Traumatic dental injuries of permanent incisors in 11- to 13-year-old South African schoolchildren

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.

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

Background

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

Aim

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

Methods

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

Results

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

Conclusion

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

Measurement of association between malocclusion, nutritional status, and dental trauma in adolescents: A cross-sectional study

Background

With the decrease in the incidence of dental caries globally, traumatic dental injury (TDI) has emerged as a major cause of morbidity and distress among adolescents. The aim of this study was to assess the prevalence of TDI and explore its association with malocclusion and nutritional status among adolescent population of Udupi taluk, Karnataka state, India.

Methods

The sample consisted of 770 children, from randomly selected schools in Udupi taluk. An anthropometric measurement was done to record the "body mass index", an oral examination was done to record the "Dental Aesthetic Index" for malocclusion and "Andreasen classification" for TDI. Statistical analysis included chi-square test and bivariate and multivariate binary logistic regression. A p value of ≤0.05 was considered statistically significant.

Results

The prevalence of TDI was 11.8%. The prevalence of overweight and obesity was 20.3%. The prevalence of malocclusion recorded in the study population was 49.8%. When prevalence of TDI was compared against gender, the type of school attended, and presence/absence of malocclusion, it was found that there was a statistically significant difference in prevalence of trauma between the aforementioned parameters (p ≤ 0.05). Results of the multivariate analysis through logistic regression indicated that being a male [3.87 (3.21-4.72)], attending a public school [1.41 (1.19-1.63)], and having malocclusion [1.55 (1.32-1.71)] significantly increased the odds of sustaining TDI.

Conclusion

The results indicated a strong association between TDI, gender, the type of school attended, and malocclusion, and they have important implications toward the health and well-being of the individual communities.

Body Image in Preschool Children Following Premature Loss of Primary Teeth: A Cross-sectional Study

Introduction

Pediatric dentists often see a good number of children under 6 years of age and are likely to encounter a child with missing anterior teeth. Here the parents are more concerned about the facial esthetics of the child and also about the timing of permanent teeth to erupt.

Aim

To know the impact on self-esteem or body image of preschool children following the premature loss of primary anterior teeth.

Materials and methods

The present cross-sectional study was conducted among 780 children in the age group of 4–6 years. The COHIP-SF 19 was utilized to know the social well-being of the child following the premature loss of anterior teeth. The descriptive and inferential analysis of the data was done by using IBM SPSS software.

Results

There was a statistically significant association between gender and social well-being. More number of boys were concerned about their looks (p = 0.054). However, girls were found to be significantly more (p = 0.003) shy or withdrawn as compared to boys. There was a statistically significant association between a child's age and social well-being. More number of children between the ages of 4 years (23.1%) and 6 years (25.8%) were worried or anxious due to premature loss of an anterior tooth. Significantly more no of children of age 5 years (48.6%) was uncomfortable when asked about the missing tooth as compared to 4- and 6-year-old children. No statistically significant (p > 0.05) difference in the mean social well-being scores between boys and girls. No statistically significant difference in the mean social well-being scores between children of ages 4, 5, and 6 years (p > 0.05).

Conclusion

There is an association between the self-image of younger children and missing anterior teeth.

How to cite this article

Acharya S, Biswas R. Body Image in Preschool Children Following Premature Loss of Primary Teeth: A Cross-sectional Study. Int J Clin Pediatr Dent 2022;15(3):293-298.

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.

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

Background

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

Materials and Methods

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

Results

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

Conclusion

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

Risk factors and patterns of traumatic dental injuries among Indian adolescents

Background/purpose

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

Materials and methods

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

Results

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

Conclusion

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

Prevalence of traumatic dental injury to the anterior teeth in children attending paramilitary and nonparamilitary schools in Nigeria

Objective:

The objective of this study was to determine the prevalence of traumatic dental injuries (TDIs) in the anterior teeth among children attending paramilitary and nonparamilitary schools in Benin City, Nigeria.

Materials and Methods:

A multistage sampling technique was used to select children aged 8–12 years with a previous history of trauma to the orofacial region. A self-administered questionnaire was then applied, and each participant was examined clinically. Data collected included demographic characteristics, etiology and place of injury, affected teeth, type of dental injury, lip competence, and overjet values. Analysis of data was done with the SPSS version 21.0 software. Pearson's Chi-squared test was used to determine the association between variables and odds ratio. Statistical significance was determined at P < 0.05.

