Dental trauma in an Australian rural centre

Traumatic dental injuries over an 8-year period at a German dental center: a retrospective overview and cross-sectional analysis

BACKGROUND/AIM

The aim of this study was to analyze a population of patients who had suffered from traumatic dental injuries (TDIs) by using different patient-, trauma- and treatment-related parameters.

MATERIAL AND METHODS

All dental records of patients ≥ 3 years old who had presented at the dental emergency service between Jan 1, 2009 and Dec 31, 2016 for the treatment of dental trauma were analyzed. A total of 2758 patients were invited for a recall examination at the Department for Dental Surgery and Implantology, ZZMK Carolinum, Goethe University Frankfurt, Germany; of these, 269 patients attended their recall appointments.

RESULTS

The enrolled patient population consisted of 1718 males and 1040 females, with a mean age of 19.63 years (median 12.00 ± 17.354 years). A total of 4909 injured teeth were assessed, with a mean of 1.78 injured teeth per patient (median 2.00 ± 1.279). Males were found to be more frequently affected by TDIs compared to females (1.65:1). The majority of these injuries occurred in the first two decades of life (66.1%; n = 1824). The majority of the patients presented for initial treatment within 24 h of their accident (95.7%). The most frequent TDIs were isolated luxation injuries 49.4% (n = 2426) and isolated crown fractures 30% (n = 1472). Combination injuries were diagnosed in 20.6% of the cases (n = 1011).

CONCLUSIONS

Based on the findings of the present analysis, it can be concluded that males were more frequently affected by TDIs than females. Most patients had suffered from TDI before they had turned 10 years of age. Overall, the enamel-dentin fracture was found to be the most frequent injury, followed by concussions and lateral luxations.

Indications for root canal treatment following traumatic dental injuries to permanent teeth

The dental pulp may respond favourably or unfavourably to traumatic dental injuries. The most serious unfavourable responses are pulp necrosis and infection of the root canal system. These cause apical periodontitis and/or external inflammatory resorption of the tooth. The following injuries require root canal treatment as part of their emergency management-(A) complicated crown fractures (but some may be suitable for conservative pulp treatments, such as pulp capping, partial pulpotomy or pulpotomy), (B) complicated crown-root fractures, (C) supra-crestal coronal third root fractures and (D) injuries where pulp necrosis is predictable or highly likely to occur AND where there has been damage to the root surface and/or periodontal ligament with the aim of preventing external inflammatory resorption. This latter group of injuries are avulsion, intrusion, lateral luxation with a crown fracture, extrusion with a crown fracture (all in fully developed teeth) plus avulsion with a crown fracture and intrusion with a crown fracture (both in incompletely developed teeth). All other injuries should not have root canal treatment commenced as part of the emergency management, but they must be reviewed regularly to monitor the pulp for any adverse changes to its status, particularly pulp necrosis and infection of the root canal system.

Prevalence and pattern of traumatic orofacial injuries in Kabaddi players in Delhi-NCR region

BACKGROUND/AIM

Contact-sports are known to have higher risk of orofacial injuries due to the bodily contact with other players or equipment. Kabaddi is a traditional contact-sport of India that has gained an international recognition. There is a paucity of data regarding prevalence of traumatic dental and orofacial injuries among the Kabaddi players. Hence this study aimed to assess the prevalence, distribution and pattern of orofacial injuries among the Kabaddi players of Delhi and NCR region.

MATERIAL AND METHODS

This observational cross-sectional study was designed as per the best practices of epidemiology and reported as per the STROBE guidelines. The sample size was calculated as 440 and comprised of 10-18 years old players of either gender. Cluster random sampling was performed and the information was collected by one-calibrated evaluator by using a self-designed proforma. The injuries were classified as per standard criteria and the description of each episode was recorded. Statistical analysis was performed using the Statistical software-STATA-version-14(StataCorpLLC,Texas,USA).

RESULTS

Total of 393 players were included in the study (Males-295, Females-98) with majority of them between 15 and 18 years of age. The prevalence of traumatic episode was 49.11% and the prevalence orofacial-trauma was 44.02%.The frequency of extraoral-injuries was higher when compared to the intraoral injuries, with orbit(26.67%) being the commonest-site. Most of the players had not received adequate emergency treatment in the first incident which had improved in the second.

CONCLUSIONS

The prevalence of traumatic orofacial injuries in 10-18 years old Kabaddi players of Delhi-NCR region was found to be 44.02% while the prevalence of traumatic episodes was 49.11%. The prevalence of dental injuries was 5.1%. Majority of the players perceived that Kabaddi can lead to orofacial-injuries.

Microbial identification from traumatized immature permanent teeth with periapical lesions using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry

BACKGROUND

This study aims at identifying the microbiota in traumatized immature permanent teeth with periapical lesions using Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS).

METHODS

The study included 16 immature maxillary central incisors with periapical lesions in 13 patients. Field decontamination and negative control samples were performed before and after access cavity preparation. Root canal samples were taken using sterile stainless-steel hand files following field decontamination. In-office inoculation and pure sub-cultures were performed. Bacterial isolates were prepared for MALDI-TOF MS (Bruker, Billerica, MA USA) analysis using the formic acid extraction method. A comparison of the prevalence of isolated microorganisms was done using a one-sample chi-square test. Comparisons between identified microbial species with the, cone beam computed tomography periapical index (CBCT PAI) scores and lesion volume were also conducted. The Chi-square test was applied to investigate the association between the categorical variables .

