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

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

AIM

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

A two-year retrospective study on traumatic dental injury in the primary dentition

The aim of this study was to analyze the causes, clinical characteristics, social factors, and current status of treatment of traumatic dental injury (TDI) in the primary dentition. A retrospective analysis was performed on 144 children (213 teeth) with TDI in the primary dentition from our hospital between December 2017 and June 2020. Data were analyzed using the chi-square test and the Mann-Withney-Wilcoxon test. Boys accounted for 68.1% (98/144) and girls for 31.9% (46/144) of all 144 children with TDI in the primary dentition, with a boy-girl ratio of 2.13:1. The primary age of TDI in deciduous teeth was 2 to 4 years old, accounting for 59% of all cases. Collision with others and fall were the 2 main causes of trauma to the deciduous teeth, making up 52.1% and 44.4% of all causes, respectively. Crown fracture injury was the most common type of TDI in the primary dentition, accounting for 37% of all cases (53/144). Of the 144 cases, 17.4% (25/144) was accompanied by soft tissue laceration, while 22.2% (32/144) by swelling or contusion of tissue. Maxillary teeth (92.4%) were more vulnerable to injury than mandibular teeth (7.5%), with maxillary incisor being the most vulnerable 1 (91.5%). The percentage of children arrived at the hospital for treatment 24 hours after the injury was the highest (57.0%, 82/144). After the hospital visit, 74.3% of children received treatment for the dental trauma. In terms of the treatment modalities, extraction of the traumatized teeth (27.1%) and pulpectomy + resin filling (or preformed crown) restoration were predominant. Approximately 28.5% (41/144) of cases were reviewed within 2 years, with the proportion of children with pulpitis or periapical infection being the highest (29.3%, 12/41). Age, gender, collision, and fall are the factors linked to a higher risk of TDI in the primary dentition in children under the age of 7. Resin filling (or preformed crown) restoration and pulpectomy are effective in preserving the affected tooth and controlling infection. However, the preservation of the affected tooth and the prevention of infection may be hampered by late visits and low follow-up rates.

Pediatric Dental Emergencies during the COVID-19 Pandemic in Romania: A Retrospective Study

Pediatric dental emergencies can occur as a result of untreated dental caries, or can be caused by trauma or periodontal issues. The lockdown imposed during the COVID-19 pandemic reduced the number of centers authorized to deliver dental services in Romania, with only a small number of dentists delivering dental emergency treatments. The aim of this study was to investigate the demographic characteristics of children and adolescent patients who were treated in the dental emergency department of Oradea, Romania and to compare the patients who were treated in the dental emergency department in the pre-lockdown (2019), lockdown (2020) and post-lockdown year (2021). All patients who were treated in the dental emergency department were included in the study except for adults and medical files that did not contain all relevant information. Several variables were investigated (age, gender, living environment, location of affected teeth, type of emergency). In 2019, 257 children and adolescents were treated, in 2020, 198, and in 2021, 136. Most patients were aged 7-12 years in all investigated years (2019-47.9%; 2020-50.5%; 2021-43.4%), and the most affected teeth were located in the lower posterior arch (2019-53.3%; 2020-53%; 2021-48.5%). The most frequent emergencies were pulpitis (2019-40.5%; 2020-43.9%) and acute apical periodontitis (2021-42.6%). It was observed that in 2019, patients aged between 0 and 6 years were more frequently associated with trauma (p < 0.001), and in 2019 and 2020, patients aged between 7 and 12 years were more frequently associated with periodontal emergencies (p < 0.001). In 2020, patients from rural areas were more frequently associated with pulpitis (p = 0.025), and in 2021, patients from rural areas were more frequently associated with pulpitis or acute apical periodontitis, and patients from urban areas were associated more frequently with periodontal emergencies (p = 0.042). Pediatric patients with ages between 7 and 12 years old, who lived in an urban environment were most affected. Teeth located in the lower and upper posterior dental arches were most affected, and pulpitis or acute apical periodontitis were the most common pathologies.

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.

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

Background

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

Aim

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

Methods

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

Results

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

Conclusion

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

Traumatic Dental Injuries among 12-Year-Old Schoolchildren in the United Arab Emirates

AIMS

This study aimed to evaluate the prevalence of the factors related to traumatic injuries to the permanent incisors of 12-year-old children in the Emirate of Ajman, United Arab Emirates.