Results:

A total number of 1352 children (mean age: 9.89 ± 1.4 years) were examined and 154 (11.4%) had a previous history of TDI. The prevalence among respondents in the paramilitary schools was 84 (6.2%) and those in nonparamilitary schools 70 (5.2%). Falls and play was the most common cause of TDI and was higher in children in paramilitary schools. Ellis Class I was the most prevalent type of injury in 91 (59.1%), tooth number 21 was the most traumatized, and the school environment was the most common place. Of the total number of respondents with TDI, the relationship between etiology with age, lip competence, and overjet was statistically significant (P < 0.05).

Conclusion:

The prevalence of TDI among the study participants was 11.4% and more in the paramilitary schools than the nonparamilitary.

Prevalence and factors associated with traumatic dental injuries among schoolchildren in war-torn Libya

BACKGROUND/AIMS

No previous epidemiological study has investigated the prevalence and associated factors of traumatic dental injuries (TDIs) among Libyan children. Such information is required for the planning and evaluation of health services. The aim of this study was to assess the prevalence of TDIs and associated factors among 12-year-old schoolchildren in Benghazi, Libya.

METHODS

Data for this study were collected as part of a comprehensive, cross-sectional survey investigating oral health status and treatment needs of 12-year-old schoolchildren in Benghazi, Libya, between December 2016 and May 2017. Sociodemographic information was collected through a dental health questionnaire. The children were assessed for oral health status, including TDIs according to modified World Health Organization (WHO) classification criteria, in their classroom by trained and calibrated examiners. Anthropometric measures, lip competence and overjet were all assessed and reported. History of TDIs was sought among those affected. Logistic regression models were applied for TDIs as an outcome variable. The statistical significance for all tests was ≤0.05.

RESULTS

Data from 1134 participants were included in this study. TDIs were observed in 10.3% of the sample. Most of these TDIs were enamel fractures only (55.6%) and enamel and dentine fractures (35.9%). "Falling" was the most common cause of TDIs, accounting for 51% of cases. While increased overjet appeared to be associated with higher risk of TDIs (OR: 1.92; 95% CI: 1.29-2.86), being female (OR: 0.34; 95% CI: 0.22-0.53) and overweight (OR: 0.33; 95% CI: 0.13-0.83) were also associated with lower risk of having TDIs.

CONCLUSIONS

This survey showed that a considerable proportion (10.3%) of 12-year-old Libyan children had TDIs, with relatively high unmet treatment needs. More efforts are required to develop effective prevention programmes and to enhance the provision of dental treatment of TDIs for Libyan children.

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.

Effect of two educational interventions on primary school teachers' knowledge and self-reported practice regarding emergency management of traumatic dental injuries

BACKGROUND

The present study evaluated the effect of two educational interventions on the knowledge and self-reported practice of primary school teachers regarding emergency management of traumatic dental injuries (TDIs).

METHODS

All primary school teachers (n = 664) of Arak, Iran were asked to participate in the study. Based on geographic regions, all participants were enrolled in two groups: educational leaflet and oral presentation. At baseline, teachers in both groups were asked to complete an anonymous self-administrated questionnaire consisting of demographics, eight questions on knowledge, and four paper cases on self-reported practice about TDIs. After collecting the questionnaires, interventions, including an oral presentation and an educational leaflet whose contents were prepared based on the most recent scientific evidence, were implemented. One and six months after the interventions, the questionnaire was completed by the teachers again. Repeated measures ANOVA and a linear regression model were used for statistical analysis.

RESULTS

Two hundred and ninety-two teachers participated in all stages of the study (response rate = 64.5%). In one-month follow-up, in both groups, the mean score of knowledge was significantly higher compared to baseline and six-month scores (P < 0.001 and P < 0.001, respectively). Moreover, in six-month follow-up, the mean score of knowledge was higher compared to baseline (P < 0.001) in both intervention groups. No statistically significant difference existed in the mean score of knowledge in three evaluations between two groups (P < 0.05). In one-month follow-up, the mean score of self-reported practice was significantly higher compared to baseline and six-month scores in both interventional groups (P < 0.001 and P < 0.001, respectively). There was no significant difference in the mean score of self-reported practice between the one-month and six-month follow-up (P = 0.53). There was no statistical significant difference in the mean score of self-reported practice in three evaluation phases between two groups (P < 0.05). No significant relationship was observed between the difference in knowledge and self-reported practice scores and demographic factors.

CONCLUSIONS

Both educational interventions regarding emergency management of TDIs-educational leaflet and oral presentation- were effective in increasing knowledge and self-reported practice of teachers in the short-term follow-up. In long-term evaluation, educational leaflet resulted in more positive changes in teachers' knowledge compared to their self-reported practice.

