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da Silva Arduim A, Stefanello BW, Bonzanini LIL, Lenzi TL, Hilgert JB, Hugo FN, Casagrande L. Traumatic dental injuries and molar incisor hypomineralization: a cross-sectional study of schoolchildren from southern Brazil. Eur Arch Paediatr Dent 2024; 25:569-575. [PMID: 38848027 DOI: 10.1007/s40368-024-00918-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/22/2024] [Indexed: 08/23/2024]
Abstract
PURPOSE To describe the prevalence and the variables associated with TDIs in schoolchildren aged 8 to 14 years in Estância Velha city in southern Brazil, placing emphasis on molar incisor hypomineralization. METHODS Students enrolled in public schools of a medium-sized city in the southern Brazil were selected using cluster random sampling. Clinical examinations assessed molar incisor hypomineralization-MIH (European Academy of Pediatric Dentistry criteria), dental caries (DMFT index), and TDIs (O'Brien's criteria). Socioeconomic and demographic variables were assessed using a standardized questionnaire. Prevalence ratios were estimated using Poisson regression (p < 0.05). RESULTS 513 students (54.8% female), with a mean age of 11.6 (± 1.9) years, participated in the study. The prevalence of TDIs was 11.3%, with enamel fracture representing 90.4%. The high prevalence of traumatic dental injuries was associated with MIH (PR: 2.22 CI: 1.27; 3.87; p < 0.01) and overjet > 3 mm (PR: 2.03 CI 1.19; 3.45; p < 0.01). CONCLUSION The sample of schoolchildren from southern Brazil had a low prevalence of traumatic dental injuries. Molar incisor hypomineralization and increased overjet were associated with the higher prevalence of traumatic dental injuries.
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Affiliation(s)
- A da Silva Arduim
- School of Dentistry, Graduate Program in Pediatric Dentistry, Federal University of Rio Grande Do Sul, Ramiro Barcelos 2492, Santa Cecília, Porto Alegre, RS, 90035-003, Brazil
| | - B W Stefanello
- School of Dentistry, Graduate Program in Pediatric Dentistry, Federal University of Rio Grande Do Sul, Ramiro Barcelos 2492, Santa Cecília, Porto Alegre, RS, 90035-003, Brazil
| | - L I L Bonzanini
- School of Dentistry, Graduate Program in Pediatric Dentistry, Federal University of Rio Grande Do Sul, Ramiro Barcelos 2492, Santa Cecília, Porto Alegre, RS, 90035-003, Brazil
| | - T L Lenzi
- School of Dentistry, Graduate Program in Pediatric Dentistry, Federal University of Rio Grande Do Sul, Ramiro Barcelos 2492, Santa Cecília, Porto Alegre, RS, 90035-003, Brazil
| | - J B Hilgert
- School of Dentistry, Graduate Program in Pediatric Dentistry, Federal University of Rio Grande Do Sul, Ramiro Barcelos 2492, Santa Cecília, Porto Alegre, RS, 90035-003, Brazil
| | - F N Hugo
- School of Dentistry, Graduate Program in Pediatric Dentistry, Federal University of Rio Grande Do Sul, Ramiro Barcelos 2492, Santa Cecília, Porto Alegre, RS, 90035-003, Brazil
| | - L Casagrande
- School of Dentistry, Graduate Program in Pediatric Dentistry, Federal University of Rio Grande Do Sul, Ramiro Barcelos 2492, Santa Cecília, Porto Alegre, RS, 90035-003, Brazil.
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Boer FAC, Seixas GF, Maximiano TA, Ferraresso LFOT, Neto AC, Dezan CC. Union between deciduous and permanent as intrusive luxation sequelae: A case report. Dent Traumatol 2024. [PMID: 38853604 DOI: 10.1111/edt.12975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/11/2024]
Abstract
Traumatic dental injuries (TDI) are common in children due learning to walk and lack of balance that leads to falls. Luxation is the trauma that occurs most frequently in the deciduous, being that the intrusive and the avulsive are the ones that cause more damage to the permanent successors. The potential to cause disturbances to the developing permanent germ is high due to anatomical proximity and depends on age, direction of intrusion, severity and treatment. The consequences to the permanent range from hypocalcifications of enamel to retention of the permanent germ. In this case, the developmental disturbance of the tooth 21 presenting with acute dentoalveolar abscess was a result of a three-degree intrusive luxation of the deciduous predecessor. The tooth 61 was misdiagnosed initially as avulsion, but it was a total intrusion as uncovered after a radiographic examination that showed an image suggestive of the presence of the deciduous tooth. The deciduous was extracted along with his permanent successor through outpatient procedure under antibiotic coverage and local anesthesia. The macro and microscopic analysis of the piece evidenced the presence of elements 21 and 61 closely united, as well as alterations provoked in both. There was remission of the infectious process and after 7 days it was verified the correct healing of the surgical wound. The radical outcome of this case emphasizes the relevance of appropriate clinical support as soon as possible in all TDI.
