Combined effect of anterior malocclusion and inadequate lip coverage on dental trauma in primary teeth

Critical appraisal of confounding factors of observational studies on the association between dentofacial features and dental trauma in a Brazilian population

AIMS/OBJECTIVES

Dental trauma is a highly prevalent dental emergency. Children and adolescents without inadequate lip coverage, increased overjet, and anterior open bite are associated with the occurrence of traumatic dental injuries. Observational studies do not allow the inference of causality, one of the reasons being: the potential confounding factors. Therefore, this review aimed to critically appraise the confounding factors considered in epidemiological studies that associate dentofacial features with the occurrence of dental trauma in Brazilian children and adolescents.

METHODS

Studies included in the qualitative synthesis of a recently published comprehensive systematic review and meta-analysis on the topic were screened. Studies that only mentioned the performance of bivariate analyzes or that did not mention the performance of multivariate analyzes were excluded. Evaluation of control statements for possible confounders and bias consideration was performed for each selected study. Confounding factors in these studies were also identified and categorized according to their domains.

RESULTS

Fifty-five observational studies were screened, of which 11 were excluded due to the mention of only bivariate analyzes or the lack of multivariate analyses. The remaining 44 studies were critically appraised. Of these, 9 studies specifically mentioned the term confounding, and 12 studies mentioned the term bias. However, only 14 studies mentioned limitations on confounding factors in their findings. Among the 99 different variables identified, the most used were type of trauma, followed by sex and age.

CONCLUSION

Most studies did not acknowledge the control for possible confounding factors and rarely stressed the need for caution in interpreting their results. Cross-sectional studies do not allow inferring a cause-and-effect relationship between dentofacial features and dental trauma.

Lip incompetence and traumatic dental injuries: a systematic review and meta-analysis

Background/aim Traumatic dental injury is an impact injury to the teeth and/or other hard and soft tissues severity of which can lead to pain, as well as aesthetic, psychological, behavioural and functional problems among children. Lip incompetence directly exposes teeth increasing the risk of traumatic dental injuries. This review aimed to assess the existing evidence regarding association of lip incompetence and dental trauma.Methods The review protocol was registered with PROSPERO with Protocol number: CRD42020163069. Electronic searches of grey literature and three databases were performed. Cross sectional studies conducted between the years 2009-2019 on children aged 0-15 years were selected. Studies were evaluated with the help of NIH quality assessment scale. Data on research question, study population, inclusion and exclusion criteria, sample size justification, exposure and outcome clearly defined and adjustment for confounding variables were assessed. All analyses were performed using Review Manager 5.4.Results The study identified 10,223 articles, 33 were included. Among these 20 identified articles reported 'Good' quality with 13 studies reporting 'Fair' quality post assessment. Subject with lip incompetence were at 2.44 (1.59-3.75) times the risk of developing traumatic injuries during primary dentition. This risk increases to 3.26 (2.21;4.53) times in mixed and permanent dentition. At 12 years of age the OR for dental trauma is 3.77 (2.06;6.91) in subjects with incompetent lips.Conclusions The results confirm the association between lip incompetence and dental trauma.

Association of the prevalence and severity of untreated traumatic dental injuries with body mass index among Brazilian preschool children

BACKGROUND/AIM

Children with excess weight may be more predisposed to traumatic dental injuries (TDI). The aim of this study was to investigate the association between overweight/obesity and TDI presence and severity in Brazilian preschool children.

MATERIAL AND METHODS

A cross-sectional study was conducted of 347 children aged three to five years. The main exposure was evaluated based on the body mass index (BMI). Socioeconomic-demographic characteristics and harmful oral habits were investigated using a questionnaire sent to the parents/guardians. Oral clinical examinations were performed to determine overjet (criteria proposed by Foster and Hamilton), and the presence and severity of TDI (criteria proposed by Andreassen). Descriptive statistics were performed. Univariate and multivariate Poisson regression analyses were conducted for each outcome.

RESULTS

The prevalence of TDI in the sample was 41.5% and 16% of the children had enamel and dentin fractures. In the multivariate analysis, BMI and overjet were associated with the presence and severity of TDI (PR: 2.04 and 1.78, respectively) of TDI (PR: 2.27 and 2.24, respectively) (p < .001 for all associations).

