Traumatic dental injuries in Brazilian children and oral health-related quality of life

Comparing fracture resistance on bovine incisors restored by tooth fragment reattachment versus direct composite restoration techniques

BACKGROUND/AIM

Anterior teeth are prone to traumatic dental injuries (TDIs). Although a number of techniques ranging from original tooth fragment reattachment (TFR) to direct composite restoration (DCR) can be used to restore uncomplicated crown fractures, there is no consensus on which method is best. The purpose of this study was to investigate the fracture resistance of bovine incisors restored by two different techniques (TFR and DCR) in three different fracture models.

MATERIALS AND METHODS

Sixty extracted bovine lower incisors were randomly divided into three groups (n = 20). Angle, oblique, or transverse sections of all the teeth in a group were prepared by using a disk. The cut surfaces were scanned, and the cross-sectional areas (CSA) of the enamel and dentin were measured. Half the teeth in each group were restored by DCR (n = 10) and the other half by TFR (n = 10). The forces required to fracture the restored teeth were then measured using a Universal testing machine, and the fracture modes were analyzed (cohesive, adhesive, or mixed).

RESULTS

No statistically significant differences between the TFR and DCR restorations were detected for total and enamel CSAs in any of the restoration shapes (p > .067). The fracture forces required to break DCR angle and transverse restorations were significantly greater than for the corresponding shapes restored with TFR (p < .033). However, the difference in the forces needed to fracture oblique section restorations by DCR or TFR was not statistically significant (p = .239), despite a similar trend (143.4 ± 51 N and 120.9 ± 25 N, respectively).

CONCLUSION

This study revealed that a greater force is required to fracture teeth restored by the DCR than by the TFR technique, especially for a transverse section. This demonstrates that restoring a fractured tooth provides a superior outcome compared to reattaching the fractured fragment.

Contextual and individual factors associated with traumatic dental injuries in deprived 12-year-old schoolchildren: A cohort study

AIM

Traumatic dental injuries (TDIs) among children and adolescents have been acknowledged as of public health concern worldwide. The aim of the study was to assess the relationship between contextual and individual characteristics and TDIs in 12-year-old schoolchildren.

MATERIALS AND METHODS

A cohort study was conducted with 355 schoolchildren living in deprived communities in the city of Manaus, Brazil. Contextual factors (place of residence and socio-economic indicators) and individual characteristics, including sex, family income, parents/guardians years of schooling, overjet and open bite (Dental Aesthetic Index), self-esteem (Rosenberg Self-Esteem Scale), sense of coherence (Sense of Coherence Scale), oral health beliefs, social support (Social Support Appraisals) were assessed at baseline. TDIs were measured at baseline and at 2-year follow-up using the O'Brien Index. Data were analysed through confirmatory factor analysis and structural equation modeling.

RESULTS

The baseline prevalence of TDIs was 17.6% and the incidence of TDIs at 2-year follow-up was 26.8%. Better psychosocial status had a direct protective effect on the incidence of TDIs (β = -.184). Better contextual characteristics (β = -.135) and greater overjet (β = -.203) were directly associated with poor psychosocial status. Higher schooling of parents/guardians directly predicted better psychosocial status (β = .154). Psychosocial status mediated the relationship of greater overjet (β = .036), contextual factors (β = .024) and parental/guardian schooling (β = -.027) with TDIs.

CONCLUSIONS

Contextual factors and individual characteristics predicted TDIs. Psychosocial status was a relevant individual attribute in the causal network of TDIs, due to the direct effect on the incidence of TDIs as well as a mediator on the influence of contextual factors, overjet and parents/guardians schooling on the incidence of TDIs.

