Reducing the risk of tooth injury in anterior maxillary interdental osteotomy for cleft lip and palate patients using a surgical navigation technique

The aim of this study was to investigate the clinical feasibility of preventing tooth injury from anterior maxillary interdental osteotomy by using a surgical navigation technique. A retrospective review was conducted on cleft lip and palate patients treated with anterior maxillary osteotomy followed by distraction osteogenesis between August 2019 and May 2022. Patients operated on through image guidance were enrolled in the navigation group, while those who were operated on freehand were enrolled in the freehand group. Tooth injuries were identified on postoperative images. Linear and angular deviations of the osteotomy line were measured. Twelve patients were enrolled in the study, seven in the navigation group and five in the freehand group. Altogether, 24 osteotomy lines and 53 adjacent teeth were evaluated. The dental injury rate was 3% in the navigation group and 27% in the freehand group (P = 0.016). The average linear deviations (mean ± standard deviation) were 0.67 ± 0.30 mm and 2.05 ± 1.33 mm, respectively (P < 0.001), while the average angular deviations were 1.67 ± 0.68° and 11.41 ± 7.46°, respectively (P < 0.001). The results suggest that navigation was able to reduce the tooth injury risk compared with freehand interdental osteotomies in crowded dental arches.

Development and psychometric properties of a questionnaire about knowledge of lay people about traumatic dental injury

BACKGROUND/AIMS

The level of knowledge about traumatic dental injuries (TDI) of lay people from a national point of view has never been studied and there is currently a lack of validated research instruments on this issue. The present study aims to develop and validate a questionnaire (TDI-Q) to assess the knowledge of lay people about TDI, including participants from the five regions of Brazil.

MATERIAL AND METHODS

TDI-Q was drafted, in Brazilian Portuguese, based on the recommendations of the International Association of Dental Traumatology (IADT). Before its application, TDI-Q was evaluated by dentists, lay people, linguists, and psychometrists. The questionnaire was applied to measure temporal stability at two distinct times, with an interval of 15-20 days between the two applications: test (n = 110) and retest (n = 50). The presence of floor and ceiling effects were investigated by analyzing the frequency of responses of the questionnaire; convergent construct validity was tested through Spearman's correlation; the Mann-Whitney test was applied to discriminant construct validity. Temporal stability and internal consistency were evaluated through intraclass correlation coefficient and Cronbach's alpha, respectively.

RESULTS

The floor and ceiling effects were not observed (0.9% and 2.7%, respectively); convergent validity analysis indicated a positive and strong correlation (r = 0.50; p < .001). Significant discriminant construct validity (p < .05) was observed. Satisfactory internal consistency (α = 0.7) and temporal stability (ICC = 0.82, p < .001) were also achieved.

CONCLUSION

TDI-Q proved to have good psychometric properties and to be a reliable tool for evaluating the knowledge of lay people regarding TDI in the Brazilian population.

Patient perception of service quality to preanesthetic oral examination: a cross-sectional study using the SERVQUAL model

BACKGROUND

A phase-III interdisciplinary quality improvement program, the preanesthetic oral examination (PAOE), was implemented as a new program in an academic medical center to prevent perioperative dental injuries. This study was aimed at surveying the perceived service quality and satisfaction of patients who had undergone PAOE based on the SERVQUAL model.

METHODS

This cross-sectional survey was conducted at the Kaohsiung Medical University Hospital using convenience sampling. Patients referred for PAOE (PAOE group) and those who had voluntarily availed dental services (control group) were recruited. A modified SERVQUAL questionnaire was used to assess the perceived service quality and patient satisfaction with dental services. Cronbach's alpha for SERVQUAL was 0.861.

RESULTS

We enrolled 286 (68.8%) and 130 (31.2%) participants in the PAOE and control groups, respectively. The path analysis revealed that the PAOE group scored lower in dimensions of reliability (β = -0.074, P = 0.003), responsiveness (β = -0.148, P = 0.006), and empathy (β = -0.140, P = 0.011). Furthermore, reliability (β = 0.655, P < 0.001) and responsiveness (β = 0.147, P = 0.008) showed a direct effect on patient satisfaction. Overall, participants were highly satisfied with the dental services.

CONCLUSIONS

The PAOE group showed lower satisfaction and perceived quality of dental services compared to the control group. Although implementing an interdisciplinary program reduces the perceived service quality, its influence is limited. Employing an interdisciplinary teamwork is a win-win strategy encouraged to improve patient safety and reduce malpractice claims. Future suggestions should focus on establishing waiting times that are considered reasonable by patients. Patient-centered education related to the risk of perioperative dental injuries should be provided, and awareness of oral conditions for patient safety should be improved. Moreover, interprofessional education in continuous and undergraduate programs is necessary to improve professional quality.

The Reparative Function of MMP13 in Tertiary Reactionary Dentinogenesis after Tooth Injury

MMP13 gene expression increases up to 2000-fold in mineralizing dental pulp cells (DPCs), with research previously demonstrating that global MMP13 deletion resulted in critical alterations in the dentine phenotype, affecting dentine-tubule regularity, the odontoblast palisade, and significantly reducing the dentine volume. Global MMP13-KO and wild-type mice of a range of ages had their molar teeth injured to stimulate reactionary tertiary dentinogenesis. The response was measured qualitatively and quantitatively using histology, immunohistochemistry, micro-CT, and qRT-PCR in order to assess changes in the nature and volume of dentine deposited as well as mechanistic links. MMP13 loss affected the reactionary tertiary dentine quality and volume after cuspal injury and reduced Nestin expression in a non-exposure injury model, as well as mechanistic links between MMP13 and the Wnt-responsive gene Axin2. Acute pulpal injury and pulp exposure to oral fluids in mice teeth showed upregulation of the MMP13 in vivo, with an increase in the gene expression of Mmp8, Mmp9, and Mmp13 evident. These results indicate that MMP13 is involved in tertiary reactionary dentine formation after tooth injury in vivo, potentially acting as a key molecule in the dental pulp during dentine-pulp repair processes.

