Oral Health-Related Quality of Life and Traumatic Dental Injuries in Young Permanent Incisors in Brazilian Schoolchildren: A Multilevel Approach

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.

Traumatic Dental Injuries among 12-Year-Old Schoolchildren in the United Arab Emirates

AIMS

This study aimed to evaluate the prevalence of the factors related to traumatic injuries to the permanent incisors of 12-year-old children in the Emirate of Ajman, United Arab Emirates.

METHODS

A sample of 1008 12-year-old children (510 boys and 498 girls) participated in this study. A multi-stage randomized sampling technique was used to select children from public schools for their inclusion in the sample population. An oral examination was completed by a calibrated examiner after receiving training for traumatic dental injury (TDI) to permanent incisor teeth utilizing a modified version of Ellis's classification. Data that were related to sociodemographic factors, TDI causes, and where the TDI took place were recorded using a structured questionnaire.

RESULTS

Of all of the children that were examined, 9.8% of them had experienced dental trauma. The difference in TDI prevalence between boys (15.9%) and girls (3.9%) was statistically significant (p < 0.05). The children whose mothers had low levels of education experienced a higher prevalence of TDI (p = 0.001). The children with incisal overjets that were greater than 5 mm or with inadequate lip coverage tended to have experienced dental injuries (p < 0.01). The main causes of injury to permanent incisors were collision against an object or person (53.5%) and falling (42.4%). Most of the accidents happened at home (58.6%) and school (25.3%). The most prevalent injuries were enamel fractures (58.7%) and enamel-dentine fractures (34.3%).

CONCLUSIONS

This research highlighted many predisposing factors for traumatic dental injuries among children. There is an urgent need to initiate detailed public health policies to decrease the prevalence of dental trauma cases, especially in the identified risk group.

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.

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.

Impact of oral diseases on oral health-related quality of life: A systematic review of studies conducted in Latin America and the Caribbean

Background

We performed a systematic review of studies conducted in Latin America and the Caribbean (LAC) to assess the impact of oral diseases on oral health-related quality of life (OHRQoL).

Materials and methods

Searches were performed of the following PubMed, EMBASE, CINAHL, Scopus, and LILACS databases. Randomized clinical trials, quasi-experimental studies, cohort studies, case and control studies, and cross-sectional studies which included at least 100 participants evaluating the impact of oral diseases on OHRQoL were included. PROSPERO registry number: CRD42020156098.

Results

After exclusion of duplicates, 3310 articles were identified, 40 of which were included in this review. 90% of the studies were conducted in Brazil. The most commonly used OHRQoL measuring instruments were CPQ 11–14 (n = 9), ECOHIS (n-8) and B-ECOHIS (n = 8). The study designs included 32 cross-sectional, 2 cohort and 6 case and control studies. Most of the studies were conducted in children (n = 25) and adolescents (n = 9). Most studies identified an impact on OHRQoL in children, adolescents and adults with oral diseases. Moreover, greater oral disease severity had a greater impact on OHRQoL.

Conclusions

Most studies in LAC report a negative impact of diseases on OHRQoL. More longitudinal studies are required to confirm the results of these studies.

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.

Do malocclusion and orthodontic treatment impact oral health? A systematic review and meta-analysis

INTRODUCTION

Currently, there is limited evidence on the effects of malocclusion on oral health and whether the correction of malocclusion results in an improvement in oral health. In this review, we examined the evidence from randomized controlled trials and prospective cohort studies to provide information on any association between malocclusion and oral health and the effects of orthodontic treatment.

METHODS

We conducted this review in 2 parts: (1) we looked at the impact of malocclusion on oral health, and (2) we reviewed the evidence on the effect of orthodontic treatment on oral health. We searched for randomized controlled trials and prospective cohort studies. The searches were completed for articles published between January 1, 1990 and October 8, 2018 and covered Medline via Ovid, Embase, and the Cochrane Database of Systematic Reviews. References of included articles and previous systematic reviews were hand-searched. No language restrictions were applied. Two members of the study team assessed the quality of the studies using the Appraisal Tool for Cross-Sectional Studies to appraise the quality of studies in part 1. The assessment was performed at the study level. Two authors assessed each study independently, with a third author consulted when a disagreement occurred. For studies in part 2, we used the Newcastle-Ottawa scale to assess the risk of bias. When studies were included in a Cochrane review, we incorporated the risk of bias assessment. We developed data extraction forms for each area of oral health under investigation (trauma, quality of life, caries, and periodontal disease). Each author piloted the form, and we held discussions to inform any necessary refinements. We extracted data from studies into 2 × 2 tables, which provided a binary analysis of malocclusion vs the outcome of interest. If these data were not available from the published paper, then studies were not included in the meta-analysis. The authors were contacted when possible to request data in this format.