RESULTS

Out of the forty isolates recovered from the 16 traumatized teeth included in the present study with the mean patients' age of 10.93 ± 1.77, 37 isolates were reliably identified by MALDI-TOF MS. Twelve teeth (62.5%) were polymicrobial. The recovered bacteria belonged to five phyla, 15 genera and 25 species. Firmicutes were the predominant phylum (P < 0.001) over Bacteroidetes, Proteobacteria, Actinobacteria and Fusobacteria. Gram positive bacteria were significantly more prevalent than Gram negative (p = 0.03). Facultative anaerobes were the most prevalent (P < 0.001) compared to the obligate anaerobes and the obligate aerobes. The latter were the least prevalent. Statistically, significant differences existed in the comparison between CBCT PAI scores according to bacterial gram staining.

CONCLUSION

Traumatized immature permanent teeth with periapical lesions showed a significant predominance of Gram-positive facultative anaerobes. MALDI-TOF MS provided accurate identification of numerous viable endodontic microbes.

A retrospective study of emergent traumatic dental injuries in permanent teeth in Xi'an, China

Traumatic dental injury is one of the common injuries seen in the emergency department. To determine the distribution features of emergency traumatic dental injuries in Xi'an, China, data from the medical records of 623 patients (aged 6-78 years) were evaluated and analyzed according to age, gender, etiology, factors predisposing teeth to injury, and types of teeth traumatized. The patient records of 397 males (63.7%) and 226 females (36.3%), with a 1.8:1 male-to-female ratio, were included. The total number of traumatized teeth was 1475. The highest frequency of dental trauma was found in the 19- to 30-year age group (30.7%). The greatest frequency of dental trauma injuries was in May (13%). Over one-third of patients with traumatic injuries to permanent teeth (n = 218, 35%) injured 2 permanent teeth. The most commonly affected teeth were the maxillary central incisors (59.3%). The most common type of trauma was concussion (20.4%). There was statistically significant difference among the type composition ratio of age groups (P < .05). The most common causes of dental trauma were falls (50.2%). There was statistically significant difference among the etiological composition ratio of age groups (P < .05). Combined injuries were present in 120 teeth in 103 patients (16.5%). The epidemiological characteristics of dental trauma in Xi'an shows that the occurrence of dental trauma is closely related to the age, sex, time, type of injury, and cause of injury. There exists cross-correlation among the epidemiological factors. The most common type of trauma is concussion and the most common cause of dental trauma is fall. High incidence of combined injuries needs extra attention.

Trends and seasonality in public interest in dental trauma: Insights from Google Trends

AIM

To assess trends and seasonal variation of dental trauma by using the Google Trends data.

DESIGN

Google Trends was used to obtain relative search volume (RSV) of search terms such as dental trauma, broken tooth, chipped tooth, knocked-out tooth, avulsed tooth, and gum trauma. The search strategy was set to the time period (January 2004 to December 2019), region (worldwide, the United States, the UK, Australia, Canada, New Zealand, Ireland, and Turkey), Web search, and all categories. Seasonal variation was evaluated using the cosinor analysis.

RESULTS

The worldwide RSV values of broken tooth, chipped tooth, knocked-out tooth, and avulsed tooth have shown a general increase in recent years with an upward forecast line. The RSV values of dental trauma have shown a general increase in recent years with a plateau forecast line, and gum trauma has shown a stable trend with a plateau forecast line. Seasonal variation of chipped tooth, broken tooth, dental trauma, knocked-out tooth, avulsed tooth, and gum trauma was not found statistically significant in any of the countries (p > .025). The top related queries of chipped tooth and broken tooth were about pain, fix/repair, and cost. The top related topics for avulsed tooth and knocked-out tooth are about infant, child, toddler, and primary tooth.

CONCLUSIONS

People's interest on dental trauma, broken tooth, chipped tooth, knocked-out tooth, and avulsed tooth has shown a general increase in recent years without showing a seasonal pattern. Healthcare professionals should pay more attention to people's concerns and informational needs.

Traumatic dental injuries in adults attending a London-based trauma clinic in the UK: a seven-year survey

Introduction This survey reports the incidence of traumatic dental injuries in an adult population attending an adult dental trauma clinic in a London teaching hospital.Materials and methods Retrospective data were collected from patients attending an adult dental trauma clinic between 2012 and 2018.Results In total, 1,769 patients attended, with more men seen (1,030; 58.2%) compared to women (739; 41.8%) and this was statistically significant (p <0.05). The most common aetiological factor was an accidental fall (728; 41.15%), followed by assaults (413; 23.35%), bicycle accidents (253; 14.3%), sports injuries (132; 7.46%) and road traffic accidents (84; 4.75%). Lateral luxation (833) was the most common traumatic injury and this was followed by avulsions (362; 17%). Enamel-dentine fractures were the most common type of fracture injury (1,273; 64%).Discussion This retrospective survey attempts to report on the incidence of traumatic dental injuries in a London-based cohort of patients attending a specialised dental trauma clinic. In line with other reports, there were more men than women affected, which is probably attributed to behavioural activities.Conclusion(s) Accidental falls are the most common cause of a traumatic dental injury, lateral luxation was the most common type of displacement injury and enamel-dentine fractures were the most common type of fracture injury.

Evaluation of Clinical and Radiographic Findings among Patients with Traumatic Dental Injuries Seeking Delayed Treatment

Background

Time elapsed between trauma and treatment greatly influences the prognosis of traumatic dental injuries (TDIs). The aim of this study was to analyze clinical and radiographic findings related to complications of TDIs among patients seeking delayed treatment of such injuries.

Materials and Methods

123 permanent teeth with a history of previous TDIs were included in the study. Clinical findings analyzed were the type of fracture, type and number of injured teeth, crown discoloration, and pulpal status of the injured tooth (pulpal diagnosis). The radiographic findings analyzed included pulp canal obliteration (PCO), root resorption (RR), and periapical radiolucency (PR). Statistical analysis included descriptive analysis.