A review of the iadt 2020 guidelines

Traumatic dental injuries (TDIs) are a relatively frequent occurrence, with roughly a third of adults experiencing a dental trauma at some time in their life.1 TDIs may present to dental professionals working within primary or secondary care settings. Patients presenting at the time of acute injury will require immediate management and careful long term follow up. Patients may also present later reporting a history of TDI, with developing complications and onward management required. To support dental care professionals, the International Association of Dental Traumatology's (IADT) Guidelines are available globally as a standardised tool to aid the assessment, management and follow up of dental trauma. These easy to access guidelines were updated in 2020 with four distinct publications:General Introduction,1 Fractures and Luxations,2 Avulsion of Permanent Teeth,3 and Injuries in the Primary Dentition.4 The current guidelines represent the best evidence based on available literature and expert opinion.1This paper aims to support dental professionals by specifically highlighting and describing updates in guidance, using the 2020 IADT published guidelines. By incorporating the 2020 guidelines into our everyday practice we aim to provide the most appropriate, standardised care, based on the highest level of available evidence to our patients.The full published guidelines are available free online via the IADT website.

Dental injury offenses and compensation imposed by Spanish courts, before and during Covid-19. A cross-sectional study

Injuries to the dentofacial region caused by third parties can affect physiological, sensory and esthetic functions with legal repercussions. The personal and social circumstances generated by Covid-19 and the governmental measures taken to control it, have increased the risk factors for violence and with it, the resulting injury rate. The aim of the present investigation was to compare the amount of civil liability for dental injury crimes agreed by Spanish courts, in certain Autonomous Communities, before and during the pandemic situation caused by Covid-19. For this purpose, a analytic cross-sectional study was carried out by analyzing sentences from the database of the Judicial Documentation Center. A comparison of means (one-way ANOVA) was used on the amount of compensation between the different years, and between the Autonomous Communities of Madrid, Catalonia Cataluña, Andalusia, the Canary Islands and the Valencian Community. It was observed that the year 2020 stood out for the increase in the number of cases of dental injury offenses. For its part, the Autonomous Community of Andalusia showed the highest amount of compensation during the pandemic, although the highest number of cases corresponded to the Community of Madrid. The statistical analysis yielded a probability of more than 0.05, which eliminated the possibility of significant differences in each of the comparisons.

Critical appraisal of the 2020 IADT Guidelines: A personal commentary

The 2020 International Association of Dental Traumatology (IADT) Guidelines feature several important changes in the treatment recommendations for traumatic dental injuries (TDIs) from the previous 2012 iteration of these Guidelines. This evidence-based narrative review aims to provide a detailed appraisal of five specific changes incorporated in the 2020 IADT Guidelines, based on the available literature evidence that may have prompted these changes. The paper discusses three excellent additions/changes to the new Guidelines: (i) inclusion of a core outcome set for reporting TDIs; (ii) more conservative management of primary dentition TDIs including the changed recommendations for radiation exposure and managing primary dentition luxation injuries; and (iii) the changes in the treatment recommendations for permanent dentition avulsion injuries. The paper further debates whether two other changes made in the current IADT Guidelines for-(i) intrusion injuries in immature teeth; and (ii) complicated crown-root fractures in mature teeth-have sufficient evidence to support the changed recommendations.

Long-term Outcome of Endodontically Treated Traumatized Immature Upper Incisors

INTRODUCTION

In a growing child, preservation of traumatized immature permanent upper incisors is challenging. This study aimed to evaluate the long-term outcome of endodontically treated traumatized immature upper incisors and associated variables.

METHODS

A total of 183 traumatized immature upper incisors treated with pulpotomy, apexification, or regenerative endodontic procedure (REP), with follow-up between 4 and 15 years, were assessed for presence of pulpal responses or periodontal/bone responses using standardized clinical and radiologic criteria. Logistic regression, including stage of root development, type and complexity of traumatic event, type of endodontic intervention, and history of orthodontic management, were used to estimate impact on tooth survival and occurrence of tissue responses. Study approved by Ethics Committee Research UZ/KU Leuven (S60597).

RESULTS

After a median follow-up of 7.3 years (interquartile range, 6.1-9.2), 159 teeth (86.9%) were still functional. From these teeth, 58 (36.5%) developed tissue responses. This was significantly associated with stage of root development at moment of trauma (root length <¾) and type of endodontic intervention (REP presenting worst outcome). Tooth loss (24 teeth, 13.1%) occurred after a mean time span of 3.2 years (±1.5) and was significantly associated with type and complexity of the traumatic event and type of endodontic intervention, with apexification showing better results than REP (odds ratio, 0.30; 95% confidence interval, 0.11-0.79).

CONCLUSIONS

A large number of endodontically treated traumatized immature teeth could be kept functional. Very immature teeth, teeth with periodontal tissue damage, and teeth treated with REP were at highest risk for an unfavorable outcome.