Knowledge and Attitudes of Parents about Oral Health in the Primary Dentition Stage in a Peruvian High Andean City

Children's oral health depends on parents' knowledge and attitudes. The primary dentition stage, in particular, plays a crucial role in the comprehensive development of children. Therefore, the objective was to evaluate parents' knowledge and attitudes about oral health in the primary dentition stage in Chachapoyas (Amazonas, NW Peru). A questionnaire was administered to 409 parents from 15 educational institutions, and the data were analyzed using multinomial logistic regression. Among the surveyed parents, 75.3% could identify at least one habit harmful to their children's teeth (such as excessive sugar consumption) and one of its effects (such as dental caries). Additionally, 77.5% reported that their children presented some dental problem, more frequent in the peripheral areas than in the city's center. Gender (odd ratio, OR = 0.484; p = 0.037), educational level (OR = 2.144; p = 0.043), and type of health insurance (OR = 2.627; p = 0.044) of the parents influenced awareness of taking care of their children's primary dental health. The geographic location of the school (1.729 < OR < 2.079; p ≤ 0.011) and family income (OR = 3.504; p = 0.028) influenced parents' identification of the different harmful effects of children's habits. Factors such as low socioeconomic status and never taking the child to the dentist increased the risk of dental problems (p < 0.05). It is suggested that peripheral areas, like rural areas, lack the same oral health programs and access to treatment as central urban areas, leading to disparities in parental knowledge and attitudes.

Elementary school teachers' knowledge and attitudes toward emergency management of traumatic dental injuries

The consequences of traumatic dental injuries can be even more serious when their emergency management procedures are inadequate. Since traumatic accidents frequently occur at school, it is crucial that teachers be knowledgeable enough to assist an injured child. This study aimed to assess the knowledge and attitudes of the elementary school teachers of a Brazilian city toward dental trauma in permanent teeth, and its emergency practices. A combination of convenience and snowball sampling methods was used. An online questionnaire was distributed through social media, consisting of three parts: demographic characteristics and professional information; previous experiences and attitudes toward dental trauma; teachers' knowledge of this subject. Descriptive and statistical analyses were carried out. Pearson chi-squared test (p < 0.05) was used. A total of 217 teachers participated in the study. The power of the sample was 95%. Half of the teachers had already witnessed a dental trauma incident involving students, and 70.5% never received any information on the subject. The teachers who were provided previous information were the ones who opted to search for the tooth fragment (p=0.036) in cases of crown fracture, and for the lost tooth (p = 0.025) in cases of avulsion. They were also the ones who chose to wash the tooth in running water (p = 0.018), and look for a dentist in the first 30 or 60 minutes after the trauma (p = 0.026). Most of the teachers assessed did not have adequate knowledge of dental trauma. Having previous information was associated with more assertive practices in trauma management.

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.

Dental patient-reported outcomes following traumatic dental injuries and treatment: A narrative review

Dental patient-reported outcomes (dPROs) are self-reported descriptions of a patient's oral health status that are not modified or interpreted by a healthcare professional. Dental patient-reported outcome measures (dPROMs) are objective or subjective measurements used to assess dPROs. In oral healthcare settings, the emphasis on assessing treatment outcomes from the patient's perspective has increased and this is particularly important after traumatic dental injuries (TDIs), as this group of injuries represent the fifth most prevalent disease or condition worldwide. The purpose of this review is to summarize the current use of dPROs and dPROMs in the field of dental traumatology. Oral Health-Related Quality of Life, pain, swelling, aesthetics, function, adverse effects, patient satisfaction, number of clinical visits and trauma-related dental anxiety are the key dPROs following TDIs. Clinicians and researchers should consider the well-being of patients as their top priority and conduct routine evaluations of dPROs using measures that are appropriate, accurate and reflect what is important to the patient. After a TDI, dPROs can assist clinicians and patients to choose the best management option(s) for each individual patient and potentially improve the methodology, design and relevance of clinical studies.