Results

Tooth discoloration was the most common presenting complaint (53.65%), while fall (48.78%) was the most frequent cause of trauma. The range of time duration between trauma and presentation for treatment was 5 months to 30 years (average time 12.82 years). Pulp necrosis (PN) was the most common complication (90.24%). Almost half of the teeth with PN had fracture injury and discoloration along with a high frequency of PR (78.37%). Even teeth with a normal appearance were found to have a high incidence of PN (76.92%) and PR (53.84%). The crown discoloration was the second most frequent finding (48.78%). Many teeth (41.66%) with vital pulp were also discolored. Most of the teeth (79.31%) with yellowish discoloration and all teeth with brownish discoloration were nonvital. A high frequency of PN (90%) and PR (78.33%) was found in teeth with discoloration. PR was the most common radiographic finding (69.10%), while PCO and RR were observed in 17.88% and 21.13% of teeth, respectively.

Conclusion

The findings of this study support the fact that delayed treatment of TDIs leads to increased complications. PN was the most common complication followed by tooth discoloration, RR, and PCO among patients seeking delayed treatment after TDIs.

An analysis of clinical and imaging features of unilateral impacted maxillary central incisors: A cross-sectional study

INTRODUCTION

This cross-sectional study sought to assess clinical features and 3-dimensional distribution of unilateral impacted maxillary central incisors and identify factors associated with the root morphology.

METHODS

Cone-beam computed tomography (CBCT) images from 94 subjects exhibiting unilateral impacted maxillary incisors were selected and evaluated. Original CBCT data were reconstructed using Mimics software (version 17.0; Materialise, Belgium). Clinical features and 3-dimensional distribution of impacted maxillary central incisors and factors associated with the root morphology were observed and analyzed by 2 orthodontists.

RESULTS

This patient cohort included 52 male patients and 42 female patients. Thirty-three incisors (35.11%) with dilacerated roots, 17 incisors (18.09%) with retained deciduous teeth, 15 incisors (15.96%) with supernumerary teeth, and 15 incisors (15.96%) with a history of trauma were identified in the study. Of the 94 impacted incisors, the most common were labially impacted (n = 65; 69.15%), followed by vertically impacted (n = 17; 18.09%) and palatally impacted (n = 12; 12.77%). Chi-square tests revealed that differences in subjects with supernumerary teeth, buccolingual position, sagittal position, and axial position in the upright and dilacerated root groups were statistically significant (P <0.05). Logistic regression analysis indicated that the incidence of dilacerations was higher in the inverted position than in the inclined position and horizontal position (P <0.05).

CONCLUSIONS

Labially impacted maxillary incisors were more common than vertically or palatally incisors. Dilaceration was most commonly observed in patients with inverted incisors. In clinical practice, CBCT is a valuable tool for diagnosing impacted maxillary central incisors and for making appropriate treatment plans for patients.

Introduction of an interactive tool (the Dental Trauma Guide) in the undergraduate dental teaching to manage traumatic dental injuries

BACKGROUND/AIMS

Traumatic dental injuries (TDI) are complex problems where lack of proper care may result in serious complications. The need to improve the management of TDI is a frequently addressed concern. Methods of improvement in their diagnosis and management are continuously evolving. The interactive Internet tool, the Dental Trauma Guide (DTG), helps to simplify diagnostic and management dilemmas. However, it is not a freely available tool. The aim of the current study was to assess the knowledge and diagnostic skills of undergraduate dental students with access to the DTG compared with students without such access, in order to validate and promote this tool in dental education.

MATERIALS AND METHODS

Two groups of students were randomly selected where one group of final year dental undergraduate students were exposed to lectures, demonstrations, discussions and tutorials on the management of TDI according to the standard undergraduate curriculum in Sri Lanka. Another test group of 21 students were provided with access to DTG during their training in paediatric dentistry. At the end of the study period, students were assessed on their knowledge of TDI using MCQs (Multiple Choice Questions) and OSCEs (Objective Structured Clinical Examination), based on the DTG.

RESULTS

The students with access to the DTG were more knowledgeable in providing the correct answers to three out of the seven OSCE questions. Evaluation based on the MCQs did not reveal a significant difference (p = .913). However, users of the DTG showed a statistically significant difference with better overall knowledge based on their answers (p = .028). Following this period of evaluation, all of the students were provided with access to the DTG to supplement their learning experience.

CONCLUSION

The Dental Trauma Guide is a useful supplementary tool for undergraduate students to arrive at a correct diagnosis and treatment plan for TDI.

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.

Educational Impact of Notebook Covers on the Knowledge of Sixth-Grade Primary Pupils About Tooth Avulsion and Replantation: A Randomized Trial

BACKGROUND

Tooth avulsion is a common cause of tooth loss. However, there is a significant lack of knowledge about dental trauma and the appropriate emergency procedures to handle these cases.

AIM

The aim of this study was to evaluate the educational effect of notebook covers illustrated with figures and informative texts about tooth avulsion and replantation in sixth-grade primary school pupils.

MATERIAL AND METHODS

Sixth-grade pupils of two public school participated in this study. An experimental group consisting of 134 pupils received notebook covers illustrated with figures and informative texts about tooth avulsion and replantation, while a control group of 108 pupils received notebooks with neutral covers. An assessment of the educational effects on pupils was performed after 9 months, with a standardized questionnaire normally used to evaluate dental trauma. Statistical analysis was conducted with SPSS 21.0 (α = .05) for group description and comparison using chi-square and Student t tests.

