by the parents. It provided information about several socioeconomic factors as well as the parents' perception of their child's oral health. The chi-square for trends test was used to verify changes in TCI prevalence throughout the years. The association between socioeconomic and clinical factors with TCI was assessed by the Poisson regression analysis. A total of 1,640 children were examined. The prevalence of TCIs decreased significantly from 2008 to 2013 (10.12%; p < 0.001). Central incisors were the most vulnerable to injury, independent of the year. Moreover, older children and those with inadequate lip coverage were more likely to present with some traumatic dental injury (p < 0.001). prevalence of traumatic crown injuries decreased following the years, however TCI remain an important subject to consider when planning oral health policies.

Prevalence of anterior dental trauma and its associated factors among children aged 3-5 years in Jaipur City, India - A cross sectional study

Objective:

To study the prevalence of anterior dental trauma and its associated factors among 800 preschool children aged 3 to 5 years in Jaipur City, Rajasthan, India.

Materials and Methods:

A cross-sectional survey was conducted among children aged 3-5 years, who were enrolled in various private and public schools in Jaipur. Parents were asked to fill a form addressing socio-demographic data and clinical examinations were performed by a single dentist. Traumatic dental injuries (TDI) were assessed and recorded based on Andreasen's classification. Associated factors such as sex, socioeconomic status (SES), and the type of injury were also analyzed. The data were analyzed statistically using Statistical Package for the Social Sciences software (version 20).

Results:

An overall 10.2% prevalence of TDI was observed among the study population. TDI were reported to be more among male children (11.87%) compared to female children (8.14%). Enamel fractures (69%) were the most prevalent type of anterior dental trauma. Upper central incisors were the most frequently affected. The SES of the parents had little influence on the prevalence of TDI.

Conclusions:

The prevalence rate of dental trauma among children aged 3-5 years was 10.2%. Associated factors, such as SES, were observed to be not significantly correlated to dental trauma among the studied preschoolers.

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

Trends in the prevalence of traumatic crown injuries and associated factors in Brazilian preschool children: 10-year observational data

OBJECTIVE

To assess trends in the prevalence of traumatic crown injuries (TCI) in children aged 1-4 years living in Diadema city (Brazil) and to investigate whether TCI were associated with socio-demographic and clinical variables.

METHODS

Six cross-sectional surveys with representative samples were carried out from 2002 to 2012 following the same criteria and methodology. A total of 6389 children were evaluated and systematically selected on the National Children's Vaccination day. Calibrated examiners performed the children's oral examination for TCI according to Andreasen's criteria. Chi-square test for trends was used to perform comparative analysis. Poisson regression was used to associate TCI to socio-demographic and clinical variables.

RESULTS

The prevalence of TCI in 2002 for preschool children aged 1, 2, 3 and 4 years was 4.5%, 11.4%, 14% and 13.9%, respectively, and the prevalence in 2012 for the same age groups was 10.4%, 15.9%, 25.7% and 28.1%, respectively. There was a significant increase in the prevalence of TCI for all age groups and for the total sample (P < 0.05). Children's age was associated with TCI in all the surveys. Male gender, presence of anterior open bite and inadequate lip coverage were associated with TCI in some surveys along the years (P < 0.05).

CONCLUSION

This study has shown an increase of TCI prevalence in Brazilian preschool children in the last 10 years and its association with children's age, male gender, presence of anterior open bite and inadequate lip coverage. However, this increase does not seem to be relevant to decisions on public policy.

Oral Health-Related Quality of Life and Traumatic Dental Injuries in Young Permanent Incisors in Brazilian Schoolchildren: A Multilevel Approach

BACKGROUND

Traumatic dental injury (TDI) during childhood may negatively impact the quality of life of children.

OBJECTIVE

To describe the association of oral health-related quality of life (OHRQoL) and domains (oral symptons, functional limitation, emotional- and social-well-being) of children with individual and contextual variables.

