Incidence of dental trauma among obese adolescents - a 3-year-prospective study

Wearability and preference of mouthguard during sport in patients undergoing orthodontic treatment with fixed appliances: a randomized clinical trial

Background

Orthodontic patients wearing fixed appliances are susceptible to traumatic dental injuries during a wide range of sporting activities. This randomized clinical trial investigated wearability and preference of mouthguards during sporting activities in patients undergoing orthodontic treatment with fixed appliances.

Methods

A prospective three-arm crossover randomized clinical trial conducted in the UK. Thirty patients in active orthodontic treatment with fixed appliances undertaking at least 120 minutes of contact sport per 6–8-week observation period were randomly assigned to one of six mouthguard allocation sequences consisting of three mouthguard types: (MG1) custom-made laboratory constructed, (MG2) mouth-formed OPRO® Gold Braces, and (MG3) pre-fabricated Shock Doctor® Single Brace. Patients completed a nine-outcome 100-mm visual analogue scale (VAS) questionnaire relating to mouthguard wearability during sport. Once feedback was completed, subjects were allocated the next mouthguard in the sequence. At study-end, subjects were asked to identify their preferred mouthguard.

Results

Twenty-four patients (median age = 13; inter-quartile range 12–14.5 years) completed n = 72 follow-up questionnaires with most playing rugby union or field hockey. Considering VAS score as a continuous variable, for comfort, stability, hardness, ability to breathe, ability to not cause nausea, and inclination to chew, MG2 performed better than MG3. For categorization of VAS score into low (less than 80 mm) or high (at least 80 mm) wearability, for comfort, stability, ability to not cause nausea, and inclination to chew, MG1 and MG2 also rated superior to MG3. Patients preferred MG1 overall.

Conclusions

This randomized clinical trial found that during contact sport patients in fixed appliances reported superior wearability for custom-made and mouth-formed mouthguards in comparison to pre-fabricated. Overall, patients preferred custom-made mouthguards.

Clinical trials registration

ClinicalTrials.gov: NCT04588831.

Pattern of Traumatic Dental Injuries Among Adults

Background

The etiology, presentation and management of traumatic dental injuries (TDIs) vary significantly between the adult and the younger population. Most epidemiological studies on TDIs have focused on the pediatric age group. This study aims to report and compare the distributions of TDIs among adults in a sub-population in India.

Methods

This prospective observational study was performed on 1562 consecutively selected patients (1218 males and 344 females) from a university dental hospital in India, between July 2014 and June 2018. The clinical examinations were performed by a single trained and calibrated endodontist. Only TDIs to anterior teeth were recorded (canine to canine in the maxilla and mandible) and classified using a modified version of the World Health Organization's (WHO’s) classification. Periapical and panoramic radiographs were taken for all the subjects.

Results

A total of 1562 patients aged between 20 and 73 years, with a mean age of 36 years, were examined during the study period. The total number of teeth with TDIs was 3044. Males (78%) clearly outnumbered the females (22%) in all the age groups. The most common type of injury occurring in both the genders is uncomplicated crown fractures (male=31.0% and female=36.6%). Avulsion injuries are more likely to be seen by a dentist within 1 hour post-trauma. About two-third of the TDIs were caused by road traffic accidents (RTAs) followed by falls in about 20% of the patients.

Conclusion

Uncomplicated crown fracture was the most commonly observed type of TDI, and RTAs were the primary cause of TDI.

Traumatic dental injuries in special health care needs children and association with obesity

BACKGROUND

Special needs children are at a higher risk of dental trauma because of neurological, physical, mental, and behavioral impairments. They are also at higher risk of developing obesity due to the side effects of medication.

OBJECTIVE

Assess the association between traumatic dental injuries (TDIs) and obesity in children with special health care needs.

DESIGN

Analytical cross-sectional study.

SETTING

Schools for special needs children.

STUDY POPULATION AND METHODS

Special needs children with a diagnosis of TDI according to the Andreasen criteria were included in the study. Data on the disability status were obtained from a national demographic survey in 2016. Demographic and dental variables were measured for analysis. Multivariable logistic regression was used to analyse any relationship between TDI prevalence and obesity.

MAIN OUTCOME MEASURE

Relationship of body mass index (BMI) to TDI prevalence.

SAMPLE SIZE

350 (131 boys and 219 girls) special needs children with a median (interquartile range) age of 12.0 (2.0) years.

RESULTS

Eighty-one (23.1%) children presented with TDIs. The mean (standard deviation) BMI for the entire study population was 24.7 (7.8). Children with obesity had a 30.3% TDI prevalence compared normal-weight children (20.6%) (P=.035), but BMI category was not statistically significant in the regression analysis (P=.541), which showed that children with an overjet of >3 mm were 4.82 times (CI: 2.55-9.09, P=.001) more likely to have TDI than children with an overjet of ≤3 mm. Those with inadequate lip coverage were 2.85 times (CI: 1.49-5.44, P=.002) more likely to have TDI. Children with cerebral palsy were 3.18 times (CI: 1.89-11.32, P=.024) more likely to have TDI than children with other disabilities.

CONCLUSION

The study showed a significant association between TDI prevalence and increased overjet, inadequate lip coverage, and cerebral palsy. The prevalence of TDI among obese special needs children was statistically significant according to bivariate analysis, but not in a multivariate analysis that adjusted for other variables.

LIMITATIONS

Causal relationship cannot be established with cross-sectional study.

CONFLICT OF INTEREST

None.

Clarifying the effect of refractive errors and stereopsis on traumatic dental injuries in childhood

BACKGROUND/AIM

Visual acuity and stereopsis both play an important role in developing posture and balance in children. The aim of this study was to investigate whether children with traumatic dental injuries (TDI) have abnormal stereopsis, due to a reduction in visual acuity, compared to children with good dental health.

MATERIAL AND METHODS

A total of 140 participants (75 with traumatic dental injuries resulting from falls and crashes, and 65 age-matched controls without dental trauma) were enrolled in this prospective, cross-sectional study. The participants underwent complete dental and ophthalmologic examinations. After the ophthalmologic examination, the stereo acuities were assessed by a Titmus stereo test at 40 cm.

RESULTS

Titmus test scores were significantly worse in the TDI group (mean score 252.46 ± 629.12 seconds of arc) compared to the control group (mean score 56 ± 27.39 seconds of arc) (P < .05). The percentage of subjects with abnormal Titmus test scores was higher in the TDI group (28%) than in the control group (3.1%). The mean anisometropia value was 3.03 ± 2.37 D and 0.55 ± 0.41 D in the TDI group and the control group, respectively (P < .001). The severity of anisometropia correlated with the degree of stereopsis (r = .83, P < .01).

CONCLUSIONS

The presence of abnormal stereopsis may lead to postural instability which can lead to traumatic dental injuries. The prevalence of abnormal stereopsis in children with TDI was higher than in children with good binocular vision and stereopsis.

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.

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.

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

BACKGROUND/AIMS

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

MATERIALS AND METHOD

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

RESULTS

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

CONCLUSION

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

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.