Dental trauma: prevalence and risk factors in schoolchildren

The effect of sleep disorders, school jet lag, and anxiety in students 8-10 years of age on traumatic dental injuries

BACKGROUND/AIM

Traumatic dental injuries (TDI) constitute a public health problem. The aim of the present study was to investigate whether sleep disorders, school jet lag, and anxiety are associated with TDI in schoolchildren 8-10 years of age.

METHODS

An analytical, cross-sectional study was conducted with 739 pairs of parents/guardians and children enrolled in public and private schools. The parents/guardians answered a socioeconomic questionnaire, the Sleep Disturbance Scale for Children, Circadian Energy Scale, and Revised Children's Manifest Anxiety Scale. Four examiners underwent calibration exercises for the diagnosis of TDI (K > 0.80) using the criteria proposed by Andreasen (2007). A directed acyclic graph was used for the formulation of the theoretical model and statistical adjustments. Unadjusted and adjusted robust binary logistic regression analyses were performed (α = 5%).

RESULTS

The prevalence of TDI was 16.2%. The following variables remained associated with the outcome in the final model: family income less than or equal to the minimum monthly wage (OR = 1.77; 95% CI: 1.09-2.88; p = .02), child's height >137.6 cm (OR = 1.68; 95% CI: 1.06-2.64; p = .02), the occurrence of school jet lag (OR = 2.12; 95% CI: 1.27-3.53; p = .004), anxiety (OR = 1.77; 95% CI: 1.04-3.00; p = .04) and sleep disorders (OR = 1.63; 95% CI: 1.38-1.93; p = .05).

CONCLUSION

Children from families with a lower income, taller children, those with school jet lag, those with anxiety and those with sleep disorders had a greater occurrence of TDI.

Risk factors associated with the occurrence of avulsion in the primary incisors: A case-control study

BACKGROUND

Identifying factors associated with the occurrence of primary tooth avulsion is essential to promote prevention strategies.

AIM

To investigate the risk factors associated with primary incisor avulsion and variables associated with post-avulsion sequelae in the permanent successor.

DESIGN

This case-control study comprised 407 children (cases) with primary incisor avulsion and 407 children (controls) with other traumatic dental injuries (TDI). The association between explanatory variables and avulsion was evaluated through logistic regression. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated. Poisson regression analyses between potential explanatory variables and sequelae were run, from which relative risks (RR) and corresponding 95% CI were estimated.

RESULTS

TDI caused by moderate falls (OR = 2.20; 95% CI = 1.47 to 3.27), affecting lateral incisors (OR = 10.10; 95% CI = 3.89 to 26.54) and the lower arch (OR = 9.54; 95% CI = 3.15 to 28.85), were associated with primary incisor avulsion. Moreover, children with previous severe TDI, anterior open bite, and anterior crossbite had higher odds of primary incisor avulsion. Children who suffered from any primary tooth avulsion (RR = 2.68; 95% CI = 1.82 to 3.95) had a higher risk of sequelae in the permanent successors. The risk for sequelae in the permanent teeth was significantly greater for younger children under age 2 years than for children ages 3 to 5 years.

CONCLUSION

Risk factors for primary incisor avulsion are related to the severity of the fall, tooth position, history of previous TDI, and malocclusion. Furthermore, avulsion increases the risk of sequelae in the permanent successors.

Partial Ceramic Veneer Technique for Challenging Esthetic Frontal Restorative Procedures

Frontal darkened teeth have shown to be one of the most challenging treatments for esthetic dentistry in recent years. This case report, along with a 30-month follow-up, describes the application of a partial ceramic veneer, restricted to the mid-cervical third region, made in the upper left central incisor darkened by trauma. The procedure consisted of maintenance of the entire incisal face, as well as esthetic and morphological rehabilitation of the smile line with veneers and ultra-thin partial ceramic veneers. The planning process was thoroughly elaborated by photographs, study models, a virtual smile designed, diagnostic waxing, and reproduction in the patient's mouth through mock-up. Following, dental home bleaching, esthetic gingival contouring, and minimally invasive tooth preparation were performed. Two types of glass ceramics (lithium disilicate and feldspathic) were used in different regions due to the peculiar characteristics of resistance, finishing, and polishing. According to the present case report, preparing a cervical partial ceramic veneer is an innovative, viable, and safe approach to maintaining the incisal portion of the tooth preserved and setting a detailed tooth morphology/color. The application of partial ceramic veneer provides incisal edge preservation and simplifies the reproduction of the adjacent tooth characteristics, avoiding multiple esthetic appointments.