METHODS

A cross-sectional study was performed using a representative sample of 1,201 schoolchildren, 8-10 years-old, from public and private schools of Belo Horizonte, Brazil. The CPQ8-10 was used to assess OHRQoL, dichotomized in low and high impact. Sociodemographic information was collected through questionnaires to parents. Children were examined at schools, using the Andreasen criteria. Individual variables were gender, age, number of residents in home, parents/caregivers' level of education, family income, and TDI (dichotomized into without trauma/mild trauma and severe trauma). Dental caries and malocclusion were considered co-variables. Contextual variables were the Social Vulnerability Index and type of school. Ethical approval and consent forms were obtained. Data were analyzed using SPSS for Windows 19.0 and HLM 6.06, including frequency distribution, chi-squared test and multilevel approach (p < 0.05).

RESULTS

The prevalence of a negative impact on OHRQoL in children with severe trauma was 55.9%. The TDI negatively impacted emotional and social domains of OHRQoL. A multilevel analysis revealed a significant difference in OHRQoL according to the type of school and showed that 16% of the total variance was due to contextual characteristics (p < 0.001; ICC = 0.16). The negative impact on OHRQoL was higher in girls (p = 0.009), younger children (p = 0.023), with severe TDI (p = 0.014), those from public schools (p = 0.017) and whose parents had a lower education level (p = 0.001).

CONCLUSION

Severe trauma impacts OHRQoL on emotional and social domains. Contextual dimensions add information to individual variability to explain higher impact, emphasizing socioeconomic inequalities.

Derivation and growth characteristics of dental pulp stem cells from patients of different ages

The dental pulp contains a relatively low number of stem cells; however, it is considered to be a promising source of stem cells for use in regenerative therapy. To date, it has remained elusive whether there are certain differences in the dental pulp stem cells (DPSCs) from donors of different ages. In the present study, DPSC lines were derived using teeth from children, adolescents, adults and aged donors. The derivation efficiency, the proliferative and apoptotic rate, cell marker expression and the differentiation capacity were investigated and compared among these DPSC lines. The derivation efficacy was decreased with increasing donor age. Although a large part of cell surface markers was expressed in all DPSC lines, the expression of CD29 was downregulated in the DPSCs from aged teeth. In addition, the doubling time of DPSCs from aged teeth was prolonged and the number of apoptotic cells was increased with the propagation. These DPSCs were able to differentiate into a neuronal linage, which positively expressed the neuron-specific class III beta-tubulin and microtubule‑associated protein 2, as well as into an osteogenic lineage, which positively expressed CD45; however, these DPSCs from aged teeth were completely or partially deprived of differentiation capacity. By contrast, DPSCs from younger teeth displayed significantly higher vitality and a higher potential for use in dental regenerative medicine.

Absence of an association between socioeconomic indicators and traumatic dental injury: a systematic review and meta-analysis

OBJECTIVE

The aim of this study was to perform a systematic review and search for scientific evidence on the association between socioeconomic indicators and traumatic dental injury (TDI) in the primary dentition.

METHODOLOGY

The PubMed, ISI, LILACS, Cochrane Library, and Embase databases were searched for articles addressing possible associations between socioeconomic indicators and TDI in the primary teeth in journals dating from the inception of the databases through to December 2013. Two independent reviewers performed data extraction and analyzed the quality of the studies. Meta-analysis was undertaken. Pooled estimates were calculated with a 95% confidence interval (CI) and odds ratios (OR).

RESULTS

Sixteen articles were included in the systematic review. Children from families with household income less than two times average salary (U$ 592) (OR: 0.77; 95% CI: 0.66-0.90) or more than three times the average salary (U$ 888) (OR: 0.76; 95% CI: 0.65-0.89) had a significantly lower chance of having TDI in the primary dentition. TDI was not associated with socioeconomic status (high vs low - OR: 0.77; 95% CI: 0.43-1.36; high vs medium - OR: 1.03; 95% CI: 0.72-1.48; medium vs low - OR: 0.70; 95% CI: 0.42-1.19), house ownership (owned vs rented - OR: 1.28; 95% CI: 0.98-1.66), mother's schooling (OR: 0.89; 95% CI: 0.74-1.08), or father's schooling (OR: 1.01; 95% CI: 0.62-2.74).

