The prevalence of traumatic dental injuries to permanent anterior teeth and its relation with predisposing risk factors among 8-13 years school children of Vadodara city: an epidemiological study

The effect of sleep disorders, school jet lag, and anxiety in students 8-10 years of age on traumatic dental injuries

BACKGROUND/AIM

Traumatic dental injuries (TDI) constitute a public health problem. The aim of the present study was to investigate whether sleep disorders, school jet lag, and anxiety are associated with TDI in schoolchildren 8-10 years of age.

METHODS

An analytical, cross-sectional study was conducted with 739 pairs of parents/guardians and children enrolled in public and private schools. The parents/guardians answered a socioeconomic questionnaire, the Sleep Disturbance Scale for Children, Circadian Energy Scale, and Revised Children's Manifest Anxiety Scale. Four examiners underwent calibration exercises for the diagnosis of TDI (K > 0.80) using the criteria proposed by Andreasen (2007). A directed acyclic graph was used for the formulation of the theoretical model and statistical adjustments. Unadjusted and adjusted robust binary logistic regression analyses were performed (α = 5%).

RESULTS

The prevalence of TDI was 16.2%. The following variables remained associated with the outcome in the final model: family income less than or equal to the minimum monthly wage (OR = 1.77; 95% CI: 1.09-2.88; p = .02), child's height >137.6 cm (OR = 1.68; 95% CI: 1.06-2.64; p = .02), the occurrence of school jet lag (OR = 2.12; 95% CI: 1.27-3.53; p = .004), anxiety (OR = 1.77; 95% CI: 1.04-3.00; p = .04) and sleep disorders (OR = 1.63; 95% CI: 1.38-1.93; p = .05).

CONCLUSION

Children from families with a lower income, taller children, those with school jet lag, those with anxiety and those with sleep disorders had a greater occurrence of TDI.

Investigation of Anterior Teeth Fractures Among Students Aged Between 8 and 13 Years in Hyderabad, India

Introduction Trauma involving anterior teeth stands as a prevalent type of dental injury among school-age children, impacting physical, psychological, and social well-being. This study aimed to assess the occurrence of fractures in anterior teeth among school children in Hyderabad and its associated risk factors. Materials and methods This research incorporated a cross-sectional analysis, involving 2046 children in the age group of 8 to 13 years from different schools in Hyderabad City. Alongside clinical evaluations, all participants completed a questionnaire regarding traumatic dental injuries.  Results Results indicated a prevalence rate of 8.5%, notably higher among younger boys. Factors such as lip competence coverage, increased overjet, and malocclusion with maxillary incisor proclination were associated with a heightened risk of such injuries. The peak incidence was observed at age 12, with fractures involving enamel and dentin being the most common type, predominantly affecting the maxillary central incisors. Conclusion The findings emphasize the significance of educational programs aimed at enhancing awareness and understanding of dental injuries among parents, students, and school staff.

Prevalence and attributes of traumatic dental injuries to anterior teeth among school going children of Kolkata, India

Background

Traumatic Dental Injuries (TDI) have emerged as a very significant public health and social problem, especially among children and adolescents. The aim of this study was to investigate the prevalence and associated risk factors of traumatic dental injuries to permanent anterior teeth in school going children of Kolkata aged 7-14 years.

Method

A cross-sectional study was conducted among 3762 school going children attending various private and public schools of Kolkata aged 7-14 years. A multistage random clustering sampling technique was adopted to select the children.Type of trauma using Ellis and Davey classification of fractures along with Andresen's Epidemiological Classification of Traumatic Injuries to Anterior Teeth, including WHO codes, was used. All values were considered statistically significant at P < 0.05.

Results

Prevalence of TDI to anterior teeth was found to be 9.89%. The mean age of children who presented with TDI was 11.06 ± 1.99.years. The most common place of occurrence of TDI was home. Falls were the most common causes of trauma. Children belonging to higher socioeconomic status were observed to have an increased prevalence of TDIs.The highest potential risk factor for the occurrence of trauma was a past history of trauma.

Conclusion

Present study found a prevalence of 9.89%, and a very low percentage of children had received treatment.

Prioritizing model trimming to prevent thinning during mouthguard thermoforming: Influence of increased height associated with an acute model angle

BACKGROUND/AIM

The shape of the working model is one of the major factors affecting the thickness of thermoformed mouthguards. The aim of this study was to clarify the priority of model trimming to prevent thinning during mouthguard thermoforming.

MATERIALS AND METHODS

Mouthguards were thermoformed using 4.0 mm thick ethylene-vinyl-acetate sheets and a vacuum forming machine. Working models were trimmed so that the angles of the labial surface to the model base were 100°, 90°, and 80°. The posterior height was unified to 30 mm, and the anterior heights were 30 mm (A100-L), 35 mm (A90-M), and 40 mm (A80-H), respectively. When the sheet temperature reached 100°C, vacuum forming was performed. Six specimens were formed for each condition. Mouthguard thickness (incisal edge, labial surface, cusp, and buccal surface) was measured using a specialized caliper accurate to 0.1 mm. Differences in thickness reduction rate due to model shapes were analyzed by one-way ANOVA and Bonferroni's multiple comparison tests.