RESULTS

For part 1 of the study, we identified 87 studies. The overall quality was low. We could not include any of the data into an analysis because of a large variation in the nature of the studies, data collected, and outcome measures that were selected. For part 2 of the study, we found 7 studies; however, there were similar deficiencies in the data as in part 1, and thus, we could not reach any strong conclusions.

CONCLUSIONS

Overall, there is an absence of published evidence regarding the effects of malocclusion on oral health and the impact of orthodontic treatment on oral health.

Impact of complicated and uncomplicated traumatic dental injuries on oral health-related quality of life of preschoolers and their family

The severity of a traumatic dental injury (TDI) can influence the prognosis of deciduous teeth and the formation of permanent successors. Consequently, it can have a negative influence on the daily lives of children and their parents. The present study aimed to evaluate the impact of complicated and uncomplicated TDI on the oral health-related quality of life (OHRQoL) of preschoolers and their families. A cross-sectional study was carried out according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. After sample calculation and application of the eligibility criteria, 76 children from public preschools (aged 2 to 5 years) with TDI were selected during a period of 5 months. TDI was diagnosed using the Dental Trauma Index and classified according to the severity as complicated or uncomplicated. The Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS) was used to determine OHRQoL. The Poisson regression model and Poisson regression model with robust estimates were calculated according to p-values <0.05. The complicated group and the uncomplicated group presented low average impact according to ECOHIS scores and there was no significant difference in the total scale, subscale, and domains (P>0.05) according to the type of TDI. Based on these findings, it can be concluded that severity of TDI did not influence the OHRQoL of preschoolers and their families.

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.

Permanent Anterior Teeth Fractures and its Impact on Oral Health-Related Quality of Life among 8-15-Year-Old Schoolchildren of Chennai City - A Cross-Sectional Survey

Background:

Tooth fracture is not only a distressing experience on the physical level of a child, but it may also have an effect on emotional and psychological levels. This study aims to assess the permanent anterior teeth fractures and their impact on Oral Health-Related Quality of Life (OHRQoL) among 8–15-year-old schoolchildren of Chennai city.

Materials and Methods:

Thirty schools were randomly selected by stratified random sampling. All school-going children aged 8–15 years were invited to participate. A total of 7247 children were screened and 628 children with permanent anterior teeth fractures were included. Data were collected using Child Oral Health Impact Profile questionnaire. In addition, questionnaire addressing sociodemographic data and factors influencing permanent anterior teeth fractures were recorded. Descriptive statistics was performed to characterize the sample. One-way analysis of variance and Tukey's honestly significant difference post hoc tests was applied for multiple pair-wise comparisons.

Results:

The prevalence of permanent anterior teeth fracture was found to be 8.7%. The type of school had highly significant (P < 0.001) influence on the impact of permanent anterior teeth fracture on OHRQoL with negative OHRQoL among the corporation schools. The study participants of corporation schools had negative OHRQoL with significant difference in oral health well-being (P < 0.001) and self-image (P = 0.014).

Conclusion:

All the children reporting with tooth fractures had negative OHRQoL. The study stresses the importance of promoting good oral health-care practices to prevent oral disease in children and to meet children's unmet oral health-care needs.

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.

Effect of two educational interventions on primary school teachers' knowledge and self-reported practice regarding emergency management of traumatic dental injuries

BACKGROUND

The present study evaluated the effect of two educational interventions on the knowledge and self-reported practice of primary school teachers regarding emergency management of traumatic dental injuries (TDIs).

METHODS

All primary school teachers (n = 664) of Arak, Iran were asked to participate in the study. Based on geographic regions, all participants were enrolled in two groups: educational leaflet and oral presentation. At baseline, teachers in both groups were asked to complete an anonymous self-administrated questionnaire consisting of demographics, eight questions on knowledge, and four paper cases on self-reported practice about TDIs. After collecting the questionnaires, interventions, including an oral presentation and an educational leaflet whose contents were prepared based on the most recent scientific evidence, were implemented. One and six months after the interventions, the questionnaire was completed by the teachers again. Repeated measures ANOVA and a linear regression model were used for statistical analysis.