RESULTS

Compared with the control group, the experimental group showed statistically significant improvements in correct meaning of dental trauma (38% vs. 58.2%); procedures to follow in the case of dental avulsion (2.8% vs. 70.9%); storing the avulsed tooth in milk (18.5% vs. 76.9%); general knowledge about dental anatomy (61.1% vs. 95.5%); and the ideal time for the tooth to remain outside the mouth prior to replantation (20.4% vs. 59.7%).

CONCLUSION

The use of notebook covers illustrated with figures and informative texts about dental trauma led to a significant increase in the knowledge of schoolchildren about tooth avulsion, first aid, and replantation.

Causes of dental trauma: Results of findings among patients in a secondary oral healthcare center, Jos, Nigeria

Background:

Dental trauma is a major type of traumatic dental injury (TDI) and a common presentation in many oral health facilities in Nigeria. Despite the high prevalence of TDIs, causes of dental trauma are yet to be fully investigated among Nigerians.

Aim:

The aim of this study is to determine the types of dental trauma, aetiology, and the causes of dental trauma as it relates with sociodemographic characteristics among dental patients.

Materials and Methods:

This was a cross-sectional study among patients attending a secondary oral healthcare facility in the North Central city of Jos between January 2019 and December 2020. The sociodemographic features of the patients include patients’ complaints, clinical and social history, result of simple clinical oral examinations, and diagnoses of dental trauma. The classification of Ellis and Davey (1970) was used to classify dental trauma for this study.

Results:

One hundred and seventy-six (6.7%) patients presented with dental trauma involving 281 teeth. The mean age was 37.54 ± 2.16 years. The most common cause of dental trauma in 48 (27.3%) patients was bone cracking, followed by falls in 33 (18.8%), road traffic accidents (RTAs) in 26 (14.8%), and bottle opening with teeth in 26 (14.8%). Bone cracking was the major cause of dental trauma in 18 (31.0%) educated and 2 (28.6%) non-educated patients. Among the patients, 118 (67.1%) presented with single traumatized tooth. Permanent anterior teeth 151 (53.74%) were more involved, and class 2 trauma involving enamel and dentinal structure was the most common presentation.

Conclusion:

Oral health awareness campaign on the damaging effect of bone cracking and use of tooth for opening metal caps of bottled drinks among adult population will reduce the prevalence of dental trauma among many adult Nigerians.

A cross-sectional evaluation of knowledge among Chinese dentists regarding the treatment of traumatic injuries in primary teeth

BACKGROUND/AIM

Injuries to the primary dentition affect children's esthetics, function, and mental health. They may also affect the development of the permanent teeth. The knowledge of dentists about deciduous tooth trauma is rarely evaluated. The aim of this study was to evaluate the knowledge and attitude of dentists in China regarding traumatic dental injuries to primary teeth.

MATERIAL AND METHODS

A self-administered online questionnaire containing questions on demographic data and knowledge based on a clinical scenario was given to a purposive sample of dentists, recruited by a non-probability convenience sampling method. The chi-square test was used for statistical analysis, with the significance level set at P <.05.

RESULTS

A total of 394 out of 409 dentists provided valid data. There was no significant difference in demographic data. Questions about the treatment of hard dental tissue injuries in primary teeth presented a correct-response rate of 66.4%, with the highest correct-response rate for enamel fracture (n = 368, 93.4%) and lowest for complicated crown-root fracture with pulp exposure (n = 104, 26.4%). Questions about treatment of luxation injuries in primary teeth presented a correct-response rate of 66.6%, with subluxation presenting the highest correct-response rate (n = 391, 99.2%). Factors associated with higher correct-response rates were specialist disciplines, educational qualifications, workplaces, experience of injured teeth treated, and educational experience about primary tooth trauma. No significant differences were found in the correct-response rates of dentists with different years of work experience. Lack of cooperation from children was considered a major obstacle for treatment. Special lectures and Internet courses were the most preferred methods of obtaining knowledge.

CONCLUSION

The results suggest that it is necessary to enhance dental trauma education for dentists in China. More attention needs to be paid to trauma in primary dentition to ensure adequate treatment for traumatized primary teeth.

Evaluating the knowledge level, attitudes, and therapeutic approaches of Greek dentists for traumatic dental injuries

BACKGROUND/AIM

Greek dentists are facing a new era of a globally continuous effort to improve the first-aid management and long-term treatment outcome of traumatic dental injuries (TDI). In Greece, where the basic and clinical research in the field of dental trauma has been limited until recently, assessing the attitudes and therapeutic strategies of Greek dentists for dental trauma is of great importance. The aim of this study was to evaluate the knowledge attitudes and therapeutic approaches of Greek dentists in different clinical scenarios of TDI.

MATERIALS AND METHODS

A cross-sectional study was conducted among 448 dentists. A questionnaire-based survey of demographic characteristics, attitudes, and a scenario-based knowledge test, of TDI, which was used to formulate a "Dental Trauma Knowledge Score" with a 0-8 score range, was administered. Mann-Whitney U tests (for two categories variables) and Kruskal-Wallis tests (for more than two categories variables) were performed.

RESULTS

The median knowledge score was 5.0 (IQR: 4-7), a level considered as "Acceptable." Knowledge scores were found to significantly differ by age group, with the younger dentists presenting the highest scores. Dentists with a self-evaluation as "Acceptable" had significantly higher scores. Most of the dentists would refer for CBCT in severe trauma cases. A significant association was found between younger ages and on awareness of the mobile application ToothSOS. Female dentists had significantly higher scores compared to males when asked about avulsion management.

CONCLUSION

An acceptable level of knowledge on TDI management was revealed among dentists in Greece. Higher knowledge scores were observed among younger dentists.