RESULTS

At the incisal edge, there were no significant differences in the reduction rate of the thickness of the mouthguard according to model shapes. On the labial surface, cusp, and buccal surface, the smaller the model angle, the smaller the reduction rate of thickness, and significant differences were observed between A100-L and A80-H, and A90-M and A80-H. On the labial and buccal surfaces, A80-H was more than 7.1% thicker compared with A100-L and more than 5.6% thicker compared with A90-M, and the thickness reduction rate was reduced when the model was trimmed to an acute angle. At the cusp, A80-H was more than 4.3% thicker than A100-L and A90-M.

CONCLUSIONS

It is useful to trim the model at an acute angle in order to prevent thinning during mouthguard thermoforming, even if the anterior height of the model is increased.

Prevalence of Dental Trauma and Their Relationship to Risk Factors among 8-15-Year-Old School Children

Background

Tooth injuries lead to functional, aesthetic, and psychological disorders, accompanied by the great concern of the child, the parents, and the dentist.

Aim

(a) To assess the prevalence of traumatic dental injury (TDI) and its relationship to risk variables among 8-15-year-old school children in Mahbubnagar, India. (b) To collect baseline data as there are limited reports of TDI studies in South India to date.

Methods

A cross-sectional study was conducted among 6643 children from 78 schools in Mahbubnagar using a multilevel random sampling method. The permanent incisors were examined according to the WHO classification using a standard oral mirror and probe. Individuals with clinical evidence of trauma were asked about the details of the injury event using a structured questionnaire. The chi-square test analyzed the distribution of all measurements in this study with a statistical significance of 0.05.

Results

Among the 6643 children from the 78 schools surveyed, 9.3% experienced TDI. TDI occurred in 68% of boys, which was about twice as high in girls at 32%. The most commonly affected teeth were the maxillary central incisors. A higher number of children with an incisal overjet more significant than 3 mm had TDI than the children less than 3 mm, although this difference was not statistically significant. The lip closure incompetence was more common in children with TDI. The most frequent causes of TDI were falls, and the site of occurrence was school. Type I fractures were the most prevalent and most went untreated.

Conclusion

The high level of dental trauma and the low percentage of children with trauma seeking treatment emphasize the need for greater awareness among the Mahbubnagar children.

Prevalence and Patterns of Traumatic Dental Injuries in the Permanent Dentition: A Three-Year Retrospective Overview Study at the University Dental Clinic of Vienna

The aim of this study was to retrospectively analyze the prevalence and patterns of traumatic dental injuries (TDIs) in permanent teeth at the University Dental Clinic of Vienna and examine influential variables. The study included all patients with dental trauma in permanent teeth who presented at the University Dental Clinic of Vienna (Austria) between 2014 and 2016. Dental records, including age, gender, location of trauma, type of trauma, cause of TDI, and location of the traumatic incident, were obtained. Clinical oral and radiographic examinations were conducted in accordance with the current guidelines of the German Society of Dental, Oral, and Craniomandibular Sciences (DGZMK). The sample comprised 1132 permanent teeth of 578 patients with TDIs. The most frequently injured teeth were upper central incisors (n = 719, 63.5%), followed by upper lateral incisors (n = 231, 20.4%). Fractures were the most frequent injury type (53%, n = 596). TDIs mostly occur due to falling accidents. The majority of traumatic incidents occurred at home (79.4%, n = 459). The injury characteristics are comparable to the results of other international studies. Due to the high prevalence of TDIs in dental medicine, dental practitioners should be equipped to effectively manage their immediate care and treat potential long-term complications.

Prevalence of Traumatic Dental Injuries among 1- to 14-year-old Children: A Retrospective Study

Aim and objective

To evaluate the prevalence of dental trauma in children in the age-group of 1 to 14 years in New Delhi.

Materials and methods

This is a retrospective study conducted from March 2017 to December 2017. A total of 6,765 children between 1 years and 14 years of age, who reported in OPD were evaluated for age, gender, type of trauma, and involvement of soft tissue.

Results

The mean age of participating children was 9.98 ± 1.704 and trauma was present in 1.25% of children. Ellis class IV type of trauma was seen in maximum (36.5%) cases with maxillary central incisors being most frequently injured during dental trauma.

Conclusion

The present retrospective study surveys traumatic dental injuries which are frequently seen. The knowledge of the prevalence and etiology of trauma to anterior teeth is necessary to identify the risk groups, treatment requirements, and strengthening of preventive programs.

How to cite this article

Goswami M, Aggarwal T. Prevalence of Traumatic Dental Injuries among 1- to 14-year-old Children: A Retrospective Study. Int J Clin Pediatr Dent 2021;14(4):467–470.

Management of a Complex Dentoalveolar Traumatic Injury with Multiple Avulsions

Background

Dentoalveolar trauma is a major cause of tooth loss in children. Avulsion, luxation, crown, and root fracture are the injuries to primary and permanent dentition. The incidence of trauma for maxillary anterior teeth ranges for 4%-91%. Many case reports have been published regarding the treatment of trauma to anterior teeth; however, case reports comprising multiple avulsions including canines and premolars are rare in literature.

Method

After mouth rinsing was done with 2% betadine solution, the luxated teeth numbers 31 and 42 were repositioned into the tooth socket and were secured with the composite resin-wire splint. Tooth number 32 was extracted because it was disarticulated from the socket, and the socket was disrupted because of the alveolar fracture. The maxillary avulsed teeth could not be reimplanted because of the alveolar socket damage which was due to the alveolar bone fracture.

