Pattern of Traumatic Dental Injuries Among Adults

Background

The etiology, presentation and management of traumatic dental injuries (TDIs) vary significantly between the adult and the younger population. Most epidemiological studies on TDIs have focused on the pediatric age group. This study aims to report and compare the distributions of TDIs among adults in a sub-population in India.

Methods

This prospective observational study was performed on 1562 consecutively selected patients (1218 males and 344 females) from a university dental hospital in India, between July 2014 and June 2018. The clinical examinations were performed by a single trained and calibrated endodontist. Only TDIs to anterior teeth were recorded (canine to canine in the maxilla and mandible) and classified using a modified version of the World Health Organization's (WHO’s) classification. Periapical and panoramic radiographs were taken for all the subjects.

Results

A total of 1562 patients aged between 20 and 73 years, with a mean age of 36 years, were examined during the study period. The total number of teeth with TDIs was 3044. Males (78%) clearly outnumbered the females (22%) in all the age groups. The most common type of injury occurring in both the genders is uncomplicated crown fractures (male=31.0% and female=36.6%). Avulsion injuries are more likely to be seen by a dentist within 1 hour post-trauma. About two-third of the TDIs were caused by road traffic accidents (RTAs) followed by falls in about 20% of the patients.

Conclusion

Uncomplicated crown fracture was the most commonly observed type of TDI, and RTAs were the primary cause of TDI.

Knowledge of Australian primary education providers towards dental avulsion injuries: a cross-sectional study

BACKGROUND/AIM

The aim of this study was to evaluate the knowledge of school professionals regarding the emergency management of dental avulsion.

METHODS

This cross-sectional study utilised a self-administered, pilot-tested questionnaire for school staff from primary schools. Descriptive statistics were used for the analysis - the prevalence and univariate associations between a categorical outcome and the variables under consideration, were evaluated using Pearson's Chi-squared test.

RESULTS

This survey yielded a response rate of 43.5% (n = 313). Approximately 60% of participants held valid first-aid certificates and 23% had received avulsion advice previously. Over 80% of participants expressed an unwillingness to replant an avulsed tooth, and over 90% believed that there should be greater awareness in this area. This unwillingness to replant was influenced by respondents' age (x2 = 8.13 df = 3, P = 0.043) and receiving advice previously (x2 = 13.15, df = 1, P < 0.001). Under-preparedness was related to years of experience (x2 = 15.03, df = 5, P = 0.010), first-aid training (x2 = 6.41, df = 1, P = 0.011) and receiving advice previously (x2 = 43.47, df = 1, P < 0.001). It was also evident that first-aid training positively influenced appropriate dental referral in the management pathway (x2 = 10.49, df = 1, P = 0.001).

CONCLUSION

This study suggests that there is an inadequate level of knowledge on the appropriate management of dental avulsion injuries amongst primary school professionals in Australia.

Differential gene expression profiles of human periodontal ligament cells preserved in Hank's balanced salt solution and milk

BACKGROUND/AIM

Various types of storage media have been investigated to preserve avulsed teeth. However, the efficacies of storage media mainly focus on the aspect of cell viability. The aim of this study was to evaluate and compare the gene expression profiles of human periodontal ligament cells preserved in Hank's balanced salt solution (HBSS) and milk over different storage durations.

MATERIAL AND METHODS

Human periodontal ligament cells were cultured and preserved in HBSS and milk for 3 and 6 hours. Next, total RNA was isolated. QuantSeq 3' mRNA-Sequencing was used to examine differences in gene expression in HBSS- and milk-grown periodontal ligament cells. Bioinformatics analysis was also performed to predict the function of the differentially expressed genes.

RESULTS

The number of differentially expressed genes shared among all groups was 101. In gene set enrichment analysis, the shared differentially expressed genes in HBSS and milk were associated with the TNF-α signaling pathway (P = 1.07E^-7 ). Seven hallmark gene sets were also identified in HBSS. Moreover, hallmark gene sets associated with hypoxia (P = 7.26E^-5 ) and apoptosis (P = 4.06E^-4 ) were identified in HBSS. In milk, 10 hallmark gene sets along with gene sets for inflammatory response (P = 6.87E^-3 ) were identified.