Dental Trauma

Dental trauma and injuries to the dentition are difficult to treat because the treatment goals serve to restore esthetics and function. The oral and maxillofacial surgeon is often called on to coordinate the efforts of rehabilitation after a dentoalveolar injury. A comprehensive understanding of the ideal treatments and use of endodontic, orthodontic, periodontal, and pediatric dental colleagues leads to the best possible results with regards to a restoration of form and function. This article provides a succinct review of the oral and maxillofacial surgeon's treatment in dentoalveolar trauma. Epidemiology, treatment, and preventative measures are discussed in this article.

Prevalence and Occlusal Risk Factors for Fractured Incisors among 11-12-Year-Old Children in the Trinidad and Tobago Population

This cross-sectional survey was carried out to ascertain the prevalence of fractured incisors in 11-12-year-olds. In addition we explored the relationship with overjet, incompetent lips, incisor inclination and to determine if there was any association with ethnicity and gender. All permanent incisors were examined in 672 children comprising 356 females (53.1%) and 315 males (46.9%). The sample comprised 11-12-year-olds in high schools across Trinidad and Tobago. Statistical analysis was undertaken using Chi-square test, independent t-test, and binary logistic regression. The prevalence of fractured incisors was 18.9%. Boys presented with an increased incidence of fractured incisors than girls. 86.3% of dental trauma was untreated. The average overjet of subjects with fractured incisors was 4.2 mm. 18.62% of subjects with fractured incisors had incompetent lips. The most common malocclusion (18.81%) with fractured incisors was class 2 division 1. The Afro-Trinidadian ethnicity had the highest prevalence of fractured incisors (11.0%) when compared to mixed ethnicities, which was statistically significant. Maxillary central incisors were the most commonly injured teeth. Most patients delayed in seeking dental treatment for fractured incisors in our population. Early orthodontic treatment is recommended to help reduce the risk of dental trauma.

Permanent Anterior Teeth Fractures and its Impact on Oral Health-Related Quality of Life among 8-15-Year-Old Schoolchildren of Chennai City - A Cross-Sectional Survey

Background:

Tooth fracture is not only a distressing experience on the physical level of a child, but it may also have an effect on emotional and psychological levels. This study aims to assess the permanent anterior teeth fractures and their impact on Oral Health-Related Quality of Life (OHRQoL) among 8–15-year-old schoolchildren of Chennai city.

Materials and Methods:

Thirty schools were randomly selected by stratified random sampling. All school-going children aged 8–15 years were invited to participate. A total of 7247 children were screened and 628 children with permanent anterior teeth fractures were included. Data were collected using Child Oral Health Impact Profile questionnaire. In addition, questionnaire addressing sociodemographic data and factors influencing permanent anterior teeth fractures were recorded. Descriptive statistics was performed to characterize the sample. One-way analysis of variance and Tukey's honestly significant difference post hoc tests was applied for multiple pair-wise comparisons.

Results:

The prevalence of permanent anterior teeth fracture was found to be 8.7%. The type of school had highly significant (P < 0.001) influence on the impact of permanent anterior teeth fracture on OHRQoL with negative OHRQoL among the corporation schools. The study participants of corporation schools had negative OHRQoL with significant difference in oral health well-being (P < 0.001) and self-image (P = 0.014).

Conclusion:

All the children reporting with tooth fractures had negative OHRQoL. The study stresses the importance of promoting good oral health-care practices to prevent oral disease in children and to meet children's unmet oral health-care needs.

Diagnosis and Management of Transverse Root Fractures

BACKGROUND

Root fractures are not a common injury, but a thorough understanding of their etiology, healing responses, diagnosis, management, and prognosis is essential.

REVIEW

The prognosis is largely related to the patient's age; degree of displacement, if any, of the coronal fragment; and the location and orientation of the fracture. The more apical the fracture is located, the better the prognosis. Teeth with root fractures located supracrestally may have the worst prognosis, but their management and outcome depend on many factors, with the most influential factor being the ability to restore the tooth because the coronal fragment usually needs to be removed. In contrast, root fractures located in the apical and middle thirds and those subcrestally in the coronal third of the root have a good prognosis and usually require little, if any, treatment apart from immediate repositioning (if the coronal fragment has been displaced) and stabilization. Monitoring of root-fractured teeth over time is essential to determine the healing response and to assess whether the pulp survives or not. In some cases, the pulp in the coronal fragment may necrose and become infected, thus requiring root canal treatment, but this should only be done to the fracture line. Pulp necrosis and infection typically occur within the first 3-4 months if it is a direct result of the trauma. However, pulp necrosis and infection can also occur many years later, in which case it is likely to be a result of bacterial penetration via cracks or breakdown of restorations.

CONCLUSION

Overall, root fractures should be managed conservatively unless they are located supracrestally.

Assessment of schoolteachers' knowledge about management of traumatic dental injuries in Al-Madinah city, Saudi Arabia

Objective:

This study aimed to assess the knowledge of primary and intermediate schoolteachers about the management of TDIs in Al-Madinah city, Saudi Arabia.

Materials and Methods:

A previously validated, self-administered, anonymous, close-ended structured questionnaire was administered to schoolteachers in 13 different schools. It included two parts: basic demographic information (part one) and questions regarding the management of dental traumatic injuries (part two).

Results:

A total of 178 schoolteachers voluntarily completely filled in the questionnaire. Nearly 28.1% of the teachers acquired a first-aid training program and 6.2% only learned about dental injury management in first-aid training. Concerning the knowledge about the management of dental traumatic injuries, 55.1% of teachers realized the appropriate time for treatment of dental traumatic injuries. A few percentage of teachers selected correct answers for the suitable storage medium. The most commonly selected storage media were found to be cold milk, physiological saline, and patient's saliva at 14.6%, 6.7%, and 2.2%, respectively.

