Development of clinical and radiographic signs associated with dark discolored primary incisors following traumatic injuries: a prospective controlled study

Experts consensus on management of tooth luxation and avulsion

Traumatic dental injuries (TDIs) of teeth occur frequently in children and adolescents. TDIs that impact the periodontal tissues and alveolar tissue can be classified into concussion, subluxation, extrusive luxation, intrusive luxation, lateral luxation, and avulsion. In these TDIs, management of injured soft tissue, mainly periodontal ligament, and dental pulp, is crucial in maintaining the function and longevity of the injured teeth. Factors that need to be considered for management in laxation injuries include the maturation stage of the traumatic teeth, mobility, direction of displacement, distance of displacement, and whether there are alveolar fractures. In avulsion, the maturation stage of the permanent tooth, the out-socket time, storage media/condition of the avulsed tooth, and management of the PDL should also be considered. Especially, in this review, we have subdivided the immature tooth into the adolescent tooth (Nolla stage 9) and the very young tooth (Nolla stage 8 and below). This consensus paper aimed to discuss the impacts of those factors on the trauma management and prognosis of TDI to provide a streamlined guide for clinicians from clinical evaluation, diagnostic process, management plan decision, follow-up, and orthodontic treatment for tooth luxation and avulsion injuries.

The risk of healing complications in primary teeth with root fractures: A retrospective cohort study

BACKGROUND/AIM

Primary teeth are frequently affected by traumatic dental injuries. Root fractures are rare and have a reported incidence of 2% in the primary dentition. Hence, there is limited evidence on this topic. This study aims to evaluate the risk of healing complications in primary teeth with root fracture and to identify possible sequelae in the permanent dentition following root fracture in the primary dentition.

MATERIALS AND METHODS

A retrospective analysis of a cohort of 53 patients with 74 root fractured primary teeth. The standard follow-up program included clinical and radiographic examination after 4 weeks, 8 weeks, 6 months, and 1 year after the trauma and when the patient was 6 years of age. The following complications were registered: pulp necrosis (PN), pulp canal obliteration (PCO), ankylosis with replacement root resorption (ARR), infection-related root resorption (IRR), premature tooth loss (PTL), and repair-related resorption (RRR).

STATISTICS

The Kaplan-Meier and Aalen-Johansen estimators were employed. The level of significance was 5%.

RESULTS

A total of 74 teeth were included. 42 teeth were extracted at the initial examination. Risks estimated after 3 years: PTL 45.9% [95% CI: 28.8-63.0], PCO 12.9% [95% CI: 2.3-23.4], PN 14.9% [95% CI: 3.9-25.9], RRR 2.6% [95% CI: 0.0-7.5]. No teeth showed ARR or IRR. All complications were diagnosed within the first year. Most common sequelae in the permanent dentition was demarcated opacities, with an estimated risk of 20% [95% CI: 8.2-41.3].

CONCLUSIONS

There is a low risk of healing complications following a root fracture in the primary dentition. Root fractures often result in early extraction of the coronal fragment. The remaining apical fragment will undergo a physiological resorption. Aside from opacities, there is a low risk of sequelae in the permanent dentition.

Evaluation of primary teeth affected by dental trauma in patients visiting a university clinic, part 2: dental injury types, treatment strategies, and complications

OBJECTIVES

This article focuses on treatments and complications in patients presenting dental trauma in primary teeth. Treatment alternatives begin with the decision of performing a procedure under clinical settings or pharmacological techniques (PC) in young children. Correct diagnosis and treatment are crucial to maximize the chances of a favorable outcome.

MATERIALS AND METHODS

The files of 320 patients aged 0-9 years who presented to the Erciyes University Faculty of Dentistry Department for dental trauma management in primary teeth were evaluated in between 2018 and 2021 for 3-year period. The following information were extracted from patients' records: injury type, affected teeth, caries condition of the teeth, treatment preferences of the dentists. Additionally postoperative complications and their management were evaluated.

RESULTS

While 63.1% of the traumatized teeth were caries-free, 35.8% of the teeth had caries. The most frequent dental injuries was simple crown fractures (42.9%), followed by complicated crown fractures (38.5%). Treatments were mostly done in clinical conditions (67.9%) and mostly patients attend regularly to follow-up visits (85.6%). Clinicians prefer more radical treatments under sedation or GA (92.4% extraction of injured tooth). Coronal discoloration was the most common complication, and 35.3% had pulp necrosis for longer term results.

