Risk factors associated with traumatic dental injuries in individuals with special healthcare needs-A systematic review and meta-analysis

BACKGROUND/AIM

Individuals with special healthcare needs (SHCN) are more likely to sustain traumatic dental injuries (TDIs) due to distinct risk factors. The aim of this review was to assess various risk factors associated with TDIs in individuals with SHCN.

MATERIALS AND METHODS

The protocol was designed according to the recommendations of the Cochrane-handbook, Joanna Briggs Institute, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in PROSPERO (CRD42022357422). A comprehensive search was performed in PubMed, LILACS, Web of Science, EMBASE and Scopus using a pre-defined strategy without any limitation of language and year of publication. It was last updated on 25 April 2023. Studies addressing the TDIs in individuals with SHCN were included. Data extraction and analyses were performed, risk of bias (ROB) assessment was done using the Joanna Briggs Institute's critical appraisal tool, and a meta-analysis was performed using random-effects model.

RESULTS

A total of 21 studies were included in the review. They were categorized according to the target disease/condition: cerebral palsy (n = 5), ADHD and autism spectrum disorders (n = 5), visually impaired (n = 4), and multiple disorders (n = 7). The studies showed variability in the design and methods; however, 17 out of 21 studies showed moderate to low ROB. Increased overjet and lip incompetence were the main risk factors reported in the studies. The commonest injuries were observed to be enamel and enamel and dentine fractures.

CONCLUSION

The overall pooled prevalence of TDI in individuals with special healthcare needs was 23.16% with 20.98% in males and 27.06% in females. Overjet >3 mm and inadequate lip coverage were found to be associated with a higher risk of TDI in all the categories of individuals with special healthcare needs except ADHD and ASD. Falls at home in cerebral palsy, falls while walking and self-harm in ADHD and ASD, falls at home and collision in visual impairment, and unspecified falls in multiple disorders could be identified as the most common cause of TDI.

Comparison of two composite resin materials for splinting of dental luxation injuries: A double blind randomized controlled trial

BACKGROUND/AIM

Luxation is a common traumatic dental injury treated with a wire composite (WC) splint. However, bulk-fill flowable composite and conventional packable composite have not been compared for retaining these splints. Therefore, the objectives of this randomized controlled trial were (1) to compare retention of WC splints, and (2) to compare adhesive point dimension, application and removal time, and effect on tooth mobility between the two WC splints.

MATERIALS AND METHODS

In this parallel group, non-inferiority double blind randomized controlled trial, a total of 90 patients, aged 16-50 years participated. They were randomly allocated into two groups, the packable composite group (PC) n = 45 and the bulk-fill flowable composite group (BF-FC) n = 45 by lottery method. Following measurements were taken at the splint application appointment. Horizontal tooth mobility measured via Periotest, splint application time, and frontal images of splinted teeth to measure the percentage composite adhesive point area. After 2 weeks, splints were visually inspected for retention, whereas mobility and removal times were also recorded. Statistically, comparisons were made using independent samples sample T-test, Fisher's exact test, and Mann-Whitney U at p ≤ .05.

RESULTS

A total of 88 patients with 156 luxated teeth completed the trial, as two patients were lost to follow-up. Two patients in the PC group reported with completely de-bonded splints while none de-bonded in the BF-FC group. Both groups were similar in terms of splint retention (p = .352), reduction of mobility (p = .426), and splint removal times (p = .372). The BF-FC group performed significantly better in adhesive point dimension percentages (p < .001) and splint application time (p < .001).

CONCLUSION

Both groups were comparable in most parameters of the study. However, for BF-FC group application time and adhesive point dimension were significantly less.

A retrospective comparative study of maxillofacial injury patterns caused by electric scooters and bicycles

BACKGROUND/AIM

The emergence of shared stand-up electric scooters has led to an increase in their usage and, subsequently, an increase in the incidence of maxillofacial trauma. This study aimed to investigate the trauma pattern associated with the use of stand-up electric scooters compared with that related to the use of bicycles, which was a popular mode of personal mobility before the emergence of stand-up electric scooters.

MATERIALS AND METHODS

This study investigated the medical records of patients who visited Wonju Christian Hospital for maxillofacial trauma due to the use of stand-up electric scooter and bicycles between November 1, 2017 and October 31, 2022. Maxillofacial trauma was analyzed based on medical records, including those in the evaluation results of teeth, maxillofacial bones, and soft tissues.