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Affiliation(s)
| | - Gabriela Fleury Seixas
- Department of Oral Medicine and Dentistry for Children, State University of Londrina, Londrina, Paraná, Brazil
| | - Thais Alexandre Maximiano
- Department of Oral Medicine and Dentistry for Children, State University of Londrina, Londrina, Paraná, Brazil
| | | | - Antonio Carrilho Neto
- Department of Oral Medicine and Dentistry for Children, State University of Londrina, Londrina, Paraná, Brazil
| | - Cássia Cilene Dezan
- Department of Oral Medicine and Dentistry for Children, State University of Londrina, Londrina, Paraná, Brazil
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Negro BD, Hermann NV, Lauridsen E, Mendes FM, Wanderley MT. Risk factors associated with the occurrence of avulsion in the primary incisors: A case-control study. Int J Paediatr Dent 2024. [PMID: 38572855 DOI: 10.1111/ipd.13172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/22/2024] [Accepted: 02/12/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Identifying factors associated with the occurrence of primary tooth avulsion is essential to promote prevention strategies. AIM To investigate the risk factors associated with primary incisor avulsion and variables associated with post-avulsion sequelae in the permanent successor. DESIGN This case-control study comprised 407 children (cases) with primary incisor avulsion and 407 children (controls) with other traumatic dental injuries (TDI). The association between explanatory variables and avulsion was evaluated through logistic regression. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated. Poisson regression analyses between potential explanatory variables and sequelae were run, from which relative risks (RR) and corresponding 95% CI were estimated. RESULTS TDI caused by moderate falls (OR = 2.20; 95% CI = 1.47 to 3.27), affecting lateral incisors (OR = 10.10; 95% CI = 3.89 to 26.54) and the lower arch (OR = 9.54; 95% CI = 3.15 to 28.85), were associated with primary incisor avulsion. Moreover, children with previous severe TDI, anterior open bite, and anterior crossbite had higher odds of primary incisor avulsion. Children who suffered from any primary tooth avulsion (RR = 2.68; 95% CI = 1.82 to 3.95) had a higher risk of sequelae in the permanent successors. The risk for sequelae in the permanent teeth was significantly greater for younger children under age 2 years than for children ages 3 to 5 years. CONCLUSION Risk factors for primary incisor avulsion are related to the severity of the fall, tooth position, history of previous TDI, and malocclusion. Furthermore, avulsion increases the risk of sequelae in the permanent successors.
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Affiliation(s)
- Bianca Del Negro
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of São Paulo - USP, São Paulo, Brazil
| | - Nuno Vibe Hermann
- Department of Pediatric Dentistry and Clinical Genetics, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Eva Lauridsen
- Department of Oral and Maxillofacial Surgery, University Hospital, Copenhagen, Denmark
| | - Fausto Medeiros Mendes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of São Paulo - USP, São Paulo, Brazil
- Department of Dentistry, Research Institute for Medical Innovation, Radboud university medical center, Nijmegen, Netherlands
| | - Marcia Turolla Wanderley
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of São Paulo - USP, São Paulo, Brazil
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4
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O'Connell AC, Olegário IC. International teaching practices in dental trauma education. Dent Traumatol 2024; 40:152-160. [PMID: 37915297 DOI: 10.1111/edt.12906] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND/AIM Several publications highlight the insufficient knowledge possessed by dentists and dental students regarding the management of traumatic dental injuries (TDIs). A lack of clinical experience during Undergraduate (UG) education could explain the reported deficits in managing dental trauma post-graduation. Despite its importance in dentistry, there are very few reports on how, where and who teaches Dental Traumatology (DT) in the UG curriculum. The aim of this study was to investigate teaching practices in DT around the world in UG education. MATERIALS AND METHODS UG educators involved in DT teaching activities were invited to complete an online questionnaire hosted on Qualtrics®. The survey consisted of close-ended and open-ended questions on their teaching practices in DT. Only one answer per institution was included in the final descriptive analysis. RESULTS A total of 203 responses from 164 institutions were obtained from 69 countries. All institutions reported that DT is included in their UG curriculum, and is mainly taught within Paediatric Dentistry and Endodontics. Most teaching and evaluation was delivered in traditional format. The number of contact hours dedicated to DT teaching activities ranged from 2 to 185 h (median = 10). Only 35% of institutions had a unified approach across disciplines. DT was taught as a separate course/module in 23% of the universities. Insufficient exposure to emergency care and the lack of formal clinical exposure to TDI was highlighted by many institutions. The need for a core curriculum was supported by 84% of the institutions with agreement on essential topics required at UG level. CONCLUSIONS Teaching practices in DT varied internationally. Very few teaching hours were devoted to DT and many institutions identified a need for increased clinical exposure. There was a desire for a standardised coherent approach to DT in the UG education with suggestions to improve educational resources.
