Prevalence of traumatic dental injuries and associated factors among preschool children in Amman, Jordan

Traumatic Dental Injuries and their Association with Demographics and Other Predisposing Risk Factors in School Children Aged between 8-13 Years: A Descriptive, Cross-Sectional Study

Background

Traumatic dental injuries are most commonly seen in school age children. This not only affects physical, but, also, the psychological and social well-being of a child. The aim of the present study was to assess the prevalence of traumatic dental injuries in school children aged between 8 and 13 years and their association with the demographics and other predisposing risk factors.

Materials and Methods

The present study was conducted as a cross-sectional study design on 1500 school children aged between 8 and 13 years. Apart from clinical examination, all the participants were asked to complete a questionnaire related to the injuries sustained. Statistical analysis was conducted using Statistical Package for Social Sciences (SPSS) version 21.0 (IBM, Chicago). Pearson's Chi-square (Χ²) test was used for categorical data analysis and distribution to determine the association between categorical variables, while P < 0.05 was considered statistically significant.

Results

The prevalence of traumatic dental injuries in the present study was calculated at 9.7%. Also, the occurrence of such injuries was found to be higher in the age group of 8-11 years with 10 years being the peak age of incidence for sustaining such injuries. Again, crown fracture involving enamel was found to be the most common type of injury sustained, while proclination observed in relation to upper anterior teeth, and incompetent lips were found to be the independent, significant risk predictors associated with the frequency and severity of such injuries.

Conclusions

The results obtained in the present study suggested a high prevalence of traumatic dental injuries in school children aged between 8 and 13 years highlighting the need for conducting educational programs, for increasing knowledge and awareness of parents, school children and school faculty in this regard to save the affected child patients from the more dreaded sequelae including complete loss of tooth structure, and social and emotional trauma.

Treatment priorities and arrival time of traumatic dental injuries-An 8-year retrospective study

BACKGROUND/AIM

Most of the previous studies in the available literature discussed the time of arrival in general to the healthcare system, while a minority studied the relationship between the type of trauma and arrival. The aim of this retrospective study is to assess the arrival time of traumatic dental injuries (TDIs) depending on the urgency of treatment according to Andreasen.

MATERIALS AND METHODS

This 8-year retrospective study was carried out at the Department of Pediatric Dentistry at the University Dental Clinic in Zagreb, Croatia. Andreasen's classification was used to define the kind of TDI as well as to divide them by the need for urgent treatment or treatment priorities in three groups: acute, subacute, and delayed.

RESULTS

The sample consisted of 1040 children (59% male and 41% female) with a median age of 7. Each year, the age group most affected by TDIs was 6-12 years old. While there is a general increase in the prevalence of TDIs overall, there is a decline in TDIs among children aged 6-12 and an increase among preschoolers and adolescents (below 6 and above 12 years old). Throughout the years, 52.73% red/acute and 41.16% yellow/subacute TDIs were not treated on time due to delayed arrival. More patients from Zagreb come in the first 24 h, while more patients from outside Zagreb come to the clinic a month or more after their injuries. Patients which suffered TDI accompanied with soft-tissue injury arrived sooner.

CONCLUSIONS

It is necessary to introduce monitoring and education of patients under the age of 6 and over 12, as well as their parents/caregivers. New programs should be implemented and new referent centers that specialize in treating TDIs outside of Zagreb should be established.

Knowledge, Awareness, and Practice Regarding Management of Dental Trauma in Children among Dental Practitioners: A Cross-sectional Survey

AIM

The aim of this study was to determine the current level of knowledge and understanding about dental trauma and its management in children among dental practitioners.

MATERIALS AND METHODS

The study was conducted after obtaining the ethical clearance from the Institutional Review Board (IRB). A structured questionnaire was prepared, which comprised 20 questions and was validated by dental trauma experts. The questionnaire, which covers all aspects of traumatic dental injuries (TDIs) in both primary and permanent dentition, was distributed online to 850 dental practitioners. The questionnaire was open from January 2022 to April 2022, with a 3-month time frame to complete it. The responses were collected and statistical analysis was done using SPSS software.