RESULTS

Crown fractures and tooth avulsions were observed more frequently with the use of stand-up electric scooters than with the use of bicycles. In contrast, crown-root fractures, tooth subluxation, and extrusive luxation were more commonly observed in bicycle riders. Additionally, the proportion of root fractures was similar between the two groups. However, no vertical root fractures were observed in patients who rode bicycles. The maxillofacial bone fracture rates between the two groups were similar, although the fracture patterns were different.

CONCLUSION

The number of patients using stand-up electric scooters is increasing, and they are likely to have a worse prognosis compared with those using existing personal mobility devices.

Methods and applications of finite element analysis in dental trauma research: A scoping review

Finite Element Analysis (FEA) is vital for understanding dental traumatology (DT) biomechanics, aiding diagnosis, treatment planning, and outcome prediction. This review explores FEA applications in DT research, evaluates their quality and outcomes, and assesses methodological aspects. Accordingly, recommendations for future researchers are provided. The study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping reviews and registered in Open Science framework. A comprehensive search using relevant text-words and MeSH terms was performed in established databases. The inclusion criteria encompassed all Finite element analysis (FEA)-based Dental traumatology (DT) studies without language or publication year restrictions. Risk of bias was assessed with the Risk of bias tool for the use of finite element analysis in dentistry (ROBFEAD) tool. Forty-six studies published from 2001 to 2023 were included in the qualitative synthesis. The studies were categorized into five domains and six subdomains based on objectives. Maxillary central incisors and surrounding structures were commonly modelled (n = 27). Most studies utilized Computed tomography (CT), Cone Beam CT, or micro CT. Traumatic injury forces ranged from 100 N to 2000 N, and occlusal forces ranged from 150 N to 350 N. All studies were rated as high risk of bias. Fory-six studies were categorized, with most focusing on stress distribution and fracture patterns in dento-alveolar structures under various conditions, while few assessed displacements. Methodological quality lacked robustness in model development and substructure properties. Future studies should address these limitations and enhance reporting practices.

Qualitative research in dental traumatology-A narrative review

This review highlights the recent contributions of qualitative research in advancing understanding of dental trauma injury and the barriers and enablers to guide policy for improved patient-centred care including transitional care. It summarises the common approaches and methods used and outlines the key factors that guide the appraisal of qualitative studies. It highlights the importance of the application of qualitative research methods in dental research to generate rich and detailed data to provide explanations and insights into people's experiences, beliefs and attitudes and the complexity of human decision-making and behaviour. In the past decade while there have been a growing number of publications of qualitative studies in dental journals, qualitative studies remain a small percentage of the published dental traumatology research. This may be because of limited understanding about the background, methods and rigour of qualitative research.

Investigation of Anterior Teeth Fractures Among Students Aged Between 8 and 13 Years in Hyderabad, India

Introduction Trauma involving anterior teeth stands as a prevalent type of dental injury among school-age children, impacting physical, psychological, and social well-being. This study aimed to assess the occurrence of fractures in anterior teeth among school children in Hyderabad and its associated risk factors. Materials and methods This research incorporated a cross-sectional analysis, involving 2046 children in the age group of 8 to 13 years from different schools in Hyderabad City. Alongside clinical evaluations, all participants completed a questionnaire regarding traumatic dental injuries.  Results Results indicated a prevalence rate of 8.5%, notably higher among younger boys. Factors such as lip competence coverage, increased overjet, and malocclusion with maxillary incisor proclination were associated with a heightened risk of such injuries. The peak incidence was observed at age 12, with fractures involving enamel and dentin being the most common type, predominantly affecting the maxillary central incisors. Conclusion The findings emphasize the significance of educational programs aimed at enhancing awareness and understanding of dental injuries among parents, students, and school staff.

[Pulp revascularization procedure for external inflammatory dental root resorption treatment]

THE AIM OF THE STUDY

To assess the effectiveness of pulp revascularization procedure in children with external inflammatory root resorption (EIRR) after constant teeth injury.

MATERIALS AND METHOS

The study comprised 17 children aged 6-10 years diagnosed with EIRR as a long-term complication of dental trauma in 19 teeth. EIRR was diagnosed with periapical radiographs and CBCT was performed to further assess the pathology extension. Pulp revascularization was carried out in all 19 teeth.

RESULTS

There was no resorption progression in all cases. EIRR areas were substituted by bone. In 10 from 19 teeth with early stages of root development bone or cement-like tissue ingrowth into the root canal was observed radiologically. In cases of severe EIRR this ingrowth may partially compensate for lost tissues which is confirmed by a high percentage (94.7%) of functional teeth during mean follow up time of 38±10 months.