Dental trauma and oral health-related quality of life among 7th-grade students of public elementary schools

Dental trauma is a public health problem because of its high prevalence rates and treatment costs and for affecting mainly younger individuals. Aim: This cross-sectional study aimed to investigate the variables associated with dental trauma and its influence on oral health-related quality of life among 7th-grade students of public elementary schools. Methods: The data was collected with semi-structured and self-administered questionnaires and an intraoral clinical examination (n = 204). The variables collected regarded dental trauma, lip coverage, overjet, oral health-related quality of life (Child Perceptions Questionnaire - CPQ11-14 ISF: 8), and sociodemographic profile. Association tests and the Mann-Whitney test were performed at a 5% significance level. Results: Dental trauma occurred in 12.3% of students, 94.6% had adequate lip coverage, and the mean overjet was 2.7 mm (±2.0). Sex was the only variable with a statistically significant association with dental trauma (p = 0.021). There was no statistically significant difference in the CPQ11-14 ISF: 8 score between students with and without dental trauma (p = 0.136). Conclusions: Dental trauma was significantly associated with sex and did not impact the oral health-related quality of life of the students.

Impact on Quality of Life and Risk Factors Associated with Visible Maxillary Incisors Trauma among Young Children in Faridabad, Haryana

Aim

To assess the impact of upper incisor trauma on the quality of life (QoL) in young children studying between the age group 8 and 13 years in Faridabad, Haryana.

Materials and methods

A cross-sectional, prospective study was conducted to assess the visible permanent maxillary incisor traumas according to the classification of traumatic dental injuries (TDI) and to determine the predisposing risk factors that affect TDI and their impact on QoL in children aged 8-13 years. Questionnaires were made to gather information on demographic and socioeconomic characteristics like age, gender, and the father's and mother's education. Data on dental caries in anterior teeth were also collected using current World Health Organization criteria.

Result

There were a total of 66 males and 24 females. The total decayed, missing, and filled permanent teeth (DMFT) prevalence observed was 8.9%. The main reason for trauma was found to be an accident or accidental fall (36.7%). The most common place for trauma followed by road (21.1%). Time lapsed from the injury reported was >1 year in males (34.8%), while it was within 1 year (41.7%) in females (p = 0.014). The most prevalent and impacted performance was smiling (80.0%; m = 8.7778 ± 8.658), and the least affected was speaking (4.4%; m = 0.5111 ± 3.002).

Conclusion

A number of risk factors need to be considered when assessing TDIs, as TDIs can have a negative impact on the functional, social, and psychological well-being of young children. As they are frequent in children, affecting teeth, their supporting structures, and adjacent soft tissues, they may cause both functional and esthetic problems.

Clinical significance

When injuries to incisor(s) produce pain, disfigurement, poor aesthetics, or other psychological effects, children may avoid laughing or smiling, and this can affect their social relationships. So, it is important to address the risk factors that predispose upper front teeth to TDIs.

How to cite this article

Elizabeth S, Garg S, Saraf BG, et al. Impact on Quality of Life and Risk Factors Associated with Visible Maxillary Incisors Trauma among Young Children in Faridabad, Haryana. Int J Clin Pediatr Dent 2022;15(6):652-659.

Does the school environment exert influence on quality of life related to traumatic dental injury in children?

The aim of this cross-sectional study was to assess whether favorable factors related to school characteristics have a positive effect on the impact of traumatic dental injury (TDI) on oral health-related quality of life (OHRQoL). An epidemiological survey of oral health was conducted with 12-year-old schoolchildren from Quito, Ecuador. Children were examined for TDI, dental caries, and malocclusion. Individual socioeconomic data were also collected. Information on the physical environment, health practices, and occurrence of negative episodes at school was collected from the school coordinators. The Child Perceptions Questionnaire 11-14 (CPQ11-14) was used to evaluate the OHRQoL (outcome variable). Multilevel Poisson regression analysis was conducted. Severe TDI was associated with higher CPQ11-14 scores, even in the multiple model adjusted for oral health conditions, sex, individual socioeconomic variables, and school-related variables. Children from schools that had an appropriate tooth-brushing environment for their students exhibited a lower impact on OHRQoL, even after adjustment for the occurrence of TDI and other variables. A favorable school environment may exert a positive effect on OHRQoL, independent of the occurrence of TDI.