RESULTS

The mean age of the participants were 22-30 years. Furthermore, 515 participants were females and 263 were males. In this survey among 784 responses, 449 dentists were trained in dental trauma and 618 participants had personal experience in managing dental trauma. All other questions about knowledge and awareness of dental trauma management received fewer correct answers.

CONCLUSION

According to the present study, dental practitioners have only mild-to-moderate knowledge and awareness about dental trauma. From the latest the International Association for Dental Traumatology guidelines, dentists need to consistently update their knowledge through dental trauma conferences, workshops, trainings, and symposiums.

CLINICAL SIGNIFICANCE

This study informs us about the existing level of dental knowledge about dental trauma, which is significantly low. This will considerably boost dental practitioners' interest in TDIs. As a result, practitioners' expertise will grow, allowing them to better care for their patients.

Effect of surface treatment of ethylene vinyl acetate on the delamination of custom-fitted mouthguards

BACKGROUND/AIM

Contamination of ethylene vinyl acetate (EVA) during mouthguard fabrication can cause delamination. The study evaluated the effects of different EVA surface treatments on the contact angle, laminate bond strength, and elongation capacity.

MATERIALS AND METHODS

Specimens of two bonded EVA plates were prepared (n = 30). The Shore A hardness of standardized EVA plate specimens was measured before and after thermo-plasticization. The EVA plates were randomly allocated to one of five different surface treatment groups: no treatment (control); isopropyl alcohol, 100%; chloroform, 99.8%; self-cure acrylic resin monomer (methacrylate, ethylene glycol dimethacrylate, and chemical initiator-amine type); and ethyl alcohol, 70%. The maximum breaking force and elongation at the site of fracture were recorded using a universal testing machine. The contact angle surface was measured using ImageJ software. Scanning electron microscopy of the EVA surface was performed. The laminate bond strength was obtained by dividing the maximum breaking force by the bonding area between the two EVA plates. The laminate bond strength and maximum elongation data were analyzed by one-way ANOVA, followed by the Tukey's and the Dunnet test. The failure mode data was analyzed using the chi-square test (α = .05).

RESULTS

EVA surface treatment significantly influenced the laminate bond strength and maximum elongation (p < .001). The control group had a higher contact angle and significantly lower laminate bond strength and maximum elongation than the other groups (p < .001). The acrylic resin monomer and chloroform-treated specimens had similar laminate bond strength and maximum elongation. The acrylic resin monomer group had a significantly lower contact angle (p < .001).

CONCLUSIONS

All treatments had a significantly higher laminate bond strength and maximum elongation than the control group. The acrylic resin monomer and chloroform groups had a significantly higher laminate bond strength and maximum elongation and the acrylic resin monomer group had a lower contact angle than the other groups. The chloroform should be avoided due its hazardous effects.

Psychiatric symptoms and pain in maxillofacial injury following motor vehicle accidents: A comparative study

BACKGROUND/AIM

Post-traumatic stress disorders, depression, and pain are rarely discussed in the literature on maxillofacial injuries, and psychiatric symptoms and pain are not identified and managed in such patients. The aim of this study was to determine the symptoms of post-traumatic stress disorders, depression, and pain in people with maxillofacial injuries following motor vehicle accidents.

MATERIAL AND METHODS

In this cross-sectional study, people injured in motor vehicle accidents from March to September 2015 who were referred to a medical educational center in the northern part of Iran for treatment follow-up were sampled. The existing symptoms of post-traumatic stress disorder by PSS, depression by BDI-II, and pain by NRS were assessed. SPSS software version 21 was used for analysis.

RESULTS

Maxillofacial injured patients had significant differences in terms of post-traumatic stress disorder (p = .006), depression (p = .001), pain (p = .001), and length of hospital stay (p = .002) than patients without maxillofacial injuries.