Conclusion:

The knowledge among primary and intermediate schoolteachers in the management of dental traumatic injuries is unsatisfactory.

Community-level predictors of Australian children's dental caries and injury

BACKGROUND

Social determinants of oral health are complex and have been described by conceptual frameworks. A widely embraced model of children's oral health was published by Fisher-Owens et al. (2007), identifying theoretical constructs influencing oral health. The current study aimed to investigate community-level constructs described in the conceptual model.

METHODS

The Longitudinal Study of Australian Children is a cross-sequential dual cohort study, with a representative sample (n = 10090) of Australian children. Generalized estimating equations were applied to model seven waves of carer-reported oral health and community measures.

RESULTS

In the final model, children living in Queensland had a 1.48 (CI 1.35-1.62) increased odds of dental caries over time. Children in low socio-economic status (SES) areas (OR 1.32 CI 1.20-1.44) had an increased odds of caries. The state of Queensland (OR 1.24 CI 1.05-1.46) and poor neighbourhood liveability (OR 1.17 CI 1.05-1.31) were predictors of dental injury.

CONCLUSION

By modelling available community measures, this study found SES and rurality were predictors of caries over childhood. Our results highlight the difficulty of applying conceptual models to oral health. The use of qualitative studies and realist reviews should be considered to complement statistical models to provide contextualized insights into funding, policy and service delivery on children's oral health.

Changes in the aetiological factors of dental trauma in children over time: An 18-year retrospective study

BACKGROUND/AIM

Dental trauma causes significant aesthetic, functional and psychosocial problems that often require emergency attention in children. The aim of this retrospective study was to assess the factors related to dental injuries in children. A secondary aim was to better understand how to improve the education given to children, parents and teachers in schools regarding dental trauma.

MATERIALS AND METHODS

Records of children who were referred to the Department of Pedodontics at Suleyman Demirel University were reviewed. A total of 1971 patients with a history of dental trauma who attended the clinic from 1999 to 2017 were evaluated. The following information was recorded: age, gender, year, aetiology, location, season and time elapsed after trauma. Results were evaluated using the Pearson chi-square test.

RESULTS

The patients' average age was 8.56 ± 0.08. Dental injuries were frequent in the 7- to 12-year age group (55.9%). Children in the 0- to 6-year age group attended the clinic more frequently during the years 2013 and 2017 compared to previous years. Boys had a higher frequency of trauma than girls (P < 0.05). The most frequent cause of trauma was falls (46%). The accidents occurred predominantly in the street (41.8%). Trauma that took place at home increased in the later years of the study period, whereas the percentage of injuries occurring in schools decreased. The ratio of patients who attended the clinic within the first two days after trauma was 33.4% between 1999 and 2007, and this increased to 59.8% between 2013 and 2017. The majority of the injuries occurred during the summer.

CONCLUSIONS

The aetiological factors related to trauma in children, and the number of patients who attended the clinic, have not changed over the 18-year period but the elapsed time to attend the clinic has changed. Education will increase the awareness regarding the importance of emergency intervention immediately following dental trauma.

[Prevalence survey of dental trauma to immature permanent teeth in Xi'an schoolchildren]

OBJECTIVE

The prevalence rate, distribution, and reasons of immature permanent-tooth trauma in Xi'an were investigated and described, and a scientific basis was provided for the decision-making of health-administration departments.

METHODS

Through cluster and simple random sampling survey, 4 013 pupils in schools from nine districts and four counties in Xi'an were sampled. All pupils and their parents were requested to complete a questionnaire. Oral examinations were conducted for children who had immature permanent teeth trauma. The number of trauma teeth and teeth were recorded. Survey data were analyzed statistically.

RESULTS

The prevalence rate of immature permanent dental trauma was 10.5% in Xi'an. No significant differences were observed between districts and counties (P>0.05). The peak age of permanent dental trauma was at 7-9 years old, and the most was at 8 years old (31.5%). The first reason of trauma was falling down (50.9%), and the second reason was crash (36.0%). The most common trauma teeth were maxillary incisors (75.4%).

CONCLUSIONS

The prevalence rate of immature permanent teeth trauma in Xi'an was in the middle of all international levels. Children, who are vulnerable to dental trauma at their age, should be provided with appropriate prevention measures to reduce the incidence of dental trauma.

Etiologic factors and clinical evaluation of restored fractured anterior teeth: an observational study

Purpose:

The aims of this study were to investigate the etiologic factors and to evaluate performance of composite resin on fractured crown in permanent anterior teeth at 6 and 12 months.

Subjects and Methods:

Records from 51 patients were retrieved from a Dental School Clinic, comprising 73 fractured anterior teeth directly restored with a submicron hybrid composite (Spectrum TPH) resin and respective adhesive system (Prime and Bond NT) were evaluated. The United States Public Health Service criteria were used to assess the clinical evaluation. Data were analyzed using the Wilcoxon Signed Rank, Kruskal–Wallis, Mann–Whitney U, and Siegel and Castellan tests.

Results:

Seventy-two maxillary incisors and one canine of 51 patients were evaluated. The patient’s age at the time of therapy ranged from 14 to 64 years old (mean 25.47). Mostly observed crown fracture was seen in upper incisors (84.9%) and due to falls (58.8%). At the 6-month follow-up, one patient lost one restoration and at the 12-month, one patient lost one and one lost two restorations. A statistically significant difference was found in terms of marginal adaptation between 6 and 12 months.