Prevalence of traumatic crown injuries in German adolescents

OBJECTIVES

Although dental trauma and its unfavorable sequelae are considered major public health problems worldwide, the published data on the prevalence of traumatic crown injuries (TCIs) in Germany are lacking. Therefore, the present study assessed the prevalence of TCIs among adolescents in Bavaria, Germany.

MATERIAL AND METHODS

Ethical approval and parental consents were obtained, and population-based information from 10- (N = 1158), 12- (N = 416), and 15-year-olds (N = 1302) from two different cohort studies performed in Bavaria (GINIplus/LISA and LAGZ) were examined for the presence of TCIs, dental caries, and restorations. Statistical comparisons were made using Mann-Whitney U test and Wilcoxon signed-rank test.

RESULTS

The prevalence of TCIs was 6.3% in the 10- and 12-year-old children and 14.0% in 15-year-old children, and a higher prevalence was observed in boys than in girls. Most (87.5%) of the traumatized teeth were maxillary incisors. The caries prevalence was low in all three populations.

CONCLUSION

The prevalence of TCIs in Bavarian adolescents at a low risk for caries was found to be low.

CLINICAL RELEVANCE

Dental trauma is a prevalent event in children and adolescents, and incisors are the most affected teeth. Therefore, dental practitioners should be able to manage the spectrum of traumatic injuries.

[Outcomes of traumatic dental injuries in children]

The aim of the study was to review literature data on incidence and outcomes of traumatic dental injuries (TDI) in pediatric population. A systematic search was conducted using Elibray, Pubmed/Medline, Scopus databases in October 2018. Reference lists were also hand-searched to identify additional literature. The most prevalent complication of TDI is pulp necrosis (PN) which triggers inflammatory root resorption (IRR). PN and IRR are however much more specific for mature permanent teeth. In immature teeth pulp revascularization may occur even after avulsion. Pulpectomy timing is well defined for mature teeth only. It is accepted that pulp extirpation should be performed in the first 10 days after trauma. In immature teeth no criteria exist with pulp electrosensitivity having very low negative prognostic value as drop of pulp sensitivity because of trauma not necessary indicate PN. Follow-up protocol for immature teeth with various TDI would be useful for proper timing of pulpectomy and prevention of IRR.

Prevalence of traumatic dental injuries and their relation with predisposing factors among 8-15 years old school children of Indore city, India

Background

Dental injuries result in functional, esthetic and psychological disturbances accompanied by great concern from the child, the parent and the dentist. Oral injuries are fourth most common area of bodily injuries among 7-30 year-old individuals.

Aim

a) To assess the prevalence of traumatic dental injuries (TDI) and their relation with predisposing factors among 8-15 years old school children in Indore city, India.b) To collect baseline data as there have been no reported studies of TDI in central India to this date.

Methods

A cross sectional study was carried out among 4000 children of 60 schools in Indore using multistage random sampling method. Examination of permanent incisor teeth was done in accordance with the modified Elli's and Davey Classification using a standard mouth mirror and probe. Subjects who had clinical evidence of trauma were interviewed for details of the injury event by using structured questionnaire. Chi square test was used to analyze the distribution of all the measurement in this study at the statistical significance of 0.05.

Results

Among the 4000 children of 60 schools examined, 10.2% experienced TDI. 68.38% boys experienced TDI, which was approximately twice as higher in females being 31.62%. The most commonly affected teeth were maxillary central incisors. A higher number of children with incisal overjet greater than 3 mm had TDI than those with less than 3 mm, although this difference was not statistically significant. Lip closure incompetence was found to be more common in subjects having a TDI. Fall was the most common cause for TDI and place of occurrence was home. Most common type of fracture was class I and most of them were untreated.

Conclusion

The high level of dental trauma and low percentage of children with trauma seeking treatment stresses the need for increased awareness in Indore population.