CONCLUSION

Overweight/obesity was associated with both the presence and severity of TDI in early childhood.

Prevalence of dental trauma in Brazilian children and adolescents: a systematic review and meta-analysis

This study aimed to investigate the prevalence of dental trauma in Brazilian children and adolescents. A systematic review was conducted considering eight databases: MEDLINE (via PubMed), LILACS, BBO, Scopus, Embase, Web of Science, Open Access Theses and Dissertations, and OpenThesis. Only prevalence studies that used a probabilistic sampling method were included, without restriction on year or language of publication. The JBI critical appraisal tools for prevalence studies were used to assess the individual risk of bias. The individual studies were combined in the meta-analysis using the random-effects model. The heterogeneity between the studies was analyzed by Cochran's Q and the I-square statistics. A meta-regression analysis was performed to evaluate the sources of heterogeneity. The GRADE approach assessed the certainty of evidence across included studies. The search resulted in 2,069 records, of which 36 were included in the study. The eligible studies were published from 2000 to 2021, with a total sample of 40,194 children and adolescents. Most studies (75%) had a low risk of bias. In permanent teeth, the prevalence of dental trauma was 21% (95%CI: 16.0; 26.0) and in deciduous teeth; 35% (95%CI: 26.0; 44.0). The prevalence of dental trauma among boys was higher than among girls for both dentitions. Based on a low certainty, the prevalence of traumatic dental injuries in Brazilian children and adolescents is higher than that found worldwide both in deciduous and permanent teeth. Also, the prevalence of dental trauma among boys is higher than among girls.

Prevalence and patterns of traumatic dental injuries in primary teeth: a 3-year retrospective overview study in Vienna

OBJECTIVES

The aim of this study was to retrospectively identify the prevalence, patterns, and accident types of traumatic dental injuries (TDIs) in children with primary teeth in Vienna, Austria.

MATERIAL AND METHODS

The investigation was conducted as a retrospective overview study including all children with TDIs in primary teeth at the University Dental Clinic of Vienna (Austria) between 2014 and 2016. Dental records including age, gender, location of trauma, type of trauma, cause of TDI, and location of traumatic incident were obtained. Furthermore, the time of presentation and the time span between TDI and initial treatment were evaluated.

RESULTS

The sample comprised TDIs in 243 patients with 403 primary teeth. In a ratio of 1:1.45, boys were significantly more involved than girls. Upper central and lateral incisors were most frequently affected (n = 371, 92.1%). Dislocations were the most common type of injury (n = 298, 74%) with subluxations being the most prevalent form (n = 85, 28.5%). In 23% (n = 92), fractures were observed. The majority of traumatic incidents occurred at home (88.5%).

CONCLUSION

The injury characteristics are comparable to what has previously been reported in other studies in pediatric populations.

CLINICAL RELEVANCE

TDIs are a prevalent event in children worldwide and incisors are the most affected teeth in the primary dentition. Thus, dental practitioners should be able to handle these injuries.

The association of inadequate lip coverage and malocclusion with dental trauma in Brazilian children and adolescents - A systematic review and meta-analysis

BACKGROUND/AIM

Dental trauma (DT) occurs frequently in children and adolescents. Therefore, understanding the factors associated with its occurrence in these age groups is important to establish specific preventive measures. The aim of this study was to investigate the relationships of lip coverage, overjet, and open bite to dental trauma in Brazilian children and adolescents.

MATERIAL AND METHODS

The review protocol was registered in the PROSPERO database (CRD42020156290) and the bibliographic search was performed in nine electronic databases until July 2020. The studies included were observational, performed in Brazil, with healthy children and adolescents (0-19 years old), and without the restriction of date or language. Two reviewers assessed the individual risk of bias of the eligible studies with a standardized checklist. The meta-analyses were stratified by dentition stage and age range using fixed or random effects, odds ratio (OR) as the effect measure, and 95% confidence interval. The heterogeneity across studies was assessed with the I² test and the GRADE approach assessed the certainty of evidence.

RESULTS

The search presented 2493 initial results, from which 55 met the eligibility criteria and were included. Most studies (67%) presented a low risk of bias and were published between 2000 and 2019. Children and adolescents with inadequate lip coverage are 1.86-2.36 times more likely to suffer from DT, while those with increased overjet are 1.94-3.11 times more likely. Children with primary dentitions and anterior open bites are 1.76 (95% CI: 1.20-2.59) times more likely to suffer from DT. The certainty of evidence varied from very low to moderate.