METHODS

A sample of 1008 12-year-old children (510 boys and 498 girls) participated in this study. A multi-stage randomized sampling technique was used to select children from public schools for their inclusion in the sample population. An oral examination was completed by a calibrated examiner after receiving training for traumatic dental injury (TDI) to permanent incisor teeth utilizing a modified version of Ellis's classification. Data that were related to sociodemographic factors, TDI causes, and where the TDI took place were recorded using a structured questionnaire.

RESULTS

Of all of the children that were examined, 9.8% of them had experienced dental trauma. The difference in TDI prevalence between boys (15.9%) and girls (3.9%) was statistically significant (p < 0.05). The children whose mothers had low levels of education experienced a higher prevalence of TDI (p = 0.001). The children with incisal overjets that were greater than 5 mm or with inadequate lip coverage tended to have experienced dental injuries (p < 0.01). The main causes of injury to permanent incisors were collision against an object or person (53.5%) and falling (42.4%). Most of the accidents happened at home (58.6%) and school (25.3%). The most prevalent injuries were enamel fractures (58.7%) and enamel-dentine fractures (34.3%).

CONCLUSIONS

This research highlighted many predisposing factors for traumatic dental injuries among children. There is an urgent need to initiate detailed public health policies to decrease the prevalence of dental trauma cases, especially in the identified risk group.

Relationship between oral health literacy of caregivers and the oral health-related quality of life of children: a cross-sectional study

Background

Oral health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate oral health decisions. However, scientific evidence about the oral health literacy of caregivers and the children’s oral health-related quality of life. The purpose of this study was to verify the relationship between the level of oral health literacy of caregivers and the children's oral health-related quality of life (OHRQOL).

Methods

This study was conducted with children aged 2 to 4 in Diadema, São Paulo, Brazil. Six hundred thirty children were examined to assess the prevalence of dental caries (dmft index). Parents were interviewed to obtain sociodemographic status, oral conditions, and oral health literacy (OHL). The variable outcome was the children's OHRQOL as assessed by the Early Childhood Oral Health Impact Scale (ECOHIS). We fitted zero-inflated negative binomial regression (ZINB) models to evaluate associations between the study outcome and covariates in terms of PR (Prevalence Ratios), RR (Rate Ratios), and their respective Confidence Intervals (95% CI).

Results

Children's OHRQOL was not associated with OHL. Dental caries had a negative impact on the children's quality of life (p < 0.05). A reduced impact on OHRQOL is also associated with having siblings (PR = 0.70, 95% CI 0.52–0.95). A higher age of the mother reduced OHRQOL impacts (PR = 0.72, 95% CI 0.52–0.98).

Conclusions

The factors associated with children's OHRQOL were the number of siblings, the mothers' age, and dental caries. This study observed no association between parental OHL and children's OHRQOL.

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.

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.

A 5-year data report of traumatic dental injuries in children and adolescents from a major dental trauma center in Greece

BACKGROUND/AIM

Prevalence and demographic characteristics of traumatic dental injuries (TDI) differ in different countries. The aim of this retrospective study was to assess TDI in primary and permanent teeth among children and adolescents who presented to the Department of Paediatric Dentistry, National and Kapodistrian University of Athens, Greece, during the last 5 years.

MATERIAL AND METHODS

Dental records of 236 new patients who presented with dento-alveolar trauma to the Postgraduate Dental Clinic from 1/1/2014 to 31/12/2019 were reviewed. Data recorded were gender, age, month of the year the injury occurred, type of trauma, and number of traumatized teeth. Injuries were classified as fracture, luxation, or combination injuries. Descriptive statistics, chi-squared (x² ), and Fisher's exact tests were used to evaluate the results. Level of significance was set at 5%.

RESULTS

The age of the patients ranged from 1 to 18 years old, with a mean of 8.63 years (SD: 3.52). There were 395 anterior traumatized teeth and 2 cases with traumatized posterior teeth. Children suffered trauma more often at the ages of 5 years, 7 years, and 11 years. In this cohort, 60% were boys who had a higher chance of having trauma than girls (odds ratio = 1.418 95% CI = 0.724, 2.777). Most TDI occurred in March and May, followed by June and February, and most traumatized teeth were permanent (80%). Maxillary central incisors in both dentitions were injured most often and significantly more compared to lateral incisors (p < 0 .01). The most common type of injury was a fracture in the permanent dentition (60%) and luxation injuries (69%) in the primary dentition.