World traumatic dental injury prevalence and incidence, a meta-analysis-One billion living people have had traumatic dental injuries

Traumatic dental injuries (TDIs) account for a considerable proportion of bodily injuries. Nevertheless, global TDI frequency is unknown, probably because TDI diagnosis is not standardized. This study estimated world TDI frequency. A literature search (publication years 1996-2016) was aimed at covering as many countries, communities, ethnic groups as possible, thus achieving high generalizability. In particular, non-specific keywords, no language restrictions, and large databanks were used. Observational studies reporting proportions of individuals with at least one TDI (prevalence) and who developed TDI (incidence rate) were considered. Prevalence rates to permanent dentition, primary dentition and in 12-year-olds, incidence rate to any tooth for any age, male-to-female prevalence ratio (PR) in 12-year-olds, with 95% confidence intervals (95 CIs), were extracted/calculated. Study quality, Z-score distribution, funnel plot symmetry analysis, between-study heterogeneity, sensitivity, and subgroup analyses were performed. Selected primary studies were 102 (permanent dentition; 268 755 individuals; median age, 13.8 years), 46 (primary dentition; 59 436 individuals; median age, 3.4 years), 42 (12-year-olds; 33 829 individuals), 11 (incidence rate; 233 480 person-years; median age, 7.8 years), and 31 (PR; 16 003 males, 16 006 females). World TDI frequency resulted as follows: permanent dentition prevalence 15.2% (95 CI, 13.0%-17.4%); primary dentition prevalence 22.7% (95 CI, 17.3%-28.7%); 12-year-olds prevalence 18.1% (95 CI, 15.3%-21.0%); incidence rate, 2.82 (95 CI, 2.28%-3.42%) per 100 person-years; PR, 1.43 (95 CI, 1.34%-1.52%). Differences between WHO Regions were found. This study shows that more than one billion living people have had TDI. TDI is a neglected condition which could rank fifth if it was included in the list of the world's most frequent acute/chronic diseases and injuries.

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.

Psychosocial factors and traumatic dental injuries among adolescents

OBJECTIVES

To examine the association of traumatic dental injuries (TDI) and psychosocial factors in adolescents and to identify psychological profiles associated with TDI.

METHODS

A cross-sectional study was conducted involving 531 students aged 13-16 years. Data were collected through oral examination and a structured interview with the adolescents, in conjunction with a questionnaire answered by their mothers. Associations between TDI and independent variables were analysed using a model-based approach, while an exploratory data analysis was applied to identify homogenous clusters of adolescents in relation to their sense of coherence (SoC), perception of parental support and their mothers' SoC. These clusters were examined further for associations with TDI and psychosocial variables.

RESULTS

The prevalence of TDI was 15.8%. Adolescents with high TDI prevalence were males, nonfirstborns, or those frequently engaging in physical activity. In addition, both their own SoC and that of their mother were low and they reported low parental support. They were also prone to complaining about the behaviour of their peer group. The hierarchical cluster analysis (HCA) demonstrated three homogenous clusters. The cluster with the highest scores for all psychological variables included adolescents with low TDI prevalence, low paternal punishment, spacious home environment, high Family Affluence Scale (FAS) score, good school grades, few complaints about schoolmates and higher maternal education.

CONCLUSIONS

Psychosocial factors appear to influence an adolescent's risk of TDI. High parental support, high own and maternal SoC and a higher socioeconomic status (SES) are typical of adolescents with low TDI experience.

Knowledge and Attitude of Parents towards Avulsed Permanent Tooth of their Children and its Emergency Management in Bhopal City

INTRODUCTION

Dental avulsion is a commonly reported traumatic injury causing pain, aesthetic, functional, psychological and mental impairment. Since parents are in the immediate vicinity of children in such situations, their knowledge regarding the same is of great importance.

AIM

The aim of present study was to assess the level of parental knowledge and their attitude towards dental avulsion and its emergency management.

MATERIALS AND METHODS

A 10-stemmed questionnaire was prepared for this study which was modified form of questionnaire used by Raphael and Gregory. The questionnaire consisted of two parts and was provided in both English and Hindi languages. Parents had to mark one option provided to them in multiple choice questions, which they found to be right. A written consent according to ethical guidelines was taken by all the participants before filling up the questionnaire. The survey consisted of 550 parents who accompanied their children aged between 6 to 13 years in the Department of Pedodontics and Preventive Dentistry, Peoples Dental Academy, Bhopal, Madhya Pradesh, India. Chi- square test was applied to evaluate the associations in this study.

RESULTS

Statistically it was observed that 34.5% of male participants exhibited more knowledge regarding the necessity of reimplantation of avulsed tooth in comparison to female participants. Also parents with higher educational background have showed positive response toward knowledge and attitude of emergency treatment of avulsed permanent tooth. About 25.6% of higher secondary level, 20.9% of undergraduate level, 10.9% of elementary school level and 0.4% of illiterate participants responded that reimplantation of avulsed permanent tooth is possible.

CONCLUSION

It was concluded from the study that regardless of the age, education level or other factors, parental knowledge of tooth avulsion management was found to be very low in our society. Parents who participated in this study reported having insufficient knowledge about dental trauma and unskilled to provide emergency care to their child.