RESULTS

Two hundred and ninety-two teachers participated in all stages of the study (response rate = 64.5%). In one-month follow-up, in both groups, the mean score of knowledge was significantly higher compared to baseline and six-month scores (P < 0.001 and P < 0.001, respectively). Moreover, in six-month follow-up, the mean score of knowledge was higher compared to baseline (P < 0.001) in both intervention groups. No statistically significant difference existed in the mean score of knowledge in three evaluations between two groups (P < 0.05). In one-month follow-up, the mean score of self-reported practice was significantly higher compared to baseline and six-month scores in both interventional groups (P < 0.001 and P < 0.001, respectively). There was no significant difference in the mean score of self-reported practice between the one-month and six-month follow-up (P = 0.53). There was no statistical significant difference in the mean score of self-reported practice in three evaluation phases between two groups (P < 0.05). No significant relationship was observed between the difference in knowledge and self-reported practice scores and demographic factors.

CONCLUSIONS

Both educational interventions regarding emergency management of TDIs-educational leaflet and oral presentation- were effective in increasing knowledge and self-reported practice of teachers in the short-term follow-up. In long-term evaluation, educational leaflet resulted in more positive changes in teachers' knowledge compared to their self-reported practice.

Prevalence of traumatic crown injuries in German adolescents

OBJECTIVES

Although dental trauma and its unfavorable sequelae are considered major public health problems worldwide, the published data on the prevalence of traumatic crown injuries (TCIs) in Germany are lacking. Therefore, the present study assessed the prevalence of TCIs among adolescents in Bavaria, Germany.

MATERIAL AND METHODS

Ethical approval and parental consents were obtained, and population-based information from 10- (N = 1158), 12- (N = 416), and 15-year-olds (N = 1302) from two different cohort studies performed in Bavaria (GINIplus/LISA and LAGZ) were examined for the presence of TCIs, dental caries, and restorations. Statistical comparisons were made using Mann-Whitney U test and Wilcoxon signed-rank test.

RESULTS

The prevalence of TCIs was 6.3% in the 10- and 12-year-old children and 14.0% in 15-year-old children, and a higher prevalence was observed in boys than in girls. Most (87.5%) of the traumatized teeth were maxillary incisors. The caries prevalence was low in all three populations.

CONCLUSION

The prevalence of TCIs in Bavarian adolescents at a low risk for caries was found to be low.

CLINICAL RELEVANCE

Dental trauma is a prevalent event in children and adolescents, and incisors are the most affected teeth. Therefore, dental practitioners should be able to manage the spectrum of traumatic injuries.

Psychosocial Impacts Relating to Dental Injuries in Childhood: The Bigger Picture

Traumatic dental injuries (TDI) in childhood are fairly commonplace, with a reported prevalence of up to 30% worldwide. These injuries can have significant impacts on patients, their families and dental professionals; however, this area is currently underrepresented within paediatric oral health research. The psychosocial impacts of traumatic injury are personal to each patient and should be addressed as part of a holistic treatment plan. A review of the current evidence base shows that children who have suffered a traumatic injury to the dentition report worse oral-health-related quality of life. They are also more likely to suffer decreased self-esteem due to their appearance, especially where the injury is not effectively managed. Society (including other children) often judges poorly those with obvious dental disease or anomaly, and with the rising use of social media, these judgements can be made by even greater audiences. There is currently a paucity of qualitative research in this topic to explore the negative psychosocial impacts of dental trauma in greater detail. Although there is growing evidence for the benefit of treatment in improving children’s wellbeing following a TDI, the field of paediatric dental traumatology still has much to learn about young patients’ perspectives, experiences and values.

Prevalence of early loss of primary molar and its impact in schoolchildren's quality of life

BACKGROUND

Evidence regarding the impact of premature loss of primary molars on oral health-related quality of life (OHRQoL) is lacking.

AIM

To evaluate the prevalence of premature loss of primary molars in schoolchildren and its impact on OHRQoL.