CONCLUSIONS

Inadequate lip coverage, increased overjet, and anterior open bite are associated with the occurrence of dental trauma in Brazilian children and adolescents.

Web-based dental trauma database using Eden Baysal dental trauma index: a turkish multicenter study

Purpose

To describe the prevalence and pattern of traumatic dental injuries (TDIs) among Turkish children in a web-based and multicenter design using Eden Baysal Dental Trauma Index (EBDTI).

Materials and methods

The study sample consisted dental trauma patients aging 1-15 years and a webbased form was developed and used to record the information of the patients' clinical and radiographic findings including EBDTI. The obtained data also included patient gender, age at the initial date of trauma, date of trauma, cause of injury and emergency treatment. Data were analyzed using Pearson Chi-square and Fisher's exact tests.

Results

A total of 280 traumatized teeth in 252 patients were evaluated. Dental trauma was seen more in boys and 7-10 years age group (p<0.05). There were significant differences between permanent and deciduous teeth with regard to uncomplicated and complicated crown fracture rate (p<0.05). The root fractures were mostly located at the apical third of the root in both dentitions.

Conclusion

TDI was associated with age, gender, and type of dental trauma. EDBTI provided easy and proper recording of multiple dental injuries and maturity of the apex and it was found to be a very useful tool to facilitate online recordings of dental injuries.

The prevalence of traumatic dental injuries in primary teeth: A systematic review and meta-analysis

BACKGROUND/AIMS

The varied prevalence of traumatic dental injuries (TDI) in primary teeth around the globe raises a serious knowledge gap in the available literature. The aim of this study was to evaluate the prevalence of TDI in primary teeth and also to evaluate the different factors associated with TDI in primary teeth.

MATERIALS AND METHODS

Comprehensive searches were performed in PubMed, Embase, Google Scholar, and The Cochrane Central Register of Controlled Trials with predefined search criteria. The primary outcome was the prevalence of TDI in primary teeth, and the secondary outcomes were the factors associated with TDI in primary teeth. Qualitative analysis was done using the Newcastle-Ottawa scale adapted for cross-sectional studies. The random-effect model was used for meta-analysis, and meta-regression analysis was done to evaluate the heterogeneity between the included studies. Meta-analysis was done using the "meta" package of "R" language. The overall quality of evidence was assessed using GRADEpro GDT software.

RESULTS

A total of 24 cross-sectional studies met the inclusion criteria representing 4876 TDIs in 22 839 children aged between 0 and 6 years old. The overall prevalence of TDI in primary teeth was 24.2% (95% CI: 18.24-31.43, P = 0, I²  = 99%). Falls contributed the highest number of TDI - 59.3% (95% CI: 41.05-76.40, P < .01, I²  = 98%) - in primary teeth. The most common type of tooth fracture in primary teeth was an enamel fracture (61.9%), and prevalence of TDI in children with incompetent lip closure was 49.4%.

CONCLUSION

The prevalence of TDI in cross-sectional studies of primary teeth was 24.2% with very low quality of evidence. Falls contributed the highest number of TDI in primary teeth, accounting for 59.3%. Children with incompetent lip closure have the highest prevalence (49.4%) of TDI in primary teeth.

Association between malocclusion and the severity of dental trauma in primary teeth

BACKGROUND/AIMS

The literature does not clearly state whether the type of malocclusion is associated with a specific type of trauma and the severity of the injury. Hence, the aim of this retrospective study was to assess the occlusal condition in children with traumatic dental injuries of the primary teeth, and the association between the occlusal characteristics and the type and severity of these injuries.

MATERIAL AND METHODS

Data were collected from records of children treated at a dental trauma center in Brazil over a period of 16 years. The data included age, gender, etiology of the trauma, place of occurrence, number of affected teeth, type of trauma, and injury severity. The occlusal condition was assessed by a trained dentist using photographs of the patients from their first visit. Chi-square tests and Poisson regression were used for data analyses.

