Prevalence of sequelae after traumatic dental injuries to anterior primary teeth: A systematic review and meta-analysis

BACKGROUND/AIM

Clinical and radiographic sequelae are common following traumatic dental injuries to primary teeth. The aim of this systematic review was to assess the prevalence of such sequelae.

MATERIALS AND METHODS

Searches were conducted in the PubMed, Scopus, Embase, Web of Science, and BBO/LILACS databases as well as the gray literature. The outcome of interest was the prevalence of the most common sequelae following traumatic dental injuries to anterior primary teeth. Observational studies that evaluated such sequelae were included. Data were extracted, and methodological quality was appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. The number of sequelae per tooth and the total number of teeth evaluated in each study were considered to calculate pooled prevalence rates with 95% confidence intervals (CI). The quality of the evidence was determined using the GRADE approach.

RESULTS

Twenty-five articles were included in this systematic review and meta-analysis. The prevalence of each complication in descending order was as follows: 39.7% crown discoloration (95% CI: 29.52-50.32), 24.3% pulp necrosis with infection (95% CI: 17.34-32.06), 16.2% periapical radiolucency (95% CI: 8.88-25.49), 15.9% premature tooth loss (95% CI: 9.93-23.15), 14.8% pulp canal obliteration (95% CI: 8.46-22.73), 11.9% pathological root resorption (95% CI: 7.68-16.98), 7.1% abscess/fistula (95% CI: 4.4-10.6), and 1.8% ankylosis (95% CI: 0.82-3.17). The certainty of the evidence was very low.

CONCLUSIONS

Crown discoloration was the most common sequela in injured primary teeth, but this should be interpreted with caution due to the very low certainty of the evidence. Considerable variation was found in the prevalence of each sequela.

Prevalence of toothache and associated factors in children and adolescents: a systematic review and meta-analysis

OBJECTIVES

This systematic review aimed to determine the pooled prevalence of toothache in children and adolescents and to verify its association with sociodemographic characteristics and dental caries experience.

MATERIAL AND METHODS

Six main and three grey literature databases were searched in February 2021. Observational studies that assessed the prevalence of toothache and associated factors were included. The methodological quality of the studies was evaluated following the guidelines by Fowkes and Fulton. Proportion and association meta-analyses were performed in MedCalc and Revman software, respectively. The certainty of the evidence was determined with the GRADE approach.

RESULTS

Seventy-one studies met the inclusion criteria. Thirty-two presented high methodological quality and a low risk of bias. The overall pooled prevalence of toothache in children and adolescents was 36.2% (95%CI: 33.0-39.42; I²: 99.72%; P < 0.001). Females (OR: 1.17; 95%CI: 1.08-1.26; I²: 91%; P < 0.001) and children and adolescents whose caregivers had ≤ 8 years of schooling (OR: 1.42; 95%CI: 1.30-1.56; I²: 77%; P < 0.001) presented the higher chance of reporting toothache. Dental caries experience increased the chance of reporting toothache in 3.49 times (95%CI: 2.70-4.51; I²: 92%; P < 0.001). The certainty of the evidence was very low.

CONCLUSIONS

The overall pooled prevalence of toothache was considered high. Sociodemographic characteristics (sex and caregivers' educational level) and previous dental caries experience were significantly associated with toothache reports.

CLINICAL RELEVANCE

Toothache is still a recurrent issue in many countries. Thus, it is essential to understand its possible associated factors to reduce the occurrence of new episodes.

The top 100 most-cited papers authored by Dr. Jens Ove Andreasen: A bibliometric analysis

BACKGROUND/AIM

Dr. Jens Ove Andreasen, the "father" of dental traumatology, passed away on September 26, 2020. As a tribute, the aim of this study was to catalog and analyze the top 100 most-cited papers (co)authored by Dr. Andreasen.

