Impact of crown fracture treatment on oral health-related quality of life of children, adolescents, and their families: A prospective clinical study

Hospital usage for oral and dental conditions in Hawaii: A cross-sectional study using the 2021 Hawaii statewide hospital data

OBJECTIVE

To investigate the frequency of emergency department (ED) usage primarily for oral/dental conditions in Hawaii and to examine social-demographic factors associated with the identified ED visits.

METHODS

This was a cross-sectional study of the 2021 Hawaii Statewide Hospital data. We identified records indicating ED usage and a primary diagnosis of non-traumatic dental conditions (NTDC) and other oral dental conditions (OODC). Descriptive analyses of ED visits for NTDC and OODC were performed to identify vulnerable individuals based on age, sex, race/ethnicity, primary source of payment, county of residence, and total charges per hospital record. A multivariable negative binomial regression model included age, sex, and county of residence was used to obtain adjusted rate ratios (aRR) and 95% confidence intervals (CI) of ED visits for NTDC.

RESULTS

Among hospital records with diagnoses for oral or dental conditions (n = 12,336), 97% indicated ED, of which half had an NTDC diagnosis, and the remaining half had an OODC diagnosis. Distinct differences in the characteristics of ED visits were observed between NTDC and OODC. The median total charges per record indicating ED for NTDC and OODC were $1439 and $2439, respectively. A higher rate of ED visits for NTDC was found for those aged 21-44 (aRR [95%CI] = 3.02 [2.41, 3.80], reference: 0-9 years) and those living in a less populous county (Hawaii: 1.73 [1.43, 2.07]; Kauai: 1.78 [1.45, 2.19], reference: Honolulu).

CONCLUSIONS

Continued effort to improve dental health is required to reduce ED visits for oral and dental conditions among Hawaii residents, especially for vulnerable individuals.

Agreement between schoolchildren and their parents on rating the child's oral health-related quality of life

The perceptions of parents/caregivers regarding their children's oral health can influence the standard of care and decision-making regarding oral health. The children's perspective on their own oral health-related quality of life (OHRQoL) may differ from the parents/caregivers' views. This cross-sectional study aimed to analyze the agreement between the perceptions of parents/caregivers and schoolchildren regarding OHRQoL. It was conducted with a sample of children between 8 and 11 years old and their parents/caregivers from Pelotas. Children answered the Child Perceptions Questionnaire 8-10 (CPQ), and parents/caregivers answered the short form of the Parental-Caregiver Perceptions Questionnaire (P-CPQ). Socioeconomic data were also collected. Children's dental caries, traumatic dental injuries, and malocclusions were examined. The Spearman's correlation test was performed. A total of 119 parents/caregivers-children pairs were included. There was an agreement between the total scores of parents/caregivers and children (0.2770; p = 0.003), in the oral symptoms (0.1907; p = 0.038), and functional limitations (0.2233; p=0.015) domains. The Bland-Altman graph showed an agreement between children's and parents/caregivers' OHRQoL total score, but there was an underestimation of approximately two points in the parents/caregivers' perception compared to the children's score. There was an agreement between the reports of parents/caregivers and children regarding children's OHRQoL.

Dental patient-reported outcomes following traumatic dental injuries and treatment: A narrative review

Dental patient-reported outcomes (dPROs) are self-reported descriptions of a patient's oral health status that are not modified or interpreted by a healthcare professional. Dental patient-reported outcome measures (dPROMs) are objective or subjective measurements used to assess dPROs. In oral healthcare settings, the emphasis on assessing treatment outcomes from the patient's perspective has increased and this is particularly important after traumatic dental injuries (TDIs), as this group of injuries represent the fifth most prevalent disease or condition worldwide. The purpose of this review is to summarize the current use of dPROs and dPROMs in the field of dental traumatology. Oral Health-Related Quality of Life, pain, swelling, aesthetics, function, adverse effects, patient satisfaction, number of clinical visits and trauma-related dental anxiety are the key dPROs following TDIs. Clinicians and researchers should consider the well-being of patients as their top priority and conduct routine evaluations of dPROs using measures that are appropriate, accurate and reflect what is important to the patient. After a TDI, dPROs can assist clinicians and patients to choose the best management option(s) for each individual patient and potentially improve the methodology, design and relevance of clinical studies.