CONCLUSIONS

Compared to those in milk, genes in HBSS were differentially expressed with increasing storage duration, suggesting that diverse and different gene expression may be involved in HBSS and milk. However, a more detailed functional analysis of these differentially expressed genes in storage solutions should be performed in the future.

Nature's Benefaction as a Life Saver for an Avulsed Tooth: An In vitro Study

INTRODUCTION

Dentoalveolar trauma is a very common and avulsion is the most frequent injury. Treatment of choice following avulsion is immediate reimplantation. However, in cases where this might not be possible the prognosis of reimplanted teeth can be improved by the selection of an appropriate storage media. Prevention of ankylosis and replacement resorption depends more on the potential of storage media to maintain cell viability rather than the extraalveolar time period.

AIM

To compare and evaluate the efficacy of different storage media in maintaining the viability of Periodontal Ligament (PDL) cells in an avulsed tooth.

MATERIALS AND METHODS

A total of 58 freshly extracted human premolar teeth were divided into four experimental groups and two control groups. The positive and negative controls corresponded to 0 minute and an eight hours dry time, respectively. The experimental teeth were stored dry for 30 minutes and then immersed in one of the four media: Hank's Balanced Salt Solution (HBSS), coconut water, aloe vera and saline for 45 minutes. The teeth were then treated with Collagenase Type II and Dispase for 30 minutes. The number of viable PDL cells were counted with a haemocytometer and analysed. The statistical analysis was done using SPSS version 15.0. The Analysis of Variance (ANOVA) and Post-hoc tests (Tukey-HSD) were performed to reveal the statistical significance. The values were represented in number (%) and mean±SD.

RESULTS

Statistical analysis demonstrated that among the experimental groups maximum percentage of viable cells were seen in HBSS (87.33%) followed by coconut water (79.87%), aloe vera (70.59%) and saline (50.56%).

CONCLUSION

Within the parameters of this study, it can be concluded that the HBSS is the most effective storage media in maintaining the viability of PDL cells. However, in Indian scenario where availability of HBSS is questionable, coconut water can be considered as the best natural storage media for an avulsed tooth followed by aloe vera.

Effects of tooth storage media on periodontal ligament preservation

BACKGROUND/AIMS

An easily available tooth storage medium is required to preserve a tooth after avulsion. Milk and Hank's balanced salt solution (HBSS) are recommended as tooth storage media, and egg white is also reported to be comparable with milk. The aim of this study was to histologically and immunohistochemically evaluate the effect of different tooth storage media on the periodontal ligament (PDL) of extracted teeth.

MATERIALS AND METHODS

This experiment used HBSS, milk, and egg white as tooth storage media. A total of ninety-six 6-week-old male Sprague-Dawley rats were used in these experiments. In each experiment, six rats were used for each medium and for the control group. Extracted rat molar teeth were immersed in these three different storage media for 1 hour. In each medium, six samples (n=18) were fixed immediately, and the remaining samples (n=54) were subcutaneously transplanted. In the control group (n=24), the extracted teeth were fixed or transplanted immediately after extraction. At day 4, 1 and 2 weeks after transplantation, the teeth were examined by radiographic, histological, and immunohistochemical methods. The number of PDL cells in the storage media was also counted.

RESULTS

Teeth immersed for 1 hour in milk showed the thinnest PDL. Immunohistochemistry of periostin and CD68 labeling suggested degradation of the extracellular matrix in the PDL. In the media used for immersion, more PDL cells were observed in milk than in the other solutions. After transplantation, the HBSS and egg white groups maintained adequate thickness of PDL but in the milk group, thinner PDL and ankylosis were observed.

CONCLUSION

Adequate thickness of PDL was maintained in the egg white group, whereas the milk group showed disturbance in the PDL, which may lead to ankylosis.

Lip and tooth injuries at public swimming pools in Austria

BACKGROUND/AIMS

There is an increased risk of orofacial injuries in swimming pool facilities. Nevertheless, only a few studies have addressed this issue. The aim of this study was to identify the frequency of lip and tooth injuries at public swimming pools in Austria. A further aim was to examine which gender and age groups were affected, where and why these injuries occurred, and whether pool attendants had sufficient knowledge of dental first-aid measures.

MATERIAL AND METHODS

A total of 764 pool attendants in Austria were contacted by telephone and 689 participated in the study (90.2%). The attendants were interviewed retrospectively about accident occurrences in 2014 by a standardized questionnaire. Responses to the provision of first aid and choice of storage medium for avulsed teeth were subsequently evaluated.