Results

The patient was reevaluated for the removable prosthesis in recall visits; the patient was well adapted to the appliance with no complaints regarding mastication and speech. The patient was advised to report periodically for further adjustments in the prosthesis and for radiographic evaluation.

Conclusions

This case report includes proper history taking, diagnosis, and treatment of a complex dentoalveolar trauma along with short-term prosthetic rehabilitation for improvement of aesthetics, phonetics, and mastication of growing child.

Clarifying the effect of refractive errors and stereopsis on traumatic dental injuries in childhood

BACKGROUND/AIM

Visual acuity and stereopsis both play an important role in developing posture and balance in children. The aim of this study was to investigate whether children with traumatic dental injuries (TDI) have abnormal stereopsis, due to a reduction in visual acuity, compared to children with good dental health.

MATERIAL AND METHODS

A total of 140 participants (75 with traumatic dental injuries resulting from falls and crashes, and 65 age-matched controls without dental trauma) were enrolled in this prospective, cross-sectional study. The participants underwent complete dental and ophthalmologic examinations. After the ophthalmologic examination, the stereo acuities were assessed by a Titmus stereo test at 40 cm.

RESULTS

Titmus test scores were significantly worse in the TDI group (mean score 252.46 ± 629.12 seconds of arc) compared to the control group (mean score 56 ± 27.39 seconds of arc) (P < .05). The percentage of subjects with abnormal Titmus test scores was higher in the TDI group (28%) than in the control group (3.1%). The mean anisometropia value was 3.03 ± 2.37 D and 0.55 ± 0.41 D in the TDI group and the control group, respectively (P < .001). The severity of anisometropia correlated with the degree of stereopsis (r = .83, P < .01).

CONCLUSIONS

The presence of abnormal stereopsis may lead to postural instability which can lead to traumatic dental injuries. The prevalence of abnormal stereopsis in children with TDI was higher than in children with good binocular vision and stereopsis.

Fabrication method to maintain mouthguard thickness regardless of the model angle

BACKGROUND/AIM

The safety and effectiveness of mouthguards depend on the sheet material and thickness. The aim of this study was to investigate the fabrication method for a mouthguard with appropriate thickness using a single sheet regardless of the model angle.

MATERIALS AND METHODS

Mouthguards were thermoformed using 4.0 mm thick ethylene vinyl acetate sheets and a vacuum forming machine. The working models were three hard plaster models trimmed so that the angle of the anterior teeth to the model base was 90°, 100°, and 110°. The model position was 40 mm from the front of the forming unit. The sheet was softened until it sagged 15 mm, after which the sheet frame was lowered to cover the model. Next, the vacuum was turned on and held for 30 seconds for the control. Under the forming conditions in which the model position (MP) was moved, after the model was covered with the sheet, a scissors handle was positioned at the rear of the model and used to push it forward 20 mm, and then, the vacuum switch was turned on for 30 seconds. Six specimens were formed for each condition. Mouthguard thickness after formation was measured using a specialized caliper. The differences in mouthguard thickness due to forming conditions and model angle were analyzed.

RESULTS

The MP was significantly thicker than the control in each model (P < .01). The mouthguard thickness tended to decrease as the model angle increased. The average thickness of the labial surface in the MP was 3 mm or more and was not affected by the model angle.

CONCLUSIONS

This study suggested that the fabrication method in which moving the model forward by 20 mm just before formation could produce a mouthguard with approximately 3 mm thickness on the labial side with a single sheet regardless of the model angle.

Risk factors and patterns of traumatic dental injuries among Indian adolescents

Background/purpose

Dental injuries in children have functional, esthetic, and psychological effects, with consequences for the child, parent, and dentist. This study assessed the pattern of traumatic dental injuries and their relationship with predisposing factors among 12- and 15-year-old school children in Kanpur, India.

Materials and methods

A cross-sectional study was conducted on 1100 boys and girls aged 12 or 15 years. Anterior permanent teeth were examined based on the modified Ellis classification. Type of damage, size of incisal overjet, and adequacy of lip coverage were also recorded. Chi-square tests and multiple regression analysis were used for statistical analysis.

Results

The prevalence of traumatic dental injuries to anterior teeth was 10.9%. Age and gender distribution indicated that most injuries occurred in 15-year-old age group (11.3%) and among boys (11.5%). The gender-related difference was statistically significant (p < 0.024). Maxillary central incisors (83.7%) were frequently involved. The predominant injury type was enamel fracture (68.3%) mainly due to falls (52.5%). Increased overjet, inadequate lip coverage, type of school, and gender were significant contributing factors for traumatic dental injuries.

Conclusion

Study reveals the frequency and cause of traumatic injuries to anterior teeth, which assists in identifying risk groups and treatment needs in order to establish effective preventive strategies.

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.

Prevalence of traumatic dental injury to the anterior teeth in children attending paramilitary and nonparamilitary schools in Nigeria

Objective:

The objective of this study was to determine the prevalence of traumatic dental injuries (TDIs) in the anterior teeth among children attending paramilitary and nonparamilitary schools in Benin City, Nigeria.

