Clarifying the effect of behavioral and clinical factors on traumatic dental injuries in childhood: a hierarchical approach

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.

Family structure and social vulnerability as risk factors for traumatic dental injuries in children and adolescents: a systematic review and meta-analysis

OBJECTIVE

To investigate the associations between family structure and social vulnerability with TDIs in children and adolescents.

METHODS

An electronic search was conducted in seven databases (PubMed, Scopus, LILACS, Embase, Web of Science, ProQuest, and Google Scholar) to retrieve observational studies that evaluated the prevalence of TDIs. The risk of bias was assessed using the JBI Critical Appraisal Tools. Meta-analyses were also conducted using odds ratios (ORs) and 95% confidence intervals (CIs). The certainty of evidence was evaluated using the GRADE approach.

RESULTS

Out of 7,424 records, seventeen articles were included (n = 18,806 children and adolescents aged between 0 and 19 years). Only two studies had a low risk of bias. Children and adolescents from nonnuclear families were more likely to suffer from TDIs (OR: 1.39; 95% CI: 1.17; 1.66). On the other hand, the level of social vulnerability did not show a positive association with TDIs (OR - 1.21; 95% CI: 1.00; 1.47). The GRADE approach assessed the certainty of evidence as low.

CONCLUSION

Despite the uncertainty of the evidence, children and adolescents from nonnuclear families are more likely to have TDIs than are those from nuclear families. On the other hand, social vulnerability does not seem to be associated with episodes of TDIs in children and adolescents.

CLINICAL RELEVANCE

Through knowledge of the risk factors for TDIs, it is possible to develop public policies for their prevention.

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 arch perimeter changes as a result from premature loss of primary anterior teeth due to trauma: A case series in infant and pre-school children

BACKGROUND

The premature loss of primary anterior teeth in deciduous arches is a controversial topic in the literature, especially due to the lack of robust scientific evidence about the consequences in the arch perimeter space and magnitudes of the effects involved.

AIM

Evaluate the association between premature loss of primary anterior teeth and dental arch perimeter changes, according to clinical variables as deciduous arch type, erupted primary canines, midline involvement and deleterious oral habits, on infants and pre-school children.

DESIGN

Patients with avulsion or referral to extraction due to traumatic dental injuries (TDI) were evaluated. After the tooth loss, two trained operators measured the tooth/teeth space, both with a digital caliper and a dry tip compass. The clinical documentation included photographs and radiographs. Follow-up visits occurred from the baseline and every two months over a 12-month period. Chi-square test was used to evaluate the association between arch perimeter changes and clinical variables (α = 0.05). A descriptive statistic was performed to explore the magnitude of space changes, with 95% confidence intervals.

RESULTS

Eighteen infants/children (mean, 2.78 ± 1.39 years) were included. Nine patients presented space loss (50.0%) (mean, -1.32 mm), six patients gained space (33.3%) (mean, +1.55 mm), and three patients presented space maintenance (16.7%). Clinical variables did not influence dental arch perimeter changes.

CONCLUSIONS

Premature loss of primary anterior teeth, as well as deleterious oral habits, deciduous arch type, midline involvement and erupted primary canines, were not associated with dental arch perimeter changes.

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.

Prevalence of traumatic injuries in deciduous dentition and associated risk factors in a Spanish children population

Background

The frequency of traumatic dental injuries (TDI) in primary dentition and those agents that favor them present a great variability. Therefore, the objective of this study was to determine the prevalence of TDI in a population of Spanish preschoolers in temporary dentition and identify the factors associated with these injuries.

Material and Methods

An epidemiological observational prevalence study was carried out. A total of 343 children aged between 3 and 5 years were selected. A questionnaire was completed in relation to socioeconomic factors, cultural level, dietary habits and oral parafunction. Through an intraoral examination, information was collected on the occlusal characteristics and the presence of TDI. Data analysis was performed using the SPSS Statistics 25.0 program for Windows, using the descriptive and frequencies procedure, contingency tables, Chi-square test, and logistic regression analysis.