RESULTS

The frequency of lip injuries was 19.0%, and tooth injuries were 11.3%. Male bathers (P < .05) and children under 12 years (P < .001) most frequently suffered injuries. The waterslide was the most common accident site. The most common cause of lip injuries was slipping on wet surfaces (39.0%), and for tooth injuries it was collisions with other persons or objects (each 28.1%). The pool attendants' responses were predominantly good or sufficient on first aid, with the exception of what storage medium to choose. Tooth rescue boxes were available in only 8.6% of all pool facilities.

CONCLUSION

Orofacial injuries are a frequently occurring problem in swimming pool facilities. The pool attendants' knowledge on first-aid care of tooth injuries could still be improved.

A poster and a mobile healthcare application as information tools for dental trauma management

BACKGROUND/AIMS

Prompt management of dental trauma in children affects outcomes, and multiple educational resources are available. The aim of this study was to compare subjects' accuracy in answering a survey about dental trauma management utilizing a poster and a mobile healthcare application and to determine user preference for mode of delivery of information.

MATERIALS AND METHODS

A survey was administered to parents of patients in two pediatric dental practices. Questions collected demographic information, frequency of internet use, and responses to questions regarding dental trauma management for two separate scenarios. Participants used both a poster and a mobile application, but were randomly assigned as to which tool was utilized first.

RESULTS

Eighty-nine surveys were usable. The majority of respondents were aged 36-45 years (50.6%), had education beyond high school (64%), and had private insurance (52.8%). Less-educated individuals were more likely to report searching the Internet (74%) compared to individuals with a graduate degree (57%) (P = 0.017). The majority of subjects answered trauma management questions correctly with both tools. However, for an avulsed permanent tooth, individuals receiving the mobile application were more likely to select: 'put the tooth back in place' (71.1%) compared to those utilizing the poster, who chose 'put the tooth in milk' (56.8%) (P = 0.004). Less-educated individuals were willing to pay more for the application (P = 0.015) and were more likely to report being interested in receiving dental information through mobile technology in the future (P = 0.006).

CONCLUSIONS

Both a poster and a mobile healthcare application are effective in delivering dental trauma information.

Storage media for avulsed teeth: a literature review

Dental avulsion is the most severe type of traumatic tooth injuries because it causes damage to several structures and results in the complete displacement of the tooth from its socket in the alveolar bone. The ideal situation is to replant an exarticulated tooth immediately after avulsion because the extraoral time is a determinant factor for treatment success and for a good prognosis. However, it is not always possible. The success of replantation depends on a number of factors that may contribute to accelerate or minimize the occurrence of root resorption or ankylosis, among which is the type and characteristics of the medium used for temporary storage during the time elapsed between avulsion and replantation. Maintaining the tooth in an adequate wet medium that can preserve, as longer as possible, the vitality of the periodontal ligament cells that remain on root surface is the key to success of replantation. Recent research has led to the development of storage media that produce conditions that closely resemble the original socket environment, with adequate osmolality (cell pressure), pH, nutritional metabolites and glucose, and thus create the best possible conditions for storage. Although these storage media can now be purchased in the form of retail products, the most common scenario is that such a product will not be readily available at the moment of the accident This paper reviews the literature on the different storage media that have been investigated for avulsed teeth based on full-length papers retrieved from PubMed/Medline, Lilacs, BBO and SciELO electronic databases using the key words 'storage medium', 'transportation medium', 'avulsion', 'tooth avulsion', 'replantation', 'tooth replantation', 'milk' and 'propolis'. After application of inclusion and exclusion criteria, 39 papers were selected and critically reviewed with respect to the characteristics, efficacy and ease of access of the storage medium. The review of the literature showed that a wide array of types of wet storage media have been evaluated in laboratory studies and clinical reports, including cell and tissue culture solutions like Hank's Balanced Salt Solution (HBSS); medical/hospital products developed specifically for organ storage purposes, such as Viaspan® and Euro-Collins®; culture media, like Minimum Essential Medium (MEM); saline; natural products like water, saliva, bovine milk and its variations, propolis, green tea, Morus rubra (red mulberry), egg white and coconut water; rehydrating solutions, like Gatorade® and Ricetral, and even contact lens solutions. Based on the literature, it could be stated that, so far, apart from Based on the literature, it could be stated that, so far, apart from solutions designed specifically for storage and culture purposes, regular pasteurized whole milk is the most frequently recommended and with the best prognosis among other solutions that are likely to be available at the scene of an accident, such as water, saline or saliva. Its advantages include its high availability, ready accessibility, physiologically compatible pH and osmolality (fluid pressure) with the root-surface adhered PDL cells, presence of nutrients and growth factors. However, there is not yet a single solution that fulfills all requirements to be considered as the ideal medium for temporary storage of avulsed teeth, and research on this field should carry on.