CONCLUSION

Pulp revascularization is an effective method for retaining teeth with EIRR for a relatively long period of time and allows maintaining alveolar bone volume both due to functional tooth preservation and healing of bone lesions in periapical and resorption areas.

Evaluation of problem-based learning in dental trauma education: An observational cohort study

BACKGROUND/AIM

Problem-based learning (PBL) allows higher thinking among dental students and has improved first-time pass-rates in predoctoral pediatric dentistry education. The aim of this retrospective observational cohort study was to evaluate the impact of PBL-based, traumatic dental injuries case discussions on predoctoral dental trauma education.

MATERIALS AND METHODS

Student performance and perceptions after receiving dental trauma curriculum with or without PBL-based dental trauma case discussions were evaluated. All the students challenged their simulated patient-based assessments. Three recall-based, objective structured clinical examinations, and critical thinking competencies assessed student knowledge about management of traumatic injuries affecting primary or permanent dentition including avulsion. The scores and number of attempts for each competency were compared between the study cohorts using t-tests. Student's self-perceived learning outcomes were measured through a voluntary, five-question survey. Mantel-Haenszel ordinal Chi-square tests were used to assess for differences in rates of agreement on survey responses from the students. Linear regression was used to assess effect of training on scores adjusting for student type (predoctoral or advanced standing). Pearson's correlations were used to assess association between scores. Significance was set at 0.05.

RESULTS

For the PBL cohort, there was a significant (p > 0.05) improvement in the first-time pass-rates and scores in three out of four competencies. A higher proportion of students in the PBL cohort perceived that their dental trauma education improved their radiographic and diagnostic skills compared to the cohort that did not receive PBL (p > 0.05). There was no correlation between recall-memory versus critical thinking competencies (r < 0.5).

CONCLUSION

The PBL-based dental trauma case discussion had a positive impact on predoctoral student learning and perceived benefits while managing simulated traumatic dental injuries. Due to a lack of correlation between recall-memory and critical thinking assessments, evaluation of predoctoral student's dental trauma competencies should involve multi-model assessment.

Avulsion Injuries: Assessment and Management

Avulsion injuries, though relatively uncommon, are one of the most serious of dentoalveolar injuries. Replantation at the scene of the incident is almost always the treatment of choice whenever possible. This paper outlines a step-by-step approach for the management of avulsion injuries, including a splinting protocol. This aims to support general dental practitioners in feeling more confident with managing these injuries.

Dental injuries in Swiss soccer supporters: A comparative study of regular fans, ultras, and hooligans for public health strategies

OBJECTIVES

Violence among soccer supporters continues to pose a significant public health concern in many parts of the world. In Switzerland, hooliganism is largely uninvestigated. This study aimed to examine incidents of violence and associated dental injuries among different groups of soccer supporters, as well as assess the impact of intoxicants on their behavior, using survey data from regular fans, ultras, and hooligans in the Swiss Football League.

MATERIAL AND METHODS

A cross-sectional survey using a standardized questionnaire was conducted among distinct factions of soccer supporters in the Swiss Football League in 2022. A total of 165 participants self-identified as belonging to one of three subgroups: "regular fan," "ultra," or "hooligan." Data were gathered on physical altercations, dental injuries, possession of mouthguards, intoxicant use, and medical assistance. Descriptive statistics, logistic regression models, and significance tests were used for data analysis (α = .05).

RESULTS

Hooligans had a higher frequency of dental injuries resulting from fights than ultras and regular fans. Hooligans with 11-20 fights per soccer season had a 9.6 times higher probability of dental trauma than those with 0-5 fights (p = .048). Possession of a mouthguard was associated with a lower risk of dental injuries for hooligans but an increased risk for ultras. Additionally, hooligans were found to differ significantly from other groups in their consumption of amphetamines and cocaine (p < .001).

CONCLUSIONS

The study found a strong link between physical altercations and dental injuries among soccer supporters. To promote better prevention, there is a necessity for enhanced educational initiatives facilitated by dentists to amplify the dissemination of mouthguards. Furthermore, it is crucial to raise awareness regarding their proper fitting to minimize the occurrence of combat-related dental injuries. Health authorities and other stakeholders should take a comprehensive approach to addressing some of the root causes of violent behavior, which include alcohol abuse and illicit substance consumption.

Effect of icariin surface treatment on the resorption of denuded roots after replantation in rat

AIM

Limiting the incidence of resorption associated with delayed replantation of avulsed teeth is critical for long-term tooth survival. In this study, we assessed whether icariin, a natural product with anti-osteoclastic properties, could reduce root resorption in a rat model of tooth replantation.