Critical appraisal of confounding factors of observational studies on the association between dentofacial features and dental trauma in a Brazilian population

AIMS/OBJECTIVES

Dental trauma is a highly prevalent dental emergency. Children and adolescents without inadequate lip coverage, increased overjet, and anterior open bite are associated with the occurrence of traumatic dental injuries. Observational studies do not allow the inference of causality, one of the reasons being: the potential confounding factors. Therefore, this review aimed to critically appraise the confounding factors considered in epidemiological studies that associate dentofacial features with the occurrence of dental trauma in Brazilian children and adolescents.

METHODS

Studies included in the qualitative synthesis of a recently published comprehensive systematic review and meta-analysis on the topic were screened. Studies that only mentioned the performance of bivariate analyzes or that did not mention the performance of multivariate analyzes were excluded. Evaluation of control statements for possible confounders and bias consideration was performed for each selected study. Confounding factors in these studies were also identified and categorized according to their domains.

RESULTS

Fifty-five observational studies were screened, of which 11 were excluded due to the mention of only bivariate analyzes or the lack of multivariate analyses. The remaining 44 studies were critically appraised. Of these, 9 studies specifically mentioned the term confounding, and 12 studies mentioned the term bias. However, only 14 studies mentioned limitations on confounding factors in their findings. Among the 99 different variables identified, the most used were type of trauma, followed by sex and age.

CONCLUSION

Most studies did not acknowledge the control for possible confounding factors and rarely stressed the need for caution in interpreting their results. Cross-sectional studies do not allow inferring a cause-and-effect relationship between dentofacial features and dental trauma.

Dental trauma and oral health-related quality of life among 7th-grade students of public elementary schools

Dental trauma is a public health problem because of its high prevalence rates and treatment costs and for affecting mainly younger individuals. Aim: This cross-sectional study aimed to investigate the variables associated with dental trauma and its influence on oral health-related quality of life among 7th-grade students of public elementary schools. Methods: The data was collected with semi-structured and self-administered questionnaires and an intraoral clinical examination (n = 204). The variables collected regarded dental trauma, lip coverage, overjet, oral health-related quality of life (Child Perceptions Questionnaire - CPQ11-14 ISF: 8), and sociodemographic profile. Association tests and the Mann-Whitney test were performed at a 5% significance level. Results: Dental trauma occurred in 12.3% of students, 94.6% had adequate lip coverage, and the mean overjet was 2.7 mm (±2.0). Sex was the only variable with a statistically significant association with dental trauma (p = 0.021). There was no statistically significant difference in the CPQ11-14 ISF: 8 score between students with and without dental trauma (p = 0.136). Conclusions: Dental trauma was significantly associated with sex and did not impact the oral health-related quality of life of the students.

Measurement of association between malocclusion, nutritional status, and dental trauma in adolescents: A cross-sectional study

Background

With the decrease in the incidence of dental caries globally, traumatic dental injury (TDI) has emerged as a major cause of morbidity and distress among adolescents. The aim of this study was to assess the prevalence of TDI and explore its association with malocclusion and nutritional status among adolescent population of Udupi taluk, Karnataka state, India.

Methods

The sample consisted of 770 children, from randomly selected schools in Udupi taluk. An anthropometric measurement was done to record the "body mass index", an oral examination was done to record the "Dental Aesthetic Index" for malocclusion and "Andreasen classification" for TDI. Statistical analysis included chi-square test and bivariate and multivariate binary logistic regression. A p value of ≤0.05 was considered statistically significant.

Results

The prevalence of TDI was 11.8%. The prevalence of overweight and obesity was 20.3%. The prevalence of malocclusion recorded in the study population was 49.8%. When prevalence of TDI was compared against gender, the type of school attended, and presence/absence of malocclusion, it was found that there was a statistically significant difference in prevalence of trauma between the aforementioned parameters (p ≤ 0.05). Results of the multivariate analysis through logistic regression indicated that being a male [3.87 (3.21-4.72)], attending a public school [1.41 (1.19-1.63)], and having malocclusion [1.55 (1.32-1.71)] significantly increased the odds of sustaining TDI.

Conclusion

The results indicated a strong association between TDI, gender, the type of school attended, and malocclusion, and they have important implications toward the health and well-being of the individual communities.

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.

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.

Oral Health-Related Knowledge, Attitudes and Behaviours of Elementary School Teachers

BACKGROUND

elementary schoolteachers play a central role in shaping their students' beliefs, attitudes, and behaviours related to health and oral hygiene. This study was designed to evaluate Turkish schoolteachers' levels of oral health knowledge, attitudes, and behaviours.