MATERIALS AND METHODS

A bibliometric analysis was conducted on October 21, 2020, in the Web of Science Core Collection (WoS-CC) database. The numbers of citations in the WoS "All Databases" section, Scopus, and Google Scholar databases were cross-matched. Two researchers collected the following bibliometric data: title, number of citations, authors, country, year, journals, study design, and theme. The VOSviewer software was used to generate collaborative network maps for the authors and keywords.

RESULTS

Of 194 papers identified in WoS-CC, a list was compiled with the 100 most-cited papers (co)authored by Dr. Andreasen. The number of citations of each paper ranged from 24 to 365 (mean: 85.4). Nine papers were cited more than 200 times. Most papers were published in Dental Traumatology (55%), between the 1990's and 2000's (60%), with a laboratory design (40%). One hundred and nine (co)authors, from 19 countries were identified in the top 100 most-cited papers. Dental traumatology was the most studied theme (52%).

CONCLUSIONS

The top 100 most-cited papers (co)authored by Dr. Jens Ove Andreasen were composed mainly of laboratory and observational studies, published mostly in Dental Traumatology. The present study was a humble homage to highlight the importance of his research and work. However, his legacy goes beyond the numbers and will always remain unsurpassed.

Is there an association between crown discoloration and pulp necrosis in traumatized per in vitro manent teeth? A meta-analysis

The present study aimed to identify the scientific evidence regarding the association between crown discoloration and pulp necrosis in traumatized permanent teeth. A systematic literature search was conducted in the PubMed/Medline, Lilacs/BBO, Scopus, Web of Science, Cochrane Library databases, and grey literature. Quality assessment and bias control were carried out according to the Fowkes and Fulton guidelines. Meta-analysis was performed, and the odds ratio was calculated with a 95% confidence interval. The quality assessment of the evidence was determined for the meta-analysis outcomes using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. From 2,702 studies identified, five articles met the inclusion criteria. One among these showed no methodological soundness and was excluded from the meta-analysis, and the remaining four studies were included in the meta-analysis. The total number of traumatized permanent teeth evaluated in the meta-analysis was 367. The results showed a positive association between crown discoloration and pulp necrosis in permanent teeth. Teeth with crown discoloration showed 23 times more chance to present pulp necrosis than teeth without crown discoloration (OR 23.82 [1.25, 452.87]; p = 0.03), with a very low certainty of evidence. There is a significant association between crown discoloration and pulp necrosis of traumatized permanent teeth. Due to the very low strength of evidence according to GRADE, this result should be viewed with caution.

Pulp necrosis and crown discoloration: a systematic review and meta-analysis

BACKGROUND

The association between pulp necrosis and crown discoloration in traumatized primary teeth has not been clearly determined yet.

AIM

The study verified whether there is an association of pulp necrosis and crown discoloration in traumatized primary teeth through a systematic review and meta-analysis.

METHODS

A systematic literature search was conducted in PubMed/Medline, Lilacs/BBO, Scopus, Web of Science, Cochrane Library databases, and grey literature. A methodological quality assessment appraisal was independently conducted by two researchers. Random-effects models were employed, and heterogeneity was tested (I2 index/P ≤ 0.05).

RESULTS

Eight studies with low risk of bias were included in the analysis. A total of 1,494 traumatized primary teeth participated in the pooled meta-analysis. Diagnosis of pulp necrosis was evaluated in 1,414 teeth through clinical and/or radiographic analyses, and the analysis demonstrated a positive association (P = 0.0005/OR 8.37 [2.51, 27.90], I2  = 87%). Eighty teeth were diagnosed with pulp necrosis through endodontic access, and there was no statistically significant association (P = 0.36/OR 2.46 [0.36, 16.94], I2  = 54%). The pooled meta-analysis showed a positive association (P = 0.0003/OR 5.93 [2.24, 15.72], I2  = 83%).

CONCLUSION

The positive association between pulp necrosis and crown discoloration should be considered with caution once the diagnosis of pulp necrosis was performed by limited criteria.