Strategies for Oral Health Research in Africa and the Middle Eastern Region

The highest burden of diseases worldwide is in low- and middle-income countries, but due to lack of capacity and inadequate infrastructure, research output from these countries is unable to address existing and emerging challenges in health care. Oral health research has particularly been hampered by low prioritization, resulting in insufficient development of this sector. There is an urgent need for research correlating oral health to upstream social and environmental determinants and promoting the common risk factor approach for prevention of noncommunicable diseases. Population-wide preventive measures for oral health care are more effective than purely curative approaches, especially for vulnerable groups who have limited access to information and appropriate health care. This article identifies priorities and proposes strategies for researchers, stakeholders, and policy makers for the initiation and sustenance of appropriate oral health care research. The proposed interventions are intended to promote collaboration, capacity building, and health advocacy. Local ownership in multinational research projects in low- and middle-income countries, complemented by skills transfer from high-income countries, is encouraged to ensure that regional health needs are addressed. Emphasis is placed on a shift toward translational research that has a direct impact on oral health care systems.

Impact of Dental Trauma on Quality of Life Among 11-14 Years Schoolchildren

Background

Traumatic injuries are common dental problems in pediatric dentistry that may influence the children's quality of life.

Aim

the aim of this study is to assess the impact of traumatic dental injuries (TDI) and oral health-related quality of life (OHRQoL) among Egyptian schoolchildren aged 11-14 years.

Materials and Methods

A cross-sectional study was carried out involving a sample of 11700 schoolchildren from public and private schools of Mansoura city, Egypt. OHRQoL was assessed using Child Perceptions Questionnaire. Clinical examination included the presence and type of TDI, malocclusion status, and dental caries in anterior teeth (decayed, missing, and filled teeth).

Results

The prevalence of TDI was 13.6%. Untreated TDI was more likely to have a negative impact on the children's daily living regarding pain, functional, emotional, and social aspect than treated injuries and control children. Pearson's correlation test indicated significant association between trauma and malocclusion and dental caries.

Conclusion

Untreated dental injury has a negative impact on quality of life regarding social, functional, and emotional aspects. However, treated injured teeth appear to improve social and emotional aspects of the OHRQoL of school children, whereas functional limitations may continue because of the pulpal and periodontal effects of the injury.

Does dental trauma in the primary dentition increases the likelihood of trauma in the permanent dentition? A longitudinal study

OBJECTIVES

The aim of this longitudinal study was to assess the likelihood of children suffering traumatic dental injuries in the permanent dentition subsequent to traumatic dental injuries in their primary dentition.

MATERIALS AND METHODS

A longitudinal study was conducted in Pelotas, Brazil. Children were assessed in 2007, when they were aged 2-5 years, and in 2013, at which time, they were aged 8-11 years. Data collection included interviews with parents and clinical oral examination for dental trauma and occlusion. The classification proposed by Andreasen and Andreasen was used, and crown discoloration and fistula were added to this criterion in order to assess pulp involvement. Child/parent report was used to aid in the diagnosis of both treated and untreated injuries. As a limitation, no radiographs were taken. Descriptive, univariate, and multivariate logistic regression analyses were performed.

RESULTS

A total of 110 children were included. Dental trauma frequency in the primary dentition was 38.2% and that in the permanent dentition was 30.9%. In the multivariate analyses, children with dental trauma in the primary dentition showed a higher likelihood of suffering dental trauma in the permanent dentition [odds ratio (OR) 2.97, 95% confidence interval (CI) 1.01-8.91, P = 0.05].

CONCLUSIONS

Individuals with previous trauma in the primary dentition are prone to further trauma in the permanent dentition. The history of dental trauma may be used to predict dental trauma in the permanent dentition and to establish preventive measures.

CLINICAL RELEVANCE

Behavioral characteristics may be related to the risk of a child suffering injuries. The results suggested that some children are accident-prone.

Prevalence of Traumatic Dental Injuries in Patients Attending University of Alberta Emergency Clinic

Objectives:

This study evaluated the prevalence of dental trauma for patients attending the emergency dental clinic at the University of Alberta Hospital between 2006-2009. Patients’ examination and treatment charts were reviewed.

Methods:

Total number of patients’ charts was 1893.The prevalence of different types of trauma was 6.4 % of the total cases (117 patients). Trauma cases were identified according to Ellis classification and as modified by Holland et al., 1988.