RESULTS

This study included 209 patients, and most were aged between 2-4 years (50.55%). Multivariate regression analysis showed that children with an anterior open bite had a 47% higher prevalence of severe trauma than those who did not have an anterior open bite, and those with class II canines had a 56% higher prevalence of severe trauma than those with class I and III canines. Children with an anterior open bite had a 46% higher prevalence of injuries affecting multiple teeth than those without an anterior open bite.

CONCLUSIONS

Anterior open bite and class II canine relationship were associated with a higher prevalence of severe traumatic dental injury in primary teeth, and anterior open bite was associated with trauma affecting multiple teeth.

Do malocclusion and orthodontic treatment impact oral health? A systematic review and meta-analysis

INTRODUCTION

Currently, there is limited evidence on the effects of malocclusion on oral health and whether the correction of malocclusion results in an improvement in oral health. In this review, we examined the evidence from randomized controlled trials and prospective cohort studies to provide information on any association between malocclusion and oral health and the effects of orthodontic treatment.

METHODS

We conducted this review in 2 parts: (1) we looked at the impact of malocclusion on oral health, and (2) we reviewed the evidence on the effect of orthodontic treatment on oral health. We searched for randomized controlled trials and prospective cohort studies. The searches were completed for articles published between January 1, 1990 and October 8, 2018 and covered Medline via Ovid, Embase, and the Cochrane Database of Systematic Reviews. References of included articles and previous systematic reviews were hand-searched. No language restrictions were applied. Two members of the study team assessed the quality of the studies using the Appraisal Tool for Cross-Sectional Studies to appraise the quality of studies in part 1. The assessment was performed at the study level. Two authors assessed each study independently, with a third author consulted when a disagreement occurred. For studies in part 2, we used the Newcastle-Ottawa scale to assess the risk of bias. When studies were included in a Cochrane review, we incorporated the risk of bias assessment. We developed data extraction forms for each area of oral health under investigation (trauma, quality of life, caries, and periodontal disease). Each author piloted the form, and we held discussions to inform any necessary refinements. We extracted data from studies into 2 × 2 tables, which provided a binary analysis of malocclusion vs the outcome of interest. If these data were not available from the published paper, then studies were not included in the meta-analysis. The authors were contacted when possible to request data in this format.

RESULTS

For part 1 of the study, we identified 87 studies. The overall quality was low. We could not include any of the data into an analysis because of a large variation in the nature of the studies, data collected, and outcome measures that were selected. For part 2 of the study, we found 7 studies; however, there were similar deficiencies in the data as in part 1, and thus, we could not reach any strong conclusions.

CONCLUSIONS

Overall, there is an absence of published evidence regarding the effects of malocclusion on oral health and the impact of orthodontic treatment on oral health.

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.

Maternal characteristics, home environment, and other factors associated with traumatic dental injuries in preschool children

BACKGROUND/AIMS

The importance of external factors such as maternal and home characteristics on traumatic dental injuries needs to be investigated. The aim of this study was to evaluate the association between maternal and home characteristics and dental trauma in preschool children.

MATERIAL AND METHODS

This cross-sectional study using a cluster random sample evaluated children between 3 and 4 years of age from Porto Alegre, Brazil. Mothers completed the Brazilian version of the Beck Depression and Anxiety Inventories (BDI and BAI). They answered questions about sociodemographics, maternal behaviors, and home characteristics. Dental trauma was assessed by the Children's Dental Health Survey criteria. Malocclusion and deleterious habits were also assessed. The multinomial logistic regression model was used to investigate the association of exploratory variables with different categories of dental trauma. Odds ratios (OR) and 95% confidence intervals were calculated.

RESULTS

A total of 163 pairs of children and mothers agreed to participate (78.4% response rate). The prevalence of dental trauma was 49.8%. Mother's work outside the home, overjet, and anterior crossbite were associated with the occurrence of enamel trauma, while having a younger mother, families having more siblings, and having a mother with university education were associated with increased odds of dentin/pulp trauma.

CONCLUSION

Depression and anxiety in the mothers were not associated with dental trauma, while malocclusion characteristics were more relevant for less severe, enamel trauma. Socioeconomic and home environment characteristics played a role in more severe, dentin/pulp trauma.