Results

The prevalence of TDI in the total sample was 12.2%. The most frequent lesion was crown discoloration (0.4%) followed by crown fracture (0.1%) and avulsion (0.1%). The most affected tooth was the deciduous upper central incisor. In the multivariate logistic regression analysis the presence of dental trauma did correlate significantly with the age (5 years in reference to 3 years: OR = 4.209; 95% C.I. = 1.591-11.134; p = 0.004) and overjet (OR = 2.609; 95% C.I. = 1.306-5.214; p = 0.007).

Conclusions

The prevalence of these lesions in a Spanish infant population with temporary dentition is low. Only age and overjet are risk factors. Key words:Dental trauma, deciduous dentition, risk factors.

Breastfeeding in the First Hours of Life Protects Against Pacifier Use: A Birth Cohort Study

Objective: To investigate risk factors for pacifier use in the first year of life. Materials and Methods: A prospective cohort study was conducted with children enrolled at birth in Porto Alegre, Southern Brazil, whose mothers underwent prenatal care at primary care units. Soon after the birth of the children, data were collected on anthropometrics, type of childbirth, and time until breastfeeding on the first day of life. At 6 and 12 months of age, data were collected on breastfeeding practices and whether the child had used a pacifier in the previous 6 months. Statistical analysis involved the use of Poisson regression with robust variance. Results: The incidence of pacifier use in the first year of life was 60% (317/532). The multivariable analysis showed that pacifier use in the first year of life was 33% higher when the mother was younger than 18 years of age (relative risk [RR] = 1.33; confidence interval [95% CI]: 1.01-1.76). Infants who breastfed in the first 30 minutes after birth had a 25% lower risk of pacifier use in the first year of life (RR = 0.75; 95% CI: 0.60-0.94), and those who breastfed between 30 minutes and 6 hours after birth had an 18% lower risk (RR = 0.82; 95% CI: 0.69-0.97) compared to those who took longer to begin breastfeeding or did not breastfeed. Conclusions for Practice: Breastfeeding soon after being born protected against pacifier use in the first year of life. This finding suggests pathways to improve child health, especially in the prenatal period and with an emphasis on pregnant adolescents.

Sequelae in permanent teeth after traumatic injuries to primary dentition

Traumatic injuries to the primary dentition are critical events in dentistry not only due to the need for urgent care, but also since they have potential sequelae in the permanent dentition, with a prevalence ranging from 12% to 74%. The aim of this article was to provide an overview of the prevalence, etiology, and clinical and radiographic characteristics as well as the management of permanent teeth sequelae resulting from traumatic injuries to their deciduous predecessors. An extensive literature review was performed to reveal the current evidence on enamel discoloration with or without hypomineralization/hypoplasia, crown dilaceration, odontoma-like malformation, root anomalies, partial or complete arrest of root formation, sequestration of the permanent tooth germ, and eruption disturbances.

Italian guidelines for the prevention and management of dental trauma in children

Dental trauma is a frequent occurrence in children and adolescent and a correct diagnosis and treatment are essential for a favourable long-term prognosis. The present Guidelines aim to formulate evidence-based recommendations to assist dentists, paediatricians, surgeons, teachers, school and sport staff, parents in the prevention and first aid of dental trauma in children and to provide a careful assessment of the medico-legal implications, reviewing the first draft of the guidelines published in 2012. A multidisciplinary panel on the behalf of the Italian Ministry of Health and in collaboration with the WHO Collaborating Centre for Epidemiology and Community Dentistry of Milan, developed this document. The following four queries were postulated: 1) Which kind of precautions the health personnel, parents, sports and educational personnel must activate in order to prevent the dental trauma damage? 2) How an orofacial trauma in paediatric patients should be managed either in the Emergency Care Unit and/or in private dental office? 3) What criteria should be adopted by a dentist private practitioner to fill in a certificate in cases of dental and/or tempomandibular joint trauma occurring in children and adolescents? 4) What are the elements that should lead clinicians to suspect a non-accidental dental trauma? A systematic review and analysis of the scientific literature published in English, Italian and French from 2007 to 2017 regarding dental trauma in children and adolescents aged 0-18 years was performed, and about 100 papers were analysed and included. The following four domains were analysed and discussed: Dental Trauma Prevention Strategies and Health Education, First aid in orofacial and dental trauma, Certificate of the dental trauma, Oral and dental signs of child abuse and neglect. Twenty-eight recommendations were draw up and codified by the panel according to the Methodological handbook, produced by the Istituto Superiore di Sanità, in order to guide physicians in the prevention and first aid of dental trauma in children and adolescents. In addition, a careful assessment of the medico-legal implications is reported in this document.