CONCLUSIONS

Motor vehicle accident victims with maxillofacial injuries suffered significantly more from post-traumatic stress disorders and depression, pain and length of hospital stay than patients with other injuries.

Impact on Quality of Life and Risk Factors Associated with Visible Maxillary Incisors Trauma among Young Children in Faridabad, Haryana

Aim

To assess the impact of upper incisor trauma on the quality of life (QoL) in young children studying between the age group 8 and 13 years in Faridabad, Haryana.

Materials and methods

A cross-sectional, prospective study was conducted to assess the visible permanent maxillary incisor traumas according to the classification of traumatic dental injuries (TDI) and to determine the predisposing risk factors that affect TDI and their impact on QoL in children aged 8-13 years. Questionnaires were made to gather information on demographic and socioeconomic characteristics like age, gender, and the father's and mother's education. Data on dental caries in anterior teeth were also collected using current World Health Organization criteria.

Result

There were a total of 66 males and 24 females. The total decayed, missing, and filled permanent teeth (DMFT) prevalence observed was 8.9%. The main reason for trauma was found to be an accident or accidental fall (36.7%). The most common place for trauma followed by road (21.1%). Time lapsed from the injury reported was >1 year in males (34.8%), while it was within 1 year (41.7%) in females (p = 0.014). The most prevalent and impacted performance was smiling (80.0%; m = 8.7778 ± 8.658), and the least affected was speaking (4.4%; m = 0.5111 ± 3.002).

Conclusion

A number of risk factors need to be considered when assessing TDIs, as TDIs can have a negative impact on the functional, social, and psychological well-being of young children. As they are frequent in children, affecting teeth, their supporting structures, and adjacent soft tissues, they may cause both functional and esthetic problems.

Clinical significance

When injuries to incisor(s) produce pain, disfigurement, poor aesthetics, or other psychological effects, children may avoid laughing or smiling, and this can affect their social relationships. So, it is important to address the risk factors that predispose upper front teeth to TDIs.

How to cite this article

Elizabeth S, Garg S, Saraf BG, et al. Impact on Quality of Life and Risk Factors Associated with Visible Maxillary Incisors Trauma among Young Children in Faridabad, Haryana. Int J Clin Pediatr Dent 2022;15(6):652-659.

Evaluation of primary teeth affected by dental trauma in patients visiting a university clinic, Part 1: Epidemiology

OBJECTIVES

The retrospective study reported herein was the first of three that investigated dental trauma in primary teeth. This article discusses the study that aimed to reveal the epidemiology of trauma with data such as prevalence, risk factors, and types of injuries, and to highlight prevention.

MATERIALS AND METHODS

The records of 320 patients aged 0-9 years who visited the Erciyes University Faculty of Dentistry Pedodontics Department due to dental trauma were evaluated according to the age, gender, medical condition, season, oral habits, trauma environment/type/cause, personal characteristics, and number of siblings. The chi-square test was used to compare the categorical variables by group.

RESULTS

Of the patients, 25.9% were aged 24-35 months at the time of study, 62.8% were male, 38.1% had two siblings, 37.2% had a sucking habit, 93.4% had a healthy medical condition, 41.3% experienced the trauma in summer, and 26.3% were aged 30-34 months at the time they incurred the trauma. Of the traumas, 54.1% were caused by falling, 60% occurred at home, 23% pertained to lateral luxation, and 70% were incurred when the patients were with their mother.

CONCLUSION

Given the results of this study, mothers with low education levels should be informed about their children's risk of incurring injuries from falling at home, especially in summer. Parents should also be warned that their children's oral habits increase their risk of trauma.

CLINICAL RELEVANCE

This study can help increase the knowledge level of clinicians, can raise social awareness, and can guide plan formulation for preventing risks.

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 and patterns of traumatic dental injuries in primary teeth: a 3-year retrospective overview study in Vienna

OBJECTIVES

The aim of this study was to retrospectively identify the prevalence, patterns, and accident types of traumatic dental injuries (TDIs) in children with primary teeth in Vienna, Austria.