Oral Health-Related Quality of Life in Children and Adolescents with a Traumatic Injury of Permanent Teeth and the Impact on Their Families: A Systematic Review

The aim of this systematic review was to evaluate the impact of a traumatic dental injury (TDI) of permanent teeth in children and adolescents on their oral health-related quality of life (OHRQoL) as well as on their families. A bibliographic search in the biomedical databases (PubMed, Cochrane Library, MEDLINE) was limited to studies published between January 2000 and February 2021. The study selection criteria were cross-sectional, case control, or prospective clinical studies, which analyzed TDI before and after the treatment of permanent teeth in healthy children and adolescent, assessed their OHRQoL, and were written in English. The search found 25 eligible articles that were included in the study. The quality assessment of the studies was performed using the quality assessment checklist for survey studies in psychology (Q-SSP). The results indicated that a TDI of permanent teeth strongly influences the OHRQoL of children and adolescents, and the timely-performed dental management of a TDI allows for preventing further biological and socio-psychological impacts. Sociodemographic status, economic status, parent’s education, gender, age group, and type of schooling were determinants of the TDI impact on OHRQoL.

[Application of the dental trauma guide of the international association of dental traumatology in a group of paraguayan dentists]

Objective

To evaluate the application of the dental trauma guide according to the International Association of Dental Traumatology in a group of Paraguayan dentists from April to May 2021. The was a descriptive, cross-sectional, observational study. A group of Paraguayan dentists with internet access accepted to participate in the study. The measurement instrument was a closed questionnaire from Google Forms, distributed by instant messaging (WhatsApp) from January to April 2021. Based on the Guidelines for the Evaluation and Management of Traumatic Dental Injuries by the International Association of Dental Traumatology (IADT), the questionnaire includes 20 questions on the assessment of clinical and radiographic signs, determination of treatment variables, differentiation of the type of treatment, biological consequences of trauma, materials and splint time, and postoperative indications and medication.

Results

230 dentists participated; the mean age was 33 (SD = 6.4) years, 70.43% were women, 30.87% were general dentists, and 70.87% were practicing exclusively in private practice. 68.70% responded that they were familiar with the management and treatment of dentoalveolar trauma, while 70.87% had not heard or read about the IADT dental trauma guide. Regarding the level of knowledge, 60.00% scored an average mark.

Conclusion

Most of the dentists surveyed had moderate knowledge regarding the evaluation and management of traumatic dental injuries.

Splint stiffness and extension effects on a simulated avulsed permanent incisor-A patient-specific finite element analysis

BACKGROUND/AIM

Splinting is an important procedure after avulsion. However, the role of splint stiffness and extension is not fully understood. The aim of this study was to evaluate the effect of splint stiffness and extensions on the mobility and stress on an injured tooth under physiological biting load.

MATERIALS AND METHODS

Three-dimensional (3D) finite element models were created from a cone beam computer tomogram of a patient with normal occlusion. An avulsion injury of the right central incisor was created with a 1000 N load application on the palatal of the injured tooth, causing increased socket width. Splints made from four materials were tested: 0.9 mm diameter wire-composite splint (WCS1), 0.4 mm diameter wire-composite splint (WCS2), 1.0 mm diameter nylon-composite splint (NCS), and a 2 mm high by 0.2 mm thick plastic strip composite splint (PSS). Three splint extensions (involving 6, 5, and 3 teeth) were evaluated. Mobility of the avulsed tooth and the maximum principal stress distributions in the adjacent teeth were calculated.

