Orofacial manifestations of child maltreatment: A review

Traumatic dental injuries in the first year of life and related risk factors in three regions of Brazil: a multicenter birth cohort study

BACKGROUND

Traumatic dental injuries (TDIs) in early childhood exert a negative impact on the quality of life of children and their families. However, there is no evidence from cohort studies on which to base prevention strategies at the beginning of life, when children are entirely dependent upon supervision. The aim of the present study was to estimate the incidence of TDI in the first year of life and explore risk factors in a birth cohort followed up in three major cities in different regions of Brazil.

METHODS

A birth cohort study was conducted with children in the cities of Porto Alegre, Salvador, and Manaus. Socioeconomic, demographic, and anthropometric characteristics were collected at baseline. Behavioral characteristics were collected when the children were six and 12 months of age. After the first year of life, clinical examinations were performed by trained, calibrated dentists for the assessment of TDI (Andreasen's criteria). Poisson regression models were used to estimate associations between the independent variables and TDI, with the calculation of crude and adjusted relative risk (RR) and respective 95% confidence intervals (CI).

RESULTS

The incidence of TDI in the first year of life (range: 12 to 16 months) was 18.1% (95% CI: 13.6-22.6%). The multivariable analysis revealed a significantly greater risk of TDI in children from non-nuclear families (RR = 1.83; 95% CI: 1.11-3.00) as well as those whose mothers had a higher level of schooling (RR = 2.42; 95% CI: 1.04-5.63) and when tooth eruption began up to six months of age (RR = 2.30; 95% CI: 1.34-3.95). Being the first-born child was a protective factor (RR = 0.48; 95% CI: 0.27-0.87) for the occurrence of the outcome.

CONCLUSION

The high incidence of TDI in the first year of life indicates the need for primary prevention strategies with an emphasis on active supervision in the first months of life. Risk factors associated with TDI related to the family, mother and child suggest pathways for the planning of such strategies.

Mechanisms Underlying Sex Differences in Temporomandibular Disorders and Their Comorbidity with Migraine

Sexual dimorphism in temporomandibular disorders (TMDs) and their comorbidity with migraine are important phenomena observed in clinics. TMDs are the most prevalent orofacial pain conditions with jaw joint and masseter muscle dysfunction. Migraine is the predominant headache commonly associated with TMDs. Women much more often suffer from this orofacial pain than men. However, currently, there is no gender-specific therapy for such pain conditions. Understanding the pathophysiological mechanisms behind sex differences in TMDs as well as their comorbidity with migraines is essential for developing novel approaches for gender-specific treatment of TMDs and related orofacial pain comorbidity. In this review, we summarize recent research progress regarding sex differences in TMDs, focusing on the underlying mechanisms including craniofacial anatomy, hormonal regulation, and roles of opioids, transient receptor potential channels, and endocannabinoid systems. We also discuss the mechanisms of comorbid TMDs and migraine. The information covered in this review will provide mechanistic insights into sex differences in TMDs and their comorbidity with migraine, which could aid in developing effective treatment strategies for the overlapping orofacial pain condition.

The role of dental professionals in identifying, reporting, and supporting domestic violence victims

Domestic violence is a pervasive social issue affecting individuals across all demographics and has severe consequences for both the victims and society. Domestic violence is commonly defined as the exertion of power by one individual over another within a relationship, aiming to establish a sense of fear, control, and authority. The connection between domestic violence and oral health is established, with common oral health issues associated with domestic violence, such as dental trauma, head and neck bruises and injuries as well as facial fractures. Dental professionals play a crucial role in detecting signs of domestic violence by closely examining the head and neck region and the oral cavity during routine examinations. The significance of approaching patients suspected of experiencing domestic violence with sensitivity and empathy is of utmost importance. Recommendations include establishing trust, maintaining confidentiality, using open-ended questions, and providing information about local resources. Legal and ethical considerations are paramount, highlighting the obligations of dental professionals in cases of suspected domestic violence, including mandatory reporting laws and the balance between patient autonomy and safety. Challenges faced by dental professionals in reporting and intervening are discussed as well in this narrative review, emphasizing the importance of collaboration with other healthcare professionals and support services. This review underscores the vital role of dental care providers in recognizing signs of domestic violence, promoting intervention and support, and contributing to the well-being and safety of individuals impacted by domestic violence.

Associations between child abuse and neglect, and dento-alveolar injuries in a Children's hospital population

BACKGROUND/AIM

The purpose of this study was to identify social variables common to children with dento-alveolar trauma (DAT) and child abuse and neglect (CAN) in a large children's hospital population.

METHODS

Emergency department data from an urban trauma Level 1 children's hospital were queried between December 02, 2017 and September 30, 2022 to identify children with both DAT and CAN. Patients with DAT and CAN were compared to DAT-only children in a case-control study design. Descriptive statistics were used to report characteristics of children in case and control groups. Chi-Squared and Fisher's exact tests were used to compare cases and controls. The level of significance was set at p ≤ .05.

RESULTS

In total, 14 children who had DAT and CAN reported simultaneously comprised the case group. A total of 42 children with DAT-only, age/sex matched with cases, comprised the control group. Mean (SD) age of cases was 10.4 (±4) and controls was 10.1 (±3.9) years-old. Eight cases (57.1%) and 24 controls (57.1%) were female. No statistical differences (p = .05) were present for language, race, insurance coverage, parental custody, legal guardianship, and type of residence for cases versus controls. Five (35.7%) cases had a special need versus 4 (9.5%) controls and was statistically different (p = .03). Nine (64.3%) cases had behavioral problems versus 13 (31%) controls (p = .05). Cases were more likely to have facial injuries than controls (74.3 vs. 31%), however no significant differences were present for total number of injured teeth, head injury or neck injury between cases and controls. In half of cases, the perpetrator reported was the sibling.

CONCLUSIONS

Demographics did not predict CAN in children with dental injuries. Sibling violence should be considered in suspected CAN children.

Dental and maxillofacial injuries associated with domestic violence against women in Israel: A report for 2011-2021

BACKGROUND/AIM

The WHO, in its 2002 report, indicated the dramatic worldwide increase in the incidence of intentional injuries affecting people of all ages and both sexes, but especially children, women, and the elderly. The aim of this study was to analyze dental and maxillofacial injuries associated with domestic violence against women in Israel between the years 2011-2021.

METHODS

This was a retrospective cohort study based on data from the Israeli National Trauma Registry (INTR). The INTR provides comprehensive data on hospitalized patients from all six Level I trauma centers (TC) and 15 of the 20 Level II TCs in Israel. Women, ages 14 and older, injured and hospitalized due to domestic violence between 2011 and 2021 were identified.

RESULTS

Between 2011 and 2021, there were 1818 cases of women ages 14 + that were hospitalized due to violence, excluding terror, occupational trauma, and attempted suicide. Out of these injuries, 753 cases were attributed to domestic violence, 537 were defined as non-domestic violence and 528 were a result of a brawl/fight. Of the domestic violence cases, 5% (38) exhibited maxillofacial injuries compared to the non-domestic violence cases where 6.2% (33) exhibited maxillofacial injuries and the brawl group where 5.7% (30) exhibited maxillofacial injuries. The most injured areas in domestic violence cases were the maxilla followed by the zygomatic bone and the mandible. Almost half of the domestic violence cases (47.7%) required surgical intervention during their hospitalization. The spouse was the perpetrator responsible for the domestic violence in the majority of the cases.

CONCLUSIONS

Dental professionals might be able, in some cases, to identify and report domestic violence signs and thus, better understanding of the specific characteristics of domestic violence related to traumatic injuries is important.