Delayed tooth replantation in rats: effect of systemic antibiotic therapy with amoxicillin and tetracycline

Systemic antibiotic therapy (SAT) has usually been recommended after tooth replantation, but its actual value has been questioned. As there are no reports in the literature about its influence on tooth replantation, the aim of this study was to evaluate the influence of systemic administration of antibiotics (amoxicillin and tetracycline) at the different phases of the repair process (7, 15, 30 days) in delayed rat tooth replantation. Ninety Wistar rats (Rattus norvegicus albinus) had their maxillary right incisors extracted and bench-dried for 60 min. The dental papilla, enamel organ, pulp tissue, and root surface-adhered periodontal ligament were removed, and the teeth were replanted. The animals received no antibiotics (n = 30) or were medicated systemically with amoxicillin (n = 30) and tetracycline (n = 30), and were euthanized after 7, 15, and 30 days. Regardless of the evaluation period, the acute inflammatory infiltrate was less intense and root resorption presented smaller extent and depth in the group treated with amoxicillin. The results suggest that SAT has a positive influence on the repair process in delayed tooth replantation and that amoxicillin is an excellent treatment option.

Knowledge and attitude regarding management of tooth avulsion injuries among school teachers in rural India

Objectives:

Traumatic dento-alveolar injuries are frequent in children and adolescents, affecting teeth, their supporting structures, and adjacent soft tissues. Because school teachers are likely to be in contact with the child soon after injury, it is important to ascertain their knowledge and attitude about this.

Aim:

The study aimed to assess the knowledge and attitude of school teachers in Coorg with regard to immediate management of avulsed teeth.

Materials and Methods:

This cross-sectional study was conducted among school teachers in Coorg district. A self-administered questionnaire containing 16 questions was given to a sample of 600 school teachers.

Results:

Descriptive statistics and independent sample t-test were used for analysis. Only 24.7% teachers thought the tooth was important and wanted to search for the avulsed tooth. Regarding the knowledge about replantation of tooth, 25.7% teachers knew that a fallen tooth can be placed back in the socket. Extraoral time for replantation of the tooth that was opted by 44 teachers (30.3%) was ≤30 min.

Conclusion:

This survey reflected the lack of experience and inadequate knowledge regarding dental trauma management among school teachers in Coorg. The implications of this study are directed toward education of these school teachers who are involved in the supervision of children in schools.

Continuing dental education in the treatment of dental avulsion: Polish dentists' knowledge of the current IADT guidelines

OBJECTIVES

To evaluate the knowledge and experience of the treatment of avulsed teeth amongst Polish dentists 5 years after the publication of IADT guidelines.

METHODS

On the basis of IADT guidelines, a voluntary anonymous 12-item questionnaire was developed to evaluate dentists' knowledge on the treatment of avulsed teeth. The survey was conducted during three continuing education courses, which took place in Bialystok, Poland and covered 133 dentists. Data were analysed with Statistica 6.0 using Mann-Withney U- and Kruskal-Wallis tests (P < 0.05).

RESULTS

The study revealed that Polish dentists were not prepared to deal with dental avulsion. 63.2% of respondents have never treated such patients, and 68.45% have never attended any postgraduate course on dental trauma. Sufficient knowledge was presented only according to the way of cleaning a contaminated tooth. Lack of knowledge was observed in fields: method of choice in first aid in dental avulsion (23.3% of correct answers) and critical extra-oral dry time (26.3%). Dentists practising <10 years had better knowledge than those with greater experience (P = 0.0000). Gender, previous experience in the treatment of avulsion, postgraduate education in dental trauma and subjective knowledge assessment were not statistically significant.

CONCLUSIONS

There is a gap in the system of continuing dental education in Poland. Polish dentists need to familiarise themselves with the avulsion management procedures.