RESULTS

The injured incisor tooth mobility was not affected by the splint extensions. The NCS and PSS stabilized the avulsed incisor but allowed, respectively, 10 and 20 times more mobility under horizontal loading than the WCS1, which inhibited most mobility, while the WCS2 allowed double the mobility compared with WCS1. The NCS and PSS allowed more tooth mobility, mainly in the extrusion direction. Splints were 2-3 times more effective in limiting mobility under intrusive loads than extrusive loads. High levels of stress were found at the base of the composite attachments in the adjacent incisors.

CONCLUSION

Splinting an avulsed tooth to one or two teeth bilaterally using a nylon splint or a plastic strip is appropriate for tooth stabilization and should be recommended over the 0.4mm wire-composite splint, while the 0.9 mm orthodontic wire is too rigid and not recommended.

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.

Primary School Teachers' Knowledge on Tooth Avulsion

Objective

Permanent teeth trauma is most frequent in children aged 7-9 years, and the primary school teachers (PSTs) are often the first to notice it. The aim of this study was to evaluate the competence in tooth avulsion clinical issues and knowledge on dental trauma of PSTs, as they can occasionally take on the role of school nurses.

Material and Methods

Questionnaires were handed to 312 PSTs from 24 randomly selected primary schools in Zagreb, Croatia. An algorithm was designed for PST competence assessment.

Results

Response rate amounted to 81.37% (N=255). Only 3.14% (N=8) of the PSTs would replant the permanent tooth properly and only 43.92% of them (N=112) would immediately take the child to a doctor of dental medicine. Dry tissue, as a transport medium for an avulsed tooth, was chosen by 50.20% (N=128) of the respondents. Altogether, 4.71% (N=12) of PSTs were graded as competent in case of child’s tooth avulsion.

Conclusion

These results provided significant implications for school health, showed the educators' serious lack of knowledge in cases of dental trauma and stressed a need for continuous education of PSTs on the topic.

Impact of dental treatment and the severity of traumatic dental injuries on the quality of life of Brazilian schoolchildren

BACKGROUND/AIMS

Traumatic dental injuries (TDI) are most prevalent during adolescence and infancy, and they have an important impact on the oral health-related quality of life (OHRQoL). The aim of this study was to assess the effect of dental treatment and the severity of TDI on the OHRQoL of schoolchildren in public schools in Brazil.

MATERIALS AND METHODS

This cross-sectional study evaluated schoolchildren aged 11 to 14 years in Brasilia, Brazil. The criteria used for the examinations were TDI-O'Brien criteria; Dental caries-DMFT criteria; and malocclusion-the Dental Aesthetic Index. The impact of oral health on the children's quality of life was assessed with the Child Perceptions Questionnaire (CPQ_11-14 ) that was completed by the children while on the school premises. Socio-demographic information was also collected from the parents. Statistical analysis was performed using non-parametric and association tests, as well as linear regression.

RESULTS

A total of 20.2% of the students had some TDI in their permanent anterior teeth; 20% of traumatized teeth were treated, and 80% were not treated. Sorting by severity, 75.1% of the schoolchildren had a TDI involving only the enamel, and 24.9% had a TDI extending beyond the enamel. Significant differences were observed between the severity of a TDI and the total scores of CPQ_11-14 (Kruskal-Wallis; p = 0.0026), emotional well-being (p = 0.0006), and social well-being (p = 0.0001) when the group with TDI extending beyond the enamel was compared with the other groups (control and with TDI involving only the enamel), even after adjustment for socio-demographic and clinical variables. For oral symptoms and functional limitation, no differences were observed among the groups.

CONCLUSIONS

Dental trauma and fractures extending beyond the enamel, treated or not, have a negative impact on the OHRQoL of schoolchildren, suggesting effects on self-perception and in the social and emotional spheres.

Traumatic dental injury and oral health-related quality of life among 15 to 19 year old adolescents from Santa Maria, Brazil

BACKGROUND/AIMS

The literature is scarce on the association between traumatic dental injuries (TDI) and oral health-related quality of life (OHRQoL) among adolescents, and there is no study assessing this relationship using clinical criteria for the assessment of TDI in this age group. The aim of this study was to assess the association between TDI and OHRQoL among 15 to 19yearold adolescents from Santa Maria, Brazil.