Traumatic dental injuries in preschool-age children: Prevalence and risk factors

This study examined the prevalence, socio-demographic correlates, and clinical predictors of traumatic dental injuries (TDIs) in the primary dentition among a community-based sample of preschool-age children. The sample comprised 1,546 preschool-age children (mean age 49 [range: 24-71] months) in North Carolina public preschools, enrolled in a population-based investigation among young children and their parents in North Carolina. Information on socio-demographic, extraoral, and intraoral characteristics was collected and analyzed with bivariate and multivariate methods, including logistic regression modeling and marginal effects estimation. The prevalence of dental trauma was 47% and 8% of TDI cases were "severe" (pulp exposure, tooth displacement, discolored or necrotic tooth, or tooth loss). In bivariate analyses, overjet and lip incompetence were significantly associated with TDI. Overjet remained positively associated with severe trauma in multivariate analysis, OR = 1.4, 95% confidence interval (CI) [1.2, 1.6], corresponding to an absolute 1.3%, 95% CI [0.7, 1.8], increase in the likelihood of severe trauma, per millimeter of overjet. Children with increased overjet (>3 mm) were 3.8, 95% CI [2.0, 7.4], times as likely to have experienced severe TDI compared with those with ≤3 mm. Overjet is a strong risk factor for TDIs in the primary dentition. Incorporating and operationalizing this information may help TDI prevention and related anticipatory guidance for families of preschool-age children.

Association between occlusal characteristics and the occurrence of dental trauma in preschool children: a case-control study

BACKGROUND/AIMS

Occlusal features may increase the risk of dental trauma. The aim of the present study was to evaluate the association between occlusal characteristics and the occurrence of dental trauma in preschool children.

MATERIALS AND METHODS

A population-based case-control study was conducted with a representative sample of 200 children 3-5 years of age enrolled at private and public preschools in the city of Diamantina, Brazil. The case and control groups were matched for gender, age and type of preschool (public or private) at a ratio of 1:1 (100 cases and 100 controls). Independent variables of interest to the study (occlusal characteristics) and potential confounders (sociodemographic characteristics, sucking habits and lip coverage) were investigated. Intra-examiner and inter-examiner kappa values were higher than 0.80 for all oral conditions evaluated. The SPSS 22.0 program was used to analyse the data. Descriptive and univariate analyses as well as simple and multiple logistic regression analyses were performed.

RESULTS

The occlusal feature most strongly associated with trauma was anterior open bite (OR = 3.80; 95% CI: 1.42-10.16). Maxillary anterior crowding (OR = 2.14, 95% CI: 1.00-4.63) and overjet (OR = 1.12, 95% CI: 0.58-2.17) were associated with the occurrence of trauma independently of the confounding variables (sociodemographic characteristics, sucking habits and lip coverage), but these variables lost their significance when adjusted for other types of malocclusion. Anterior open bite remained strongly associated with dental trauma, regardless of confounding variables and other types of malocclusion.

CONCLUSION

Anterior open bite was the main variable associated with dental trauma in the preschool children analysed independently of the confounding variables and the presence of other malocclusions.

Risk factors for traumatic dental injuries in the Brazilian population: A critical review

BACKGROUND/AIMS

Strategies for the prevention of traumatic dental injuries (TDI) should consider the risk factors involved for each population studied. The aim of this study was to perform a critical review regarding the risk factors for TDI in the Brazilian population.

MATERIALS AND METHODS

A systematic literature search was performed in the MEDLINE, Scopus, Web of Science, Lilacs, and BBO databases using MeSH terms, synonyms, and keywords, with no language or date restrictions. In the first step, all relevant studies identified, regardless of the type of statistical analysis performed, were grouped according to their geographic location. In a second step, the studies using Andreasen's criteria to classify the injuries and multivariate analysis to identify the risk factors for TDI in Brazilian subjects were included for data extraction.

RESULTS

The search strategy initially identified 3373 articles. However, only 108 articles assessed TDI with predisposing factors and were included in the first step. From those, 28 were deemed eligible for inclusion in the second step. No consensus related to the relationship between gender and TDI in the primary dentition was achieved. Nonetheless, males were found to be more prone to trauma in the permanent dentition. Overjet, inadequate lip sealing and anterior open bite increased the risk for TDI, both in primary and permanent dentitions. Social environment was related to trauma only in primary dentition. For permanent dentition, dental caries, obesity, binge drinking, and drug use were identified as considerable risk factors for TDI.