METHODOLOGY

Cytocompatibility of icariin (10, 20, 40 and 80 μM) was evaluated by CCK-8 proliferation assay in vitro, and an osteoclastogenesis assay was performed to evaluate the effect of icariin on the differentiation of rat bone marrow macrophages and human peripheral blood monocytes into tartrate-resistant acid phosphatase-stained (TRAP+ ) multinucleated giant cells (MNGCs). Differentiation of human periodontal ligament stem cells (hPDLSCs) treated with icariin (10 μM) was also evaluated at 5, 10 and 21 days of osteogenic induction. The first maxillary molars of five-week-old male Sprague-Dawley rats were extracted, denuded of PDL, then treated either with neutralized collagen solution (Carrier control) or icariin in collagen (3 μg/μL) before replantation into their sockets. The animals were euthanized 2 weeks post-surgery for micro-computed tomography (micro-CT) imaging and histological analyses.

RESULTS

Icariin was cytocompatible and significantly reduced the differentiation of TRAP+ MNGCs in a dose-dependent manner compared to the control. Moreover, icariin enhanced alkaline phosphatase activity, expression of osteogenic marker genes and proteins, and calcium deposition in hPDLSCs. Micro-CT imaging of the replanted samples demonstrated a significantly higher volume of remaining roots in the icariin-treated group than in the control group. Histological analysis revealed a marked number of resorptive lacunae with TRAP activity in the control group, whereas icariin-treated samples showed signs of functional healing and reduced osteoclastic activity.

CONCLUSIONS

Icariin was biocompatible and demonstrated potent anti-osteoclastic and pro-osteogenic properties that reduced resorption and promoted functional healing of denuded roots in a rat maxillary first molar model of replantation. These findings indicate that root surface treatment with icariin may be a clinically relevant and practical method for improving the retention and survival of teeth with compromised PDL after delayed replantation following traumatic avulsion.

Fluorescence-aided identification technique using a low-cost violet flashlight and rotatory instruments for dental trauma splint removal

BACKGROUND/AIM

Removing resin composites used for bonding dental trauma splints may result in irreversible damage to the enamel. This in vitro study evaluated the influence of additional violet illumination and different bur types on damage caused to tooth enamel.

MATERIALS AND METHODS

Fifteen maxillary models with four bovine incisor teeth were prepared. All models were scanned using a laboratory scanning system (s600 ARTI; Zirkonzahn). Six experimental groups (n = 10) were generated by two study factors: lighting type (three levels), (1) low-cost (5-7 US$) violet LED flashlight (LUATEK, LT 408); (2) VALO Cordless light curing unit (Ultradent) with black lens; or (3) without additional illumination; and rotatory instrument (two levels), (1) diamond bur or (2) multifluted tungsten-carbide bur. New scanning was performed after splint removal, and the generated files were superimposed on the initial scans using Cumulus software. The light emitted by both violet light sources was characterized by using integrating sphere and beam profile. A qualitative and quantitative analysis of enamel damage and two-way ANOVA followed by Tukey's post hoc was used at an α = 0.05.

RESULTS

The use of low-cost violet flashlight that emitted the violet peak light at 385 nm and VALO Cordless with black lens at 396 nm resulted in significantly lower damage to the enamel surface than those in the groups without additional violet light (p < .001). An interaction between rotatory instruments and lighting was found. When no additional violet lighting was used, the diamond bur presented higher mean and maximum depth values.

CONCLUSIONS

Fluorescence lighting facilitated the removal of remnant resin composite dental trauma splints, leading to less invasive treatment. The diamond bur resulted in higher enamel damage than that affected by the multifluted bur when no violet lighting was used. A low-cost violet flashlight is a useful fluorescence-aided identification technique for removing resin composite dental trauma splints.

YouTube™ as a source of tooth avulsion information: A video analysis study

BACKGROUND/AIM

Evaluate the informative content in tooth avulsion videos intended for dentists available on YouTube™ and analyse their compliance with the International Association of Dental Traumatology (IADT) guidelines 2020.

MATERIALS AND METHODS

Google Trends was used to identify the most searched term for tooth avulsion. Tooth avulsion-related videos in Brazilian Portuguese intended for dentists were searched on YouTube™ with a 12-month filter. Two raters reviewed these videos to extract their features and evaluate and qualify them with two 9-point checklists based on the IADT 2020 guidelines. The emergency steps for tooth avulsion at the accident site were assessed before, during and after clinical management; each step received 1 point if present and 0 points if absent. The final score ranged from 0 to 9 points on each checklist (18 points total), and the total score was used to classify the videos as having poor, moderate or rich content. Reliability and video quality were evaluated by an adapted version of the DISCERN tool and global quality scale (GQS), respectively. The data were analysed with the Mann-Whitney U-test, Pearson chi-square test, and the Kappa statistic (p < .05).