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Affiliation(s)
- Anne C O'Connell
- Dublin Dental University Hospital, School of Dental Science, Trinity College Dublin, Dublin, Ireland
| | - Isabel C Olegário
- Dublin Dental University Hospital, School of Dental Science, Trinity College Dublin, Dublin, Ireland
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de Souza Cantão ABC, da Silva Lima TC, Fernandes MIAP, Nagendrababu V, Bastos JV, Levin L. Prevalence of dental, oral, and maxillofacial traumatic injuries among domestic violence victims: A systematic review and meta-analysis. Dent Traumatol 2024; 40 Suppl 2:33-42. [PMID: 38214027 DOI: 10.1111/edt.12922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/10/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND/AIMS Domestic violence (DV) encompasses a series of abusive behaviors, perpetrated in a family environment, against individuals of all ages and genders. Injuries to the head, neck, and face are frequent findings among victims of abuse, negatively impacting their quality of life. Although oral and maxillofacial injuries (OMFI) and traumatic dental injuries (TDI) are commonly diagnosed among DV victims, their prevalence is still unknown. This systematic review was aimed to assess the prevalence of OMFI and TDI among victims of DV. METHODS The protocol of the review was registered in PROSPERO (CRD42023424235). Literature searches were performed in eight electronic databases, up to August 7th, 2023. Observational studies published in the Latin-roman alphabet and reporting the prevalence of OMFI and/or TDI were included. The Joanna Briggs Institute's critical appraisal tool, checklist for prevalence studies, was used for quality assessment. Results were presented as qualitative and quantitative syntheses. RESULTS Seventeen studies, totaling 12,375 victims of domestic violence, were included. Meta-analyses showed an overall prevalence of 29% (95% CI: 15%-48%, I2 = 99%) and 4% (95% CI: 1%-10%, I2 = 98%) for OMFI and TDI, respectively. Higher pooled prevalence for OMFI (41%, 95% CI: 13%-46%, I2 = 99%) was demonstrated in samples with only women. OMFI was less prevalent (20%) among DV victims under 18, while TDI was lower among adults (1%). Hospital samples presented higher pooled prevalence of OMFI (32%), and forensic data from fatal victims presented higher prevalence of TDI (8%). CONCLUSION The overall prevalence of OMFI and TDI in DV victims was 29% and 4%, respectively. Women victims of DV presented higher rates of OFMI (41%) and TDI (6%).
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Affiliation(s)
| | | | | | | | | | - Liran Levin
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Devi K P, Tewari N, O'Connell A, Srivastav S, Rajeswary A, Upadhyay AD, Haldar P, Rahul M, Mathur VP, Bansal K. Risk factors associated with traumatic dental injuries in individuals with special healthcare needs-A systematic review and meta-analysis. Dent Traumatol 2024; 40:91-110. [PMID: 37638637 DOI: 10.1111/edt.12882] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/28/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023]
Abstract
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.
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Affiliation(s)
- Pavithra Devi K
- Division of Pediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Nitesh Tewari
- Division of Pediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Anne O'Connell
- Paediatric Dentistry, Dublin Dental University Hospital, Trinity College (University of Dublin), Dublin, Ireland
| | - Sukeshana Srivastav
- Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Amritha Rajeswary
- Division of Pediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Dutt Upadhyay
- Clinical Research Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Partha Haldar
- Centre of Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Morankar Rahul
- Division of Pediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Prakash Mathur
- Division of Pediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Kalpana Bansal
- Division of Pediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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Šimunović L, Špiljak B, Vranić L, Negovetić Vranić D. Treatment priorities and arrival time of traumatic dental injuries-An 8-year retrospective study. Dent Traumatol 2024; 40:11-21. [PMID: 37750007 DOI: 10.1111/edt.12889] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND/AIM Most of the previous studies in the available literature discussed the time of arrival in general to the healthcare system, while a minority studied the relationship between the type of trauma and arrival. The aim of this retrospective study is to assess the arrival time of traumatic dental injuries (TDIs) depending on the urgency of treatment according to Andreasen. MATERIALS AND METHODS This 8-year retrospective study was carried out at the Department of Pediatric Dentistry at the University Dental Clinic in Zagreb, Croatia. Andreasen's classification was used to define the kind of TDI as well as to divide them by the need for urgent treatment or treatment priorities in three groups: acute, subacute, and delayed. RESULTS The sample consisted of 1040 children (59% male and 41% female) with a median age of 7. Each year, the age group most affected by TDIs was 6-12 years old. While there is a general increase in the prevalence of TDIs overall, there is a decline in TDIs among children aged 6-12 and an increase among preschoolers and adolescents (below 6 and above 12 years old). Throughout the years, 52.73% red/acute and 41.16% yellow/subacute TDIs were not treated on time due to delayed arrival. More patients from Zagreb come in the first 24 h, while more patients from outside Zagreb come to the clinic a month or more after their injuries. Patients which suffered TDI accompanied with soft-tissue injury arrived sooner. CONCLUSIONS It is necessary to introduce monitoring and education of patients under the age of 6 and over 12, as well as their parents/caregivers. New programs should be implemented and new referent centers that specialize in treating TDIs outside of Zagreb should be established.