CONCLUSION

The scientific evidence demonstrates that socioeconomic indicators are not associated with TDI in the primary dentition. The evidence of an association between a low income and TDI is weak. In general, studies had low risk of bias. Further prospective cohort studies are needed to confirm this association.

Over two hundred million injuries to anterior teeth attributable to large overjet: a meta-analysis

BACKGROUND/AIM

The association between large overjet and traumatic dental injuries (TDIs) to anterior teeth is documented. However, observational studies are discrepant and generalizability (i.e. external validity) of meta-analyses is limited. Therefore, this meta-analysis sought to reconcile such discrepancies seeking to provide reliable risk estimates which could be generalizable at global level.

MATERIAL AND METHODS

Literature search (years 1990-2014) was performed (Scopus, GOOGLE Scholar, Medline). Selected primary studies were divided into subsets: 'primary teeth, overjet threshold 3-4 mm' (Primary3); 'permanent teeth, overjet threshold 3-4 mm' (Permanent3); 'permanent teeth, overjet threshold 6 ± 1 mm' (Permanent6). The adjusted odds ratios (ORs) were extracted. To obtain the highest level of reliability (i.e. internal validity), the pooled OR estimates were assessed accounting for between-study heterogeneity, publication bias and confounding. Result robustness was investigated with sensitivity and subgroup analyses.

RESULTS

Fifty-four primary studies from Africa, America, Asia and Europe were included. The sampled individuals were children, adolescents and adults. Overall, there were >10 000 patients with TDI. The pooled OR estimates resulted 2.31 (95% confidence interval - 95CI, 1.01-5.27), 2.01 (95CI, 1.39-2.91) and 2.24 (95CI, 1.56-3.21) for Primary3, Permanent3 and Permant6, respectively. Sensitivity and subgroup analyses corroborated these estimates.

CONCLUSIONS

Reliability and generalizability of pooled ORs were high enough and made it possible to assess that the fraction of global TDIs attributable to large overjet is 21.8% (95CI, 9.7-34.5%) and that large overjet is co-responsible for 235 008 000 global TDI cases (95CI, 104,760,000-372,168,000). This high global burden of TDI suggests that preventive measures must be implemented in patients with large overjet.

Socio-economic indicators and predisposing factors associated with traumatic dental injuries in schoolchildren at Brasília, Brazil: a cross-sectional, population-based study

Background

This study assessed the prevalence of traumatic dental injuries (TDI) and its association with sociodemographic and physical characteristics in the anterior permanent teeth of 12-year-old schoolchildren at the city of Brasília – DF, Brazil.

Methods

A cross-sectional, population-based study was conducted on a sample of 1,389 boys and girls aged 12 years, enrolled in public and private fundamental schools at the Administrative Region (RA) of Brasília, Brazil, from October 2011 to September 2012. The demographic details were achieved by a structured questionnaire. The study recorded the type of damage, the size of incisal overjet, and whether lip coverage was inadequate. Sociodemographic data included sex, income and educational level of the parents or caretakers.

Results

A total of 1118 schoolchildren were examined, yielding a response rate of 80.48%. The prevalence of TDI was 14.63% in public schools and 23.40% in private schools. The students did not differ according to sex, income and educational level of the parents or caretakers concerning the occurrence of traumas in permanent anterior teeth. Increased overjet and inadequate lip coverage were found to be important contributing factors for TDIs.

Conclusion

In conclusion, this study showed an expressive prevalence of TDI in 12-year-old in schoolchildren at Brasília DF, Brazil. Sex and educational level of the parents were not associated with trauma. The increased overjet and inadequate lip coverage were significantly associated with dental trauma.