CONCLUSION

The risk factors for TDI in the Brazilian population are similar to those found worldwide. However, some differences can be observed, such as gender and socioeconomic indicators as predisposing factors.

Osseo-gingival pathology as sequelae of dental trauma to the primary upper incisor: a case series

BACKGROUND

Osseo-gingival pathology (OGP) may be observed in traumatized primary teeth, and its knowledge is essential for treatment decision.

AIM

To describe the occurrence and treatment of OGP in traumatized primary upper incisors.

DESIGN

One examiner collected data from patients' charts of the Clinic of Trauma in Primary Teeth of the University of Sao Paulo. OGP was divided into apical fenestration (AF), total gingival recession (TGR), and partial gingival recession (PGR).

RESULTS

From 2516 charts, 61 patients (2.4%) presented 73 teeth with OGP (9.6% AF, 19.2% TGR and 71.2% PGR). OGP was observed in 63% of male and 43.8% of children aged 4-5 years old. Mean time between trauma and diagnosis was 15 months AF, 23.5 months TGR, and 7.5 months PGR. Periodontal trauma occurred in 86.3% of teeth with OGP. Pulp necrosis was observed in all cases of AF and 92.9% of TGR; however, 76.9% of PGR were vital. All teeth with AF and 85.7% of TGR were extracted, and 44.2% of PGR were monitored.

CONCLUSIONS

Osseo-gingival pathology has low occurrence in traumatized primary upper incisors. The treatment for AF and TGR is tooth extraction, and for PGR is tooth monitoring or extraction depending on the case severity.

Trend of traumatic crown injuries and associated factors in preschool children

The aim of this study was to assess trends in traumatic crown injuries (TCIs), their prevalence, and association with socioeconomic and clinical factors in preschool children over a 5-year period. A series of cross-sectional surveys was conducted in Santa Maria, Brazil, on children attending a National Day of Children's Vaccination. The same protocol was used in all surveys conducted in 2008, 2010, and 2013. Clinical examinations were performed to evaluate types of traumatic crown injuries using the O'brien index. A semi-structured questionnaire was answered by the parents. It provided information about several socioeconomic factors as well as the parents' perception of their child's oral health. The chi-square for trends test was used to verify changes in TCI prevalence throughout the years. The association between socioeconomic and clinical factors with TCI was assessed by the Poisson regression analysis. A total of 1,640 children were examined. The prevalence of TCIs decreased significantly from 2008 to 2013 (10.12%; p < 0.001). Central incisors were the most vulnerable to injury, independent of the year. Moreover, older children and those with inadequate lip coverage were more likely to present with some traumatic dental injury (p < 0.001). prevalence of traumatic crown injuries decreased following the years, however TCI remain an important subject to consider when planning oral health policies.

Risk factors for traumatic dental injuries in the primary dentition: concepts, interpretation, and evidence

The purpose of this comprehensive review is to explore the main concepts related to quantification and interpretation of risk factors and investigate characteristics associated with traumatic dental injuries (TDI) in the primary dentition. Initially, the main concepts related to causality and risk factors were summarized, including how to measure, express, and compare risk as well as interpret statistical significance. Based on a structured search through PubMed, original research articles regarding TDI and associated factors in the primary dentition were then reviewed by two examiners. Studies with a sample size of at least 300 children aged between 0 and 6 years were summarized according to journal, country, study design, and type of statistical analysis. Variables associated with TDI in primary teeth were identified from studies with multivariable analysis. Measures of effect size and P values were presented. Thirty-two studies were retrieved: most were cross-sectional in design and only 17 (53.1%) performed multivariable analysis. Most investigations did not find an association between gender and socioeconomic variables with TDI. Increased overjet was the only factor consistently identified as an associated factor. Behavioral characteristics have been recently investigated and suggested as potential risk factors for TDI in the primary dentition. In conclusion, increased overjet is undoubtedly associated with TDI in the primary dentition. As behavioral factors may be targeted by preventive strategies, their role on TDI occurrence should be clarified in future cohort studies. Clinicians should understand the terms and measures described in studies on risk factors to properly apply knowledge and benefit patients.