Association between occlusal characteristics and the occurrence of dental trauma in preschool children: a case-control study

BACKGROUND/AIMS

Occlusal features may increase the risk of dental trauma. The aim of the present study was to evaluate the association between occlusal characteristics and the occurrence of dental trauma in preschool children.

MATERIALS AND METHODS

A population-based case-control study was conducted with a representative sample of 200 children 3-5 years of age enrolled at private and public preschools in the city of Diamantina, Brazil. The case and control groups were matched for gender, age and type of preschool (public or private) at a ratio of 1:1 (100 cases and 100 controls). Independent variables of interest to the study (occlusal characteristics) and potential confounders (sociodemographic characteristics, sucking habits and lip coverage) were investigated. Intra-examiner and inter-examiner kappa values were higher than 0.80 for all oral conditions evaluated. The SPSS 22.0 program was used to analyse the data. Descriptive and univariate analyses as well as simple and multiple logistic regression analyses were performed.

RESULTS

The occlusal feature most strongly associated with trauma was anterior open bite (OR = 3.80; 95% CI: 1.42-10.16). Maxillary anterior crowding (OR = 2.14, 95% CI: 1.00-4.63) and overjet (OR = 1.12, 95% CI: 0.58-2.17) were associated with the occurrence of trauma independently of the confounding variables (sociodemographic characteristics, sucking habits and lip coverage), but these variables lost their significance when adjusted for other types of malocclusion. Anterior open bite remained strongly associated with dental trauma, regardless of confounding variables and other types of malocclusion.

CONCLUSION

Anterior open bite was the main variable associated with dental trauma in the preschool children analysed independently of the confounding variables and the presence of other malocclusions.

Family environment and traumatic dental injuries in adolescents

BACKGROUND/AIMS

No comprehensive assessment of the influence of the home environment on traumatic dental injuries (TDI) has been conducted to date. The aim of this study was to explore the relationship between family environment and TDI among adolescents from East London.

MATERIALS AND METHODS

This cross-sectional study used data from 646 adolescents who participated in phase III of the Research with East London Adolescents Community Health Survey (RELACHS). Family environment was measured with four indicators (non-nuclear family, discordant parental relationship and levels of parental support and parental punishment) measured through a self-administered questionnaire. Clinical examinations were performed for TDI, overjet and lip coverage. Logistic regression was used to test the crude and adjusted (controlling for sociodemographic and clinical factors) association of each family environment characteristic with TDI prevalence.

RESULTS

Twenty-nine percent of adolescents were from non-nuclear families, and 52.3% reported a discordant parental relationship. The mean score for parental support was -0.01 (SD: 0.90, range: -0.11 to 0.08), and the mean parental punishment score was 0.03 (SD: 0.86, range: -0.04 to 0.10). Adolescents from non-nuclear families had 1.63 (95% confidence interval: 1.06-2.53) greater odds of having TDI than those from nuclear families. However, this association was fully attenuated after adjusting for sociodemographic and clinical factors. The other three indicators of family environment were not associated with TDI either in crude or adjusted regression models.

CONCLUSION

This study found weak evidence of an association between family environment and TDI.

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.

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.

Effect of dark discolouration and enamel/dentine fracture on the oral health-related quality of life of pre-schoolers

AIM

To determine the effect of different types of dental trauma on oral health-related quality of life (OHRQoL) among pre-school children.