Materials and Methods:

A multistage sampling technique was used to select children aged 8–12 years with a previous history of trauma to the orofacial region. A self-administered questionnaire was then applied, and each participant was examined clinically. Data collected included demographic characteristics, etiology and place of injury, affected teeth, type of dental injury, lip competence, and overjet values. Analysis of data was done with the SPSS version 21.0 software. Pearson's Chi-squared test was used to determine the association between variables and odds ratio. Statistical significance was determined at P < 0.05.

Results:

A total number of 1352 children (mean age: 9.89 ± 1.4 years) were examined and 154 (11.4%) had a previous history of TDI. The prevalence among respondents in the paramilitary schools was 84 (6.2%) and those in nonparamilitary schools 70 (5.2%). Falls and play was the most common cause of TDI and was higher in children in paramilitary schools. Ellis Class I was the most prevalent type of injury in 91 (59.1%), tooth number 21 was the most traumatized, and the school environment was the most common place. Of the total number of respondents with TDI, the relationship between etiology with age, lip competence, and overjet was statistically significant (P < 0.05).

Conclusion:

The prevalence of TDI among the study participants was 11.4% and more in the paramilitary schools than the nonparamilitary.

The association of childhood sleep problems with the prevalence of traumatic dental injury in schoolchildren

BACKGROUND/AIM

Sleep quality exerts an influence on attention level and motor skills and is associated with accidental injuries in children. The aim of this study was to evaluate the association between traumatic dental injury and sleep behaviour in children.

MATERIAL AND METHODS

A cross-sectional study was conducted in a small city in southern Brazil with a representative sample of schoolchildren aged 8-10 years (n = 537). Weight and height were measured, and examinations were performed for the determination of clinical occlusion and traumatic dental injury. The parents answered the Sleep Behaviour Questionnaire and questions addressing socio-demographic characteristics.

RESULTS

The prevalence of traumatic dental injury was 22% (95% CI: 19-26) and was higher among children who woke three to four times per night (PR = 3.30; 95% CI: 2.47-4.39), those who fell asleep in the parental bed (PR = 1.41; 95% CI: 1.09-1.83), those who were not in a good mood on waking up in the morning (PR = 1.30; 95% CI: 1.02-1.65), those who became sleepy while sitting and/or studying (PR = 1.57; 95% CI: 1.09-2.24) and while watching TV (PR = 1.41; 95% CI: 1.0005-1.97) and those who had bad dreams (PR = 1.35; 95% CI: 1.04-1.76). The Poisson multiple regression model with a multilevel approach revealed that the prevalence of traumatic dental injury was 1.51-fold higher among children with daytime drowsiness (PR = 1.51; 95% CI: 1.11-2.04) after adjusting for socio-demographic, occlusal and anthropometric variables.

CONCLUSION

Sleep problems were associated with a higher prevalence of traumatic dental injury among the children analysed.

Prevalence of traumatic dental injuries and their relation with predisposing factors among 8-15 years old school children of Indore city, India

Background

Dental injuries result in functional, esthetic and psychological disturbances accompanied by great concern from the child, the parent and the dentist. Oral injuries are fourth most common area of bodily injuries among 7-30 year-old individuals.

Aim

a) To assess the prevalence of traumatic dental injuries (TDI) and their relation with predisposing factors among 8-15 years old school children in Indore city, India.b) To collect baseline data as there have been no reported studies of TDI in central India to this date.

Methods

A cross sectional study was carried out among 4000 children of 60 schools in Indore using multistage random sampling method. Examination of permanent incisor teeth was done in accordance with the modified Elli's and Davey Classification using a standard mouth mirror and probe. Subjects who had clinical evidence of trauma were interviewed for details of the injury event by using structured questionnaire. Chi square test was used to analyze the distribution of all the measurement in this study at the statistical significance of 0.05.

Results

Among the 4000 children of 60 schools examined, 10.2% experienced TDI. 68.38% boys experienced TDI, which was approximately twice as higher in females being 31.62%. The most commonly affected teeth were maxillary central incisors. A higher number of children with incisal overjet greater than 3 mm had TDI than those with less than 3 mm, although this difference was not statistically significant. Lip closure incompetence was found to be more common in subjects having a TDI. Fall was the most common cause for TDI and place of occurrence was home. Most common type of fracture was class I and most of them were untreated.

Conclusion

The high level of dental trauma and low percentage of children with trauma seeking treatment stresses the need for increased awareness in Indore population.

Prevalence of Anterior Dental Trauma and Its Associated Factors among Preschool Children Aged 3-5 Years in Khartoum City, Sudan

Background

Traumatic dental injury (TDI) is a challenging public health problem. Its incidence and prevalence vary within countries, states, and different social groups.

Aim

The purpose of this study was to determine the prevalence of traumatic dental injuries in primary incisors among 3–5-year-old Sudanese preschool children and associated factors such as age, sex, and size of overjet and anterior open bite.

Materials and Methods

Descriptive cross-sectional study was carried out among 600 preschool children (3–5 years old) selected by multistage cluster technique from preschools located in Khartoum city, Sudan. The data regarding age, sex, causes, and treatment of TDI were collected from the mothers through structured interview questionnaire. Children were examined in an upright position, using mouth mirror and torch. A single examiner assessed the type of trauma, the tooth involved, and overbite/overjet. The data were analyzed statistically through descriptive analysis, and the chi-square test was used to compare between different variables with P < 0.05.