CONCLUSION

Follow-up decisions made after concussion in the primary teeth might be appropriate for the patient. Examination of the complication status of primary teeth with simple crown fracture injury revealed that 59.5% of patients did not have any complications. Follow-up decisions were found to be appropriate for crowns with coloration alone.

CLINICAL RELEVANCE

All options should be considered to provide the best care for children after primary tooth trauma; this can be achieved by being informed about the treatment and its consequences, and if necessary, a positive prognosis can be achieved with an interdisciplinary approach.

Prevalence of sequelae after traumatic dental injuries to anterior primary teeth: A systematic review and meta-analysis

BACKGROUND/AIM

Clinical and radiographic sequelae are common following traumatic dental injuries to primary teeth. The aim of this systematic review was to assess the prevalence of such sequelae.

MATERIALS AND METHODS

Searches were conducted in the PubMed, Scopus, Embase, Web of Science, and BBO/LILACS databases as well as the gray literature. The outcome of interest was the prevalence of the most common sequelae following traumatic dental injuries to anterior primary teeth. Observational studies that evaluated such sequelae were included. Data were extracted, and methodological quality was appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. The number of sequelae per tooth and the total number of teeth evaluated in each study were considered to calculate pooled prevalence rates with 95% confidence intervals (CI). The quality of the evidence was determined using the GRADE approach.

RESULTS

Twenty-five articles were included in this systematic review and meta-analysis. The prevalence of each complication in descending order was as follows: 39.7% crown discoloration (95% CI: 29.52-50.32), 24.3% pulp necrosis with infection (95% CI: 17.34-32.06), 16.2% periapical radiolucency (95% CI: 8.88-25.49), 15.9% premature tooth loss (95% CI: 9.93-23.15), 14.8% pulp canal obliteration (95% CI: 8.46-22.73), 11.9% pathological root resorption (95% CI: 7.68-16.98), 7.1% abscess/fistula (95% CI: 4.4-10.6), and 1.8% ankylosis (95% CI: 0.82-3.17). The certainty of the evidence was very low.

CONCLUSIONS

Crown discoloration was the most common sequela in injured primary teeth, but this should be interpreted with caution due to the very low certainty of the evidence. Considerable variation was found in the prevalence of each sequela.

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.

Pulp Aspects of Traumatic Dental Injuries in Primary Incisors: Dark Coronal Discoloration

Dark coronal discoloration is a common outcome of traumatic dental injuries in primary incisors. However, there are only a few research studies on the mechanism that causes dark discoloration, the condition of the pulp, and the preferred treatment of such teeth. This article is a summary of the author's research studies and personal experience regarding dark coronal discoloration of traumatized primary incisors.

Pulp aspects of traumatic dental injuries in primary incisors: Dark coronal discoloration

Dark coronal discoloration is a common outcome of traumatic dental injuries in primary incisors. However, there are only a few research studies on the mechanism that causes dark discoloration, the condition of the pulp, and the preferred treatment of such teeth. This article is a summary of the author's research studies and personal experience regarding dark coronal discoloration of traumatized primary incisors.

Pulp necrosis and crown discoloration: a systematic review and meta-analysis

BACKGROUND

The association between pulp necrosis and crown discoloration in traumatized primary teeth has not been clearly determined yet.

AIM

The study verified whether there is an association of pulp necrosis and crown discoloration in traumatized primary teeth through a systematic review and meta-analysis.

METHODS

A systematic literature search was conducted in PubMed/Medline, Lilacs/BBO, Scopus, Web of Science, Cochrane Library databases, and grey literature. A methodological quality assessment appraisal was independently conducted by two researchers. Random-effects models were employed, and heterogeneity was tested (I2 index/P ≤ 0.05).