Crown Fracture of an Unerupted Incisor in a Young Child: Case Report and Restorative Protocol

Aim

This case report describes a protocol for restoring a crown fracture of an unerupted permanent incisor in a child.

Background

Crown fractures are an important concern in pediatric dentistry due to the negative impact on oral health-related quality of life (OHRQoL) in children and adolescents resulting from functional limitations as well as consequences related to social and emotional well-being.

Case description

An enamel and dentin fracture of the crown of unerupted tooth 11 due to direct trauma is being presented in a 7-year-old girl. The restorative treatment involved minimally invasive dentistry, including computer-aided design (CAD)/computer-aided manufacturing (CAM) technology and direct resin restoration.

Conclusion

The treatment decision was essential for maintaining pulp vitality and continued root development, as well as ensuring esthetic and functional results.

Clinical significance

Crown fracture of an unerupted incisor may occur in childhood, requiring a long-term clinical and radiographic follow-up. Predictable, positive, and reliable esthetic outcomes can be achieved using CAD/CAM technology combined with adhesive protocols.

How to cite this article

Kamanski D, Tavares JG, Weber JBB, et al. Crown Fracture of an Unerupted Incisor in a Young Child: Case Report and Restorative Protocol. Int J Clin Pediatr Dent 2022;15(5):636-641.

The role of dental pain and psychosocial factors on the relationship between dental caries and oral health-related quality of life in children

Background

To examine the role of dental pain, sense of coherence (SOC) and social support on the relationship between dental caries and oral health-related quality of life (OHRQoL) in children aged 12 years.

Methods

A cross-sectional study involving 400 schoolchildren selected from public schools in a socioeconomically disadvantaged region in the city of Manaus, Brazil was carried out. The predictors of OHRQoL were selected according to the Wilson and Cleary theoretical model, including number of decayed teeth and its clinical consequence (component D of the DMFT index and PUFA/pufa index), dental pain (symptom status), and SOC and social support (individual and environmental characteristics). Statistical analysis was conducted through structural equation modelling and multivariable negative binomial regression. The significance level established for all analyses was 5%.

Results

Number of dental caries was indirectly linked with OHRQoL (β = 0.19, 95% CI 0.11/0.29) through dental pain, SOC and social support. Clinical consequences of untreated caries directly predicted poor OHRQoL (β = 0.12, 95% CI 0.01/0.23). Dental pain, SOC and social support did not moderate the effect of dental caries measures on OHRQoL.

Conclusion

Our findings suggest the role of dental pain, SOC and social support as mediator factors on the link between dental caries and OHRQoL. Tackling dental caries along with psychosocial factors may attenuated the impact of oral health on OHRQoL in children.

Oral Health-Related Quality of Life in Children and Adolescents with a Traumatic Injury of Permanent Teeth and the Impact on Their Families: A Systematic Review

The aim of this systematic review was to evaluate the impact of a traumatic dental injury (TDI) of permanent teeth in children and adolescents on their oral health-related quality of life (OHRQoL) as well as on their families. A bibliographic search in the biomedical databases (PubMed, Cochrane Library, MEDLINE) was limited to studies published between January 2000 and February 2021. The study selection criteria were cross-sectional, case control, or prospective clinical studies, which analyzed TDI before and after the treatment of permanent teeth in healthy children and adolescent, assessed their OHRQoL, and were written in English. The search found 25 eligible articles that were included in the study. The quality assessment of the studies was performed using the quality assessment checklist for survey studies in psychology (Q-SSP). The results indicated that a TDI of permanent teeth strongly influences the OHRQoL of children and adolescents, and the timely-performed dental management of a TDI allows for preventing further biological and socio-psychological impacts. Sociodemographic status, economic status, parent’s education, gender, age group, and type of schooling were determinants of the TDI impact on OHRQoL.