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Affiliation(s)
- Luka Šimunović
- Department of Orthodontics, School of Dental Medicine Zagreb, University of Zagreb, Zagreb, Croatia
| | - Bruno Špiljak
- School of Dental Medicine Zagreb, University of Zagreb, Zagreb, Croatia
| | - Lara Vranić
- Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
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Del Negro B, Kimura JS, Menezes AN, Mendes FM, Wanderley MT. Traumatic dental injuries in the primary lower incisors. Int J Paediatr Dent 2023; 33:498-506. [PMID: 36695106 DOI: 10.1111/ipd.13052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/18/2022] [Accepted: 01/19/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Primary lower incisors are susceptible to traumatic dental injury (TDI), which may affect both primary and permanent dentitions. AIM This study aimed to evaluate the prevalence of TDIs in the primary lower incisors and the factors associated with their occurrence and with the incidence of sequelae in the permanent successor teeth. DESIGN Dental files (n = 2926) from patients who attended a reference center for dental trauma in the primary teeth, from 1998 to 2020, were screened. Multilevel Poisson regression analyses were conducted between exploratory variables related to the traumatized teeth and outcome variables: occurrences of severe TDI and sequelae in the permanent successor. Prevalence ratios (PRs), relative risks (RRs), and respective 95% confidence intervals (95% CIs) were calculated. RESULTS One hundred and thirteen (3.9%) children and 208 teeth presented with TDIs in the primary lower incisors. The prevalence of severe TDI was lower in 4-year-olds (PR = 0.43; 95% CI = 0.19-0.94) than in 2-year-olds. Moreover, severe TDI was significantly associated with the occurrence of sequelae in the permanent successors (RR = 3.97; 95% CI = 1.72-9.18), when compared to not severe TDI. CONCLUSIONS The prevalence of TDI in the primary lower incisors is low, with a higher prevalence in children younger than 3 years. Older children also present less frequently with severe TDI, and the risk of sequelae in permanent teeth is higher following severe TDI.
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Affiliation(s)
- Bianca Del Negro
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of São Paulo - USP, São Paulo, Brazil
| | - Juliana Sayuri Kimura
- Surgery Course in Pediatric Dentistry at the Foundation for the Scientific and Technological Development of Dentistry (FUNDECTO) at the School of Dentistry of the University of São Paulo - USP, São Paulo, Brazil
| | - Andressa Nery Menezes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of São Paulo - USP, São Paulo, Brazil
| | - Fausto Medeiros Mendes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of São Paulo - USP, São Paulo, Brazil
| | - Marcia Turolla Wanderley
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of São Paulo - USP, São Paulo, Brazil
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Kvesić AJ, Hrelja M, Lovrić Ž, Šimunović L, Špiljak B, Supina N, Vranić L, Vranić DN. Possible Risk Factors for Dental Fear and Anxiety in Children Who Suffered Traumatic Dental Injury. Dent J (Basel) 2023; 11:190. [PMID: 37623286 PMCID: PMC10453853 DOI: 10.3390/dj11080190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/26/2023] [Accepted: 08/04/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Children who undergo painful experiences such as traumatic dental injury (TDI) during their early years are more likely to be at an increased risk of developing dental fear and anxiety (DFA). The purpose of this study was to identify potential risk factors for DFA of these children. METHODS The study participants were 220 parents/caregivers and their children who experienced TDI. Their socio-demographic backgrounds were investigated with the modified WHO Oral Health Questionnaire for Children that included questions about parents' knowledge and attitudes, while the DFA level was determined using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) and the Simplified Oral Hygiene Index (OHI-S Index) was used to assess oral hygiene status. RESULTS The confirmed risk factors are parental knowledge, female gender, and degree of oral hygiene and pain in the last three months, while age, type of TDI, presence of soft-tissue injury, and number of subjective complaints were not confirmed. The overall model predicted approximately 54% of variance in DFA, R2 = 0.545, F (4.215) = 64.28 p < 0.001. CONCLUSIONS These findings emphasise the importance of addressing pain management, improving oral hygiene, and enhancing parental knowledge to mitigate DFA in children with TDIs.
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Affiliation(s)
| | - Miroslav Hrelja
- Private Dental Office, 10000 Zagreb, Croatia; (A.J.K.); (M.H.); (Ž.L.)
| | - Željka Lovrić
- Private Dental Office, 10000 Zagreb, Croatia; (A.J.K.); (M.H.); (Ž.L.)
| | - Luka Šimunović
- Department of Orthodontics, School of Dental Medicine Zagreb, University of Zagreb, 10000 Zagreb, Croatia
| | - Bruno Špiljak
- School of Dental Medicine Zagreb, University of Zagreb, 10000 Zagreb, Croatia; (N.S.); (L.V.)
| | - Nika Supina
- School of Dental Medicine Zagreb, University of Zagreb, 10000 Zagreb, Croatia; (N.S.); (L.V.)