RESULTS

Eight studies with low risk of bias were included in the analysis. A total of 1,494 traumatized primary teeth participated in the pooled meta-analysis. Diagnosis of pulp necrosis was evaluated in 1,414 teeth through clinical and/or radiographic analyses, and the analysis demonstrated a positive association (P = 0.0005/OR 8.37 [2.51, 27.90], I2  = 87%). Eighty teeth were diagnosed with pulp necrosis through endodontic access, and there was no statistically significant association (P = 0.36/OR 2.46 [0.36, 16.94], I2  = 54%). The pooled meta-analysis showed a positive association (P = 0.0003/OR 5.93 [2.24, 15.72], I2  = 83%).

CONCLUSION

The positive association between pulp necrosis and crown discoloration should be considered with caution once the diagnosis of pulp necrosis was performed by limited criteria.

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

Autotransplantation of a Strange Positioned Impacted Central Incisor in a surgically Prepared Socket: A Miracle Esthetic Concept

Esthetics is a prime concern for a young lady. Any anomaly in the anterior tooth may create anxiety and depression. This anxiety and depression may hamper her married life and overall personality. This case report reveals an unerupted right central incisor situated in a strange position, creating space in the maxillary anterior region and giving an unesthetic appearance. Autotransplantation is a method of choice for a strangely positioned impacted central incisor in a new appropriate site. This method offers a new treatment option for some clinical situations if orthodontic approach is not possible. It permits tooth movement to a distant or the opposite side of the same dental arch as well as to the opposite jaw. This procedure also offers potential benefits of reestablishment of normal alveolar process development, esthetics, functions, and arch integrity. This procedure has the potential to become a viable alternative treatment plan for young patients of low socioeconomic status, allowing the reestablish-ment and restoration of a missing tooth and their functions. This article discusses methods of auto-reimplantation of a tooth in a fresh surgically prepared socket, its biological principle, and establishment of functions, esthetics, and phonetics.

Management and Sequelae of Intruded Anterior Primary Teeth: A Systematic Review

Objective

The objective of this systematic review is to analyze the various treatment modalities and sequelae of intruded anterior primary teeth.

Materials and methods

Electronic search in PubMed, Cochrane, and Science Direct databases was done. Hand search was performed using the reference list of chosen articles from electronic search. Three reviewers analyzed the articles independently, assessed the quality of the studies, and derived data.

Results

Ten case series were identified from the electronic and hand search. No randomized control studies were available. In the observational studies treatment of intruded primary teeth ranged from conservative management, which includes waiting for spontaneous re-eruption as well as repositioning to invasive procedure, such as extraction.

Conclusion

Spontaneous eruption is a treatment option of intruded primary teeth in absence of damage to a permanent tooth. Surgical repositioning of intruded primary teeth has also shown as a viable alternative treatment modality. Extraction to be performed if complications develop.

How to cite this article

Gurunathan D, Murugan M, Somasundaram S. Management and Sequelae of Intruded Anterior Primary Teeth: A Systematic Review. Int J Clin Pediatr Dent 2016;9(3):240-250.

Prevalence of Early Childhood Caries in Children of West Godavari District, Andhra Pradesh, South India: An Epidemiological Study

Aim

To determine the prevalence of early childhood caries (ECC) and its risk factors in children of West Godavari district, Andhra Pradesh.

Study design

A sample of 1,897 children between 24 and 71 months of age based on stratified cluster random sampling were clinically examined for dental caries using mouth mirror under day light. The parents/caregivers of each child were interviewed with a structured questionnaire. Data was analyzed using independent sample Student’s t-test and chi-square test.

Results

Out of the total 1,897 children, 796 were affected with ECC showing an overall prevalence of 41.9%, with boys showing a higher prevalence rate of 44.8% compared to girls (39.9%). Statistically significant correlations were found between ECC and consumption of sugary snacks (p < 0.0001) and mouth rinsing habit (p < 0.001).

Conclusion

A higher prevalence of ECC was observed and most of the teeth were not restored.

How to cite this article

Koya S, Ravichandra KS, Arunkumar VA, Sahana S, Pushpalatha HM. Prevalence of Early Childhood Caries in Children of West Godavari District, Andhra Pradesh, South India: An Epidemiological Study. Int J Clin Pediatr Dent 2016;9(3):251-255.