Conclusion:

In this short-term observation period, remaining tooth structure was conserved and good patient compliance was achieved. Factors such as esthetic and/or cost should be considered to indicate the direct composite restorations.

Clinical Performance and Epidemiologic Aspects of Fractured Anterior Teeth Restored with a Composite Resin: A Two-Year Clinical Study

PURPOSE

To investigate the etiologic factors, effect of age and gender on dental trauma, and to evaluate the performance of composite resin on the fractured crown of permanent anterior teeth.

MATERIALS AND METHODS

Over a 2-year period, 73 permanent teeth from 51 patients with dental trauma were treated with direct composite resin restoration. Informed consent and standardized trauma forms were completed by the patient; teeth were restored with a submicron hybrid composite resin (Spectrum TPH) and respective adhesive system (Prime&Bond NT). Sixty-nine teeth were directly restored without fiber posts, while four were treated with fiber posts. Two experienced clinicians, besides the operator, evaluated each restoration at 6-, 12-, and 24-month follow-ups according to US Public Health Service (USPHS) criteria for the following characteristics: anatomical form, marginal adaptation, color match, marginal discoloration, surface roughness, and caries. Data were analyzed using the Wilcoxon Signed Rank, Kruskal-Wallis, Mann-Whitney U, and Siegel and Castellan tests.

RESULTS

A total of 73 traumatized teeth in 51 patients aged from 14 to 64 years (mean age 25.47 ± 14.058 years) were assessed according to the Ellis classification and restored over a 2-year period. Crown fractures were more common in the maxilla (84.9%) and caused by falls (58.8%). At the end of 24 months, a total of ten restorations were lost. The survival rate after 24 months was 82.14%. There were statistically significant differences in marginal adaptation between the 6-, 12-, and 24-month follow-ups. Although changes in marginal discoloration over time were not significant (p = 0.194), changes in color match were significant (p = 0.029).

CONCLUSION

Within the limitations of this study, direct composite restorations were accepted as clinically satisfactory.

An Appraisal of the Prevalence and Attributes of Traumatic Dental Injuries in the Permanent Anterior Teeth among 7-14-Year-Old School Children of North East Delhi

Aims:

The aim of this study was to assess the prevalence, associated risk factors, characteristics, and pattern of traumatic dental injuries (TDIs) in the permanent anterior teeth among school children of North East Delhi area.

Settings and Design:

A cross-sectional study was done in 3000 school-going children aged 7–14 years.

Materials and Methods:

A detailed case history and clinical examination were performed on the entire sample population. TDIs were recorded according to Andreasen's epidemiological classification of TDIs including World Health Organization codes.

Statistical Analysis Used:

For finding the independent association of the significant variables with outcome, multivariable logistic regression analysis was used.

Results:

A prevalence of 10.7% was observed in the sample being studied. Dental trauma was significantly (P < 0.05) associated with male gender, and high statistical significance (P < 0.001) was noted with age, participation in sports, lip seal, and overjet. Fall of the child while playing by himself/herself was the most common cause; afternoon and schools were the most common time and place of occurrence of TDIs, respectively. Single tooth enamel fractures in the left maxillary central incisors were most commonly seen. Adhesive restorations were the most frequent form of treatment required.

Conclusions:

Organizing studies addressing the prevention and treatment needs of TDIs and educational programs aimed toward parents and school teachers are of paramount importance. Furthermore, recognizing the tremendous treatment negligence is extremely critical to adequately analyze indifference of the people toward dental trauma and its consequences.

Alveolar Bone Fracture: Pathognomonic Sign for Clinical Diagnosis

Aim:

Dental injuries, especially luxation and avulsion, are common. Dental trauma can cause alveolar bone fracture that can lead to tooth loss and malocclusion. Single tooth alveolar bone fractures are difficult to identify unless it protrudes through the overlying mucosa and can be visualized. Pain, malocclusion, and tooth mobility provide signs of suspected alveolar bone fractures. Integrity of the proximate alveolar bone should be examined for fractures where avulsion, luxation, or other tooth trauma is detected. Any suggestion of alveolar fractures should be further investigated with an appropriate radiograph.

Summary:

This case report shows a pathognomonic sign that detects and diagnosis single tooth alveolar bone fractures, i.e., a localized hematoma crossing the attached gingiva from the free gingival margin to the vestibular mucosa. This should serve as a warning for localized alveolar bone fracture.

A visualized hematoma and gentle, careful palpation may help detect covered fractures when the overlying mucosa is not perforated.

Traumatic dental injuries in a university hospital: a four-year retrospective study

Background

Traumatic dental injuries present complex injuries of the dentoalveolar system. Aim of this study was to investigate the frequency and patterns of traumatic dental injuries in a University dental emergency service over four years.

Methods

A retrospective investigation on all dental trauma patients presenting at the dental emergency service of the University Medical Center Mainz, Germany between 01/2010 and 12/2013 was conducted. Demographic data, the cause and type of trauma and the initial therapy were analyzed.

Results

Out of 16,301 patients, 1,305 patients (8 %; average age 14.7 years ±15.7; 60.1 % male, 39.9 % female) came due to trauma. 63.9 % of the traumas occurred on weekends. The most frequent reason for injuries was falls (54.6 %). No correlation could be found between the cause and the kind of trauma. In 48.6 % of the cases only one tooth was involved, in 33.5 % two. The permanent dentition was traumatized in 56.6 % of cases, the deciduous teeth in 41.1 %. The most frequently affected tooth was the central upper incisor (61.0 %). Hard-tissue injuries were significantly more frequent in the permanent dentition, while periodontal injuries were seen significantly more often in the deciduous dentition.