METHODS

A cross-sectional survey-based study was conducted among elementary schoolteachers in Istanbul using a validated self-administered questionnaire. The questionnaire was composed of 36 multiple-choice items categorised into six sections, and the participants were recruited using convenience sampling. (3) Results: A total of 385 elementary schoolteachers participated in this study. The majority were female (62.2%), qualified with a licensure degree (81.3%) and working in public schools (86.5%). Female gender and greater work experience were found to be promoters for oral health knowledge and positive attitudes. The correlation between their perceived knowledge and actual knowledge was very weak, thus suggesting that the teachers are inclined to overestimate their knowledge.

CONCLUSIONS

The Turkish elementary schoolteachers showed satisfactory oral health knowledge and attitudes toward oral health education. The teachers' knowledge about dental trauma management was inadequate, necessitating urgent educational interventions, especially for physical education teachers, who are at the greatest risk of encountering such events during their work. The oral hygiene behaviours were not associated with teachers' oral health knowledge, attitudes, or practice, thus requiring further investigation.

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.

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.

Childhood unintentional injury: The impact of family income, education level, occupation status, and other measures of socioeconomic status. A systematic review

Introduction

Unintentional injuries represent a substantial public health burden among children and adolescents, and previous evidence suggests that there are disparities in injury by socioeconomic status (SES). This paper reports on a systematic review of literature on injury rates among children and adolescents by measures of SES.

Methods

A systematic literature search was conducted using six electronic databases: MEDLINE, PsycINFO, CINAHL, HealthSTAR, EMBASE, and SportsDiscus. This review considered children ages 19 years and under and publications between 1997 and 2017-representing an update since the last systematic review examined this specific question. Fifty-four articles were summarized based on study and participant descriptions, outcome and exposure, statistical tests used, effect estimates, and overall significance.

Results

Most articles addressed risk factors across all injury mechanisms; however, some focused particularly on burns/scalds, road traffic injuries, falls/drowning cases, and playground/sports injuries. Other studies reported on specific injury types including traumatic dental injuries, traumatic brain injuries, and fractures. The studies were of moderate quality, with a median of 15.5 (95% confidence interval [CI]: 15.34 to 15.66) out of 19. Thirty-two studies found an inverse association between SES and childhood unintentional injury, three found a positive association while twenty were not significant or failed to report effect measures.

Conclusion

Given the variability in definition of the exposure (SES) and outcome (injury), the results of this review were mixed; however, the majority of studies supported a relationship between low SES and increased injury risk. Public health practice must consider SES, and other measures of health equity, in childhood injury prevention programming, and policy.

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.

Is dental trauma more prevalent in maltreated children? A comparative Study in Southern Brazil

BACKGROUND

Although a high prevalence of head and neck trauma has been reported in maltreated children and adolescents, most of these studies focused on record-based analyses, and only a few used control groups.

AIM

To assess the presence of dental trauma in maltreated children in comparison with children without a history of maltreatment.

DESIGN

A cross-sectional study with 68 maltreated children and 204 age, sex-, and school-matched control participants was conducted in Pelotas, a Southern Brazilian city. Socioeconomic and demographic data were collected. Clinical examinations were performed to evaluate dental trauma (O'Brien Index) and dental caries (WHO criteria). Fisher's exact and chi-squared tests were used for intergroup comparisons of socioeconomic and clinical variables. Multivariate logistic regression analyses were conducted to obtain adjusted odds ratios (OR).

RESULTS

The prevalence of dental trauma was 23.53% (n = 16) among maltreated children and 14.22% (n = 29) in the comparative group. After adjustment, the occurrence of dental trauma showed association with child maltreatment, with an OR of 2.14 (95% confidence interval 1.03-4.44) for maltreated children in comparison with children in the comparative group (P = 0.04).

CONCLUSIONS

Maltreated children presented with more dental trauma than those with no history of maltreatment.

Effectiveness of an audio-visual aid on the knowledge of school teachers regarding the emergency management of dental injuries

BACKGROUND/AIM

Traumatic dental injuries (TDI) occur frequently in the school environment. Many studies have shown that teachers' knowledge on the emergency management of TDI is inadequate. The aim of this study was to evaluate the knowledge level among schoolteachers in Chennai, India, regarding TDI using a questionnaire and to evaluate the effectiveness of a newly developed audio-visual aid (AV) as an educational tool by reapplying the questionnaire.

METHODS

The questionnaire was distributed to 345 teachers in 15 randomly selected schools. A pro forma document along with the questionnaire surveyed the teachers' demographic details and their knowledge regarding the emergency management of TDI. Then, a video containing evidence-based information about the emergency management of TDI in accordance with the American Academy of Pediatric Dentistry (AAPD) guidelines was played for the participants. The questionnaire was readministered to test the teachers' knowledge after they viewed the video.