RESULTS

Of 60 videos, 8 were included. All were uploaded by dental professionals or undergraduate students; the average duration was 11 min (range: 0.40-65 min), and the average number of views was 56.75. Half the videos (50%) had maximum completeness scores for questions about emergency dentist referral before clinical management, and more than half (75%) had maximum completeness regarding the steps required during and after treatment. Rich videos had higher GQS scores (p = .049) without significant correlation.

CONCLUSIONS

Although most videos in Brazilian Portuguese were considered high-quality according to the IADT checklist, half of them presented partial absence of information regarding orientations at the accident site.

Improving data quality from routine clinical appointments-Development of a minimum dataset for traumatic dental injuries in children and adolescents

BACKGROUND/AIMS

It is currently difficult to evaluate the success or not of treatment for dental injuries due to poor recording of diagnostic and treatment codes in clinical dentistry. A minimum dataset comprises a standardised minimum set of outcomes along with a specified outcome measurement instrument, to allow aggregated use of data from routine clinical care appointments. This study aimed to determine which outcomes should be included in a minimum dataset for traumatic dental injuries (TDI).

MATERIALS AND METHODS

This is a three-stage sequential, mixed-methods study, using evidence-based best practice for dataset development. Normalisation process theory informed the development of the study protocols. In Stage 1, semi-structured interviews with patients and their parent or guardian were undertaken to identify outcomes of importance to patients. In Stage 2, an online Delphi survey was undertaken to identify outcomes of importance to clinicians. In Stage 3, a National Consensus Meeting was undertaken involving patient representatives, clinicians and other stakeholders, to agree which outcomes should be included in the minimum dataset.

RESULTS

Stage 1: Eleven participants were recruited, five children and six parents. Two key themes emerged from the analysis-communication and aesthetics. In Stage 2, 34 dentists were recruited, and 32 completed both rounds of the survey (97% retention). Most outcomes were deemed by participants to be of 'critical importance', with three outcomes deemed 'important' and none to be 'of limited importance'. In Stage 3, 15 participants took part in the consensus meeting. Participants agreed that the dataset should comprise a list of clinician-important outcomes (pulp healing, periodontal healing, discolouration, tooth loss) and a list of patient-important outcomes (communication, aesthetics, pain, quality of life).

CONCLUSION

A Minimum Dataset for TDI has been developed using a robust and transparent methodology.

What is important to medical students' online learning of dental trauma in medical education

Traumatic dental injury (TDI), a topic not normally offered in the medical curriculum is made available through the medical school as an online learning course. Online learning provides an educational pathway for cross-disciplinary learning without any change to the existing curriculum. This research identified important key features that should be included in the design of an online course to provide a positive online learning experience for medical students. Ten important features were identified for medical educators to consider when they develop an online course to introduce dental trauma. These features are (1) prioritising information to TDI, (2) providing specific facts and information to TDI, (3) information must be easily retrieved, (4) providing career-related information, (5) promoting self-confidence, (6) promoting learning of new knowledge, (7) easy-to-understand content materials, (8) establishing a logical sequence of learning, (9) visual illustrations to complement written text and (10) promoting self-directed learning.

Evaluating the prospective crown-root ratio after extrusion and crown lengthening procedures in vitro

For restoration of extensively damaged teeth preprosthetic treatment measures are necessary. Crown lengthening and extrusion affect the prospective crown-root ratio (CRR). The subject of this in vitro study was to compute CRRs for both treatment approaches. 120 human maxillary central extracted incisors were measured. Measurements were calculated for five treatment groups: C (control), E-2 mm (extrusion of 2 mm), E-4 mm (extrusion of 4 mm), CL-2 mm (crown lengthening of 2 mm), and CL-4 mm (crown lengthening of 4 mm). Tooth (TL), root (RL), and crown lengths (CL) were measured from mesial (m) and facial (f) cemento-enamel junction (CEJ), and respective anatomic (CRR) and effective crown-root ratios (eCRR) were calculated. Following CRR values were computed for C: CRR-m = 0.4 ± 0.1, CRR-f = 0.7 ± 0.1. All crown-root ratios were lower (more favourable) for extrusion compared to crown lengthening (p < 0.001). ECRRs were higher than anatomic CRRs. CRR at mesial CEJ was significantly lower than CRR with facial CEJ as reference (p < 0.001). Mesial measurement-based calculations of CRR typically based on radiographic images should be interpreted with caution as they underestimate the eCRR. CRR can be expected as lower, i.e. more favourable, when teeth are extruded than crown lengthened.