CONCLUSIONS

Traumatic dental injuries in this cohort occurred mostly in spring, affected boys more than girls, permanent teeth more than primary teeth, maxillary incisors more than mandibular incisors, and central incisors more than lateral incisors, while children aged 5, 7, and 11 years old had the most injuries.

Prevalence and Etiological Factors of Dental Trauma among 12- and 15-Year-Old Schoolchildren of Lebanon: A National Study

Background

Traumatic dental injuries represent nearly 5% of children and adolescents' injuries leading to serious medical and psychological issues. This current study aims to evaluate the prevalence of dental trauma and its potential association with different predisposing factors among 12-and 15-year-old schoolchildren in Lebanon.

Materials and Methods

7902 schoolchildren, 3806 male and 4096 female aged 12 years (n = 3985) and 15 years (n = 3917), were recruited by a stratified multistaged randomized cluster sampling method from public and private schools and were clinically examined in a national cross-sectional study. WHO criteria were used to assess anterior permanent teeth; the nature of trauma, the tooth involved, the size of the incisal overjet, and the type of the lip coverage were furthermore assessed. Data regarding age, sex, and causes of TDI were recorded through a structured questionnaire.

Results

The prevalence of dental trauma to anterior teeth was 10.9%. Maxillary central incisors (83.7%) were commonly affected. The most common type of injury was enamel fracture (68.3%), falls being the main reason (52.5%). Increased overjet (OR = 2.32, p = 0.034), deficient lip coverage (OR = 5.73, p = 0.019), and gender (OR = 5.36, p ≤ 0.001) were significant predisposing factors for dental trauma.

Conclusion

This research highlighted many predisposing factors for dental trauma that affect commonly the anterior teeth. Based on these results, the implementation of strategic preventive measurements targeting especially the identified risk groups remains crucial.

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.

A 3-Year retrospective study of traumatic dental Injuries to the primary dentition

BACKGROUND/AIMS

Traumatic dental injuries (TDIs) in the primary dentition are a significant public health problem, which has been neglected worldwide. Despite its high prevalence, limited studies address this injury. The aim of this study was to determine the characteristics and treatment modalities of TDIs affecting primary teeth, along with accompanying medical co-morbidities and attendance at follow-up appointments.

MATERIAL AND METHODS

This retrospective analysis included all TDIs affecting primary teeth from January 2014 to January 2017. Data abstraction included demographics, time lapse prior to arrival at hospital, trauma etiology, classification of TDIs, soft tissue and supporting bone injuries, medical co-morbidities, emergency treatment, follow-up appointments and prognosis.

RESULTS

Records of 283 children with 536 traumatized primary teeth were reviewed. The median age was 2 years and the maxillary right central incisor (35.1%) was the most frequently injured tooth. Almost half the patients, 46.3%, sought treatment after 24 h. Periodontal tissue injuries (97.2%) predominated TDIs for which fall accidents (82.0%) were the most encountered cause. Most patients (177/283) had accompanying soft tissue/supporting bone injuries and 67.2% had multiple traumatized teeth. Seventy percent of the patients were examined only or were prescribed medication. Survival time following TDIs was unknown in 67.7% of traumatized teeth due to non-attendance at follow-up appointments. Most patients (55.1%) did not attend the follow-up appointments.

CONCLUSIONS

TDIs occurred in the primary dentition with the predominance of periodontal tissue injuries. When TDI was the presenting problem to hospital, accompanying systemic injury was rare. Treatment modalities were mostly limited to examination or extraction. The follow-up appointments were poorly attended.

Profiles of traumatic dental injuries among children aged 0-15 years in Cappadocia, Turkey: A retrospective cohort study

BACKGROUND/AIM

Traumatic dental injuries are among the most serious dental public health problems in children. The aim of this retrospective study was to evaluate the dental trauma profile of primary and permanent teeth among children aged 0-15 years who presented to a university hospital.

MATERIAL AND METHODS

The study included 650 patients (1,000 primary and permanent teeth) who presented with a history of dental trauma to the Department of Pediatric Dentistry, Faculty of Dentistry, Erciyes University between 2016 and 2019. Traumatized teeth were assessed according to the Andreasen classification. The following information was recorded: age, gender, teeth affected by trauma, etiologies of trauma, place and season of trauma, type of trauma, type of treatment, and time between the trauma and treatment.