RESULTS

In total, 301 teachers responded to the questionnaire. Wilcoxon's signed-rank test/chi-square test showed that, after the teachers viewed the video, their knowledge had significantly improved relative to the handling of TDI (P < .0001). Their attitude towards the AV aid was positive, and all participants (100%) found the AV helpful. Almost 99.7% of the participants reported increased confidence in handling dental injuries.

CONCLUSION

There is a substantial lack of basic knowledge regarding the emergency TDI management among schoolteachers. The proposed AV aid is an effective tool for providing management strategies.

Psychosocial factors and traumatic dental injuries among adolescents

OBJECTIVES

To examine the association of traumatic dental injuries (TDI) and psychosocial factors in adolescents and to identify psychological profiles associated with TDI.

METHODS

A cross-sectional study was conducted involving 531 students aged 13-16 years. Data were collected through oral examination and a structured interview with the adolescents, in conjunction with a questionnaire answered by their mothers. Associations between TDI and independent variables were analysed using a model-based approach, while an exploratory data analysis was applied to identify homogenous clusters of adolescents in relation to their sense of coherence (SoC), perception of parental support and their mothers' SoC. These clusters were examined further for associations with TDI and psychosocial variables.

RESULTS

The prevalence of TDI was 15.8%. Adolescents with high TDI prevalence were males, nonfirstborns, or those frequently engaging in physical activity. In addition, both their own SoC and that of their mother were low and they reported low parental support. They were also prone to complaining about the behaviour of their peer group. The hierarchical cluster analysis (HCA) demonstrated three homogenous clusters. The cluster with the highest scores for all psychological variables included adolescents with low TDI prevalence, low paternal punishment, spacious home environment, high Family Affluence Scale (FAS) score, good school grades, few complaints about schoolmates and higher maternal education.

CONCLUSIONS

Psychosocial factors appear to influence an adolescent's risk of TDI. High parental support, high own and maternal SoC and a higher socioeconomic status (SES) are typical of adolescents with low TDI experience.

Does dental trauma in the primary dentition increases the likelihood of trauma in the permanent dentition? A longitudinal study

OBJECTIVES

The aim of this longitudinal study was to assess the likelihood of children suffering traumatic dental injuries in the permanent dentition subsequent to traumatic dental injuries in their primary dentition.

MATERIALS AND METHODS

A longitudinal study was conducted in Pelotas, Brazil. Children were assessed in 2007, when they were aged 2-5 years, and in 2013, at which time, they were aged 8-11 years. Data collection included interviews with parents and clinical oral examination for dental trauma and occlusion. The classification proposed by Andreasen and Andreasen was used, and crown discoloration and fistula were added to this criterion in order to assess pulp involvement. Child/parent report was used to aid in the diagnosis of both treated and untreated injuries. As a limitation, no radiographs were taken. Descriptive, univariate, and multivariate logistic regression analyses were performed.

RESULTS

A total of 110 children were included. Dental trauma frequency in the primary dentition was 38.2% and that in the permanent dentition was 30.9%. In the multivariate analyses, children with dental trauma in the primary dentition showed a higher likelihood of suffering dental trauma in the permanent dentition [odds ratio (OR) 2.97, 95% confidence interval (CI) 1.01-8.91, P = 0.05].

CONCLUSIONS

Individuals with previous trauma in the primary dentition are prone to further trauma in the permanent dentition. The history of dental trauma may be used to predict dental trauma in the permanent dentition and to establish preventive measures.

CLINICAL RELEVANCE

Behavioral characteristics may be related to the risk of a child suffering injuries. The results suggested that some children are accident-prone.

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.

Is there an association between the presence of dental fluorosis and dental trauma amongst school children?

Our objective was to evaluate whether there is an association with the different levels of dental fluorosis and the presence of dental trauma amongst school children. A transversal study was conducted amongst school children from the age of 12. Dental examinations were conducted by 24 well trained and fully qualified dental surgeons. Data was collected from 36 randomly selected public schools amongst 89 schools in a municipality. The criteria used to diagnose dental fluorosis was based on the Dean's fluorosis Index and for diagnosing dental trauma we looked for clinical signs of crown fractures and dental avulsions. Multiple descriptive analysis, which was bivariate, was carried out. Amongst the 2,755 school children that took part in the study 1,089 (39.6%) were diagnosed with dental fluorosis and 106 (3.8%) had one tooth or more with dental trauma. We noted a high prevalence of dental fluorosis, independent of the level of severity, amongst individuals with one tooth or more who had dental trauma. This association was even more evident where there were severely high levels of fluorosis. We also noted that the presence of fluorosis was greater amongst those that actively paid more attention to discoloration on their teeth and who received treatment from a dental professional at their schools. Nevertheless dental fluorosis was associated with the presence of dental trauma, independent of its severity.

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

BACKGROUND/AIM

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSION

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

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.