Long-Term Clinical and Radiographic Observation of Previously Regenerated Treated Incisors Subjected to Orthodontic Movement. A Case Series

INTRODUCTION

With an increasing number of anterior traumatized teeth treated with regenerative endodontic procedures (REPs) nowadays, orthodontic movement of such teeth is expected to become a common scenario in everyday clinical practice. However, little is known about the clinical implications and the response capacity of regenerated tissues to orthodontic forces.

METHODS

The aim of this clinical article was to report on 4 cases of REP-treated immature anterior permanent teeth subjected to orthodontic forces, and to describe the long-term response of the regenerated apical and intracanal tissues.

RESULTS

Signs of orthodontic-induced external root resorption were observed in 2 of the 4 presented cases without, however, the presence of any associated adverse events. No other complications were observed, either clinically or radiographically, throughout the observation period. In the long-term, all 4 cases responded favorably to orthodontic forces, maintaining healthy apical tissues and structural integrity of both intracanal as well as apically regenerated tissues.

CONCLUSIONS

The orthodontic movement of REP-treated teeth seems feasible, nevertheless, special care should be implemented. Lightly acting orthodontic forces, short duration of active movement, and close monitoring of the patient seem to be prerequisites to limit complications to a minimum and achieve a favorable healing of REP-treated teeth in the long-term following orthodontic treatment completion.

Combined nonsurgical and implant restoration after dental trauma: a case report

Dentoalveolar trauma is an important etiologic factor for tooth loss. A multidisciplinary approach to treatment is necessary because the functional, esthetic, and psychosocial problems that result from dentoalveolar trauma can significantly influence the patient's quality of life. The objective of this article is to describe the multidisciplinary treatment of a 39-year-old man who experienced dentoalveolar trauma in a bicycle accident. Clinical and tomographic examinations revealed the avulsion of the maxillary left central incisor as well as coronal fractures of the other incisors and the maxillary right canine. The maxillary right central incisor had a subgingival fracture, and the treatment included endodontic treatment followed by orthodontic extrusion using a temporary intraradicular retention pin and an orthodontic elastic band attached to a provisional prosthesis for anchorage. A dental implant and a connective tissue graft were placed at the site of the avulsed tooth. Subsequently, 5 zirconia crowns were fabricated using a digital workflow. In some cases of dentoalveolar trauma, orthodontic extrusion accomplished with the aid of the provisional prosthesis can be a conservative, fast, and economical option to preserve periodontal tissues and restore the biologic width. In the present case, the combination of orthodontic extrusion, implant placement, and a digital workflow ensured the precision, comfort, and esthetics of the final restorations, improving the quality of life of the patient.

Orthodontic management of traumatic dental injuries in Norway and orthodontists' perceptions of referral routines: A quality assurance survey

BACKGROUND/AIM

Orthodontic treatment of patients with traumatic dental injuries is challenging, with limited evidence of routines and outcomes. The aims of this study were: (i) to describe how orthodontists perceive the information on traumatic dental injuries received by referral from the Public Dental Health Service before orthodontic treatment and (ii) to assess orthodontists' knowledge and working routines in managing traumatic dental injuries.

MATERIALS AND METHODS

Data were obtained through a survey of all practicing orthodontists registered as members of the Norwegian Association of Orthodontists (n = 203).

RESULTS

Eighty-three orthodontists were enrolled, most of whom had received their dental degree (73.0%) and specialist orthodontic training (88.5%) in Norway. They reported examining patients with a history of traumatic dental injury at weekly (34.2%) or monthly (38.0%) basis. In 85.5% of cases, they obtained a history of traumatic dental injury from patients. Half of the respondents (51.3%) favoured two-phase early orthodontic treatment for patients with an overjet ≥6 mm. The observation time and treatment strategy showed considerable discrepancies across traumatic dental injury diagnoses. Most (59.1%) orthodontists considered the information on previous traumatic dental injuries provided by the Public Dental Health Services referral 'inadequate', more commonly in cases of mild (83.5%) than severe (57.5%) traumatic dental injuries.