MATERIAL AND METHODS

The investigation was conducted as a retrospective overview study including all children with TDIs in primary teeth at the University Dental Clinic of Vienna (Austria) between 2014 and 2016. Dental records including age, gender, location of trauma, type of trauma, cause of TDI, and location of traumatic incident were obtained. Furthermore, the time of presentation and the time span between TDI and initial treatment were evaluated.

RESULTS

The sample comprised TDIs in 243 patients with 403 primary teeth. In a ratio of 1:1.45, boys were significantly more involved than girls. Upper central and lateral incisors were most frequently affected (n = 371, 92.1%). Dislocations were the most common type of injury (n = 298, 74%) with subluxations being the most prevalent form (n = 85, 28.5%). In 23% (n = 92), fractures were observed. The majority of traumatic incidents occurred at home (88.5%).

CONCLUSION

The injury characteristics are comparable to what has previously been reported in other studies in pediatric populations.

CLINICAL RELEVANCE

TDIs are a prevalent event in children worldwide and incisors are the most affected teeth in the primary dentition. Thus, dental practitioners should be able to handle these injuries.

Traumatic injuries in primary dentition and their immediate and long-term consequences: a 10-year retrospective study from the State University of Rio de Janeiro, Brazil

BACKGROUND/AIM

Dental trauma is a highly prevalent problem worldwide. The aim of this study was to describe characteristics of trauma to anterior primary teeth and its sequelae for primary and successor teeth over a 10-year period of assistance at the paediatric dental traumatology clinic in the State University of Rio de Janeiro, Brazil.

MATERIALS AND METHODS

The data were obtained from the dental records of children assisted from 2006 to 2016. Inclusion criteria were trauma to anterior primary teeth; aged <1 to 9 years at the time of trauma; and at least one follow-up appointment. The data concerning traumatized teeth, child's age, soft tissue injuries, types of traumatic dental injuries and sequelae in both dentitions were collected.

RESULTS

Of the 1230 dental records, 483 (39.3%) were eligible, consisting of 815 teeth. The mean age at the time of trauma was 37.4 months (239 males and 244 females). The most important characteristics were: tooth 51 was most affected; falls, at home, on a ceramic floor, were the main cause; gingival laceration, enamel fracture and intrusive luxation were the most frequent types of trauma; premature tooth loss of primary teeth and enamel discoloration in their successor were the most frequent sequelae; and injuries in the periodontal tissue were demonstrated as the highest risk for sequelae in successors (OR, 3.798; p< 0.001).

CONCLUSIONS

Most traumatic injuries occur in young children, in their home environment. Consequences for the primary teeth were more frequent compared to the permanent successor tooth. Traumatized primary teeth involving periodontal tissue have more chances to result in sequelae to their successor teeth.

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.

Dental trauma in toddlers 1-3 years of age living in multicultural areas of Stockholm, Sweden: A retrospective cohort study

BACKGROUND/AIM

Traumatic dental injuries are common and affect many children. The aim of this retrospective study was to investigate the prevalence and characteristics of dental trauma as well as the costs and resource use in a cohort of children aged 1-3 years in low socioeconomic areas (low income and educational level) of Stockholm.

MATERIALS AND METHODS

Data were extracted from a larger intervention trial and analyzed for the prevalence and other characteristics of dental trauma as well as patient characteristics of children (n = 1346) from six dental clinics in low-income, multicultural areas. Variables describing the trauma, socioeconomic status, direct and indirect costs, and time spent at the emergency visit for the dental trauma were retrieved from the dental records. The study also recorded which healthcare profession handled the first and follow-up visits.

RESULTS

The prevalence of dental trauma in the study cohort was 8.2%, and higher among boys (n = 71) than girls (n = 39). Boys exhibited a significantly higher risk for dental trauma (OR, 1.76; 95% CI = 1.17-2.65). Maxillary incisors were the teeth most often traumatized, and lateral luxation was the most common diagnosis. The mean time spent per child during the first year following the dental trauma was 36 min, and the mean costs per child were EUR 878. The total average per-child cost (direct and indirect costs) for dental trauma was EUR 2107. Dental visits due to traumatic injuries were significantly less common among children with an immigrant background and in families with an income ≤EUR 2000 per month.