Global status of knowledge of parents for emergency management of traumatic dental injuries: a systematic review and meta-analysis

RESEARCH PROTOCOL

The protocol was developed as per the recommendations of the Cochrane-handbook and PRISMA and was registered in PROSPERO.

LITERATURE SEARCH

Search was performed by using MeSH-Terms and keywords in PubMed, Scopus, Embase, Web of Sciences, Lilacs, and Cochrane databases and gray literature sources 15th July 2022. There were no limits regarding the year of publication and language. Hand-searching of included articles was also performed. Titles and abstracts and later full texts were screened as per strict inclusion and exclusion criteria.

DATA EXTRACTION

Self-designed pilot-tested form was used.

QUALITY APPRAISAL

Risk of bias was analyzed through Joanna-Brigg's-Institute's-critical appraisal checklist. The evidence analysis was done by using the GRADE approach.

DATA ANALYSIS

Qualitative synthesis was performed for describing the study characteristics, details of sampling, and results of various questionnaires. It was discussed by the expert group and presented using KAP heat map. Meta-analysis was done by using Random Effects Model.

RESULTS AND INTERPRETATION

The risk of bias was found to be low in seven and moderate in one study. It was observed that >50% of parents knew about the urgency to seek professional advice after TDI. Only <50% of parents were confident of their ability to identify the injured tooth, clean the soiled avulsed tooth, and perform the replantation. Appropriate responses regarding immediate action after tooth avulsion were given by 54.5% (95% CI: 50.2-58.8, p = 0.042) of parents. The knowledge of the parents regarding the emergency management of TDI was found to be inadequate. The majority of them were interested in obtaining information about dental trauma first aid.

Frequency of Obstructive Sleep Apnea in Patients Presenting with Tooth Fractures: A Prospective Controlled Study

Several factors in the pathophysiology of obstructive sleep apnea (OSA) may increase the likelihood of excessive occlusal loads. Increased occlusal loads may compromise a tooth's mechanical resistance. This prospective controlled study assessed the frequency of OSA in patients presenting with tooth fracture. Patients with and without tooth fractures were selected in a consecutive manner from a private dental clinic between February 2018 and January 2020. Demographic and dental variables were registered. A parafunctional habits questionnaire, anthropometric measurements, and validated respiratory polygraphy were performed. Descriptive, comparative, and correlation statistical analyses were performed. Multiple regression analysis was also performed. Fifty-nine patients were included, and 29 presented tooth fracture. Patients with a tooth fracture formed the case group and patients without tooth fracture formed the control group. Patient age was significantly higher in the case group (59 ± 13 years) compared to the control group (44 ± 11 years). Most of the fractured teeth were molars, had a natural tooth as an antagonist, and were not endodontically treated. Twenty-one patients had OSA (apnea-hypopnea index: ≥ 5 events per hour) in the case group compared with 12 patients in the control group (P = .027). Moreover, the patients in the case group had a significantly higher apnea-hypopnea index (P = .000). Multiple regression analysis showed that only age had a significant effect on tooth fracture (P = .002). However, there was a statistically significant relationship between OSA and the presence of tooth fracture in patients aged ≥ 40 years (P = .041). OSA was more frequent in patients presenting with tooth fractures.

Knowledge and Attitudes of Saudi Medical Students about Emergency Management of Traumatic Dental Injuries

Several studies indicate that physicians lack emergency management knowledge concerning traumatic dental injuries (TDIs), emphasizing the fact that medical students are not taught about this topic. This study aimed to assess the basic knowledge and attitudes of medical students in Saudi Arabia about emergency TDI management. This cross-sectional study recruited a convenience sample of medical students in their clinical years through social networking sites and asked them to answer a pretested internationally accepted questionnaire that included demographic questions, two case scenarios about crown fractures and avulsion of permanent teeth, and self-assessment questions. The data were analyzed statistically using descriptive statistics and the chi-squared test (p < 0.05). A total of 761 medical students responded. Only 5.8% of the students reported receiving information about TDIs in their curriculum. Medical students, mainly those ready to graduate, were more knowledgeable of the emergency management of a crown fractured permanent tooth than an avulsed permanent tooth (p < 0.0001). However, more than half of the students were unable to differentiate between a primary versus permanent fractured tooth and would manage an avulsed primary or permanent tooth similarly. Regarding students' attitudes, less than one-quarter of the students (13.5%) were confident about diagnosing TDIs and/or providing emergency management when required (18.1%). Furthermore, only about one-tenth of the students (9.3%) were satisfied with their self-perceived knowledge, and most (71%) reported needing further education about the topic. Medical students in Saudi Arabia have insufficient knowledge about the emergency management of TDIs. Gaps in students' knowledge of emergency management of avulsion injury were identified in addition to their low confidence level to either diagnose or immediately treat TDIs if required. Students felt dissatisfied with their current knowledge level, this being most prominent among graduating students. There is a need to elaborate the undergraduate medical curriculum in Saudi Arabia to include emergency management of TDIs.

The Efficacy of Advanced Platelet-rich Fibrin in Revascularization of Immature Necrotic Teeth

AIM

The present study aims to compare advanced platelet-rich fibrin (A-PRF) and conventional blood clot as scaffolds in the regenerative endodontic procedure (REP) and to evaluate their effectiveness in the development of traumatized nonvital immature teeth roots.