| | - Lara Vranić
- School of Dental Medicine Zagreb, University of Zagreb, 10000 Zagreb, Croatia; (N.S.); (L.V.)
| | - Dubravka Negovetić Vranić
- Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia;
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10
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Abbott PV. Indications for root canal treatment following traumatic dental injuries to permanent teeth. Aust Dent J 2023; 68 Suppl 1:S123-S140. [PMID: 37908151 DOI: 10.1111/adj.12989] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/02/2023]
Abstract
The dental pulp may respond favourably or unfavourably to traumatic dental injuries. The most serious unfavourable responses are pulp necrosis and infection of the root canal system. These cause apical periodontitis and/or external inflammatory resorption of the tooth. The following injuries require root canal treatment as part of their emergency management-(A) complicated crown fractures (but some may be suitable for conservative pulp treatments, such as pulp capping, partial pulpotomy or pulpotomy), (B) complicated crown-root fractures, (C) supra-crestal coronal third root fractures and (D) injuries where pulp necrosis is predictable or highly likely to occur AND where there has been damage to the root surface and/or periodontal ligament with the aim of preventing external inflammatory resorption. This latter group of injuries are avulsion, intrusion, lateral luxation with a crown fracture, extrusion with a crown fracture (all in fully developed teeth) plus avulsion with a crown fracture and intrusion with a crown fracture (both in incompletely developed teeth). All other injuries should not have root canal treatment commenced as part of the emergency management, but they must be reviewed regularly to monitor the pulp for any adverse changes to its status, particularly pulp necrosis and infection of the root canal system.
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Affiliation(s)
- P V Abbott
- UWA Dental School, The University of Western Australia, Perth, Western Australia, Australia
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Dos Santos Fernandez M, Schuch HS, Araújo ABG, Goettems ML. Splinting in the management of dental trauma in the primary dentition: a systematic review. Eur Arch Paediatr Dent 2023; 24:167-175. [PMID: 36930443 DOI: 10.1007/s40368-023-00792-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/02/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE The purpose of this study was to gather existing data on the efficacy of tooth splinting (TS) in patients with traumatized primary teeth, evaluating their overall prognosis and reported complications. METHODS Electronic searches were performed in seven databases up to Februray/2023. Clinical studies published in the last two decades and presenting the following characteristics were included: (a) reporting on children with traumatized primary teeth; (b) describing the efficacy of splinting those teeth. Studies describing imobilization of dental avulsion were excluded. RESULTS A total of 163 potentially relevant studies were initially found. After title/abstract screening, and full-text evaluation, three retrospective studies with moderate to high risk of bias were included. The studies described the outcomes of TS in primary teeth with luxation (intrusion, extrusion, lateral displacement), intra-alveolar root fracture, and/or alveolar fracture. High clinical success rate was observed for teeth with root fracture. Benefits of spliting teeth with lateral luxation were not identified, although it may be a reccomended approach. No study was found evaluating TS for alveolar fracture. CONCLUSION Based on a low level of evidence, the findings highlight a better clinical success rate of the use of TS in the management of deciduous teeth with root fractures.
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Affiliation(s)
| | - H S Schuch
- Harvard School of Dental Medicine, Harvard University, Boston, USA
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - A B G Araújo
- School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - M L Goettems
- School of Dentistry, Federal University of Pelotas, Pelotas, Brazil.
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil.
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Shimizu S, Tanabe G, Hayashi K, Churei H, Anzai T, Takahashi K, Ueno T, Fueki K. Quantitative text analysis of the mechanisms of tooth injury: Analysis of accidents in five sports that occurred in 15 years under school control. Dent Traumatol 2023; 39:132-139. [PMID: 36428271 DOI: 10.1111/edt.12808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/03/2022] [Accepted: 11/06/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND/AIM Dental trauma may occur in school settings and it can impact patients' quality of life. Analysis of the occurrences of dental trauma is essential in identifying preventive methods. There are numerous reports of such accidents but most are quantitative analyses with limited data. The aim of this study was to extract information on the mechanisms of injuries that leads to prevention by performing a qualitative analysis of the occurrence of dental trauma. MATERIAL AND METHODS After screening 7684 cases of dental injuries that occured in schools and were reported to the Japan Sports Council between 2005 and 2020, 533 detailed descriptions of injuries that occurred during sports were included. Quantitative text analysis was performed on the target data by performing statistical analysis, extracting frequently used words, and creating a co-occurrence network. Injury mechanisms were evaluated based on appearance of words. RESULTS Dental injuries occurred frequently in five sports included in the survey. They were in order of decreasing frequency: baseball, basketball, soccer, volleyball, and rugby. Males were injured more often in all sports other than volleyball. The number of accidents increased in all sports among high school students. The frequent word list and co-occurrence network were different for each sport. This allowed typical accident occurrence mechanisms to be extracted for these five sports. CONCLUSIONS Typical accident occurrence mechanisms were extracted from quantitative text analysis targeting free texts on the occurrence of accidents for five sports. Quantitative text analysis is useful for the evaluation of accident cases, which may aid in accident prevention.