MATERIALS AND METHODS

A population-based cross-sectional study was conducted including a representative sample of 1197 15 to 19yearold adolescents attending 31 public and private schools. The Oral Health Impact Profile-14 (OHIP-14) was used to evaluate the OHRQoL, and clinical examinations were performed to diagnose TDI based on the O'Brien classification. Demographic information, socioeconomic status, and clinical characteristics (caries experience, malocclusion, and gingivitis) were also collected as adjusting variables. Multilevel Poisson regression models were used to assess the association between TDI and OHRQoL. Rate ratios (RR) and 95% confidence intervals (95% CI) were estimated.

RESULTS

The overall prevalence of TDI was 17%, mild trauma was 12%, and severe trauma was 5%. In the adjusted models, adolescents with TDI had poorer OHRQoL than those without TDI (RR = 1.10; 95% CI = 1.05-1.16). This negative effect was related to the psychological disability domain (RR = 1.16; 95% CI = 1.02-1.32), to the social disability domain (RR = 1.34; 95% CI = 1.13-1.59), and to the handicap domain (RR = 1.35; 95% CI = 1.10-1.66).

CONCLUSIONS

Despite its low severity, TDI negatively affected the OHRQoL of 15 to 19yearold adolescents from Santa Maria, Brazil.

Influence of school environment on occurrence of traumatic dental injuries in 12 years old children

BACKGROUND/AIM

Since children spend most of their time in school, some environmental characteristics of the schools may influence the occurrence of traumatic dental injuries (TDI). Therefore, the aim of this cross-sectional study was to assess the prevalence of TDI in 12 years old children in Quito, Ecuador, and its association with some school environmental aspects.

MATERIAL AND METHODS

Six calibrated examiners evaluated 998 children from 31 public schools of Quito, to evaluate the occurrence of TDI in anterior teeth. School coordinators answered questionnaires on school physical conditions, promotion of health practices and the occurrence of negative episodes in school. The occlusion and socioeconomic status of the participants were also evaluated. Prevalence of TDI, unadjusted and adjusted by the design effect was calculated. Association between individual and contextual explanatory variables and presence of TDI were evaluated using multilevel Poisson regression analysis (P < .05).

RESULTS

TDI prevalence adjusted by design effect was 20.7%. Children studying in schools with patio floor of grass and with access ramps had significantly lower prevalence of TDI than children studying in schools with patio floor of cement and with only stairs, respectively. The prevalence of TDI was also lower in children from schools that offered healthy meals or that had a proper place for oral hygiene.

CONCLUSIONS

Schools with adequate physical structures and that promote health practices to their students have a lower prevalence of TDI.

Impact of uncomplicated traumatic dental injuries on the quality of life of children and adolescents: a systematic review and meta-analysis

BACKGROUND

Traumatic dental injuries (TDIs) are highly prevalent during childhood and adolescence and have a significant effect on their oral health related quality of life (OHRQoL). Uncomplicated TDIs, dental trauma involving enamel, enamel and dentin and tooth discolorations, account for approximately two-thirds of all diagnosed TDIs in children and adolescents. Hence, it may be important to understand the impact of uncomplicated TDIs on OHRQoL, by synthesizing the available literature.

METHODS

Medline, Embase, Web of Science and Scopus databases were systematically searched from January 1966 to April 2018. Studies that evaluated the effect of TDIs on the OHRQoL of children and adolescents using validated methods were selected for analysis. A narrative synthesis and a meta-analysis were performed. The studies were pooled according to age groups and OHRQoL questionnaire used. A random-effect model was applied to calculate the pooled odds ratios (OR) and their respective 95% confidence intervals.