CONCLUSIONS

Orthodontic management of patients with traumatic dental injuries was characterised by lack of uniformity in both recommended observation time before orthodontic treatment and management strategy. The referral routines by the Public Dental Health Services for patients with traumatic dental injuries were perceived as 'inadequate' in terms of frequency and quality. The results indicate the requirement of standardisation of routines related to orthodontic management of traumatic dental injuries and referral routines by the Public Dental Health Services.

Sedentary behaviour and traumatic dental injuries in adolescents: A population-based study

OBJECTIVE

Analyse factors associated with dental trauma in 12-year-old adolescents.

METHODS

An epidemiological survey was carried out in the five largest cities in the state of Mato Grosso do Sul, Brazil. Data on traumatic dental injuries (TDI) based on the World Health Organization (WHO), sociodemographic characteristics and individual clinical and behavioural characteristics in 615 adolescents were collected. Univariate and adjusted multilevel logistic regressions were performed to test the association of dental trauma with behavioural and sociodemographic factors. The study was approved by the Ethics Committee (CAAE number 85647518.4.0000.0021).

RESULTS

The prevalence of TDI at 12 years was 3.4% (95% CI 1.8; 6.4). In the adjusted models, clinical characteristics of adolescents such as overjet >3 mm (OR = 1.51 [95% CI 1.00; 2.41]) were associated with trauma. Sociodemographic characteristics such as female sex (OR = 0.13 [95% CI 0.07; 0.25]), income above the poverty level (OR = 0.34 [95% CI 0.15; 0.78]), who declared themselves white (OR = 0.23 [95% CI 0.11; 0.47]) and with sedentary behaviour (OR = 0.69 [95% CI 0.59; 0.80]) were associated with trauma, as protective factors.

CONCLUSION

Sociodemographic, behavioural and individual clinical characteristics were associated with TDI in adolescents. Oral health teams should focus on the most vulnerable groups, encouraging the use of mouthguards and access to treatment services.

The risk of healing complications in primary teeth with root fractures: A retrospective cohort study

BACKGROUND/AIM

Primary teeth are frequently affected by traumatic dental injuries. Root fractures are rare and have a reported incidence of 2% in the primary dentition. Hence, there is limited evidence on this topic. This study aims to evaluate the risk of healing complications in primary teeth with root fracture and to identify possible sequelae in the permanent dentition following root fracture in the primary dentition.

MATERIALS AND METHODS

A retrospective analysis of a cohort of 53 patients with 74 root fractured primary teeth. The standard follow-up program included clinical and radiographic examination after 4 weeks, 8 weeks, 6 months, and 1 year after the trauma and when the patient was 6 years of age. The following complications were registered: pulp necrosis (PN), pulp canal obliteration (PCO), ankylosis with replacement root resorption (ARR), infection-related root resorption (IRR), premature tooth loss (PTL), and repair-related resorption (RRR).

STATISTICS

The Kaplan-Meier and Aalen-Johansen estimators were employed. The level of significance was 5%.

RESULTS

A total of 74 teeth were included. 42 teeth were extracted at the initial examination. Risks estimated after 3 years: PTL 45.9% [95% CI: 28.8-63.0], PCO 12.9% [95% CI: 2.3-23.4], PN 14.9% [95% CI: 3.9-25.9], RRR 2.6% [95% CI: 0.0-7.5]. No teeth showed ARR or IRR. All complications were diagnosed within the first year. Most common sequelae in the permanent dentition was demarcated opacities, with an estimated risk of 20% [95% CI: 8.2-41.3].

CONCLUSIONS

There is a low risk of healing complications following a root fracture in the primary dentition. Root fractures often result in early extraction of the coronal fragment. The remaining apical fragment will undergo a physiological resorption. Aside from opacities, there is a low risk of sequelae in the permanent dentition.

The impact of COVID-19 pandemic on the epidemiological characteristics of permanent dental injury in Xi'an of China: A retrospective study

The coronavirus disease 2019 (COVID-19) has become a major global concern, seriously affecting the lives and health of the population. This retrospective study aimed to investigate changes in permanent tooth injury in the Xi'an area of China influenced by the COVID-19 pandemic. The medical records of 466 dental emergency patients in 2019 and 2020 were retrospectively analyzed. The number of injured teeth in a single patient, the number of injury types, the time from injury to hospital visit and follow-up visits within 1 year before and after the pandemic were analyzed using the chi-squared test and the paired t-test. There was significant difference in the number of emergency patients and trauma types before and during COVID-19 pandemic (P < .05). The time from injury to hospital visit and the interval between the trauma event and visit showed longer during the COVID-19 pandemic (P < .05). The rate of on-time follow-up in the following year was significantly decreased, and the rates of delayed visits and patients lost to follow-up were significantly increased (P < .05). The outbreak of the COVID-19 pandemic brought a certain change in the epidemiological characteristics of dental injury in the Xi'an area of China. Dental emergency departments should provide even more timely and effective treatments. It is also necessary to strengthen public education, with emphasis on the importance of timely medical treatment and regular follow-up for dental trauma.