MATERIAL AND METHODS

Regenerative endodontic procedure was carried out on 20 traumatized nonvital immature maxillary incisors of 17 patients between the ages of 8 and 12 years. Irrigation with 1.5% sodium hypochlorite (NaOCl) and 17% ethylene diamine tetra-acetic acid was done following minimal mechanical debridement. Canal disinfection was achieved using calcium hydroxide paste. According to the scaffold type, teeth were randomly allocated into A-PRF (n = 10) and conventional blood-clot groups (n = 10). Apical width and root dimensions (length and thickness) were analyzed radiographically and statistically after 3-, 6-, and 12-month follow-up.

RESULTS

Fifteen patients with 18 teeth (A-PRF n = 9, blood clot n = 9) completed the follow-up, and 2 patients were excluded. Patients in both groups were asymptomatic. There was a significant increase within each group in respect to root length, root thickness at one- and two-thirds, and root apex width for all timepoints. While percent of change between the two groups was statistically insignificant.

CONCLUSION

Regenerative endodontic procedure for traumatized immature nonvital teeth with either conventional blood clot or A-PRF as scaffold was comparable, except in cases where adequate bleeding cannot be achieved.

CLINICAL SIGNIFICANCE

Advanced platelet-rich fibrin provides a suitable scaffold that can be used in REP of teeth with close proximity to vital structures such as inferior alveolar nerve (IAN) or mental nerve, where using a sharp instrument to induce bleeding can cause damage and also in cases where adequate bleeding cannot be achieved.

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.

[Primary school teachers' knowledge regarding tooth trauma in Putuo district, Shanghai area]

PURPOSE

This study was conducted to evaluate the knowledge of primary school teachers regarding tooth trauma in Putuo district, Shanghai.

METHODS

A questionnaire involving the knowledge of tooth trauma was designed. A total of 1 020 teachers from primary schools were invited to participate in the survey. SPSS 20.0 software package was used for statistical analysis of the data.

RESULTS

A total of 973 valid questionnaires were collected. 74.8% of the respondents knew the information of the nearest medical institution dealing with dental trauma; 53.8% would first inform the parents when dental trauma occurred; 59.1% chose to leave the fractured teeth to the parents for treatment; 79.5 % knew that fourth graders had permanent anterior teeth. As to the preservation medium of broken teeth, 12.7% of the participating teachers chose the wrong answer.62.7% of the teachers answered correctly about the cleaning method of contaminated broken teeth. When asked about the best time to reimplant teeth, 19.6% of the teachers chose fewer than half an hour. Teachers' gender, age and whether they were trained before affected their scores of the scene simulation questions(P<0.05), and education background was not the most important factor (P>0.05).

CONCLUSIONS

Primary school teachers in Putuo district partly mastered the emergency treatment knowledge of children's tooth trauma. Medical institutions and educational institutions need to strengthen training related to children's tooth trauma.

OCCLUSAL TRAUMA OF IMPLANT-SUPPORTED METAL-CERAMIC CROWN: A CASE REPORT

In this article there is a clinical case of occlusion trauma of implant-supported metal-ceramic crown for prosthetics of central incisor. Its uniqueness is the possibility to save dental implant after acute occlusion impact, which was strong enough to break ceramic facing of fixed denture, but not able to destroy bone and implant components. The occlusion force located at the incisal edge of the crown induced a reverse torque to the implant and did not result in its failure or bone resorption. In a year after repeated fixed prosthetics, the results of clinical examination proved absence of any problem with osseointegration. Literature analysis lets us to suggest, that the phenomenon was caused by protective action of cortical bone around of dental implant. Besides, in the case of natural tooth, the bone is suddenly compressed against the conical root; it transfers occlusal breaking to the supporting periodontal ligament. A dental implant has no periodontal ligament but can have a rough surface that may preclude implant failure.

Knowledge on Pre-Hospital Emergency Management of Tooth Avulsion among Croatian Students of the Faculty of Education

The purpose of this study was to evaluate the knowledge regarding tooth avulsion and dental first aid response among Croatian students of the Faculty of Education. A cross-sectional study was conducted among students. Participants (N = 235) were female with an average age of 21.9 ± 2.7 years. The questionnaire contained 10 close-ended questions with two to eleven possible answers. Every participant chose one correct answer. Statistical significance was determined using a Chi-square test. Majority of participants had never received any kind of information on management of a knocked-out tooth. Questions in the nature of tooth injuries, a knocked-out tooth, tooth replantation and whether the knocked-out tooth should be placed back were answered confirmatively by 40.43%, 83.40%, 57.02% and 62.55% of participants, respectively. The questionnaire showed that 18.78% of participants were aware that replantation should be performed within 30 min. The appropriate cleaning and transport medium was chosen by 40.85% and 35.31% of participants, respectively. A nearby dentist would be visited by 66.38% of students. Only 8.08% of participants provided a correct answer to all of the knowledge-based questions. The “I do not know” answer was chosen by 18.30% of participants whenever it was offered. This indicates that the majority (89.78%) were not aware of the fact that the procedure they chose would be inappropriate. The current study confirmed that future primary school teachers have a lack of knowledge for immediate response to tooth avulsion, leaving small chances for a successful prognosis of tooth replantation.

Prevalence of Dental Trauma in 1485 Brazilian Adolescents Aged Between 15 and 19 Years Old and Associated Factors

PURPOSE

Investigate dental trauma among adolescents aged 15-19 years and associated factors.