RESULTS

In total, 650 patients (240 females, 410 males) and 1,000 incisors (212 primary teeth, 788 permanent teeth) were evaluated. The average age of the patients was 8.89 ± 3.41 years, and dental injuries were more frequent between 8 and 10 years of age. The maxillary central incisors, both primary (40.1%) and permanent (42.8%), were the most frequently affected teeth. The main cause of traumatic dental injuries was falls. Most accidents occurred at school and home. The most common type of dental injuries recorded was luxation injuries in the primary teeth (21.5%) and enamel-dentin fractures (35.9%) in the permanent teeth. Only 48 teeth were treated during the first hour after injury.

CONCLUSIONS

The most common type of traumatic injury affecting permanent teeth was enamel-dentin fractures, and primary teeth were luxation injury. Only 4.8% of teeth were treated within the first hour after trauma.

Inclusion of initial caries lesions in a population-based sample of Brazilian preschool children: Impact on estimates and treatment needs

This study aimed to assess changes in epidemiological estimates and treatment needed when initial caries lesions are included in a population-based survey of preschool children. A cross-sectional survey was conducted in a Brazilian municipality, collecting data of preschool children in 16 health centers. Caries detection used the merged codes (epi-codes) for ICDAS/ICCMS. An option for treatment, according to ICCMS, was chosen during the examination. Caries experience (dmft/dmfs) and prevalence were estimated considering three thresholds (A- initial, moderate, and severe lesions, B- only moderate and severe lesions and C- severe lesions). Incremental need for non-operative care was also verified. The sample consisted of 663 children aged 2–4 years (response rate of 99.85%). Including initial lesions, a 2-fold increase in dmft was observed (A: 3.36, B: 1.02, p<0.001). With the inclusion, the caries prevalence increased to 75% compared to threshold B only (28%). The majority (76%) of children who required any intervention (56%) should be scheduled for non-operative care. We suggest that including initial caries lesions in an epidemiological survey may significantly impact assessment of population caries experience.

Risk factors and patterns of traumatic dental injuries among Indian adolescents

Background/purpose

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

Materials and methods

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

Results

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

Conclusion

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

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.

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.

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.

IMPACT OF DENTAL TRAUMA AND ESTHETIC IMPAIRMENT ON THE QUALITY OF LIFE OF PRESCHOOL CHILDREN

OBJECTIVE

To evaluate the impact of dental trauma and impaired esthetics on the quality of life (QoL) of preschool children and their relatives.

METHODS

Study conducted with 192 children aged 2 to 5 years in 11 preschools in Florianópolis, Santa Catarina, South of Brazil. Parents/caregivers completed a questionnaire on quality of life (Brazilian version of the Early Childhood Oral Health Impact Scales - B-ECOHIS), a socioeconomic survey, and then answered specific questions related to dental trauma. The subjects were examined by three accordant examiners (Kappa>0.7). Dental trauma was evaluated on the basis of indexes adopted by the World Health Organization, and esthetic impairment was then classified. Data were descriptively analyzed and put to bivariate analysis by chi-square and Fisher tests, with significance level at 5%.

RESULTS

The prevalence of dental trauma was 62.5% with 15.6% of esthetic impairment. Almost 12% of parents reported impact on the quality of life of their children. Dental trauma was not significantly associated with gender, age or QoL. Crown color change by trauma was associated with esthetic impairment. Also esthetic impairment had a negative impact on QoL (p<0.05) and was associated with oral limitations (p<0.05).

CONCLUSIONS

Esthetic impairment had a negative impact on children's quality of life, while dental trauma was not associated to it.

Delayed Treatment of Traumatized Primary Teeth with Distinct Pulp Response: Follow-Up until Permanent Successors Eruption

Complicated crown fracture and crown-root fracture with pulp involvement expose dental pulp to the oral environment. The pulp outcome is often unpredictable because the patient and injury which are related to variables can influence the treatment of choice and the prognosis of the case. This report presents the case of a 4-year-old boy with complicated crown fracture with pulp polyp in the primary right maxillary central incisor (51) and crown-root fracture with pulp involvement in the primary left maxillary central incisor (61), which was treated only 3 months after the tooth injuries. The treatment of choice was extraction of tooth (61) due to a periapical lesion with disruption of the dental follicle of the permanent successor and pulpotomy (MTA) of the tooth (51), because the pulp presented signs of vitality. At the follow-up visits, no clinical, symptomalogical, and radiographic changes were observed until the primary tooth's exfoliation. However, at 3-year follow-up, the permanent successors showed hypocalcification and the position of the permanent right maxillary central incisors (11) was altered. Besides the conservative and adequate delayed treatment, the sequelae on the permanent successors could not be avoided.

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.