Results:

Logistic statistical model showed that 21.7% were Ellis class I trauma, 16.7% were Ellis class II trauma, and 6.7% were Ellis class III. In addition, 11.7 % presented with avulsion, 7.5 % presented with dentoalveolar fracture and 7.5% presented with sublaxation. Also, 17.55 % presented with tooth displacement within the alveolar bone, 3.3 % presented with crown fracture with no pulp involvement, 4.16 % presented with crown fracture with pulp involvement and 3.3 % presented with root fracture. In conclusion, the general prevalence of dentoalveolar trauma in patients attending the emergency clinic at the University of Alberta is less than other reported percentages in Canada or other countries.

Association of traumatic dental injuries with individual-, sociodemographic- and school-related factors among schoolchildren in midwest Brazil

The objective of this study was to assess the association of untreated traumatic dental injuries (TDI) with individual-, sociodemographic- and school-related factors among 12-year-old schoolchildren in Midwest Brazil. This cross-sectional study was carried out in 2010 in the city of Goiania, Brazil. A random sample of 2075 schoolchildren was examined and interviewed. Untreated TDI in the permanent incisors was assessed using the methodology of the Brazilian National Oral Health Survey. Rao-Scott test and multinomial logistic regression were used to analyze the associations between independent variables and three categories of TDI, using a hierarchical method. Independent variables were children’s sex, self rated color/race and size of incisal overjet, their mother’s level of schooling, and the schools’ type and geographic location. The prevalence of trauma was 17.3% (CI 95% = 15.2–19.4); enamel fractures were the most common TDI (13.1%). In the adjusted model, a higher chance of having two or more teeth with TDI was found among boys, those whose mothers had lowest level of schooling, and those attending schools located in health districts with lower socioeconomic indicators. It was concluded that the prevalence of TDI was low and that it was associated with individual factors as well as the school environments.

Traumatic dental injuries among 12-year-old Jordanian schoolchildren: an investigation on obesity and other risk factors

BACKGROUND

Traumatic dental injury (TDI) is an important public dental health problem among schoolchildren. The aim of the study was to investigate the relationship between TDIs, obesity, and other possible associated factors like gender, overjet, lip coverage, parents' education level and family income among 12-year old Jordanian schoolchildren.

METHODS

A cross-sectional population-based study examined a total of 1015 schoolchildren attending 34 schools randomly selected from urban and rural areas of Amman-the capital city of Jordan. The epidemiological classification adopted by WHO and modified by Andreasen et al. was used to classify TDIs. Obesity was defined according to the international cut-off points of body mass index for boys and girls between 2 and 20 years old.

RESULTS

The prevalence of TDIs was 16.3%. Enamel fracture was the most common type of TDIs (65%). Neither parents' education level nor family income had a significant effect on TDI occurrence (P > 0.05). Results of multiple logistic regression showed that TDIs were significantly more prevalent among males (OR = 1.42, CI; 1.01-2.01, P < 0.05), and children with inadequate lip coverage (OR = 1.95, CI; 1.35-2.81, P < 0.05). The relationship between TDIs and obesity was not statistically significant (P > 0.05).

CONCLUSIONS

Being a male with inadequate lip coverage was associated with higher probability of having a TDI. Obesity had no significant effect on the occurrence of TDIs.

Socio-economic indicators and predisposing factors associated with traumatic dental injuries in schoolchildren at Brasília, Brazil: a cross-sectional, population-based study

Background

This study assessed the prevalence of traumatic dental injuries (TDI) and its association with sociodemographic and physical characteristics in the anterior permanent teeth of 12-year-old schoolchildren at the city of Brasília – DF, Brazil.

Methods

A cross-sectional, population-based study was conducted on a sample of 1,389 boys and girls aged 12 years, enrolled in public and private fundamental schools at the Administrative Region (RA) of Brasília, Brazil, from October 2011 to September 2012. The demographic details were achieved by a structured questionnaire. The study recorded the type of damage, the size of incisal overjet, and whether lip coverage was inadequate. Sociodemographic data included sex, income and educational level of the parents or caretakers.

Results

A total of 1118 schoolchildren were examined, yielding a response rate of 80.48%. The prevalence of TDI was 14.63% in public schools and 23.40% in private schools. The students did not differ according to sex, income and educational level of the parents or caretakers concerning the occurrence of traumas in permanent anterior teeth. Increased overjet and inadequate lip coverage were found to be important contributing factors for TDIs.

Conclusion

In conclusion, this study showed an expressive prevalence of TDI in 12-year-old in schoolchildren at Brasília DF, Brazil. Sex and educational level of the parents were not associated with trauma. The increased overjet and inadequate lip coverage were significantly associated with dental trauma.