CONCLUSIONS

Toddlers in families who have a low socioeconomic status, a foreign background, and live in multicultural areas of Stockholm visit dental clinics for traumatic dental injuries less often than non-immigrant children living in families with a high socioeconomic status.

The prevalence of traumatic dental injuries in primary teeth: A systematic review and meta-analysis

BACKGROUND/AIMS

The varied prevalence of traumatic dental injuries (TDI) in primary teeth around the globe raises a serious knowledge gap in the available literature. The aim of this study was to evaluate the prevalence of TDI in primary teeth and also to evaluate the different factors associated with TDI in primary teeth.

MATERIALS AND METHODS

Comprehensive searches were performed in PubMed, Embase, Google Scholar, and The Cochrane Central Register of Controlled Trials with predefined search criteria. The primary outcome was the prevalence of TDI in primary teeth, and the secondary outcomes were the factors associated with TDI in primary teeth. Qualitative analysis was done using the Newcastle-Ottawa scale adapted for cross-sectional studies. The random-effect model was used for meta-analysis, and meta-regression analysis was done to evaluate the heterogeneity between the included studies. Meta-analysis was done using the "meta" package of "R" language. The overall quality of evidence was assessed using GRADEpro GDT software.

RESULTS

A total of 24 cross-sectional studies met the inclusion criteria representing 4876 TDIs in 22 839 children aged between 0 and 6 years old. The overall prevalence of TDI in primary teeth was 24.2% (95% CI: 18.24-31.43, P = 0, I²  = 99%). Falls contributed the highest number of TDI - 59.3% (95% CI: 41.05-76.40, P < .01, I²  = 98%) - in primary teeth. The most common type of tooth fracture in primary teeth was an enamel fracture (61.9%), and prevalence of TDI in children with incompetent lip closure was 49.4%.

CONCLUSION

The prevalence of TDI in cross-sectional studies of primary teeth was 24.2% with very low quality of evidence. Falls contributed the highest number of TDI in primary teeth, accounting for 59.3%. Children with incompetent lip closure have the highest prevalence (49.4%) of TDI in primary teeth.

Pediatric Sports- and Recreation-Related Dental Injuries Treated in US Emergency Departments

This study investigated characteristics and trends associated with sports- and recreation-related dental injuries among children <18 years old treated in US emergency departments using data from the National Electronic Injury Surveillance System for 2000 to 2017. There were an estimated 198 787 (95% confidence interval = 162 216-235 358) injuries during the study period, averaging 11 044 injuries annually. The rate of dental injuries per 100 000 US population <18 years old fluctuated during the study, starting at 16.9 in 2000 and ending at 13.9 in 2017. Injuries most commonly occurred among males (69.8%) and children 7 to 12 years old (44.6%). Pediatric sports- and recreation-related dental injuries were most commonly associated with bicycles (28.6%), playground equipment (15.3%), and baseball/softball (12.4%). Although emergency department visits for pediatric sports- and recreation-related dental injuries decreased during the study period overall, sports and recreation remain an important source of preventable dental injury, particularly among children 7 to 12 years old.

