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

BACKGROUND/AIM

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Prevalence of toothache and associated factors in children and adolescents: a systematic review and meta-analysis

OBJECTIVES

This systematic review aimed to determine the pooled prevalence of toothache in children and adolescents and to verify its association with sociodemographic characteristics and dental caries experience.

MATERIAL AND METHODS

Six main and three grey literature databases were searched in February 2021. Observational studies that assessed the prevalence of toothache and associated factors were included. The methodological quality of the studies was evaluated following the guidelines by Fowkes and Fulton. Proportion and association meta-analyses were performed in MedCalc and Revman software, respectively. The certainty of the evidence was determined with the GRADE approach.

RESULTS

Seventy-one studies met the inclusion criteria. Thirty-two presented high methodological quality and a low risk of bias. The overall pooled prevalence of toothache in children and adolescents was 36.2% (95%CI: 33.0-39.42; I²: 99.72%; P < 0.001). Females (OR: 1.17; 95%CI: 1.08-1.26; I²: 91%; P < 0.001) and children and adolescents whose caregivers had ≤ 8 years of schooling (OR: 1.42; 95%CI: 1.30-1.56; I²: 77%; P < 0.001) presented the higher chance of reporting toothache. Dental caries experience increased the chance of reporting toothache in 3.49 times (95%CI: 2.70-4.51; I²: 92%; P < 0.001). The certainty of the evidence was very low.

CONCLUSIONS

The overall pooled prevalence of toothache was considered high. Sociodemographic characteristics (sex and caregivers' educational level) and previous dental caries experience were significantly associated with toothache reports.

CLINICAL RELEVANCE

Toothache is still a recurrent issue in many countries. Thus, it is essential to understand its possible associated factors to reduce the occurrence of new episodes.

Prevalence of anterior open bite in children and adolescents: a systematic review and meta-analysis

PURPOSE

Anterior open bite is defined by the lack of incisal contact between the teeth in centric relation. The aim of this study was to determine the prevalence of anterior open in children and adolescents.

METHODS

This systematic review included a search in the databases: PubMed, Scopus, Web of Science, LILACS, Google Scholar, and ProQuest. The acronym PECOS was considered: (P) children and adolescents, (E) presence of anterior open bite, (C) not applicable, (O) prevalence, and (S) observational studies. The risk of bias assessment was carried out using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. The prevalence meta-analyses were performed using MedCalc^® software. The certainty of the evidence was determined with the GRADE approach.

RESULTS

26 studies were included. Eleven studies were judged at low, seven at moderate, and eight at high risk of bias. The overall prevalence of anterior open bite was 16.52% (95% CI 12.34-21.17) in children and adolescents. The prevalence was 19.38% (95% CI 13.77-25.69) in South America. The prevalence of anterior open bite was 22.67% (95% CI 16.56-29.43) among females and 16.99% (95% CI 11.77-22.94) among males. The prevalence of anterior open bite was 18.84% (95% CI 13.88-24.38) in the primary dentition, and 14.26% (95% CI 7.67-22.46) in the mixed dentition. The overall certainty of the evidence was very low.

CONCLUSION

The overall prevalence of anterior open bite was 16.52% in children and adolescents aged 2-16 years. Giving the limitations of a prevalence meta-analysis, the extrapolation of the results should be cautious.

REGISTRATION NUMBER

CRD42020183162, 10 July 2020.

Techniques to address fractured instruments in the middle or apical third of the root canal in human permanent teeth: a systematic review of the in vitro studies

OBJECTIVE

The objective of this study is to investigate techniques for approaching fractured instruments in the root canal and to present possible outcomes in relation to dentin thickness, fracture resistance, technique success, and clinical time.

MATERIALS AND METHODS

The bibliographic research was carried out in PubMed, Cochrane, Lilacs, Web of Science, Scopus, grey literature, and manual search. Following the inclusion and exclusion criteria, the titles and abstracts of 506 articles were read. Of these, 60 articles were selected and read in full. Fourteen articles were included in this systematic review.