Trends in the prevalence of traumatic crown injuries and associated factors in Brazilian preschool children: 10-year observational data

OBJECTIVE

To assess trends in the prevalence of traumatic crown injuries (TCI) in children aged 1-4 years living in Diadema city (Brazil) and to investigate whether TCI were associated with socio-demographic and clinical variables.

METHODS

Six cross-sectional surveys with representative samples were carried out from 2002 to 2012 following the same criteria and methodology. A total of 6389 children were evaluated and systematically selected on the National Children's Vaccination day. Calibrated examiners performed the children's oral examination for TCI according to Andreasen's criteria. Chi-square test for trends was used to perform comparative analysis. Poisson regression was used to associate TCI to socio-demographic and clinical variables.

RESULTS

The prevalence of TCI in 2002 for preschool children aged 1, 2, 3 and 4 years was 4.5%, 11.4%, 14% and 13.9%, respectively, and the prevalence in 2012 for the same age groups was 10.4%, 15.9%, 25.7% and 28.1%, respectively. There was a significant increase in the prevalence of TCI for all age groups and for the total sample (P < 0.05). Children's age was associated with TCI in all the surveys. Male gender, presence of anterior open bite and inadequate lip coverage were associated with TCI in some surveys along the years (P < 0.05).

CONCLUSION

This study has shown an increase of TCI prevalence in Brazilian preschool children in the last 10 years and its association with children's age, male gender, presence of anterior open bite and inadequate lip coverage. However, this increase does not seem to be relevant to decisions on public policy.

Impact of traumatic dental injury on the quality of life of young children: a case-control study

There are no longitudinal studies that assess the impact of traumatic dental injury (TDI) on the oral health-related quality of life (OHRQoL) of preschool children. To investigate the impact of TDI on OHRQoL among preschool children, a population-based case-control study was carried out with a representative sample of 335 children, 3-5 years of age, enrolled at public and private preschools in the city of Campina Grande, Brazil. The case group and the control group were matched for age, gender, type of preschool and monthly household income at a ratio of 1:4 (67 cases and 286 controls). Impact on the OHRQoL of children was assessed through administration of the Early Childhood Oral Health Impact Scale (ECOHIS). The occurrence of TDI was determined through clinical examinations performed by three calibrated dentists. Data analysis involved descriptive statistics, McNemar's test, the chi-square test with linear trend and conditional logistic regression analysis [P≤0.05; 95% confidence interval (95% CI)]. The most frequent responses were 'felt pain' (19.4%) and 'difficulty eating' (16.4%). The prevalence of TDI was 37.3% in the case group and 33.9% in the control group. No statistically significant differences were found between case and control groups regarding the presence of TDI (odds ratio=1.16; 95% CI: 0.66-2.02). TDI had no impact on the quality of life of preschool children.

Unusual transalveolar and transmuco-gingival root avulsion of a fractured primary central incisor: a case with an 8-year follow-up

The purpose of this unique case report is to describe a very unusual dentoalveolar fracture associated with avulsion of the near-complete root. A 3-year-old male patient came for consultation after a dentoalveolar trauma with a “fragment that looks like canine” found in his mouth by his mother. This boy suffered root fracture of the upper primary central right incisor, accompanied by transalveolar and transmuco-gingival avulsion of the tooth root fragment, leaving the crown in its position in the dental arch. Clinical and radiological examinations were performed in order to follow up the case: 15 days, one month, and three months after trauma, the crown had a slight mobility without other clinical or radiological signs. After six months, the upper primary central right incisor's crown was exfoliated. Open bite due to the persistence of the pacifier habit favored the crown retention in the mouth. This case emphasizes the importance of primary diagnosis and follow-up of trauma cases. To the best of our knowledge, this kind of dental injury has not been previously described in the literature nor in the current Dental Trauma guidelines for the management of traumatic dental injuries in the primary dentition.

Over two hundred million injuries to anterior teeth attributable to large overjet: a meta-analysis

BACKGROUND/AIM

The association between large overjet and traumatic dental injuries (TDIs) to anterior teeth is documented. However, observational studies are discrepant and generalizability (i.e. external validity) of meta-analyses is limited. Therefore, this meta-analysis sought to reconcile such discrepancies seeking to provide reliable risk estimates which could be generalizable at global level.