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Affiliation(s)
- Shintaro Shimizu
- Department of Masticatory Function and Health Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Gen Tanabe
- Department of Oral Microbiology, Asahi University School of Dentistry, Mizuho, Japan.,Division of Sports Dentistry, Sports Science Organization, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kairi Hayashi
- Department of Masticatory Function and Health Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan.,Division of Sports Dentistry, Sports Science Organization, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Churei
- Department of Masticatory Function and Health Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan.,Division of Sports Dentistry, Sports Science Organization, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tatsuhiko Anzai
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshiaki Ueno
- Division of Sports Dentistry, Sports Science Organization, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Sports Dentistry, Meikai University School of Dentistry, Chiba, Japan
| | - Kenji Fueki
- Department of Masticatory Function and Health Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
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A V, A S, K E, C A, Rk S, M I. Knowledge, Awareness, and Practice Regarding Management of Dental Trauma in Children among Dental Practitioners: A Cross-sectional Survey. J Contemp Dent Pract 2023; 23:1033-1038. [PMID: 37073918 DOI: 10.5005/jp-journals-10024-3402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
AIM The aim of this study was to determine the current level of knowledge and understanding about dental trauma and its management in children among dental practitioners. MATERIALS AND METHODS The study was conducted after obtaining the ethical clearance from the Institutional Review Board (IRB). A structured questionnaire was prepared, which comprised 20 questions and was validated by dental trauma experts. The questionnaire, which covers all aspects of traumatic dental injuries (TDIs) in both primary and permanent dentition, was distributed online to 850 dental practitioners. The questionnaire was open from January 2022 to April 2022, with a 3-month time frame to complete it. The responses were collected and statistical analysis was done using SPSS software. RESULTS The mean age of the participants were 22-30 years. Furthermore, 515 participants were females and 263 were males. In this survey among 784 responses, 449 dentists were trained in dental trauma and 618 participants had personal experience in managing dental trauma. All other questions about knowledge and awareness of dental trauma management received fewer correct answers. CONCLUSION According to the present study, dental practitioners have only mild-to-moderate knowledge and awareness about dental trauma. From the latest the International Association for Dental Traumatology guidelines, dentists need to consistently update their knowledge through dental trauma conferences, workshops, trainings, and symposiums. CLINICAL SIGNIFICANCE This study informs us about the existing level of dental knowledge about dental trauma, which is significantly low. This will considerably boost dental practitioners' interest in TDIs. As a result, practitioners' expertise will grow, allowing them to better care for their patients.
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Affiliation(s)
- Vasanthakumari A
- Department of Pediatric and Preventive Dentistry, Adhiparasakthi Dental College & Hospital, Melmaruvathur, Tamil Nadu, India
| | - Selvabalaji A
- Department of Pediatric and Preventive Dentistry, Adhiparasakthi Dental College & Hospital, Melmaruvathur, Tamil Nadu, India
| | - Ekambareswaran K
- Department of Pediatric and Preventive Dentistry, Adhiparasakthi Dental College & Hospital, Melmaruvathur, Tamil Nadu, India, Phone: +91 9677246945, e-mail:
| | - Anagha C
- Department of Pediatric and Preventive Dentistry, Adhiparasakthi Dental College & Hospital, Melmaruvathur, Tamil Nadu, India
| | - Swetha Rk
- Department of Pediatric and Preventive Dentistry, Adhiparasakthi Dental College & Hospital, Melmaruvathur, Tamil Nadu, India
| | - Ishwarya M
- Department of Pediatric and Preventive Dentistry, Adhiparasakthi Dental College & Hospital, Melmaruvathur, Tamil Nadu, India
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Brown D, Hussain I, Cochrane V, Barker N. The East of England dental trauma service. BMJ LEADER 2022; 6:312-315. [PMID: 36794605 DOI: 10.1136/leader-2021-000567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/25/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Current evidence suggests traumatic dental injuries can be difficult to manage in primary care due to uncommon occurrence and challenging patient presentations. Such factors may contribute to general dental practitioners lacking experience and confidence in the assessment, treatment and management of traumatic dental injuries. Furthermore, there are anecdotal accounts of patients presenting to accident and emergency (A&E) services with a traumatic dental injury, which could be placing avoidable strain on secondary care services. For these reasons, a novel primary care-led dental trauma service has been established in the East of England. METHODS This brief report shares our experiences of establishing this dental trauma service, titled 'Think T's'. It aims to provide effective trauma care across an entire region by a dedicated team of experienced clinicians from primary care settings to reduce inappropriate attendance to secondary care services and upskill colleagues in dental traumatology. FINDINGS AND CONCLUSIONS Since its inception, the dental trauma service has been public-facing and has managed referrals from a range of sources which include general medical practitioners, A&E clinicians and ambulance services. The service has been well received and has been seeking to integrate with the Directory of Services as well as NHS 111.