METHODS

The study was conducted in Recife, Brazil and the sample comprised 1485 adolescents of both sexes. The data was collected by clinical examination and interviews were conducted in-between classes by a single trained assessor. Two questionnaires (AUDIT and ASSIT 2.0) were used to investigate the involvement of adolescents with alcohol, tobacco and illicit drugs. The classification proposed by Andreasen was used to identify dental injuries. The sample size was calculated using 95% interval level. Pearson's chi-square test and Fisher's exact test were used to confirm the association between the variables.

RESULTS

The prevalence of dental injuries was 17.8%. The main causes of trauma were playing with others (20.8%) and falls (25.4%). A statistically significant percentage of adolescents reported using illicit drugs (13.9%), 15.9% used tobacco and 56.8% used alcoholic beverages. However, no statistically significant difference between the consumption of this drugs and dental injuries (p >0.005) was found.

CONCLUSION

The prevalence of dental trauma in adolescents was high, with no association with drugs use.

Incidence of traumatic dental injury in Valencia, Spain

BACKGROUND

While traumatic dental injuries (TDI) are an increasingly frequent occurrence in everyday dental practice, little research on TDIs has been published in Spain. The aim of this study was to determine the incidence of TDIs in a population in Valencia (Spain) and investigate influential variables. In addition, a protocol for TDI data collection is proposed.

MATERIAL AND METHODS

This retrospective study compiled data from patients attending a private dental clinic between January 2003 and December 2014. The data were collected using a specially-elaborated protocol entitled "Emergency care of acute dental trauma". Patients responded to each item, and data was added from case radiographs and photographs. Data were entered in a Microsoft Office Excel spreadsheet and submitted for analysis by SPSS 15.0 software (Chicago, IL) applying 2-way analysis of variance (ANOVA) (p<0.01).

RESULTS

481 TDIs in 251 patients were examined at a private dental practice in Valencia. The population comprised 62.5% men and 37.5% women, aged 1 to 78 years. The highest frequency of tooth injuries occurred in children aged 9 years or younger. The most frequent injury was non-complicated crown fracture (43.2%). Upper central incisors were the most commonly affected teeth. The most frequent place where TDI was produced was in the street (28.7%), tripping over an immobile object being the most common cause (29%).

CONCLUSIONS

Thanks to the protocol elaborated for the purposes of this work, it was possible to compile a large quantity of data on TDI, facilitating future prevention and comparison with other regions. The results obtained concur with those published in the literature.

Dental Trauma Experience, Attitudes and Trauma Prevention in 11- to 13-Year-Old Lithuanian Schoolchildren

PURPOSE

To identify the prevalence and determinants of dental trauma in permanent anterior teeth among 11- to 13-year-old schoolchildren, to compare self-reported dental trauma rates with clinical examination trauma rates, and to examine mouthguard use among children engaged in contact sports.

MATERIALS AND METHODS

A probability sampling scheme was used to recruit schools, with all 6th grade children in the selected schools invited to participate. A total of 2621 caregiver consent forms were sent, of which 807 were returned (31%). Caregivers were asked four trauma-related questions. Clinical examinations included assessment of dental trauma experience (trauma index with five severity codes), lip competence and incisal overjet. Child- and tooth-level analyses were performed.

RESULTS

Clinical evidence of dental trauma was found in 52% of participants, 13% self-reported dental trauma, and 7% of children did not remember the occurrence of any trauma. The two most frequently self-reported reasons of dental injury were falls or collisions with objects (63%) and sport/leisure activities (32%). Nearly half of the more severe dental injuries did not receive the necessary treatments. One-third of schoolchildren participated in contact sport activities, but only 3% always used mouthguards. There was a substantial difference between the clinical and self-reported findings. Logistic regression analyses revealed no statistically significant associations between dental trauma experience and the potential determinants studied: gender, lip coverage and overjet.

CONCLUSION

In this study, traumatic dental injuries were observed with 52% prevalence. A substantial discrepancy between self-reported and clinical findings was observed.

Ridge Preservation Strategies in Children Following Anterior Tooth Trauma

The sequelae associated with anterior oral trauma during childhood growth may require a protracted period of clinical management to achieve an optimal foundation for future prosthetic therapy. This article presents two case examples of long-term ridge development and preservation in children after anterior dental and alveolar trauma. These two patients were managed for periods of 11 years, one from age 8 to 19 and the other from age 9 to 20, until they were old enough to receive implantsupported restorations. Two different treatment plans were prescribed based on whether or not the teeth in question were ankylosed. In one case, fractured roots that were not ankylosed were retained; in the other, decoronation of an ankylosed tooth was performed.

Orofacial trauma awareness among sports teachers in Southern Saudi Arabia

BACKGROUND

Dental trauma is a major public oral health problem owing to its high prevalence. The school sports teachers who observe children when they participate in sports have a key role in the prevention and management of traumatic injuries. The present study aims to determine the awareness of sports teachers on the occurrence and prevention of oral-facial trauma in southern Saudi Arabia.

METHODS

The present study was a cross-sectional study design among sports teachers in a southern subpopulation of Saudi Arabia. A draft questionnaire with 11 items was constructed under three domains: occurrence pattern, prevention, and management of dental trauma.

RESULTS

A total of 191 sports teachers from various schools participated in the survey. The majority (88%) of the teachers had encountered orofacial trauma among children during sporting activity in schools. The most common orofacial structure involved in injury was the teeth (33.5%) and lips (25.2%). Only 50.8% of subjects knew stock tray as a type of mouthguard and 27.7% of teachers responded that they do not recommend mouthguards for children during sporting activities. Nearly 80.6% teachers were aware of the possibility of reimplanting an avulsed tooth. About 72.8% teachers had poor knowledge of immediate action necessary for successful outcomes of reimplanted teeth.