DESIGN

We randomly selected 667 children aged 8-9 years enrolled in public and private schools from Aracaju (Brazil). The presence of untreated dental caries and early loss of primary molars were recorded, and its impacts on OHRQoL evaluated using Child Perceptions Questionnaire (CPQ_8-10 ). Influence of some variables on tooth loss and OHRQoL was assessed by multilevel Poisson's regression analysis (P < 0.05).

RESULTS

The prevalence for early tooth loss was 65.4% (95% confidence interval 51.1%-77.3%). Children with untreated dental caries and attending public schools presented higher prevalence of early tooth loss. Moreover, early loss of primary molars provoked negative impact on OHRQoL considering total score of CPQ_8-10 and domains "oral symptoms," "functional limitations" and "emotional well-being." Children presenting early teeth loss presented significantly higher scores of CPQ_8-10 , as well as females and children with dental caries in other teeth.

CONCLUSIONS

The prevalence of early loss of primary molars is high, and it impacts the OHRQoL of children aged 8-9 years.

Oral health-related quality of life in children and adolescents with osteogenesis imperfecta: cross-sectional study

Background

Osteogenesis imperfecta (OI) affects dental and craniofacial development and may therefore impair Oral Health-Related Quality of Life (OHRQoL). However, little is known about OHRQoL in children and adolescents with OI. The aim of this study was to explore the influence of OI severity on oral health-related quality of life in children and adolescents.

Methods

Children and adolescents aged 8–14 years were recruited in the context of a multicenter longitudinal study (Brittle Bone Disease Consortium) that enrolls individuals with OI in 10 centers across North America. OHRQoL was assessed using the Child Perceptions Questionnaire (CPQ) versions for 8 to 10-year-olds (CPQ_8–10) and for 11 to 14-year-olds (CPQ_11–14).

Results

A total of 138 children and adolescents (62% girls) diagnosed with OI types I, III, IV, V and VI (n = 65, 30, 37, 4 and 2, respectively) participated in the study. CPQ_8–10 scores were similar between OI types in children aged 8 to 10 years. In the 11 to 14-year-old group, CPQ_11–14-scores were significantly higher (i.e. worse) for OI types III (24.7 [SD 12.5]) and IV (23.1 [SD 14.8]) than for OI type I (16.5 [SD 12.8]) (P < 0.05). The difference between OI types was due to the association between OI types and the functional limitations domain, as OI types III and IV were associated with significantly higher grade of functional limitations compared to OI type I.

Conclusion

The severity of OI impacts OHRQoL in adolescents aged 11 to 14 years, but not in children age 8 to 10 years.

Electronic supplementary material

The online version of this article (10.1186/s13023-018-0935-y) contains supplementary material, which is available to authorized users.

Factors associated with dental fractures in Brazilian individuals

AIM

The aim of the present study was to assess the association of sex, age, group of teeth, and type of accident (exposure) with dental fractures (outcome: enamel-dentine fracture without [EDF] or with pulp exposure [EDPF] and root fracture RF]).

METHODS

In total, 1046 patients were selected. Logistic binary regression was used.

RESULTS

The findings showed that EDF has less change of affecting individuals ≤9 years of age than ≥40 years of age (odds ratio [OR]: 0.58, 95% confidence interval [CI]: 0.35-0.95). Violence (OR: 3.07, 95% CI: 1.77-5.31), traffic accidents (OR: 1.50, 95% CI: 1.05-2.13), and sporting accidents (OR: 1.70, 95% CI: 1.19-2.44)] were associated with EDF. Regarding EDPF, the mandibular lateral incisors had a 10 times higher chance of being injured than canines and posterior teeth (OR: 10.43, 95% CI: 1.74-62.4). Those aged ≤9 years (OR: 0.21, 95% CI: 0.07-0.58) and 10-19 years (OR: 0.38, 95% CI: 0.17-0.88) had a significantly lower chance of being affected by RF.

CONCLUSION

EDF and RF are associated with individuals ≥40 years of age; violence and traffic and sporting accidents are also associated with EDF, and mandibular incisors have a greater chance of being affected by EDPF.

Importance of contextual variables related to cavitated lesions in 5-year-old children

BACKGROUND

Dental caries have a high prevalence in children and need to evaluate their individual and contextual determinants.

AIM

To evaluate the importance of individual and contextual determinants on the occurrence of cavitated lesions in 5-year-old children.