Root Fracture and Extrusive Luxation in Primary Teeth and Their Management: A Case Report

Background: Extrusion, lateral luxation, and intrusion are among the most serious types of dental trauma. Only a few studies have specifically focused on extrusion; the present one was aimed at reporting a case of domestic traumatic dental injury to primary tooth and describing the measures taken in managing the trauma in order to avoid future consequences to the underlying permanent tooth germ. Case report: A 3.5-year-old boy reported a dental injury with extrusion and root fracture of deciduous tooth 5.1. After intraoral and radiographic evaluation, the element was repositioned and stabilized by an orthodontic flexible splint attached to the adjacent teeth. Several follow-up checkups were made and showed good healing of the tissues and physiological exfoliation of the tooth, with a healthy and unaffected corresponding central permanent incisor. Conclusion: This case report strengthens the importance of well-timed diagnosis and treatment and of regular follow-up of traumatized teeth as they may affect both dentitions with a negative impact on Oral Health-Related Quality of Life. Conservative treatment should be taken into consideration when possible, being in some cases more appropriate.

Impact of traumatic dental injury treatment on the Oral Health-Related Quality of Life of children, adolescents, and their family: Systematic review and meta-analysis

BACKGROUND/AIM

Measures of oral health-related quality of life (OHRQoL) are useful in clinical trials to evaluate treatment outcomes. To detect the treatment impact of traumatic dental injuries (TDI) on OHRQoL is extremely relevant. The aim of this study was to assess whether there is scientific evidence of the impact of TDI treatment on OHRQoL of children, adolescents, and their families.

MATERIAL AND METHODS

A systematic review and meta-analysis were conducted selecting articles from PubMed, Web of Science, Scopus, Cochrane Library, and Virtual Health Library until May 22nd, 2020. The gray literature, clinical trial registers, and a manual search were performed. Two independent reviewers selected the studies, extracted the data, and assessed the ROBINS-I risk of bias. A meta-analysis was performed using RevMan 5.4 program. The certainty of the evidence was evaluated using the GRADE system.

RESULTS

In the electronic search, 413 abstracts and one registered study were found. After removing the duplicates and eligibility application, six studies were included. Individually, the studies presented low to moderate risk of bias and they found that TDI treatment reduces the negative impact on OHRQoL. In the meta-analysis, TDI treatment improved OHRQoL for 8- to 10-year-old children (p = .03; CI 5.19 [0.62, 9.75]) (detected by CPQ 8-10 questionnaire). In the perception of parents, the children, and adolescents who had suffered TDI also had their OHRQoL improved (p = .04; CI 14.77 [0.95, 28.60]) (detected by PPQ and P-CPQ questionnaire) but both evaluations had very low certainty of evidence.

CONCLUSION

Treatment of traumatic dental injuries reduces the impact on the OHRQoL of children and adolescents. However, more studies are necessary to detect the TDI treatment influence on OHRQoL of preschoolers and in the family as well to estimate the effects due to outcomes that had a very low certainty of evidence (#CRD42018091210).

Injury Prevention, Safety Education and Violence in Relation to the Risk of Tooth Fracture among Korean Adolescents