Results

The prevalence of traumatic dental injuries (TDIs) was 18.5%. Enamel fractures were the most common type (74.8%), followed by enamel and dentin (11.7%). The maxillary central incisors were the most commonly affected teeth, and the home was most common place for TDI. The prevalence rate was 45% in boys and 55% in girls with a statistically significant difference (P=0.02).

Conclusions

The prevalence of traumatic dental injuries to the primary anterior teeth among the Sudanese preschool children was relatively high (18.5%). Factors such as overjet size, overbite size, and lip competency were not significantly correlated with dental trauma among the studied population.

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.

Maxillary incisor trauma in patients with class II division 1 dental malocclusion: associated factors

Purpose:

The aim of this study was to assess the association between the presence of maxillary incisor trauma (MIT) with age, gender, dentition type, the degree of overjet (OJ), lip form, respiratory type and dental arch form in patients with Class II division 1 dental malocclusion.

Subjects and Methods:

256 patients (mean age: 15.80 ± 2.2) were included in this study. The patients’ gender, dentition type, superior lip form, dental arch form and respiratory type were recorded. Participants were divided into four groups according to the severity of OJ: 3.5 mm<Group 1 (OJ I) ≤6 mm with competent lip, 3.5 mm<Group 2 (OJ II) ≤ 6 mm with incompetent lip, 6 mm<Group 3 (OJ III) ≤9mm, 9 mm<Group 4 (OJ IV). Mann Whitney-U test was used to examine the group differences for trauma and non-trauma groups. Logistic regression analysis was used to assess the factors for trauma and their risk indicators.

Results:

3.5 mm<OJ II≤ 6 mm with incompetent lip had the highest odds of experiencing MIT among the OJ groups with an odds ratio (OR) of 3.143 and 95% confidence interval (CI) 1.125-2.779. The odds were 3.572 times higher in the group with short lip form than found in the group with normal lip form (OR 3.572, 95% CI 1.130-2.340).

Conclusion:

The age, gender, respiratory type and dental arch form were not significantly associated the risk of MIT. OJ between 3.5 mm and 6 mm (with incompetent lip) and short lips increased the risk of having maxillary incisor trauma in patients with Class II division 1 malocclusion.

An Appraisal of the Prevalence and Attributes of Traumatic Dental Injuries in the Permanent Anterior Teeth among 7-14-Year-Old School Children of North East Delhi

Aims:

The aim of this study was to assess the prevalence, associated risk factors, characteristics, and pattern of traumatic dental injuries (TDIs) in the permanent anterior teeth among school children of North East Delhi area.

Settings and Design:

A cross-sectional study was done in 3000 school-going children aged 7–14 years.

Materials and Methods:

A detailed case history and clinical examination were performed on the entire sample population. TDIs were recorded according to Andreasen's epidemiological classification of TDIs including World Health Organization codes.

Statistical Analysis Used:

For finding the independent association of the significant variables with outcome, multivariable logistic regression analysis was used.

Results:

A prevalence of 10.7% was observed in the sample being studied. Dental trauma was significantly (P < 0.05) associated with male gender, and high statistical significance (P < 0.001) was noted with age, participation in sports, lip seal, and overjet. Fall of the child while playing by himself/herself was the most common cause; afternoon and schools were the most common time and place of occurrence of TDIs, respectively. Single tooth enamel fractures in the left maxillary central incisors were most commonly seen. Adhesive restorations were the most frequent form of treatment required.

Conclusions:

Organizing studies addressing the prevention and treatment needs of TDIs and educational programs aimed toward parents and school teachers are of paramount importance. Furthermore, recognizing the tremendous treatment negligence is extremely critical to adequately analyze indifference of the people toward dental trauma and its consequences.

Exploring the impact of malocclusion and dentofacial anomalies on the occurrence of traumatic dental injuries in adolescents

OBJECTIVE

To investigate the association between malocclusion/dentofacial anomalies and traumatic dental injuries (TDI) in adolescents.

MATERIALS AND METHODS

The sample of this cross-sectional study comprised 509 adolescents aged 11 to 14 years enrolled at public schools in the city of Osório, southern Brazil. Parents answered a structured questionnaire addressing demographic and socioeconomic characteristics. An examiner who had undergone a training and calibration exercise recorded malocclusion/dentofacial anomalies (Dental Aesthetic Index, DAI), TDI (Andreasen), and dental caries (World Health Organisation). Statistical analyses (SPSS software) involved Poisson regression with robust variance.

RESULTS

The prevalence of TDI was 11.6%, and the prevalence of defined, severe, and handicapping malocclusion was 24.0%, 21.6%, and 22.0%, respectively. The multivariate analysis demonstrated that the probability of TDI was approximately twofold higher among adolescents with severe malocclusion (prevalence ratio [PR] 2.22; 95% confidence interval [CI] 1.14-4.31) and handicapping malocclusion (PR 1.95; 95% CI 1.01-3.85) in comparison to those with normal occlusion or minor malocclusion. Defined malocclusion was not significantly associated with the outcome. Among the dentofacial anomalies evaluated, the probability of TDI was nearly twofold higher among adolescents with overjet greater than 3 mm (PR 1.96; 95% CI 1.14-3.37) and 2.2-fold higher among those with an abnormal molar relationship (PR 2.24; 95% CI 1.17-4.32), after controlling for confounding variables.