Gorlin-Goltz Syndrome: A Rare Case Report of a 11-Year-Old Child

Gorlin-Goltz Syndrome, also known as nevoid basal cell carcinoma syndrome (NBCCS), is an autosomal dominant trait caused due to mutations in the patched tumor suppressor gene (PTCH) gene found on the long arm of chromosome 9. The syndrome is characterized by the presence of odontogenic keratocysts (OKCs), basal cell carcinomas, and skeletal malformations. Early diagnosis of the syndrome can be done by pedodontist as OKC is one of the early manifestations of the syndrome. Early diagnosis and treatment is important for long-term prognosis of the syndrome by reducing the severity of cutaneous carcinomas and deformities due to jaw cyst. The present case describes an 11-year-old patient with some typical features of NBCCS, which were diagnosed through its oral and maxillofacial manifestations. This case emphasizes the importance of pedodontist in early recognition of the syndrome.

HOW TO CITE THIS ARTICLE

Tandon S, Chauhan Y, Sharma M, Jain M. Gorlin-Goltz Syndrome: A Rare Case Report of a 11-Year-Old Child. Int J Clin Pediatr Dent 2016;9(3):264-268.

Prevalence of Dental Fluorosis and associated Risk Factors in Bagalkot District, Karnataka, India

INTRODUCTION

An earlier epidemiological study by these authors revealed fluorosis at very low levels of fluoride concentrations in drinking water.

AIM

The objective of present study was to investigate risk factors of dental fluorosis in permanent teeth in the villages of northern Karnataka, India.

MATERIALS AND METHODS

The present survey was carried out in three villages of Hungund Taluk, Bagalkot District, Karnataka, India, with the fluoride concentration of 0.136, 0.381, and 1.36 ppm. Children aged between 9 and 15, with permanent teeth, were examined for dental fluorosis using Dean's index, as per WHO criteria. Required relevant information regarding risk factors was obtained through a questionnaire.

STATISTICAL ANALYSIS

Data entry and analysis were performed using SPSS for Windows 16.0. Comparison of means of different indices by the three groups was performed using ANOVA and t-test (p < 0.05). Bivariate analysis was performed to identify significant risk factors that affected prevalence and severity of dental fluorosis. Those variables showing a statistically significant association (p < 0.05) on χ2 were entered into multiple logistic regressions to assess their independent effects.

RESULTS

In this study, we analyzed risk factors for both prevalence and severity of fluorosis. From multiple logistic regression analysis, only fluoride concentration in drinking water was found significant with prevalence of fluorosis and only nutritional status showed significant association with severity of fluorosis.

CONCLUSION

Presence or absence of dental fluorosis in permanent teeth was significantly associated with fluoride concentration in drinking water. Once present, its severity was determined by nutritional status of the children - malnourished children exhibiting severe form of fluorosis.

HOW TO CITE THIS ARTICLE

Mahantesha T, Dixit UB, Nayakar RP, Ashwin D Ramagoni NK, Ellore VPK. Prevalence of Dental Fluorosis and associated Risk Factors in Bagalkot District, Karnataka, India. Int J Clin Pediatr Dent 2016;9(3):256-263.

The post-traumatic colour change of primary incisors: a colourimetric and longitudinal study

BACKGROUND

Tooth colour change after trauma has been described subjectively as ranging from yellow/pink to grey/black.

AIM

To investigate the longitudinal colourimetric change of post-traumatic discoloured primary incisor using an intraoral colourimeter.

DESIGN

A total of 34 primary incisors from 15 boys and eight girls were studied. The mean post-injury day during clinic visits (SD) and number of visit was 205.4 (194.8) and 3.9 (2.0). CIE L* (lightness), a* (green-red) and b* (blue-yellow) of the maxillary primary incisors were measured at every visit. The colour difference (ΔE*ab ) was calculated between the traumatized tooth and the control. Scatter graphs were made depicting the colour change of discoloured teeth and the ΔE*ab over time.

RESULTS

Mean CIE L*, a* and b* of the unaffected control were 80.8 (2.29), 0.9 (0.77) and 13.1 (2.67), respectively. L* gradually decreased to 70.7 (on day 71), then slowly recovered. a* increased to 3.7 (day 29) and decreased slowly. b* only demonstrated a small change that was within the control range during the follow-up. ΔE*ab increased to 9.58 (day 56) and decreased slowly.

CONCLUSION

The earlier recovery of a* was followed by the recovery of L*. During the post-traumatic period, ΔE*ab failed to reach the clinically acceptable threshold.