RESULTS

There were 712 identified studies. Of these, 26 articles were selected for the review and included in the narrative synthesis, 20 of these articles concluded that uncomplicated TDIs were not associated with a negative impact in OHRQoL. Seventeen were included in the meta-analysis. The estimates were pooled by age groups: children (OR: 1.01; 95%CI; 0.85-1.19; I² = 51.9%) and adolescents (OR: 1.07; 95%CI; 0.91, 1.26; I² = 50.2%).When pooling all estimates the OR was 0.96 (95% CI: 0.85-1.10; I² = 61.4%).

CONCLUSIONS

Uncomplicated TDIs do not have a negative impact on the OHRQoL of children and adolescents. Further prospective studies are needed to confirm the results of this review. The majority of the studies included were of cross-sectional design, which may have limited the ability to reach conclusions on the nature of this association. The PROSPERO systematic review registry is CRD42018110471.

Dental trauma education intervention as a positive influence among undergraduate students

Objective

To investigate the effect of dental trauma educational intervention among undergraduate students of a Federal University in Brazil.

Materials and Methods

Students (n = 125) enrolled in the dentistry (n = 70), nursing (n = 33), and speech therapy (n = 22) courses were invited to attend a dental trauma lecture and also to answer a questionnaire about their confidence in managing crown fracture and tooth avulsion, before (T0) and immediately after (T1) the lecture. McNemar's test (P < 0.05) with logistic regression compared the answers between the courses.

Results

Female gender (78.4%) aged from 18 to 22 years (73.6%) predominated among all the participants. Dentistry students scored higher correct answers (54.3%) in T0 when compared to nursing (12%) and speech therapy (9%) students, concerning the storage medium for tooth fragment transportation. Likewise, few dentistry students (22.9%) and no nursing and speech therapy students knew about the ideal storage medium for an avulsed tooth when immediate replantation was unviable. After educational intervention, a significant improvement was found between T0 and T1 (P < 0.001) for all courses, mainly regarding tooth avulsion with almost 100% of correct answers. Furthermore, logistic regression demonstrated that dentistry students had three times more knowledge absorption than nursing and speech therapy ones.

Conclusions

The educational intervention demonstrated a significant positive impact regarding the knowledge of dental trauma emergency management among health students. Accordingly, it is essential to spread this information among health professionals to save teeth, especially in cases of avulsion.

Analysis of the combined risk of oral problems in the oral health-related quality of life of Brazilian adolescents: multilevel approach

OBJECTIVES

The objective of this study was to evaluate the combined risk of oral problems in the oral health-related quality of life (OHRQoL) of adolescents aged 15 to 19 years in São Paulo state (Brazil) in the year of 2015.

MATERIALS AND METHODS

Data from the São Paulo State Oral Health Survey (SBSP-15) and the contextual characteristics of the cities of São Paulo state, evaluated in the year 2015 were accessed. Correlations were made between contextual factors (i.e., coverage of the family health team, average supervised tooth brushing, number of first dental appointments, and average income), individual sociodemographic variables (i.e., ethnicity, gender, and schooling) and dental problems (dental pain, caries, overjet, open bite, indication for endodontic and exodontic treatment, gingival bleeding, and dental trauma). These variables were correlated with the quality of life of the adolescents using the Oral Impacts on Daily Performance (OIDP) index. Multilevel Poisson regressions were performed to calculate the rate ratio (RR) with 95% confidence interval (CI).

RESULTS

According to the bivariate analysis, the presence of low (RR, 1.62; 95% CI 1.07-2.46) and very intense (RR, 2.53, 95% CI 1.92-3.34) dental pain, indication for endodontic (RR, 1.31; 95% CI 1.05-1.63) or for exodontic (RR, 1.31; 95% CI 1.06-1.63) treatment, and gingival bleeding (RR, 1.41; 95% CI 1.11-1.80) reduced the quality of life of adolescents. All domains of OIDP scores were associated between healthy and unhealthy individuals (p < 0.001) increasing mean scores with combined oral health problems. Higher impact on quality of life was associated with simultaneous presence of dental pain, gingival bleeding, and indication for exodontic treatment (RR, 6.03; 95% CI, 4.02-9.04) in the adolescents.