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Affiliation(s)
- Danielle Brown
- Health Education England East of England, Colchester, UK
| | - Issar Hussain
- NHS England and NHS Improvement East of England, Colchester, UK
| | - Veni Cochrane
- NHS England and NHS Improvement East of England, Colchester, UK
| | - Nick Barker
- NHS England and NHS Improvement East of England, Colchester, UK
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15
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Jadav NM, Abbott PV. Dentists' knowledge of dental trauma based on the International Association of Dental Traumatology guidelines: An Australian survey. Dent Traumatol 2022; 38:374-380. [PMID: 35605159 PMCID: PMC9545508 DOI: 10.1111/edt.12761] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 11/26/2022]
Abstract
Background/Aim Traumatic dental injuries are the result of impact injuries to the teeth and/or soft and hard tissues within and around the vicinity of the oral cavity and pose a very serious public health dilemma. The aim of this study was to appraise the level of knowledge of dentists in Australia regarding the management of traumatic dental injuries based on the International Association of Dental Traumatology (IADT) guidelines. Methodology A link to an electronic questionnaire investigating personal and professional information and twelve questions about dental trauma was distributed by email using the Qualtrics Survey Software to ensure anonymity of the respondents, to members of the Australian Dental Association. The respondents were grouped according to demographic characteristics and practice profiles. Data were evaluated by the Student’s T test or one‐way ANOVA with post hoc testing using Fisher's least significant difference, with the α level set at 5%. Results A total of 180 complete responses were obtained. The overall mean number of correct answers was 7.55 ± 1.91 from a maximum possible score of twelve. Gender, year of primary dental qualification, dentist identity (general dentist or specialist), area of main practice or region worked by the practitioner did not significantly affect the mean scores. However, increased knowledge of the IADT guidelines was significantly associated with the number of trauma cases treated and the dentists' self‐reported knowledge. Conclusions The overall knowledge of Australian dentists regarding the management of traumatic dental injuries based on the IADT guidelines was generally good but it was also deficient in some areas.
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Affiliation(s)
| | - Paul V Abbott
- UWA Dental School, The University of Western Australia, Perth, WA, Australia
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Motta-Rego T, Soares MEC, Souto-Souza D, Souza EA, Paiva SM, Ramos-Jorge ML, Ramos-Jorge J. Association of the prevalence and severity of untreated traumatic dental injuries with body mass index among Brazilian preschool children. Dent Traumatol 2022; 38:206-212. [PMID: 35133712 DOI: 10.1111/edt.12734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIM Children with excess weight may be more predisposed to traumatic dental injuries (TDI). The aim of this study was to investigate the association between overweight/obesity and TDI presence and severity in Brazilian preschool children. MATERIAL AND METHODS A cross-sectional study was conducted of 347 children aged three to five years. The main exposure was evaluated based on the body mass index (BMI). Socioeconomic-demographic characteristics and harmful oral habits were investigated using a questionnaire sent to the parents/guardians. Oral clinical examinations were performed to determine overjet (criteria proposed by Foster and Hamilton), and the presence and severity of TDI (criteria proposed by Andreassen). Descriptive statistics were performed. Univariate and multivariate Poisson regression analyses were conducted for each outcome. RESULTS The prevalence of TDI in the sample was 41.5% and 16% of the children had enamel and dentin fractures. In the multivariate analysis, BMI and overjet were associated with the presence and severity of TDI (PR: 2.04 and 1.78, respectively) of TDI (PR: 2.27 and 2.24, respectively) (p < .001 for all associations). CONCLUSION Overweight/obesity was associated with both the presence and severity of TDI in early childhood.
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Affiliation(s)
- Thiago Motta-Rego
- Department of Pediatric Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte (UFMG), Belo Horizonte, Brazil
| | - Maria Eliza Consolação Soares
- Department of Pediatric Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Debora Souto-Souza
- Department of Pediatric Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Esther Aranda Souza
- Department of Pediatric Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte (UFMG), Belo Horizonte, Brazil
| | - Saul Martins Paiva
- Department of Pediatric Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte (UFMG), Belo Horizonte, Brazil
| | - Maria Letícia Ramos-Jorge
- Department of Pediatric Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Joana Ramos-Jorge
- Department of Pediatric Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte (UFMG), Belo Horizonte, Brazil
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de Abreu MHNG, Cruz AJS, Borges-Oliveira AC, Martins RDC, Mattos FDF. Perspectives on Social and Environmental Determinants of Oral Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413429. [PMID: 34949037 PMCID: PMC8708013 DOI: 10.3390/ijerph182413429] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/18/2021] [Accepted: 12/19/2021] [Indexed: 11/16/2022]
Abstract
Most oral conditions have a multifactorial etiology; that is, they are modulated by biological, social, economic, cultural, and environmental factors. A consistent body of evidence has demonstrated the great burden of dental caries and periodontal disease in individuals from low socioeconomic strata. Oral health habits and access to care are influenced by the social determinants of health. Hence, the delivery of health promotion strategies at the population level has shown a great impact on reducing the prevalence of oral diseases. More recently, a growing discussion about the relationship between the environment, climate change, and oral health has been set in place. Certainly, outlining plans to address oral health inequities is not an easy task. It will demand political will, comprehensive funding of health services, and initiatives to reduce inequalities. This paper sought to give a perspective about the role of social and physical environmental factors on oral health conditions while discussing how the manuscripts published in this Special Issue could increase our knowledge of the topic.