DESIGN

A cross-sectional study was conducted with 769 preschoolers in a city in northeastern Brazil. Parents/caregivers answered questionnaires addressing psychological aspects, socio-demographic characteristics and the child's oral health. The diagnosis of dental caries (cavitated lesion) was performed using the ICDAS-II. Variables related to the context were collected at the preschools and official municipal publications. Unadjusted and adjusted multilevel Poisson regression models with robust variance correction were used.

RESULTS

The prevalence of cavitated lesions was 58.8%. In the analysis adjusted by individual determinants, low household income (PR = 1.61; 95%CI:1.27-2.05), lower parent's/caregiver's schooling (PR = 1.57; 95%CI:1.20-2.05), not visited to the dentist (PR = 0.77; 95%CI:0.62-0.94), brushing frequency under 2 times per day (PR = 2.17; 95%CI:1.35-3.51) and weak parent's/caregiver's SOC (PR = 1.30; 95%CI:1.09-1.56) were associated with cavitated lesions. However, after the incorporation of the contextual determinants, parent's/caregiver's schooling and SOC lost their association. Considering contextual factors, children attending public preschools (PR = 1.66; 95%CI:1.34-2.05) and/or smaller preschools (PR = 1.001; 95%CI:1.001-1.002) had a greater probability of exhibiting cavitated lesions.

CONCLUSION

Contextual variables were more important to the occurrence cavitated lesions than individual socioeconomic variables.

World traumatic dental injury prevalence and incidence, a meta-analysis-One billion living people have had traumatic dental injuries

Traumatic dental injuries (TDIs) account for a considerable proportion of bodily injuries. Nevertheless, global TDI frequency is unknown, probably because TDI diagnosis is not standardized. This study estimated world TDI frequency. A literature search (publication years 1996-2016) was aimed at covering as many countries, communities, ethnic groups as possible, thus achieving high generalizability. In particular, non-specific keywords, no language restrictions, and large databanks were used. Observational studies reporting proportions of individuals with at least one TDI (prevalence) and who developed TDI (incidence rate) were considered. Prevalence rates to permanent dentition, primary dentition and in 12-year-olds, incidence rate to any tooth for any age, male-to-female prevalence ratio (PR) in 12-year-olds, with 95% confidence intervals (95 CIs), were extracted/calculated. Study quality, Z-score distribution, funnel plot symmetry analysis, between-study heterogeneity, sensitivity, and subgroup analyses were performed. Selected primary studies were 102 (permanent dentition; 268 755 individuals; median age, 13.8 years), 46 (primary dentition; 59 436 individuals; median age, 3.4 years), 42 (12-year-olds; 33 829 individuals), 11 (incidence rate; 233 480 person-years; median age, 7.8 years), and 31 (PR; 16 003 males, 16 006 females). World TDI frequency resulted as follows: permanent dentition prevalence 15.2% (95 CI, 13.0%-17.4%); primary dentition prevalence 22.7% (95 CI, 17.3%-28.7%); 12-year-olds prevalence 18.1% (95 CI, 15.3%-21.0%); incidence rate, 2.82 (95 CI, 2.28%-3.42%) per 100 person-years; PR, 1.43 (95 CI, 1.34%-1.52%). Differences between WHO Regions were found. This study shows that more than one billion living people have had TDI. TDI is a neglected condition which could rank fifth if it was included in the list of the world's most frequent acute/chronic diseases and injuries.

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.

Sectional Fixed Orthodontic Extrusion Technique in Management of Teeth with Complicated Crown-Root Fractures: Report of Two Cases

Complicated crown-root fractures account for a small percentage of traumatic dental injuries seen in children; however, management of these injuries can be very challenging to clinicians. Factors such as complexity of the injury, patient’s age and dentition stage, patient’s cooperation, and parental demands may have some bearing on the type of treatment undertaken and its outcomes. In some children, these injuries may have significant impact on their quality of life. The purpose of this article is to describe two cases of complicated crown-root fracture which were successfully managed through orthodontic extrusion using a sectional fixed orthodontic technique. The basis for the treatment technique and its favourable outcomes were highlighted with its advantages and drawbacks.

Dental caries remains as the main oral condition with the greatest impact on children's quality of life

PURPOSE

The objective of this study was to assess the negative impact of dental caries on the OHRQoL of 8- to 10-year-old Brazilian children.