Complications Arising from Dental Trauma Incurred from Falls Involving Geriatric Patients: A Case Report

Elderly patients have a high incidence of falls that result in facial injuries. Many cases present with dental crown fractures and soft-tissue lacerations. The initial diagnosis is especially important in this type of dental trauma, since an initial error can result in the failure to establish the correct treatment from the very beginning, worsening the prognosis, which, in the worst case, can compromise the teeth affected by the trauma. Case report: We present the case of a patient, a 79-year-old woman, who suffered an accidental fall. The patient was examined by a dentist in the emergency room. She was diagnosed with a simple crown fracture of the right upper central incisor and right upper lateral incisor without any pulpal involvement and with laceration of the lower lip. Months later, she had an episode of inflammation in the lower lip, and she developed edema and pain. An X-ray of the lower lip revealed a radiopaque mass compatible with a fragment of dental tissue due to the inclusion of remnants of the dental tissue resulting from the previous accident fall. Conclusions: The population of geriatric patients is steadily increasing in our society, and a higher frequency of falls has been observed in this age group, affecting the maxillofacial region, with consequent dental trauma on many occasions. Therefore, as professionals, we must pay special attention to the prevention and treatment of this problem, insisting on the importance of routine investigation in the emergency visit for dental trauma, which includes a meticulous examination of the soft tissues accompanied by a radiographic examination, when the inclusion of foreign bodies is suspected.

Illnesses and Injuries at a Remote American Residential Summer Camp Over 3 Seasons

INTRODUCTION

Residential and wilderness excursion summer camps are safe, but outdoor activities can lead to injuries. The frequency of various illnesses and injuries at summer camps has been incompletely described. The treatments provided and the need for escalation to higher levels of care are variable.

METHODS

A retrospective cohort analysis was conducted for all visits to a camp infirmary over 3 seasons at a residential summer camp in Minnesota. Seventeen descriptive categories of chief complaints and 13 categories of treatment disposition were created for all 695 eligible infirmary visits. The frequency and illness type for which escalation to a higher level of care beyond the camp infirmary was needed were reviewed.

RESULTS

Four hundred one campers sought medical care 695 times over 3 seasons. The most common chief complaints were related to skin (35%), musculoskeletal injury (17%), and upper-respiratory symptoms (15%). The most common treatment and dispositions were over-the-counter medications (43%) and simple bandage or dressing (19%). Escalation of care to a clinic or emergency room was uncommon, with 35 (5%) infirmary visits requiring escalation. Musculoskeletal injuries were the most common reason for escalations of care. While overall less common than musculoskeletal injury, dental injury almost always resulted in escalation of care.

CONCLUSIONS

An analysis of 3 y of visits to a summer camp infirmary was used by camp medical staff to update protocols and obtain new supplies for diagnosis and treatments. A more complete understanding of the prevalence of injuries and illnesses has the potential to allow better preparation for camp medical staff.

Dental trauma in children and adolescents with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis

AIM

Attention-deficit/hyperactivity disorder (ADHD) is a childhood neurodevelopmental disorder primarily characterized by inattention and hyperactivity that affects approximately 7.2% of children and adolescents worldwide. This study aimed to assess whether children and adolescents with ADHD were more likely to have dental trauma when compared to their healthy peers.

METHODS

This study was reported following the statements proposed in MOOSE (Meta-analyses Of Observational Studies in Epidemiology). PubMed, Web of Science, Scopus, Embase, APA PsycINFO, LILACS, and grey literature were searched until October 2022. Observational studies with a control group were eligible. The risk of bias was assessed using the Newcastle-Ottawa Scale. The meta-analysis was performed using the R language. GRADE (Grading of Recommendations Assessment, Development and Evaluation) was applied.

RESULTS

A total of 239 studies were detected; of these, six were included in the qualitative synthesis and four were merged in the meta-analysis (OR = 1.80 [1.16-2.80]; I2  = 18.6% [0.0%-87.5%]). The risk of bias was high. The strength of the evidence was "very low."

CONCLUSION

Children and adolescents with ADHD are more likely to have dental trauma than their non-ADHD peers. However, due to limitations in the design of the included studies, a causal relationship cannot be established.