RESULTS

The most studied technique was the ultrasonic technique and obtained good general results. The more apically the instrument is located, the more difficult it is to remove, the more dentin is removed, and the lower the fracture resistance of the tooth. When removal is not possible, the bypass technique can be performed (bypassing), and on weakened teeth or with little dental remnants, the GentleWave System technique can be used.

CONCLUSION

This systematic review shows the evidence from laboratory studies that the curvature and the root third in which the fracture of instruments occurred is relevant to fracture resistance and success. The ultrasonic technique got the best results. Well-conducted clinical studies should be performed for clinical practice.

CLINICAL RELEVANCE

The approach of fractured instruments in the root canal is efficient with the use of ultrasound, bypass technique, and Gentle Wave System.

THE PERCEPTION OF CAREGIVERS OF POOR ORAL HEALTH OF THEIR CHILDREN AND ITS RELATED CLINICAL CONDITIONS

Objective:

To determine the association between the perception of caregivers regarding the oral health of their children and socio-demographic characteristics, report of dental pain, and clinical oral conditions.

Methods:

A cross-sectional study was conducted with 570 children aged two to five years old, enrolled at public preschools, and with their caregivers. Data regarding perceptions of oral health status in children, socio-demographic characteristics, and dental pain were collected from a questionnaire. Three examiners (Kappa>0.7) evaluated children’s oral health status using the dmft index, pufa index, and the Andreasen classification for traumatic dental injury (TDI). The occurrence of open bite and overjet was also investigated. Descriptive analyses, and unadjusted and adjusted logistic regression were used, considering a 5% significance level.

Results:

A total of 24.7% of children had poor oral health status, which increased 4.92-fold (95% confidence interval [95%CI] 3.05-7.93) when children had dental caries, and 3.78-fold (95%CI 1.63-8.76) when there were consequences from dental caries. The perception of poor oral health was also associated to open bite (Odds Ratio [OR] 1.98; 95%CI 1.16-3.38) and TDI (OR 1.68; 95%CI 1.06-2.68). No associations were found between the perception of caregivers and socio-demographic variables or overjet.

Conclusions:

The perception of caregivers of poor oral health in their children was associated to dental caries, its consequences, TDI, and open bite.

Impact of social media on the oral hygiene habits of children and adolescents: a randomized controlled clinical trial

This study compared the impact of conventional oral health education with that of combined conventional and digital education on the oral hygiene outcomes and habits of children and adolescents. A double-blind, parallel, randomized controlled prevention clinical trial with 2 arms involved 80 students aged 10 to 17 years old. Students were randomly allocated to the control group (n = 40), which received conventional oral health education, or the experimental group (n = 40), which received both conventional oral health education and digital educational content through WhatsApp Messenger. Before the randomization of the groups and after the conclusion of the educational interventions, 2 examiners (κ > 0.7) who were blinded as to the groups evaluated the students and recorded the Plaque Index (PI); Gingival Bleeding Index (GBI); number of decayed, missing, and filled permanent teeth (DMFT); and number of decayed, missing, and filled primary teeth (dmft). The toothbrushing and flossing habits of the students were evaluated through questionnaires. The Fisher exact test, chi-square test, Mann-Whitney U test, Wilcoxon test for paired samples, and sign test were applied to the data (α = 0.05). After 3 students in the control group were excluded because they received fixed orthodontic appliances, 37 students participated in the control group and 40 in the experimental group. Both groups presented a 30% reduction in PI (P < 0.001) after the interventions. The experimental group flossed significantly more frequently (P = 0.003) than the control group. The interventions had no statistically significant effect on GBI, and there were no significant differences in toothbrushing frequency after interventions or between groups. Both approaches to oral health education-conventional and digital-had a positive impact on the reduction of the PI, and the use of a smartphone app seemed to be an effective resource for providing oral health education to students. Trial registration: Registro Brasileiro de Ensaios Clinicos (ReBEC) No. U1111-1216-4770.