METHODS

This population-based case-control study involved 546 children (8-10 years old), 182 cases with a high negative impact on OHRQoL and 364 controls with a low negative impact on OHRQoL. Children's OHRQOL was measured using the Child Perceptions Questionnaire (CPQ8-10). Cases and controls (1x2 ratio) were individually matched by school and gender. Dental caries experience, malocclusion, and traumatic dental injuries were used as independent variables. Dental examinations were carried out at school during daytime hours by two calibrated examiners (Kappa = 0.93-interexaminer and 0.95- intraexaminer). The data were analyzed by descriptive statistics, conditional bivariate and multiple logistic regression, with the significance level set at 5%.

RESULTS

There was no significant difference in traumatic dental injuries and malocclusion between the case and control groups (p>0.05). Children with DMFT/dmft ≥3 had a 2.06-fold (95%CI = 1.28-3.31, p = 0.003) greater chance of experiencing a high negative impact on OHRQoL than those with DMFT/dmft = 0.

CONCLUSION

Children with high dental caries experience are more likely to present a high negative impact on OHRQoL than those with no dental caries experience.

Income inequality and traumatic dental injuries in 12-year-old children: A multilevel analysis

BACKGROUND/AIM

Contextual socio-economic factors have been associated with traumatic dental injuries (TDIs). However, evidence concerning the role of income inequality on TDIs in children is scarce. The aim of this study was to investigate the association between contextual income inequality over a 10-year period and TDIs in Brazilian children.

SUBJECTS AND METHODS

The study population comprised a representative sample of 5027 children aged 12 years who participated in the Brazilian oral health survey in 2010. City-level Gini Index was used to measure contextual income inequality in the years 2000 and 2010, as well as the variation in income inequality between 2000 and 2010. Covariates were gender, ethnicity, family income, number of people per room and incisal overjet. Clinical examinations were used to assess TDIs. Multivariable multilevel ordered multinomial logistic regression was used to estimate cumulative Odds Ratio (OR) and 95% confidence intervals between income inequality and TDIs.

RESULTS

The prevalence of children who had one tooth with TDI and two or more teeth with TDIs was 15.2% and 6.4%, respectively. The maxillary central and left lateral incisors were the teeth most affected by TDIs. Gini coefficient reduction between the years 2000 and 2010 decreased the odds of TDIs even after adjustment for demographic and socio-economic characteristics, and incisal overjet. The likelihood of more TDIs decreased 21% for each 0.05 unit decrease in the Gini coefficient between the years 2000 and 2010. Boys, brown skin colour, overcrowding and incisal overjet greater than 5 mm remained statistically associated with TDIs in the final model.

CONCLUSIONS

The decrease in income inequality over a 10-year period was inversely associated with TDIs among Brazilian children aged 12 years.

A population-based study on the impact of orofacial dysfunction on oral health-related quality of life among Brazilian schoolchildren

OBJECTIVE

The aim of the present study was to assess the impact of orofacial dysfunction on oral health-related quality of life (OHRQoL) among Brazilian schoolchildren.

MATERIAL AND METHODS

A population-based study was conducted with 531 children aged eight to 10 years at schools in the city of Campo Magro, Brazil. The Brazilian version of the Child Perceptions Questionnaire (CPQ_8-10) was the outcome variable used to measure the impact on OHRQoL. The main independent variable was orofacial function, which was diagnosed using the Nordic Orofacial Test-Screening (NOT-S). Descriptive, bivariate and multiple Poisson regression analyses were performed using a multilevel approach, with the significance level set to 5%.

RESULTS

The mean (±SD) total CPQ_8-10 score was 13.95 ± 0.5. The multilevel Poisson regression model revealed that the mean CPQ8-10 score was higher among girls (RR: 1.38, 95% CI: 1.17-1.63; p < 0.001) than boys and that children from families with a higher income had lower CPQ_8-10 scores (RR: 0.67, 95% CI: 0.51-0.88; p = 0.004) than those from families with a lower income. Children who sought dental care due to pain or factors other than prevention (RR: 1.41; 95% CI: 1.18-1.68), those with orofacial dysfunction (RR: 1.62; 95% CI: 1.30-2.02) and those with a history of traumatic dental injury (RR: 1.39; 95% CI: 1.15-1.69) also experienced a greater impact on OHRQoL.

CONCLUSIONS

Schoolchildren with orofacial dysfunction experience a greater negative impact on OHRQoL.