CONCLUSIONS

Severe and handicapping malocclusion, accentuated overjet, and abnormal molar relationship were strongly associated with the occurrence of TDI. Future studies should investigate whether the treatment of these conditions can help reduce the occurrence of TDI in adolescents.

Crown-root Fracture Restoration on a Patient with Autism Spectrum Disorder

Children with intellectual and physical disabilities including autism are susceptible to dental trauma as a sequela from falls due to poor muscular coordination. In addition, their altered muscle tonus often results in an open bite with labial flaring of the maxillary incisors and lip incompetence, predisposing these teeth to fractures. This case report describes an alternative approach of restoring a fractured maxillary permanent central incisor with a composite strip crown during surgical repositioning of the periodontium on an autistic patient. The prognosis of the incisor is guarded due to the probability of re-injury. However, the decision to maintain the tooth clinically was esthetically preferable in comparison to an extraction or decoronation.

Oral health status and treatment needs among 10126 school children in West Godavari district, Andhra Pradesh, India

Objectives:

Oral diseases are affecting a large percentage of children worldwide. This study with Indian Society of Pedodontics and Preventive Dentistry collaboration was taken up with the aim to evaluate the oral health status and treatment needs in school-going children of the West Godavari district, Andhra Pradesh, India.

Materials and Methods:

This cross-sectional study was conducted among 10126 school children who were randomly selected from 32 schools in West Godavari district. To find the significance of the obtained number of cases for different age groups, Chi-square test of significance was used.

Results:

The prevalence of dental conditions are as follows: Dental caries 63.5%, periodontal diseases 13.6%, dental anomalies 3.6%, dental trauma 3.2%, and orthodontic treatment 25.1%. Among the different age groups, 11–14 years age group has the highest prevalence of oral health problems. Females were more affected with dental caries (P = 0.17), orthodontic treatment needs (P = 0.12), and dental anomalies (P = 0.86) compared to males which was statistically insignificant. The highest prevalence of dental conditions in the case of females was observed during the age of 11–14 years, and in males, the peak was seen in the 15–18 years age group.

Conclusions:

This study demonstrated that school-going children in West Godavari district suffer from a high prevalence of dental conditions and have higher treatment needs.

Prevalence and risk factors for traumatic dental injuries in adolescent children attending special needs schools in India: a comparative study

BACKGROUND

Traumatic dental injuries (TDIs) are a serious dental health problem affecting adolescents and needs special attention.

OBJECTIVE

To determine and compare the prevalence of TDIs in children attending special needs schools and normal school children and identify the risk factors for its occurrence.

METHODS

The study included 150 special needs school children and 300 normal school children in the 12-15 year age group. A questionnaire was prepared that collected information on socio-demographic characteristics of the respondents like age, sex, and details of the injury-event. The clinical examination was carried out using American Dental Association (ADA) type 3 technique following universal precautions.

RESULTS

The children attending special needs schools showed higher prevalence of TDIs than normal school children. Maxillary central incisors were the most commonly affected teeth. A majority of them showed injuries restricted to enamel fracture only and the most common cause for injury was "falling over". Logistic regression analysis showed that there was a significantly higher tendency for special needs children, boys, children with an overjet more than 3 mm, and inadequate lip closure to develop injuries.

CONCLUSION

TDIs were more prevalent in children attending special needs schools. An overjet more than 3 mm emerged as the strongest risk predictor. Effective policies need to be drafted to treat the injuries and correct the malocclusion.

Prevalence of Traumatic Dental Injuries to Anterior Teeth of 12-Year-Old School Children in Kashmir, India

Background

Traumatic dental injuries to anterior teeth are a significant public health problem, not only because their prevalence is relatively high, but also because they have considerable impact on children’s daily lives. Traumatic dental injuries (TDIs) cause physical and psychological discomfort, pain and other negative impacts, such as tendency to avoid laughing or smiling, which can affect social relationships.

Objectives

This study aimed to assess the prevalence of traumatic dental injuries to anterior teeth among 12-year-old school children in Kashmir, India.

Patients and Methods

A cross-sectional study was conducted in private and government schools of India among 1600 schoolchildren aged 12 years. In addition to recording of the type of trauma (using Ellis and Davey classification of fractures, 1970), over jet, Angle’s molar relation and lip competence were also recorded. The socioeconomic status and academic performance of the study subjects were registered. The data obtained were compiled systematically and then statistically analyzed. The statistical significance for the association between the traumatic injury and the variables was analyzed using the chi-square test. Logistic regression was used to identify potential risk predictors of TDIs.

Results

The overall prevalence of TDI to anterior teeth was found to be 9.3%. The TDI to anterior teeth in male was more than female, but the difference was statistically nonsignificant (P < 0.01). Falls and sports were the most common causes of trauma in the present study. The highest potential risk factor for the occurrence of trauma was over jet. Academic performance was found to be significantly associated to TDI to anterior teeth, when analyzed in a multiple regression model.

Conclusions

It was concluded that the prevalence of traumatic dental injuries was 9.3%. Traumatic dental injuries among children exhibit complex interaction between the victims’ oral conditions and their behavior. Therefore, prevention should consider a number of characteristics such as oral predisposing factors, environmental determinants and human behavior. It is recommended that specific and proper public places for leisure and sports activities, with impact-absorbing surfaces around the items on which children are most likely to fall, should be provided.