CONCLUSIONS

Orofacial trauma was commonly encountered by sports teachers among children during sporting activities in the school. There was poor awareness regarding types of mouth guards and its significance among the sports school teachers. The knowledge related to the management of emergency oral injuries was inadequate.

Initial management of dental trauma: musts, shoulds, and cans

When dental trauma occurs, initial management on the day of injury has a determining influence on healing and thus on the prognosis of the affected teeth. Improper, delayed, and/or inconsistent treatment often has far-reaching consequences that cannot be reversed later, even with great effort, especially in children and adolescents. In most cases, it is unrealistic or impossible for the patient to get to a specialized dental trauma facility in time. Therefore, it is every dental practitioner's duty to provide adequate initial diagnosis and treatment of dental trauma at their dental practice, even if they do not have routine experience in this area. This article serves as a guide to the initial management of dental trauma. It utilizes a three-tiered approach to illustrate which initial management measures are absolutely essential (MUSTS), which should ideally be performed (SHOULDS), and which are not top priorities but can be performed (CANS) if the necessary time, training and experience, and equipment and facilities are available. For further treatment, dental practitioners should realistically assess the limits of their ability to treat complex dental trauma cases and, if necessary, they should refer the patient to a specialist or specialized treatment center. (Quintessence Int 2020;51:763-774; doi: 10.3290/j.qi.a45103; modified from a previously published article (in German) Quintessenz 2019;70(9):990-1002).

Determination of the structure of acute injury of temporary and permanent frontal teeth in children, analysis of diagnostic and treatment measures and their effects

OBJECTIVE

The aim: To determine the structure of acute injuries of temporary and permanent frontal teeth in children, to analyze the applied diagnostic and treatment measures for acute tooth trauma and to investigate their effectiveness.

PATIENTS AND METHODS

Materials and methods: The subject of the study were 31 children aged 2-12 years with acute temporary and permanent tooth trauma. Methods: clinical (radiological, thermodiagnosis), medical and statistical.

RESULTS

Results: The number of injured permanent teeth was greater than the number of injured temporary teeth. The pattern of temporary and permanent tooth injuries differed, so in temporary teeth dislocations were observed, and in permanent teeth fractures prevailed over dislocations. In our opinion, this is due to the peculiarities of the anatomy of the temporary teeth. Usually, the therapeutic tactics of acute temporary teeth injuries is to remove them, despite their important role in the growth and development of jaws, physiological formation and eruption of permanent teeth. The therapeutic tactics of dynamic observation in the case of intrusive dislocation of the temporary tooth were selected in the clinic of the Department of Pediatric Dentistry. In some cases, with a slight change in the position of the temporary tooth, self-regulation of its position was observed, in other cases the tooth remained dystopic, but its viability remained in 50% of cases. Therapeutic tactics of acute injuries of permanent teeth were selected according to the type of trauma. In the case of permanent tooth dislocation, with a slight change in its position, tooth immobilization was carried out by splinting with fiberglass tape and photopolymer composite material.

CONCLUSION

Conclusions: Our observations have shown that the complex of modern specialized medical care for the affected children with acute traumatic injuries of the teeth should be guided by their preservation, which ensures the subsequent normal formation of the dental-jaw apparatus. To ensure these conditions, a long, reliable immobilization of the damaged tooth is required as soon as possible after injury.

Removal of composite-bonded trauma splints using the Fluorescence-aided Identification Technique (FIT)

Accident-related dental dislocations must be considered as part of an emergency treatment. The use of tooth-colored fixation composites makes the splint seem less noticeable in everyday life. However, this makes it more difficult to remove without damaging the tooth's enamel surface. In order to better visualize the transition between composite and the tooth , the fluorescent properties of some composites can be advantageous. This article will explain the individual steps of a rapid and minimally invasive splint removal, using the so-called Fluorescence- aided Identification Technique.

[Spontaneous reeruption after intrusive luxation of the permanent incisors by incomplete root formation. Two case reports (in German)]

In the context of tooth trauma mostly the maxillary central front teeth are involved, whereby their roots are in some cases in developing stage (immature). The intrusive luxation represents one of the most severe types of dental trauma because of the damage to the periodontal ligament, alveolar bone and pulp. Principally, three different treatment options are available: 1. Spontaneous reeruption, 2. orthodontic extrusion, 3. surgical repositioning. This report is aiming to illustrate, by two cases, that traumatic intruded teeth with incomplete root formation, treated without active repositioning (waiting for spontaneous reeruption), seem to be associated with the lowest risk of healing complications. Therefore, the decision of the treatment procedure should be based mainly on the stage of root development and only secondarily on the degree of intrusion.

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.

Prevalence of Traumatic Injuries to Anterior Teeth in 9-14 Year School-going Children in Mumbai, India

AIM

The aim of this study is to assess the prevalence and causes of traumatic dental injury (TDI) in 9-14 year school-going children in Mumbai, Maharashtra, India.

MATERIALS AND METHODS

A cross-sectional study consisting of 2,055 primary and secondary school-going children aged between 9 and 14 years, from 20 municipal corporation schools of Mumbai city, was selected through a stratified random sampling technique. Children were examined clinically for any signs of TDI in the permanent anterior teeth in their respective schools by two examiners trained in using WHO criteria for oral and dental examination. Data analysis involved descriptive statistics including a frequency distribution.