METHODS

Four hundred fifty-nine Brazilian pre-schoolers aged 3-5 years were submitted to an oral examination in the school environment for the evaluation of dental trauma using the criteria proposed by Andreasen et al. (2007). Parents answered a questionnaire on the OHRQoL of the children using the Early Childhood Oral Health Impact Scale (ECOHIS) and another one on socio-demographic characteristics of the children and their families. The questionnaires were sent to the parents to be answered at home. Descriptive statistics, Mann-Whitney test and Poisson regression were used for statistical analysis.

RESULTS

Children with dark discolouration and enamel-dentine fracture without pulp exposure had higher mean ECOHIS scores than those without these alterations. The multivariate regression analysis demonstrated that pre-school children with dark discolouration (PR 1.79; 95% CI 1.24-2.58) and enamel-dentine fracture without pulp exposure (PR 1.89; 95% CI 1.22-2.92) had a higher impact on quality of life than those without these alterations.

CONCLUSION

Dark discolouration and enamel-dentine fracture without pulp exposure were associated with a negative impact on the life of pre-schoolers.

Risk factors for traumatic dental injuries in the primary dentition: concepts, interpretation, and evidence

The purpose of this comprehensive review is to explore the main concepts related to quantification and interpretation of risk factors and investigate characteristics associated with traumatic dental injuries (TDI) in the primary dentition. Initially, the main concepts related to causality and risk factors were summarized, including how to measure, express, and compare risk as well as interpret statistical significance. Based on a structured search through PubMed, original research articles regarding TDI and associated factors in the primary dentition were then reviewed by two examiners. Studies with a sample size of at least 300 children aged between 0 and 6 years were summarized according to journal, country, study design, and type of statistical analysis. Variables associated with TDI in primary teeth were identified from studies with multivariable analysis. Measures of effect size and P values were presented. Thirty-two studies were retrieved: most were cross-sectional in design and only 17 (53.1%) performed multivariable analysis. Most investigations did not find an association between gender and socioeconomic variables with TDI. Increased overjet was the only factor consistently identified as an associated factor. Behavioral characteristics have been recently investigated and suggested as potential risk factors for TDI in the primary dentition. In conclusion, increased overjet is undoubtedly associated with TDI in the primary dentition. As behavioral factors may be targeted by preventive strategies, their role on TDI occurrence should be clarified in future cohort studies. Clinicians should understand the terms and measures described in studies on risk factors to properly apply knowledge and benefit patients.

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.

Enamel fracture in the primary dentition has no impact on children's quality of life: implications for clinicians and researchers

AIM

The aim of this study was to quantify the impact of traumatic dental injuries (TDI) on oral-health-related quality of life (OHRQoL) of preschool children, when enamel fractures were either included or excluded within the category of TDI.

MATERIAL AND METHODS

An oral health survey was undertaken of preschool children, age 1-5 years attending public nurseries in Canoas, Brazil. Children were examined for TDI, dental caries, and malocclusion. Parents were interviewed on their perception of their child's OHRQoL (Early Childhood Oral Health Impact Scale-ECOHIS) and their sociodemographic background. Multivariable Poisson regression models with robust variance were fitted to assess the impacts of TDI (including and excluding enamel fractures) on OHRQoL.

RESULTS

A full dataset was collected from 76% of the eligible population. The prevalence of TDI was 13.4% (171/1275). The prevalence of any impact (ECOHIS ≥ 1) was significantly higher in children with crown discoloration (29.7%), enamel/dentin fracture (29.2%), and avulsion (73.3%), compared to children with enamel fracture (16.2%) or without a TDI (15.8%) (P < 0.001). Enamel fractures were the most prevalent TDI (40%) but halved the proportion of children with a reported impact from their TDI. The mean increase in OHRQoL impact for those children with a TDI was 1.59 (95%CI 1.20-2.10) when enamel fracture was included, and 1.86 (95%CI 1.39-2.50) when it was excluded.

CONCLUSION

Enamel fractures have no significant impact on young children's quality of life. Including enamel fractures within the diagnosis of TDI increases the prevalence of TDI while reducing the OHRQoL impact of TDI for the primary dentition.