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

BACKGROUND

Traumatic dental injury (TDI) during childhood may negatively impact the quality of life of children.

OBJECTIVE

To describe the association of oral health-related quality of life (OHRQoL) and domains (oral symptons, functional limitation, emotional- and social-well-being) of children with individual and contextual variables.

METHODS

A cross-sectional study was performed using a representative sample of 1,201 schoolchildren, 8-10 years-old, from public and private schools of Belo Horizonte, Brazil. The CPQ8-10 was used to assess OHRQoL, dichotomized in low and high impact. Sociodemographic information was collected through questionnaires to parents. Children were examined at schools, using the Andreasen criteria. Individual variables were gender, age, number of residents in home, parents/caregivers' level of education, family income, and TDI (dichotomized into without trauma/mild trauma and severe trauma). Dental caries and malocclusion were considered co-variables. Contextual variables were the Social Vulnerability Index and type of school. Ethical approval and consent forms were obtained. Data were analyzed using SPSS for Windows 19.0 and HLM 6.06, including frequency distribution, chi-squared test and multilevel approach (p < 0.05).

RESULTS

The prevalence of a negative impact on OHRQoL in children with severe trauma was 55.9%. The TDI negatively impacted emotional and social domains of OHRQoL. A multilevel analysis revealed a significant difference in OHRQoL according to the type of school and showed that 16% of the total variance was due to contextual characteristics (p < 0.001; ICC = 0.16). The negative impact on OHRQoL was higher in girls (p = 0.009), younger children (p = 0.023), with severe TDI (p = 0.014), those from public schools (p = 0.017) and whose parents had a lower education level (p = 0.001).

CONCLUSION

Severe trauma impacts OHRQoL on emotional and social domains. Contextual dimensions add information to individual variability to explain higher impact, emphasizing socioeconomic inequalities.

Association between Traumatic Dental Injury, Obesity, and Socioeconomic Status in 6- and 13-Year-Old Schoolchildren

Obesity and poverty are independent risk factors in trauma-related morbidity in children as well as adolescents. The main objective of this study was to investigate the association between traumatic dental injury, obesity, and socioeconomic status in 6- and 13-year-old schoolchildren in Davangere city, Karnataka, India. Data were obtained from 1,550 schoolchildren. Dental trauma was classified according to Andreasen's criteria. The medical evaluation assessed the Body Mass Index. Overjet was considered a risk factor when it presented values higher than 3 mm, whereas lip coverage was classified as adequate or inadequate. With appropriate sample weighting, relationships between traumatic dental injury and other variables were assessed using the chi-squared test and multivariable logistic regression. Overall prevalence of dental injuries was 10.52% (3.6% in 6-year-olds and 17.2% in 13-year-olds). Boys experienced more injuries than girls, 11.03% and 9.97%, respectively (p>.05). There was a statistically significant difference between traumatic dental injury and overjet (95% confidence interval [CI] [2.06, 4.78], p < 001) and between traumatic dental injury and inadequate lip coverage (95% CI [1.23, 4.65], p < .001). When adjusted for covariates, the logistic regression model showed that there was a significant association between obese children (p < .05) and dental trauma prevalence. Children from low socioeconomic status had an odds ratio 2.33 (95% CI [1.05, 3.97]) times higher likelihood of having dental trauma than children from medium and upper socioeconomic status. To conclude the results of this study support an association between traumatic dental injuries, obesity, and poverty.

Reimplantation of avulsed maxillary central incisors – case report of an 8-year follow-up

Dental trauma is very common, especially in children and adolescents. Tooth avulsion (exarticulation), which is a result of complete rupture of periodontal ligaments is one of the most severe dental injuries. The treatment of choice in avulsion of permanent teeth is reimplantation. Survival of reimplanted teeth depends greatly on the time and conditions in which teeth were stored outside the oral cavity. This report presents a case of 18-year old male with avulsion of central maxillary incisors. The teeth were reimplanted 14 hours after injury. During 8-year follow up no major complications occurred and the teeth still maintain their function, although signs of mild replacement resorption are visible on the follow-up radiographs.

Adjunctive techniques for enhancing mandibular growth in Class II malocclusion

Class II malocclusions are generally characterized by mandible retrusion. For this reason, forward bite jumping appliances, also known as functional appliances were originally designed to enhance mandibular forward projection. However, there is still insufficient evidence to support the effectiveness, predictability and stability of functional appliances in modifying mandibular growth. This article was aimed at presenting evidences and hypotheses that mandibular growth may be enhanced through the use of adjunctive methods in conjunction with functional appliances. In formulating our hypothesis, we considered relevant data, mostly derived from animal studies, concerning alternative methods, such as low-intensity ultrasound and light-emitting diode, as well as their related cellular and molecular mechanisms. According to the evidences covered in this article, we suggest that both methods are potentially effective, and theoretically able to act in synergistic way to enhance functional appliances treatment on mandibular and condylar additional growth. The rationale for the use of these methods as adjunctive therapies for mandibular underdevelopment is attributed to their abilities on stimulating angiogenesis, cell differentiation, proliferation, and hypertrophy, as well as enhancing matrix production and endochondoral bone formation, especially on the condyle of growing animals. This article also proposed a study design which would be able to either prove or refute our hypothesis. If ratified, it would represent a significant scientific accomplishment which provides support for further investigations to be carried out on well-designed clinical trials.