Radicular maturity level of primary teeth and its association with trauma sequelae

AIM

This study aimed to investigate the influence of the radicular maturity level of primary teeth on the sequelae of traumatic dental injury (TDI).

MATERIALS AND METHODS

A longitudinal retrospective study that collected data from dental records and radiographs of patients with TDI in one or both maxillary primary central incisors was conducted. Sequelae such as crown discoloration, pulp canal obliteration (PCO) and inflammatory root resorption (IRR) were evaluated during a 12- to 18-month follow-up period after the trauma.

RESULTS

Of the 132 patients included in the study, 103 (78%) had luxations and 29 (22%) had dental fractures. At the initial postinjury examination, 12 teeth (9.1%) were found to have immature roots, 107 (81.1%) had closed apexes and 13 (9.8%) had visible root resorption. Inflammatory root resorption occurred mostly in traumatized teeth that presented with physiological root resorption at the moment of trauma (P = 0.004). The frequency of PCO was higher in teeth with a closed apex at the moment of the injury (P = 0.026). There was also an association between the type of injury and the occurrence of crown discoloration (P = 0.008) as well as between the type of injury and the development of PCO (P = 0.001).

CONCLUSIONS

The occurrence of TDI sequelae can be determined by the type of injury as well as by the radicular maturity level of the primary teeth at the moment of injury.

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition

Traumatic injuries to the primary dentition present special problems and the management is often different as compared with the permanent dentition. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialities were included in the task group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care for management of primary teeth injuries. The IADT cannot and does not guarantee favorable outcomes from strict adherence to the guidelines, but believe that their application can maximize the chances of a positive outcome.

Facial and dental injuries due to dog bite in a 15-month-old child with sequelae in permanent teeth: a case report

This article reports a longitudinal follow-up of a 15-month-old child with dental trauma resulting from an attack by a dog. The injury consisted of laceration of the facial tissues and loss of the upper central deciduous incisors, in addition to loss of bone tissue in the same area. A malformation of the crown of the right central permanent incisor and complete change of the shape of the left central permanent incisor were observed. The etiological factors of childhood injuries as well as the importance of dental emergency care are discussed and the 14-year clinical and radiographic follow up of the case is presented.

Tooth displacement and root dilaceration after trauma to primary predecessor: an evaluation by computed tomography

This case report illustrates the relationship between trauma to a deciduous tooth and the consequences to the permanent dentition. The patient suffered an injury to the central incisors at the age of four with resultant pulpal necrosis. The permanent dentition was affected by displacement from its original position and a severe dilaceration at the crown/root junction.

Long-term effect of different treatment modalities for traumatized primary incisors presenting dark coronal discoloration with no other signs of injury

The aim was to compare the long-term outcomes of root canal treatment with that of follow-up-only in traumatized primary incisors in which dark discoloration is the only sign of injury. Root canal treatment was performed in 48 dark discolored asymptomatic primary incisors following trauma. Twenty-five of them [root canal treatment (RCT) group] were followed till eruption of their permanent successors. Ninety-seven dark discolored asymptomatic primary incisors were left untreated and invited for periodic clinical and radiographic examination. Of these, 28 [follow-up (FU) group] were followed till eruption of their permanent successors. The parameters examined included early extraction of the traumatized primary incisor, early or delayed eruption of the permanent successors, ectopic eruption of the permanent successor and signs of enamel hypopcalcification or hypoplasia in the permanent successor. Chi-square test was used for statistical analysis. Seven of 25 (28%) of the RCT group and 32% (nine of 28) of the FU group required early extraction. Five of 25 (20%) of the RCT group and 21% (six of 28) of the FU group showed early or delayed eruption of the permanent successors. Sixteen of 25 (64%) of the RCT group and 79% (22 of 28) of the FU group showed ectopic eruption of the permanent successors. Enamel hypopcalcification or hypoplasia in the permanent successors was equally found (36%) in both groups (nine of 25 in the RCT group and 10 of 28 in the FU group). None of differences was statistically significant. Root canal treatment of primary incisors that had change their color into a dark-gray hue following trauma with no other clinical or radiographic symptom is not necessary as it does not result in better outcomes in the primary teeth and their permanent successors.