This study aimed to determine the injury prevention-, safety education-, and violence-related factors pertaining to tooth fracture experience (TFE) in Korean adolescents. We used data from the 14th Korea Youth Risk Behavior Survey (KYRBS) in 2018. The 60,040 participants were selected using a complex sampling design from middle and high schools. The participants completed a self-administered questionnaire. The explanatory variables, including school safety education and violence, were assessed in relation to prevention of traumatic injuries. Complex-samples multivariable logistic regression models were applied to explain the factors related to TFE over the past 12 months. The overall prevalence of TFE was 11.4%. Risk factors related to tooth fractures were not wearing a seatbelt on an express bus, not wearing helmets while riding motorcycles and bicycles, clinical treatment due to injuries at school, injuries associated with earphone/smartphones use, and lack of school safety education such as danger evacuation training. The top risk factor was injuries associated with earphone/smartphone usage, followed by lack of familiarity with school safety education. Thus, to prevent tooth fractures among adolescents, schools should strengthen their safety education, including education regarding mobile device usage, and wearing a seatbelt and wearing a helmet. Care should be taken to manage facilities around the school and to prevent injury related to tooth fracture. Further studies on various risk factors related to tooth fractures are warranted.

Associations and risk factors for dental trauma: A systematic review of systematic reviews

OBJECTIVE

We sought to revise, qualify and summarize the body of evidence based on current information on the known associations and risk factors for traumatic dental injury (TDI) occurrence with an overview of systematic reviews.

METHODS

Electronic searches were performed with no language nor date restrictions.According to the PECO strategy, systematic reviews that investigated participants (P) with (E) and without (O) the presentation of factors relating to TDI and these factors' association with TDI episodes (O) as primary or secondary outcomes were included. Quality assessment and bias control were carried out according to the AMSTAR 2 checklist. In cases of systematic review results of discordance, the Jadad decision algorithm was applied.

RESULTS

After titles, abstracts and full texts were read, 19 systematic reviews were included in this overview. Four were classified with critically low, eleven with low and four with moderate methodological quality, respectively. In all studies, 249 cross-sectional, 34 epidemiological surveys, 22 cohort, 9 case-control, 4 longitudinal, 3 ecological and 30 unspecified studies were included. Male gender, child age, greater overjet, inadequate lip coverage, anterior open bite, caries in the permanent dentition, overweight, a previous history of TDI, tongue piercing, the use of alcoholic beverages and participation in sports were all associated with a greater chance of suffering TDI.

CONCLUSIONS

Sociodemographic, clinical and environmental factors are associated with a greater chance of TDI occurrence. However, most of the systematic reviews included were of a low quality and may not provide an accurate and comprehensive summary of the available research that addresses the question of interest. Well-designed primary studies on different aspects of TDI are encouraged to provide higher quality scientific evidence.

The effect of enamel fractures on oral health-related quality of life in adolescents

BACKGROUND/AIM

Enamel fractures are the most common type of traumatic dental injury (TDI) in children and adolescents. Recognizing the impact of these fractures on oral health-related quality of life (OHRQoL) could contribute to the establishment of treatment protocols. The aim of this study was to assess and quantify the impact of enamel fractures on overall OHRQoL and domain scores in adolescents.

MATERIALS AND METHODS

A cross-sectional study was conducted with 775 adolescents aged 11 to 14 years in the city of Santo Ângelo in southern Brazil. Sociodemographic variables were collected from parents/caregivers using a structured questionnaire. The adolescents answered the Child Perceptions Questionnaire (CPQ_11-14 ). Physical examinations were performed by an examiner who had undergone training and calibration exercises for the investigation of TDI (Andreasen criteria), dental caries (WHO criteria), and malocclusion (Dental Aesthetic Index). Data analysis involved Poisson regression with robust variance.

RESULTS

The prevalence of TDI was 11.9% and enamel fractures accounted for 79.3% of all injuries. In the multivariate analysis, adolescents with enamel fractures had 29% higher CPQ_11-14 scores (worse OHRQoL) than those without TDI, even after adjustment for sociodemographic and clinical variables (mean ratio = 1.29; 95% CI: 1.09-1.53; P = .003). Enamel fractures exerted a negative impact on the functional limitation, emotional well-being, and social well-being domains.

CONCLUSIONS

Enamel fractures exert a negative impact on the OHRQoL of adolescents, suggesting that subjective measures should be incorporated in the evaluation of patients with this traumatic injury.