Over two hundred million injuries to anterior teeth attributable to large overjet: a meta-analysis

BACKGROUND/AIM

The association between large overjet and traumatic dental injuries (TDIs) to anterior teeth is documented. However, observational studies are discrepant and generalizability (i.e. external validity) of meta-analyses is limited. Therefore, this meta-analysis sought to reconcile such discrepancies seeking to provide reliable risk estimates which could be generalizable at global level.

MATERIAL AND METHODS

Literature search (years 1990-2014) was performed (Scopus, GOOGLE Scholar, Medline). Selected primary studies were divided into subsets: 'primary teeth, overjet threshold 3-4 mm' (Primary3); 'permanent teeth, overjet threshold 3-4 mm' (Permanent3); 'permanent teeth, overjet threshold 6 ± 1 mm' (Permanent6). The adjusted odds ratios (ORs) were extracted. To obtain the highest level of reliability (i.e. internal validity), the pooled OR estimates were assessed accounting for between-study heterogeneity, publication bias and confounding. Result robustness was investigated with sensitivity and subgroup analyses.

RESULTS

Fifty-four primary studies from Africa, America, Asia and Europe were included. The sampled individuals were children, adolescents and adults. Overall, there were >10 000 patients with TDI. The pooled OR estimates resulted 2.31 (95% confidence interval - 95CI, 1.01-5.27), 2.01 (95CI, 1.39-2.91) and 2.24 (95CI, 1.56-3.21) for Primary3, Permanent3 and Permant6, respectively. Sensitivity and subgroup analyses corroborated these estimates.

CONCLUSIONS

Reliability and generalizability of pooled ORs were high enough and made it possible to assess that the fraction of global TDIs attributable to large overjet is 21.8% (95CI, 9.7-34.5%) and that large overjet is co-responsible for 235 008 000 global TDI cases (95CI, 104,760,000-372,168,000). This high global burden of TDI suggests that preventive measures must be implemented in patients with large overjet.

Socio-economic indicators and predisposing factors associated with traumatic dental injuries in schoolchildren at Brasília, Brazil: a cross-sectional, population-based study

Background

This study assessed the prevalence of traumatic dental injuries (TDI) and its association with sociodemographic and physical characteristics in the anterior permanent teeth of 12-year-old schoolchildren at the city of Brasília – DF, Brazil.

Methods

A cross-sectional, population-based study was conducted on a sample of 1,389 boys and girls aged 12 years, enrolled in public and private fundamental schools at the Administrative Region (RA) of Brasília, Brazil, from October 2011 to September 2012. The demographic details were achieved by a structured questionnaire. The study recorded the type of damage, the size of incisal overjet, and whether lip coverage was inadequate. Sociodemographic data included sex, income and educational level of the parents or caretakers.

Results

A total of 1118 schoolchildren were examined, yielding a response rate of 80.48%. The prevalence of TDI was 14.63% in public schools and 23.40% in private schools. The students did not differ according to sex, income and educational level of the parents or caretakers concerning the occurrence of traumas in permanent anterior teeth. Increased overjet and inadequate lip coverage were found to be important contributing factors for TDIs.

Conclusion

In conclusion, this study showed an expressive prevalence of TDI in 12-year-old in schoolchildren at Brasília DF, Brazil. Sex and educational level of the parents were not associated with trauma. The increased overjet and inadequate lip coverage were significantly associated with dental trauma.

Traumatic dental injuries among 12-15-year-old-school children in panchkula

Background:

Traumatic dental injury (TDI) in children and adolescents has become one of the most serious dental public health problems. Despite such a high prevalence of dental trauma, very less attention has been paid to TDI, its etiology, and prevention.

Objectives:

To determine the prevalence of anterior tooth traumatic dental injuries in 12-15-year-old school children of Panchkula district, India, and to find any correlation with the cause, gender, extent of overbite as well as over-jet, and previous treatment.

Patients and Methods:

A multistage sample of 12-15-year-old school children (n = 810) in Panchkula district, Haryana, was selected. The children were screened using WHO criteria for oral examination and a trained dental surgeon examined the children. Those with clinical TDI were examined further for the type of traumatic injuries using Elis classification modified by Holland. Overjet and overbite were recorded. After examination, questions regarding the cause of trauma and its treatment were asked. Data were subjected to statistical analysis using the Chi square and Mantel-Haenszel tests by SPSS version 20.0.

Results:

The results showed that out of 810 children, 86 (10.2 %) had TDI. Males had higher prevalence of trauma than females (P < 0.05). The common cause of trauma was fall (51.11%) followed by sports injuries (41.86%). Enamel-dentin fracture without pulpal involvement was the most common type of trauma and the most frequent involved teeth were maxillary central incisors. A significant association was observed between overjet and overbite and trauma. Only 3.5% of the children affected with trauma had received treatment.

Conclusions:

The prevalence of traumatic injuries to permanent incisors in 12-15-year-old Panchkula school children was relatively high. TDI was associated with gender, overjet, and lip competence. There was a great unmet treatment need.