RESULTS

The prevalence of TDI to anterior teeth in school children of Mumbai was 16.3%. The commonest cause of trauma was fall followed by sports activities, collision, and road traffic accidents.

CONCLUSION

The occurrence and various etiologies of traumatic injuries to maxillary anterior teeth in school children of Mumbai were approximately the same as found in other countries.

CLINICAL SIGNIFICANCE

The present study gives a bird's eye view on the prevalence and common etiology of TDI in school children of Mumbai.

Parental perceptions of impact of oral disorders on Colombian schoolchildren's oral healthrelated quality of life

There is no study assessing the impact of dental caries (DC), dental fluorosis (DF) and traumatic dental injuries (TDI) on oral healthrelated quality of life (OHRQoL) in school children from Colombia. The purpose of this study was to assess the impact of DC, DF and TDI on Colombian schoolchildren´s OHRQoL using their parents as proxies. The parents of 338 children aged 6 to 14 years from public and private schools of Cartagena, Colombia answered the ParentalCaregiver Perception Questionnaire (PCPQ) on child's OHRQoL adapted to Colombian Spanish language and a socioeconomic questionnaire. Three calibrated examiners performed the clinical assessment for DC, DF and TDI. Poisson regression associated clinical and socioeconomic conditions to the outcome. Overall, 90.24% of parents reported children's oral impact (total PCPQ score ≥ 1). The mean (standard deviation) PCPQ scores were 12.49 (14.04). The multivariate adjusted model showed that children from public schools and who have dental caries experience (RR= 1.28; p=0.04 and RR= 1.37; p= 0.018, respectively) were more likely to experience negative impact on total PCPQ scores. DC was found to be associated to parentalcaregiver perception of impact on their children's oral healthrelated quality of life, but DF and TDI were not.

Parental perceptions of impact of oral disorders on Colombian preschoolers' oral health-related quality of life

There is no study assessing the impact of dental caries (DC), traumatic dental injuries (TDI) and dental malocclusions (DM) on the oral health-related quality of life (OHRQoL) of preschool children from Spanish-speaking countries in population-based samples. The purpose of this study was to assess the impact of DC, TDI and DM, on Colombian preschool children's OHRQoL through a cross-sectional study. The clinical setting included private and public preschools in Cartagena,Colombia. The sample included 643 preschool children aged 1-5 years and their parents, who answered the Colombian version of the Early Childhood Oral Health Impact Scale (C-ECOHIS) and socioeconomic questionnaire. Three calibrated examiners performed clinical assessment of severity of DC according to decayed, missing and filled primary teeth index, TDI and DM. Poisson regression associated clinical and socio economic conditions to the outcome. Overall, 48. 2% of parents reported children's oral impacts (total C-ECOHIS score >1). The mean (standard deviation) C-ECOHIS scores were 2. 20 (0. 15). The multivariate adjusted model showed that children from non-nuclear families (RR=1. 51; p=0. 003),with low and high DC severity (RR=1. 51, p=0. 003; RR=1. 53, p=0. 009) and TDI (RR=1. 56, p=0. 003), were more likely to experience negative impact on total C-ECOHIS scores. DC and TDI have negative impact on Colombian preschool children's OHRQoL. Children from non-nuclear families have worse OHRQoL at this age, independently of the presence of oral conditions.

How Does Dental Trauma Affect the Quality of Life in Turkish Families?

PURPOSE

To assess the responsiveness of the Family Impact Scale (FIS) to describe changes in quality of life (QoL) after traumatic dental injury (TDI), and compare the efficacy of subscales.

MATERIALS AND METHODS

Parents of 110 children aged 7-15 admitted to the Gazi University Faculty of Dentistry Department of Paediatric Dentistry for dental trauma were included in this study. A three-part questionnaire was distributed to the participants: questions regarding personal information, TDI and QoL. The types of TDI were classified according to Andreasen et al.3 Quality of life was measured using the FIS. The questionnaires were translation into Turkish, and QoL was measured using the Turkish Family Impact Scale (T-FIS) total score and scores for subscales. The Kolmogorov-Smirnov test was used to assess normal distribution of the data. After this procedure, the nonparametric Kruskal-Wallis test was used.

RESULTS

Traumatic dental injuries exhibited a negative impact on parents' QoL, as shown by the total T-FIS score and subscales (p < 0.001). In this study, the determined values for parental emotions > parental/family activity > financial burden > family conflict had a negative impact on the parents' QoL. Parental emotional values were statistically different from those of parental/family activity, financial burden and family conflict values (p < 0.001).

CONCLUSION

Traumatic dental injuries in children present a negative impact on Turkish parents' QoL. Parental emotions were the most affected subscale.

Tooth cracks detection and gingival sulcus depth measurement using optical coherence tomography

The aims of this study were to develop an automatic detection technique for tooth cracks and to suggest quantitative methods for measuring gingival sulcus depth using swept-source optical coherence tomography (SS-OCT). We evaluated SS-OCT with wavelength centered at 1310 nm over a spectral bandwidth of 100 nm at a rate of 50 kHz as a new diagnostic tool for the detection of tooth cracks and gingival sulcus depth. The reliability of the SS-OCT images was verified by imaging the crack in extracted human teeth and gingival sulcus of porcine sample. The SS-OCT could automatically detect the position of various cracks and visualize the deep periodontal pockets. Therefore, the detection capability of SS-OCT images could be useful diagnostic tool for dental cracks and periodontal pockets.

