History of the Dental Trauma Guide

Dental Pulp Stem Cells and Current in vivo Approaches to Study Dental Pulp Stem Cells in Pulp Injury and Regeneration

Dental pulp stem cells (DPSCs) have garnered significant interest in dental research for their unique characteristics and potential in tooth development and regeneration. While there were many studies to define their stem cell-like characteristics and osteogenic differentiation functions that are considered ideal candidates for regenerating damaged dental pulp tissue, how endogenous DPSCs respond to dental pulp injury and supply new dentin-forming cells has not been extensively investigated in vivo. Here, we review the recent progress in identity, function, and regulation of endogenous DPSCs and their clinical potential for pulp injury and regeneration. In addition, we discuss current advances in new mouse models, imaging techniques, and its practical uses and limitations in the analysis of DPSCs in pulp injury and regeneration in vivo.

How far have we come? A historic scoping review of dental traumatology literature

The status of the protocols used for the management of dental trauma (DT) in the eighteenth and early nineteenth-century is largely unknown. The end of World War II saw a tremendous resurgence of high quality research and the development of codes of ethics and publishing. The aim of this scoping review was to analyse articles related to aspects of DT published before 1945 in the English language. An expert group discussion was done to create an a priori protocol based on the PRISMA-2020-guidelines' extension for scoping reviews. A systematic search strategy based upon the Population (P), Exposure (E), Comparator (C), Outcome (O) and Time (T) was performed in five databases on 10 February 2022. Filters were used to identify the literature until 1945, and duplicates were removed. The scrutiny of the titles and abstracts and later the full texts was performed as per the pre-defined eligibility criteria. The grey literature and archives of the English language dentistry literature were searched, and a reference search was also performed. A total of 13 studies were selected from the databases and 20 from the reference searching. The first reported article was from the year 1872. Two other case reports had been published by 1899 and three more before World War I (1914). The majority of the studies originated from the United States of America. Nineteen were case reports, five were original research articles, two were classifications and guidelines papers, and one was a review. During the period before 1945, 33 articles were published regarding DT. The articles were mostly related to the description of cases, although there were a few original research papers. A significant observation, contrary to popular belief, was the presence of articles related to conservative management of injuries to tooth roots and the dental pulp. A progression in terms of the quality of protocols over time was also observed.

Re-evaluating the need for orthopantomography in the management of mandibular trauma: is computed tomography enough?

BACKGROUND

Mandibular fractures are frequent indications for computed tomography (CT) and orthopantomography (OPG) scans in emergency rooms. Numerous studies found CT to have higher sensitivity and enhanced accuracy compared to OPG in diagnosing mandible fractures. Controversy exists regarding additional need for OPG when evaluating dental trauma. This study investigates whether OPG adds diagnostic value to CT in mandibular trauma and whether additional OPG significantly alters management.

METHODS

A retrospective chart review identified 100 patients ≥ 18 years of age with known mandibular trauma who received CT and OPG in the emergency department between May 2015 and January 2020. All patients demonstrated a fracture in at least one study. CT and OPG studies were anonymized and randomized. A single attending surgeon evaluated mandible fracture and dental trauma characteristics and subsequently compared findings.

RESULTS

One hundred patient CT and OPG scans were reviewed. CT detected mandible fractures in all patients and OPG detected fractures in 93% (p = 0.01). Twenty-eight patients had different findings between scans. CT demonstrated 1 or more additional fracture(s) than OPG in 20 patients and dental trauma not seen on OPG in 4. OPG detected 1 fracture and no dental trauma that was not seen on CT. CT drove treatment-determining differences in 17 cases and OPG in 0 cases.

CONCLUSIONS

CT appears efficacious in detecting clinically significant mandible fractures and dental trauma with little additional benefit from OPG in emergency settings. Helical CT may be the only imaging necessary in evaluating patients with such trauma.

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.