Traumatic dental injuries among 12-15-year-old-school children in panchkula

Background:

Traumatic dental injury (TDI) in children and adolescents has become one of the most serious dental public health problems. Despite such a high prevalence of dental trauma, very less attention has been paid to TDI, its etiology, and prevention.

Objectives:

To determine the prevalence of anterior tooth traumatic dental injuries in 12-15-year-old school children of Panchkula district, India, and to find any correlation with the cause, gender, extent of overbite as well as over-jet, and previous treatment.

Patients and Methods:

A multistage sample of 12-15-year-old school children (n = 810) in Panchkula district, Haryana, was selected. The children were screened using WHO criteria for oral examination and a trained dental surgeon examined the children. Those with clinical TDI were examined further for the type of traumatic injuries using Elis classification modified by Holland. Overjet and overbite were recorded. After examination, questions regarding the cause of trauma and its treatment were asked. Data were subjected to statistical analysis using the Chi square and Mantel-Haenszel tests by SPSS version 20.0.

Results:

The results showed that out of 810 children, 86 (10.2 %) had TDI. Males had higher prevalence of trauma than females (P < 0.05). The common cause of trauma was fall (51.11%) followed by sports injuries (41.86%). Enamel-dentin fracture without pulpal involvement was the most common type of trauma and the most frequent involved teeth were maxillary central incisors. A significant association was observed between overjet and overbite and trauma. Only 3.5% of the children affected with trauma had received treatment.

Conclusions:

The prevalence of traumatic injuries to permanent incisors in 12-15-year-old Panchkula school children was relatively high. TDI was associated with gender, overjet, and lip competence. There was a great unmet treatment need.

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

Traumatic Dental Injuries and Its Relation to Overweight among Indian School Children Living in an Urban Area

AIM

The aim of the present study was to determine the prevalence of traumatic dental injuries to permanent incisors and explore the association between dental trauma and overweight in a sample of school children residing in an urban area. Our hypothesis was that there was a significant association between overweight and the presence of dental trauma among urban children.

MATERIAL AND METHODS

This cross-sectional survey included 858 school children aged 10-12 years, of both sexes, randomly selected from 12 schools in urban Bangalore, India. The dental examination for traumatic injuries included only maxillary and mandibular permanent incisors. Anthropometric data were collected and Body Mass Index (BMI) was calculated (weight in kg/(height in meters)(2).

RESULTS

The prevalence of Traumatic Dental Injuries (TDI) was 15.04% and boys experienced more traumatic injuries than girls, but the difference was not statistically significant (p>0.05). OW boys sustained more TDI than OW girls and the association between dental trauma and OW was statistically significant (p<0.05; OR=3.85; 95% CI=2.62-5.24).

CONCLUSION

Overweight could be considered a significant risk factor for the occurrence of TDI to permanent incisors in Indian school children residing in urban areas.

Delayed orthodontic extrusion of a traumatically intruded immature upper permanent incisor - a case report

Dental injuries are probably the most common orofacial injuries sustained during sports and play. Intrusion or intrusive luxations occur when the teeth are driven into the alveolus by an axially directed impact. This article describes the clinical case of an 8-year-old patient who suffered complete intrusive luxation of an immature permanent central incisor following an accident. An attempt at spontaneous re-eruption failed to facilitate re-emergence of the tooth beyond 2 mm. The recommended wait-and-see strategy in anticipation of spontaneous re-eruption should cease to be an option when no further elongation can be observed. Orthodontic extrusion or surgical re-positioning is a valid treatment alternative when the former fails. In this case, although the recommended time period for effecting orthodontic extrusion had elapsed, this procedure was undertaken successfully presumably owing to the application of controlled, biologically optimal forces. A review of the extruded tooth a year later revealed no clinical or radiographic signs of loss of vitality. This was confirmed radiographically by the completion of root development, an intact lamina dura and no evident signs of resorption.

Effectiveness of educational poster on knowledge of emergency management of dental trauma-part 1. Cluster randomised controlled trial for primary and secondary school teachers

Objective

To investigate the effectiveness of educational posters in improving the knowledge level of primary and secondary school teachers regarding emergency management of dental trauma.

Methods

A cluster randomised controlled trial was conducted. 32 schools with a total of 515 teachers were randomised into intervention (poster) and control groups at the school level. Teachers’ baseline levels of knowledge about dental trauma were obtained by using a questionnaire. Posters containing information on dental trauma management were displayed in the school medical room, the common room used by staff, and on a notice board for 2 weeks in each school of the intervention group; in the control group, no posters were displayed. Teachers in both groups completed the questionnaire after 2 weeks.