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18
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Noleto JW, de Abreu NMR, Dos Santos Vicente KM, da Silva AVNA, Seixas DR, de Figueiredo LS. Intrusive luxation of a permanent maxillary central incisor into the nasal cavity: A case report. Dent Traumatol 2021; 38:160-164. [PMID: 34905280 DOI: 10.1111/edt.12727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022]
Abstract
This case report out lines a rare complete intrusion of a permanent, maxillary central incisor (tooth 11) into the nasal cavity, with a late diagnosis and treatment. An eight-year-old boy was referred to an oral and maxillofacial surgery service with absence of tooth 11 after an episode of a fall from his own height. Approximately 50 days after the trauma, the patient presented, with a complaint of obstruction of the right nostril. The clinical examination and tomographic evaluation showed that the tooth had been intruded into the nasal cavity on the right side. The tooth in question was removed under general anesthesia by direct approach through the right nostril. The patient was followed up for approximately one year without complications. This case demonstrates the importance of a detailed evaluation during the first examination after intrusive luxation so the correct diagnosis is made and the correct treatment is performed to avoid greater morbidity and complications for the patient.
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Affiliation(s)
- José Wilson Noleto
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Paraíba Federal University, Paraíba, Brazil
| | | | | | | | - Déborah Rocha Seixas
- Graduate Program in Rehabilitation Sciences, University of São Paulo, Bauru São Paulo, Brazil
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19
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Andrade MRTC, Americano GCA, da Costa MP, Lenzi MM, Dede Waele SouchoisMarsillac M, Campos V. Traumatic injuries in primary dentition and their immediate and long-term consequences: a 10-year retrospective study from the State University of Rio de Janeiro, Brazil. Eur Arch Paediatr Dent 2021; 22:1067-1076. [PMID: 34313973 DOI: 10.1007/s40368-021-00652-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIM Dental trauma is a highly prevalent problem worldwide. The aim of this study was to describe characteristics of trauma to anterior primary teeth and its sequelae for primary and successor teeth over a 10-year period of assistance at the paediatric dental traumatology clinic in the State University of Rio de Janeiro, Brazil. MATERIALS AND METHODS The data were obtained from the dental records of children assisted from 2006 to 2016. Inclusion criteria were trauma to anterior primary teeth; aged <1 to 9 years at the time of trauma; and at least one follow-up appointment. The data concerning traumatized teeth, child's age, soft tissue injuries, types of traumatic dental injuries and sequelae in both dentitions were collected. RESULTS Of the 1230 dental records, 483 (39.3%) were eligible, consisting of 815 teeth. The mean age at the time of trauma was 37.4 months (239 males and 244 females). The most important characteristics were: tooth 51 was most affected; falls, at home, on a ceramic floor, were the main cause; gingival laceration, enamel fracture and intrusive luxation were the most frequent types of trauma; premature tooth loss of primary teeth and enamel discoloration in their successor were the most frequent sequelae; and injuries in the periodontal tissue were demonstrated as the highest risk for sequelae in successors (OR, 3.798; p< 0.001). CONCLUSIONS Most traumatic injuries occur in young children, in their home environment. Consequences for the primary teeth were more frequent compared to the permanent successor tooth. Traumatized primary teeth involving periodontal tissue have more chances to result in sequelae to their successor teeth.
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Affiliation(s)
- M R T C Andrade
- Department of Specific Formation - Pediatric Dentistry, Dental School, Health Institute of the Fluminense Federal University, Nova Friburgo, Brazil
| | - G C A Americano
- Department of Preventive and Community Dentistry, Dental School, Rio de Janeiro State University, Rio de Janeiro, Brazil.,Dental School, Center University of Minas Gerais' East (UNILESTE), Ipatinga, Brazil
| | - M P da Costa
- Department of Preventive and Community Dentistry, Dental School, Rio de Janeiro State University, Rio de Janeiro, Brazil.,Department of Pediatric Dentistry and Orthodontics, Dental School, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - M M Lenzi
- Department of Preventive and Community Dentistry, Dental School, Rio de Janeiro State University, Rio de Janeiro, Brazil. .,Departamento de Odontologia Preventiva e Comunitária, Faculdade de Odontologia, Universidade do Estado do Rio de Janeiro, Rua: Boulevard 28 de setembro 157 - Vila Isabel - Rio de Janeiro, Rio de Janeiro, Brasil.
| | - M Dede Waele SouchoisMarsillac
- Department of Preventive and Community Dentistry, Dental School, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - V Campos
- Department of Preventive and Community Dentistry, Dental School, Rio de Janeiro State University, Rio de Janeiro, Brazil
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