CONCLUSION

Individual and contextual factors and the various dental problems are independently associated with the quality of life of Brazilian adolescents aged 15 to 19 years, especially when they are associated with the perception of intense dental pain, gingival bleeding, and indication for exodontic treatment, with up to six times greater impact on OIDP.

CLINICAL RELEVANCE

The study highlighted the importance for an integral treatment in adolescents, considering that the associated risk of several dental diseases can progressively affect the quality of life of this population.

Dentists' knowledge of dental trauma based on the International Association of Dental Traumatology guidelines: A survey in South Brazil

BACKGROUND/AIM

Dental trauma is a public health issue with a high prevalence in children. The aim of this study was to evaluate the level of knowledge of dentists in Rio Grande do Sul, Brazil, of the management of traumatic dental injuries, using the International Association of Dental Traumatology (IADT) Guidelines as a reference.

MATERIALS AND METHODS

An electronic questionnaire investigating personal and professional characteristics and 12 questions about dento-alveolar trauma, was sent to all registered dentists of the Regional Council of Dentistry of Rio Grande do Sul (n=14 753). The respondents were grouped according to the sociodemographic and professional profiles and the data were evaluated by the Student-T test or one-way ANOVA, with Tukey's post-hoc, with α = 5%.

RESULTS

A total of 1414 dentists responded to the survey (9.59% response rate). The overall mean self-reported knowledge of dental trauma was 5.87 ± 1.57, of a maximum possible score of 12. Some factors associated with a higher knowledge of the IADT guidelines were: female gender, previous clinical experience, years from qualification, self-reported knowledge, and academic postgraduate degree. Dentists who are specialized in endodontics (6.58 ± 1.63) and pediatric dentistry (6.05 ± 1.44) achieved higher levels of knowledge on dental trauma. Analysis of the characteristics (gender, location, and proportion of specialists) of the respondents confirmed that they were representative of the target population.

CONCLUSION

The overall level of knowledge of dentists from Rio Grande do Sul of the IADT guidelines is moderate. These results highlight the need for continuing education on dento-alveolar trauma in this population.

The impact of crown fracture in the permanent dentition on children's quality of life

BACKGROUND/AIM

Among the diseases related to oral health, traumatic dental injuries (TDI) can lead to pain, loss of function and aesthetic problems, with physical, emotional and social consequences for children and their families. The aim of this study was to investigate the relationship between enamel fracture and enamel-dentin fracture with oral health-related quality of life (OHRQoL).

MATERIAL AND METHODS

This cross-sectional study had a representative sample of 1589 children between 8-10 years of age from public schools. The OHRQoL was obtained through the Child Perceptions Questionnaire (CPQ_8-10 ), which is a questionnaire validated for Brazilian children. Clinical data were collected by 4 calibrated examiners (Kappa > 0.7) using the Decay, Missing, Filled Teeth (DMFT) Index, Dental Aesthetic Index (DAI) and TDI. A socio-economic questionnaire was sent to the caregivers to be answered at home. Descriptive statistics and Poisson regression with prevalence ratio (PR) and 95% confidence interval (CI) were used for statistical analysis.

RESULTS

The prevalence of TDI was 10.6%, and among these 10.3% who had an impact on the OHRQoL, it was due to enamel-dentin fracture. Children with enamel-dentin fracture had (PR 1.35; 95% CI 1.07-1.70) higher prevalence of impact on the OHRQoL. Children with enamel fracture had no impact on the OHRQoL (P = .254).

CONCLUSION

Enamel fracture had no significant impact on children's quality of life, while enamel-dentin fracture did have an impact on quality of life.