MATERIAL AND METHODS

Literature search (years 1990-2014) was performed (Scopus, GOOGLE Scholar, Medline). Selected primary studies were divided into subsets: 'primary teeth, overjet threshold 3-4 mm' (Primary3); 'permanent teeth, overjet threshold 3-4 mm' (Permanent3); 'permanent teeth, overjet threshold 6 ± 1 mm' (Permanent6). The adjusted odds ratios (ORs) were extracted. To obtain the highest level of reliability (i.e. internal validity), the pooled OR estimates were assessed accounting for between-study heterogeneity, publication bias and confounding. Result robustness was investigated with sensitivity and subgroup analyses.

RESULTS

Fifty-four primary studies from Africa, America, Asia and Europe were included. The sampled individuals were children, adolescents and adults. Overall, there were >10 000 patients with TDI. The pooled OR estimates resulted 2.31 (95% confidence interval - 95CI, 1.01-5.27), 2.01 (95CI, 1.39-2.91) and 2.24 (95CI, 1.56-3.21) for Primary3, Permanent3 and Permant6, respectively. Sensitivity and subgroup analyses corroborated these estimates.

CONCLUSIONS

Reliability and generalizability of pooled ORs were high enough and made it possible to assess that the fraction of global TDIs attributable to large overjet is 21.8% (95CI, 9.7-34.5%) and that large overjet is co-responsible for 235 008 000 global TDI cases (95CI, 104,760,000-372,168,000). This high global burden of TDI suggests that preventive measures must be implemented in patients with large overjet.

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.

Socioeconomic, behavioral, and anthropometric risk factors for traumatic dental injuries in childhood: a cohort study

AIM

To investigate risk factors for the occurrence of traumatic dental injuries (TDI) at 4 years of age.

DESIGN

Prospective cohort study.

METHODS

A birth cohort (n = 500) was recruited from the public healthcare system in São Leopoldo, Brazil. Demographic, socioeconomic, anthropometric, and behavioral variables were collected at 6 months, 1 year, and 4 years of age. Clinical examinations at 4 years of age were carried out by a single examiner using the Andreasen classification. Poisson regression was used to determine risk factors for the occurrence of TDI at 4 years of age.

RESULTS

A total of 23.7% of the children (80/337) exhibited TDI at 4 years of age. The risk of TDI was 35% lower among children who had been breastfeed for ≥6 months relative risk (RR 0.65; 95% CI 0.43-0.97) and more than twofold higher among those who were bottle fed ≥ three times a day (RR 2.37; 95% CI 1.10-5.11) at 12 months of age. Higher household income in the first year of life and greater height at 4 years of age were significantly associated with the outcome.

CONCLUSIONS

The identification of behavioral, socioeconomic, and anthropometric risk factors for TDI in early childhood can contribute to the elaboration of prevention strategies.

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.

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

AIM

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Pulp polyp in traumatized primary teeth--a case-control study

AIM

To assess clinical characteristics and other factors associated with the occurrence of pulp polyp in traumatized primary teeth as well to evaluate the impact of pulp polyp occurrence on clinical decision-making after traumatic injuries.

MATERIAL AND METHODS

This study was divided into three phases. First, occurrence and clinical characteristics of pulp polyp were assessed followed by a descriptive analysis and categorical tests of association. Secondly, a case-control design was used, and the occurrence of pulp polyp was set as the outcome. In third phase, the occurrence of pulp polyp after fracture with pulp exposure was investigated as a variable possibly associated with clinical decision-making (dental extraction/endodontic treatment). Logistic regression analyses were used, and odds ratios and 95% confidence interval (OR; 95% CI) were calculated in second and third phases.

RESULTS

Occurrence of pulp polyp in traumatized primary teeth was of 2.3%. Hyperplastic tissue color and proliferation size were not associated with the time to seek treatment after injury (P > 0.05). Children up to 2 years of age had more chance of having pulp polyp in comparison with older children (3.15; 1.15-8.64). Teeth with crown-root fracture had more chance of dental extraction in the therapeutic approach than the teeth with only crown fracture (4.36; 1.10-17.32). Presence of pulp polyp was not associated with the treatment carried out.

CONCLUSIONS

Occurrence of pulp polyp in traumatized primary teeth is not frequent and is associated with the age when traumatic dental injury occurs but does not interfere directly with the therapeutic approach.