Profiles of Trauma in Primary and Permanent Teeth of Children and Adolescents

This retrospective study aimed to evaluate the dental trauma profile in primary and permanent teeth from patients between 0 and 15 years old who attended the Faculty of Dentistry of the Federal University of Rio de Janeiro. Data regarding gender, age, trauma classification, tooth type, and affected tissues were obtained from dental records. The data were analyzed descriptively and by the χ² test (p < 0.05). Data associated with 333 traumatized teeth (70% primary and 30% permanent teeth) were included. The mean ages of children with affected primary and permanent teeth were 3.35 ± 2.02 and 9.09 ± 2.43 years, respectively. Males presented more permanent teeth with trauma (64.4%) than primary ones (55.6%; p = 0.085). The upper central incisors, both primary (68.9%) and permanent (69.4%), were the teeth most commonly affected. Primary teeth showed a higher frequency (p < 0.001) of supportive tissue trauma (73.3%) and lower frequency (p = 0.001) of hard tissue trauma (40.7%) than those in permanent ones (51.5% and 60.6%, respectively). The most frequent trauma in the supportive tissue was subluxation (27.2%) and permanent lateral luxation (42.0%). In the hard tissues, permanent teeth presented a higher prevalence of trauma than primary ones (p = 0.001), however this difference was not statistical significant when each type of fracture injury was evaluated individually (p > 0.005). With affected primary teeth, there was a greater frequency of trauma in the gingival mucosa (31.0%; p = 0.022); in the permanent ones, traumatic lesions in the chin region were the most prevalent (20.8%; p = 0.009). Trauma was recurrent in 26.3% of primary teeth and in 20.2% permanent teeth. Therefore, primary and permanent teeth showed distinct trauma profiles, suggesting that distinct preventive and therapeutic approaches are needed for these two groups.

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.

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.

A 12-Year Retrospective Study of Avulsion Cases in a Public Brazilian Dental Trauma Service

Abstract This study assessed the epidemiological characteristics and management of the permanent teeth avulsion cases attended in a Brazilian dental trauma service from December 2005 to August 2016. A retrospective study was conducted of case records of 93 patients involving 139 avulsed teeth. Data included sex, age, trauma etiology, location of the accident, number and position of avulsed teeth, and presence and type of associated traumatic lesions. Management of the avulsed teeth was addressed as: time elapsed until teeth were retrieved from the accident’s location; teeth’s cleaning method and storage media; time elapsed until seeking treatment and replantation. The majority of the patients were children from 6-10 (31.2%) and 11-15 years old (26.9%). Male patients were more affected than female. Bicycle accident was the main etiological factor (31.2%). In 56 (60.2%) cases, traumatic lesions to neighboring teeth were present. In 55 (59.1%) cases, lesions to adjacent soft tissues were reported. In 82 (88.2%) cases, patients requested treatment at the same day of the accident. Sixty-four teeth (46.0%) were immediately retrieved and 28 (20.1%) were not found. Forty-two teeth (30.2%) were kept dry. Only one tooth (0.7%) was immediately replanted at the accident’s site, while 51 teeth (36.7%) were not replanted. Numerous avulsed teeth were inappropriately managed and immediate replantation was not frequent. Public policies must be created to raise awareness towards the particularities of avulsion cases.

Dental trauma and bicycle safety: a report in Italian children and adolescents

OBJECTIVES

This retrospective study aims to analyze the pattern of oro-facial trauma from bicycle accidents in Italian children and adolescents, focusing on the safety devices used.

METHODS

The medical records of 1405 patients of the Dental Clinic of the University of Brescia, between the age of 0 to 18, who experienced a dento-facial trauma from the use of a bicycle, were analyzed. Data regarding age, gender, weight, height, dominant hand, type of bicycle, use of safety devices, location and type of dental trauma, teeth involved, bone fractures and soft tissue lesions were recorded. Statistical analysis was performed.

RESULTS

The majority of the traumatic events occurred in children within the 8-10 years of age-range; 1085 teeth were injured, of which 975 permanent teeth (89.9%) and 110 primary teeth (10.1%). The most common dental lesions were the coronal fractures (complicated and not complicated) while the most frequently involved teeth were the upper central incisors; 11% of patients were also treated for maxillo-facial fractures. A protective helmet was worn only in 3% of the cases; not one patient wore a mouth-guard. The use of helmets was more frequent in children and adolescents riding racing-bikes competitively, compared to those who were mountain bikers (p < 0.05).

CONCLUSIONS

Bicycle accidents can have serious oro-facial consequences. Therefore, national and regional efforts should be made in Italy to promote head and mouth protection in cycling.

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.

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.