Conclusion

Eight percent of all patients seeking help at the dental emergency service presented with trauma, meaning that dental traumatology is one of the major topics in emergencies. To improve the quality of care, further public education, expert knowledge among dental professionals and a well-structured emergency service are necessary.

Prevalence of Anterior Tooth Fracture due to Trauma

Aim

To evaluate the prevalence of anterior tooth fracture due to trauma in 2000 patients randomly from the population of south Canara district.

Materials and methods

The present study was conducted on 2000 patients attending the Department of Conservative Dentistry and Endodontics, AB Shetty Dental College, Mangalore, and rural satellite centers of Nitte University. Each patient was examined for anterior tooth fracture due to trauma under dental chair in a good illumination of light using sterilized mouth mirror, explorer, tweezer and teeth are isolated by cotton roles. The patient who had anterior tooth fracture were questioned with a standard questionnaire from oral health survey WHO format 2013, to find its relation associated to age, gender, location, occupation, etiology, type of fracture and its relation to molar.

Results

According to the present study, prevalence of anterior tooth fracture due to trauma in south Canara population was low and found to be 18.8% with increase in prevalence in males (56.2%) between the age group of 36 and 45 years (33.2%), common etiological factor seen was falls (44.7%). The most common type of fracture was enamel-dentine fracture (44.7%) with class 1 molar relation (55.6%).

Conclusion

The prevalence of anterior tooth fracture due to trauma was most commonly seen in males with increased prevalence in age group between 36 and 45 years, common etiological factor being falls, type of fracture most commonly seen are cases with enamel-dentine fracture with class 1 molar relation.

How to cite this article

Hegde MN, Abootty S, Attavar S. Prevalence of Anterior Tooth Fracture due to Trauma. World J Dent 2015;6(2):77-81.

A survey on Hong Kong secondary school students' knowledge of emergency management of dental trauma

Objectives

To investigate Hong Kong secondary school students' knowledge of emergency management of dental trauma.

Method

A questionnaire survey on randomly selected secondary school students using cluster sampling.

Results

Only 36.6% (209/571) of the respondents were able to correctly identify the appropriate place for treatment of dental injury. 55.2% of the respondents knew the suitable time for treatment. Only 24.7% of the respondents possessed the knowledge of how to correctly manage fractured teeth. Only 23.6% of them knew how to manage displaced teeth. 62.5% of them correctly answered that knocked-out deciduous teeth should not be replanted to the original position, but few of them (23.6%) knew that permanent teeth should be replanted. Moreover, 37.1% of the respondents correctly identified at least one of the appropriate media for storing a knocked-out tooth. First-aid training and acquisition of dental injury information from other sources were significant factors that positive responses from these questions would lead to higher scores.

Conclusion

Hong Kong secondary school students' knowledge of emergency management of dental trauma is considered insufficient. An educational campaign in secondary schools dedicated to students is recommended. Prior first-aid training and acquisition of dental injury information from other sources positively relate to the level of knowledge. Dental trauma emergency management is recommended to be added to first-aid publications and be taught to students and health professionals.Trial Registration: Hong Kong Clinical Trial Centre

HKCTR-1344

Association between Trauma to Primary Incisors and Crown Alterations in Permanent Successors

The aim of this study was to determine the prevalence of sequelae in permanent teeth that had their predecessors traumatized and investigate associated factors. The study was carried out with clinical and radiographic data from 137 patient charts of the Traumatized Patient Care Program, Federal University of Santa Catarina (Brazil), totalizing 253 teeth. Data were gathered on gender, age at the time of trauma, type of trauma, type of post-trauma sequelae, trauma recurrence and crown alteration in the permanent successors. No statistically significant associations were found between permanent successor's crown alteration and gender, age at the time of trauma, post-trauma sequelae or trauma recurrence (p>0.05). Significant associations were found between severe trauma (crown fracture with pulp exposure, lateral luxation, intrusion and extrusion) in the primary incisors and permanent successor's crown alteration (p<0.05). Multivariate analysis revealed an association between severe trauma to the primary incisors and permanent successor's crown alteration (OR: 4.1 - IC: 1.7-10.1). Alterations in the crown of permanent successors are associated with severe trauma to the primary incisors, as primary teeth affected by severe trauma have a fourfold greater chance of exhibiting permanent successor crown alteration in comparison to primary teeth that had minor trauma.

Predisposing Factors for Traumatic Dental Injury in Primary Teeth and Seeking of Post-trauma Care

The aim of the present study was to investigate predisposing factors for traumatic dental injury (TDI) in the primary dentition and seeking of dental care after the occurrence of TDI. A randomized population-based cross-sectional study was carried out with 814 children aged 3 to 5 years enrolled at public and private preschools in the city of Campina Grande, PB, Brazil. Parents were asked to fill out a questionnaire on demographic data and the child's history of TDI. TDI was evaluated by clinical examinations performed by three previously calibrated dentists (Kappa: 0.85 to 0.90). Bivariate and multivariate Poisson regression models were constructed for TDI and the parent-reported search for dental care (α=0.05). The prevalence of TDI was 34.6%. The most common type of TDI was enamel fracture (55.0%). The central incisors were the most frequently affected teeth (87.5%). Predictors for TDI in the primary dentition were household income >U$312.50 (PR: 1.355; 95% CI: 1.050-1.724) and overjet >2 mm (PR: 1.539; 95% CI: 1.219-1.942). The predictor for seeking dental care following TDI was parent's age >30 years (PR: 1.753; 95% CI: 1.039-2.960). Household income and overjet were associated with TDI. Among children having suffered TDI, parent's age is a crucial determinant for seeking dental care.

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.