Results

The teachers in the intervention schools (where posters were displayed for 2 weeks) showed statistically significant improvement in scores in cases where they had not previously learned about dental emergencies from sources other than first aid training, with an average score increase of 2.6656 (score range of questionnaire, −13 to 9; p-value <0.0001).

Conclusion

Educational posters on the management of dental trauma can significantly improve the level of knowledge of primary and secondary school teachers in Hong Kong.

KClinicalTrials.com HKCTR-1307

ClinicalTrials.gov: NCT01707355

Social vulnerability and traumatic dental injury among Brazilian schoolchildren: a population-based study

The aim of the present study was to test the association between social vulnerability and the prevalence of traumatic dental injury (TDI). A population-based cross-sectional study was carried out with 1,556 schoolchildren aged 11 to 14 years in the city of Belo Horizonte, Brazil. The participants were examined for TDI using Andreasen's criteria and those diagnosed with TDI were interviewed to determine the history of the injury. The Social Vulnerability Index (SVI) was used for socioeconomic classification, which addresses environmental, cultural, economic, legal and security/survival dimensions. The Poisson regression model was used for the multivariate analysis, with the significance level set at 5%. The prevalence of TDI was 14.1%; 59.3% of the participants with TDI did not seek a dentist after the incident. Poorer environmental, economic and legal conditions were statistically associated with the occurrence of untreated TDI (p < 0.05) and all the five SVI dimensions were associated with seeking a dentist due to TDI (p < 0.006). The prevalence of untreated TDI was higher among boys (PR: 1.42; 95%CI: 1.11-1.81) and those in situations of greater social vulnerability (PR: 2.27; 95%CI: 1.11-4.61). In conclusion, the male gender and high social vulnerability proved to be associated with the occurrence of TDI.

Traumatic dental injuries and related factors among sixth grade schoolchildren in four Palestinian towns

BACKGROUND

Traumatic dental injuries (TDI) are recognized as an important dental public health issue among children. The West Bank, a part of the Palestinian Authority, is in immediate neighborhood to Israel. There are inadequate epidemiologic data among the Palestinian people, on dental health issues.

AIM

To determine the occurrence of TDI to permanent teeth among sixth grade Palestinian schoolchildren living in four large towns of the West Bank and to investigate associations with anatomic and demographic factors.

MATERIAL AND METHODS

Eight hundred and four children were sampled and examined in Ramallah, Bethlehem, Hebron and Jericho. Data collection included clinical examinations in schools and questionnaires for demographic and socio-economic background.

RESULTS

The prevalence of traumatic dental injuries was 17.7%. Enamel fractures and injuries involving dentine accounted for 41% and 42.5% of all injuries, respectively. The most affected teeth (89%) were upper central incisors. Only 5% of the injured teeth were treated. Results of multiple logistic regression confirmed that TDI were significantly (P < 0.001) more prevalent among boys, children presenting incisal overjet larger than 5 mm, and incompetent lip coverage.

CONCLUSIONS

The relative high prevalence and very low levels of treated TDI identified in this study suggested that both prevention and treatment of TDI in the West Bank were inadequate.

The treatment of anterior dental trauma

BACKGROUND

Avulsed frontal teeth often cannot be saved because of improper or lack of initial treatment. The result is a need for multiple interventions over the patient's lifetime, which also carry a high financial cost.

METHODS

We explored the subject of lost anterior teeth in young patients with a PubMed search based on the term "prevalence of traumatic dental injuries" over the time period 2000-2010. In this article, we selectively review the publications retrieved by the search and give case examples to illustrate the proper initial treatment of children and adolescents (ages 6 to 17) with broken anterior teeth.

RESULTS

The search retrieved 138 articles. Here, we review retrospective clinical studies of dental trauma between the ages of 6 and 17: only 6 adequately designed studies of this type were found. The estimated prevalence of anterior dental trauma in this age group ranged from 6.4% to 37.9%. The recommended initial steps for the preservation of traumatized teeth are easy to take. Avulsed teeth can and should be replanted at once. If there is no time, or if the patient simultaneously has other, life-threatening injuries, the avulsed teeth can be stored in a special nutrient medium until they can be replanted. Commercially available tooth rescue boxes enable replantation to be performed up to 24 hours after the injury.

CONCLUSION

The authors of the selected studies agree that dental trauma is often improperly treated. Timely treatment of injured anterior teeth prevents much further damage and expensive treatment for the affected young patients.