Caregiver oral health literacy: relationship with socioeconomic factors, oral health behaviors and perceived child dental status

OBJECTIVE

To assess associations between caregiver oral health literacy (OHL) and socioeconomic factors, child and caregiver's oral health behaviors and perceptions of oral health status.

BASIC RESEARCH DESIGN

Cross-sectional study.

CLINICAL SETTING

University pediatric dentistry clinic.

PARTICIPANTS

205 pairs of caregivers and children aged 6 to 12-years undergoing dental treatment.

METHOD

A questionnaire was sent to caregivers enquiring about socioeconomic factors, oral health behaviors, perceptions of own and child oral health. The clinical dental status of the children was recorded with the DMFT/dmft index.

MAIN OUTCOME MEASURE

OHL was measured by the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30). Descriptive analysis, unadjusted and adjusted logistic regression, odds ratio and confidence interval were calculated considering a significance level of 5%.

RESULTS

The frequency of poor OHL was 21%. In adjusted analysis caregivers with 8 years or less of schooling had a 3.72 (95% CI 1.74-7.95) times greater chance of have poor OHL. Caregivers who perceived their child to have poor oral health were 2.70 (95% CI 1.10-6.63) times more likely to have poor OHL.

CONCLUSIONS

Poor oral health literacy was more common among caregivers with less schooling and a poor perception of their child's oral health. OHL was unrelated to monthly family income, child dental health status, perception of own oral health or child or caregiver oral health behaviors.

Dental care utilization among children in Brazil: an exploratory study based on data from national household surveys

Abstract Wide availability of access to dental services can be considered a predictor of better oral health outcomes in a population. This article aims to compare data from the Brazilian National Household Sample Surveys (PNAD) on dental services utilization among children aged 4 to 12 years. This cross-sectional study was carried out using data from the 1998, 2003, and 2008 National Household Sample Surveys, involving a total of 61.438, 64.659 and 59.561 children, respectively. Ninety-nine percent confidence intervals were considered for the prevalence of each outcome of interest. In 1998, 60.8% (99%CI: 59.4;62.1) of children had been to a dentist; this prevalence was 65.5% (99%CI: 64.4;66.7) in 2003 and 73.8% (99%CI: 72.1;74.2) in 2008. In 1998, 41.2% (99%CI: 39.1;43.3) of children in the lowest household income quartile had been to a dentist; this value was 61.4% (99%CI: 59.5;63.2) in 2008. Among children from families whose head of household had 4 years of formal education or fewer, 49.5% and 63% had been to a dentist in 1998 and 2008, respectively. The lifetime prevalence of dentist attendance among Brazilian children increased between 1998 and 2008, especially among those from low-income families and those whose head of household had a low educational level.

Oral Health Literacy as a Predictor of Dental Anxiety in Parents of Children Undergoing Dental Treatment

PURPOSE

The purpose of this cross-sectional study was to evaluate the association between parents' dental anxiety (DA) and independent variables.

METHODS

One hundred sixty-eight dyads of parents and six- to 12-year-old children who were undergoing treatment at a university pediatric dentistry clinic were recruited. Two examiners evaluated parents' DA and oral health literacy (OHL) using the Brazilian version of Corah's dental anxiety scale and the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30), respectively. Children's DA was reported by parents through the dental anxiety question (DAQ). Demographic data was also collected. A single examiner used the decayed, missing, and filled permanent teeth and primary teeth (DMFT/dmft) indices to assess the children's oral health status. The data analysis involved univariate and multivariate Poisson regression.

RESULTS

In the multivariate regression, higher levels of parents' DA were associated with a household income equal to or less than the Brazilian monthly minimum wage (prevalence ratio [PR]=4.9; 95 percent confidence interval [CI]=2.1 to 11.7) and a lower degree of OHL (PR=1.68; 95 percent CI=1.01 to 2.8). Associations between parents' DA and children's DA and DMFT/dmft index were not found.

CONCLUSION

Parents' dental anxiety was related to a low household income and low oral health literacy.