Early Class II treatment

The treatment of children presenting with a Class II division I malocclusion involves one of two approaches. The first provides treatment in two phases; one of intervention during the mixed dentition (phase I) followed by a second definitive course of appliance treatment in early adolescence (phase II). The second approach involves providing a single course of comprehensive therapy during adolescence. The debate for and against early treatment is discussed alongside key, clinically relevant evidence related to Class II division I malocclusions.

Multimorbidity patterns of oral clinical conditions, social position, and oral health-related quality of life in a population-based survey of 12-yr-old children

The aim of this study was to describe the patterns of multimorbidities of oral clinical conditions in children. The association between social position and number of oral clinical conditions, and the relationship of social position and number of oral clinical conditions with oral health-related quality of life [OHRQoL, measured using the Brazilian Child-Oral Impacts on Daily Performance (Child-OIDP)] were also investigated. The study analysed data on 7,208 children, 12 yr of age, from the Brazilian Oral Health Survey (SBBrasil Project). Cluster analysis based on the observed/expected (O/E) ratios identified six significant clusters of oral clinical conditions: (i) dental caries and missing teeth; (ii) dental caries and dental trauma; (iii) dental trauma and gingivitis; (iv) dental caries, missing teeth, and dental trauma; (v) dental caries, dental trauma, and gingivitis; and (vi) all oral clinical conditions. Ordinal regression showed that poor social position was associated with a large number of oral clinical conditions. Poisson regression demonstrated that low social position and greater number of oral clinical conditions increased the likelihood of poor OHRQoL (Child-OIDP extent). The four oral clinical conditions clustered into six distinct clusters among Brazilian children. Multimorbidity of oral clinical conditions predicted poor OHRQoL. Social position was of high relevance to multimorbidity of oral clinical conditions and children's OHRQoL.

Prevalence of anterior dental trauma and its associated factors among children aged 3-5 years in Jaipur City, India - A cross sectional study

Objective:

To study the prevalence of anterior dental trauma and its associated factors among 800 preschool children aged 3 to 5 years in Jaipur City, Rajasthan, India.

Materials and Methods:

A cross-sectional survey was conducted among children aged 3-5 years, who were enrolled in various private and public schools in Jaipur. Parents were asked to fill a form addressing socio-demographic data and clinical examinations were performed by a single dentist. Traumatic dental injuries (TDI) were assessed and recorded based on Andreasen's classification. Associated factors such as sex, socioeconomic status (SES), and the type of injury were also analyzed. The data were analyzed statistically using Statistical Package for the Social Sciences software (version 20).

Results:

An overall 10.2% prevalence of TDI was observed among the study population. TDI were reported to be more among male children (11.87%) compared to female children (8.14%). Enamel fractures (69%) were the most prevalent type of anterior dental trauma. Upper central incisors were the most frequently affected. The SES of the parents had little influence on the prevalence of TDI.

Conclusions:

The prevalence rate of dental trauma among children aged 3-5 years was 10.2%. Associated factors, such as SES, were observed to be not significantly correlated to dental trauma among the studied preschoolers.

Risk factors for traumatic dental injuries in the primary dentition: concepts, interpretation, and evidence

The purpose of this comprehensive review is to explore the main concepts related to quantification and interpretation of risk factors and investigate characteristics associated with traumatic dental injuries (TDI) in the primary dentition. Initially, the main concepts related to causality and risk factors were summarized, including how to measure, express, and compare risk as well as interpret statistical significance. Based on a structured search through PubMed, original research articles regarding TDI and associated factors in the primary dentition were then reviewed by two examiners. Studies with a sample size of at least 300 children aged between 0 and 6 years were summarized according to journal, country, study design, and type of statistical analysis. Variables associated with TDI in primary teeth were identified from studies with multivariable analysis. Measures of effect size and P values were presented. Thirty-two studies were retrieved: most were cross-sectional in design and only 17 (53.1%) performed multivariable analysis. Most investigations did not find an association between gender and socioeconomic variables with TDI. Increased overjet was the only factor consistently identified as an associated factor. Behavioral characteristics have been recently investigated and suggested as potential risk factors for TDI in the primary dentition. In conclusion, increased overjet is undoubtedly associated with TDI in the primary dentition. As behavioral factors may be targeted by preventive strategies, their role on TDI occurrence should be clarified in future cohort studies. Clinicians should understand the terms and measures described in studies on risk factors to properly apply knowledge and benefit patients.