Knowledge, attitudes, and behavior concerning dental trauma among parents of children attending primary school

BACKGROUND

Traumatic dental injuries occur frequently in children and adolescents. The purpose of the present study is to examine the levels of knowledge and behaviors regarding dental trauma among parents of children attending primary schools in the Apulia region of Italy.

METHODS

The study was carried out using an anonymous questionnaire with closed answers distributed to 2,775 parents who were enrolled based on the entire regional school population. Analyses were conducted using the PROC CORRESP (procedure to perform multiple correspondence analysis) and PROC FASTCLUS (procedure to perform cluster analysis). Statistical significance was set at p-value <0.05.

RESULTS

A total 15.5% of the sample reported that their children had experienced dental trauma. Overall, 53.8% of respondents stated that they knew what to do in cases of dental injury. Regarding the time limit within which it is possible to usefully intervene for dental trauma, 56.8% of respondents indicated "within 30 minutes". Of the total sample, 56.5% knew how to preserve a displaced tooth. A total 62.9% of parents felt it was appropriate for their children to use dental guards during sports activities. The multivariate analysis showed that wrong knowledge are distributed among all kinds of subject. Parents with previous experience of dental trauma referred right behaviours, instead weak knowledge and wrong behaviours are associated with parents that easily worried for dental events.

CONCLUSIONS

This study showed that most parents reported no experience of dental trauma in their children, and half of them did not know what to do in case of traumatic dental injury and they would intervene within 30 minutes, suggesting that dental trauma may trigger panic. However, they did not have the information needed to best assist the affected child. Motivating parents to assume a preventive approach towards dental trauma may produce positive changes that would result an increase of long-term health benefits among both parents and children.

Predicting serious complications and high cost of treatment of tooth-knuckle injuries: a systematic literature review

PURPOSE

The tooth-knuckle injury (TKI) is a serious and potentially costly injury seen in orthopaedic practice. The aim was to conduct a systematic literature review on the factors associated with serious complications and high treatment costs in tooth-knuckle injuries.

METHODS

MEDLINE, Scopus and CINAHL were used as the literature sources.

INCLUSION CRITERIA

Original research papers that reported on factors predicting serious complications and high treatment costs in TKIs were included. There were no restrictions placed on study size, language, study design or date of publication.

EXCLUSION CRITERIA

Case studies, case series and review articles were not included.

RESULTS

After duplicates were removed, 403 unique studies remained; after titles and abstracts were screened, 48 titles remained and were retrieved in full text. Of these, 14 titles met the inclusion criteria and were included in the data synthesis. Tenosynovitis, septic arthritis, osteomyelitis and residual stiffness were common serious complications occurring in up to 36.3, 70.0, 47.6 and 65.3 % of cases, respectively. Amputation was also common in up to 18.0 % of injuries. Treatment costs were measured by length of hospital stay and the number of debridements required. On average, patients required 3.8-8 days of admission and 1.3-2.7 debridements each.

CONCLUSION

Increased time delay from injury to treatment, deeply penetrating injuries, proximal interphalangeal joint (PIPJ) injuries and, possibly, E. corrodens infections were associated with serious complications in TKIs. Delayed treatment, inadequate treatment, PIPJ injuries and deeply penetrating injuries predicted higher treatment costs.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42016029949 ( http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016029949 ).

[Expression of MMP-2 in the periodontal tissues with the mini-screw for molar intrusion with cyclic intrusive force in dogs]

PURPOSE

To observe the expression of MMP-2 in the periodontal tissues of molars in Beagle dogs after different times of intrusion by mini-screw with cyclic intrusive force.

METHODS

Three mature Beagle dogs were used for the experiment. On the buccal and palatal sites of the left maxillary second and third premolars, a minis-crew was placed at the inter-radicular septa separately, intruding the tooth with 150 g initial force, which would be reinforced every 4 weeks. The teeth of left side as the experimental group were divided into 3 subgroups, as being intruded 12, 24 and 36 weeks, and the right side as blank control. Then the dogs were sacrificed, and the second and the third premolars with the surrounding periodontal tissue were cut down, fixed, decalcified, wrapped and cut into slices. Immunohistochemical staining with MMP-2 was performed. The average optical density (OD) of MMP-2 was calculated with IPP software, which represented the expression of MMP-2. SPSS 17.0 software package was used for statistical analysis.

RESULTS

Immunohistochemical staining revealed that the expression of MMP-2 in control group was low. After tooth intrusion, MMP-2 expression significantly increased in the periodontal tissues of molars, and reached the maximum in the group of 24 weeks. Then MMP-2 expression decreased in the 36-week group but still significantly higher than the control group. There was no significant difference among the 3 subgroups for different intrusion times(P>0.05).

CONCLUSIONS

MMP-2 participates in remodeling of the periodontal tissue during tooth intrusion. The expression of MMP-2 is not significantly increased with the extension of the intrusion time with cyclic intrusive force, which suggests that with the use of mini-screw to intrude the molars with cyclic intrusive force, the periodontal tissues of the intruded tooth maintain dynamic balance of bone remodeling.

[Evidence-based quality assessment of Chinese clinical trials on the effects of stabilization of permanent anterior dental trauma]

PURPOSE

To appraise the quality of Chinese clinical trials during recent 10 years about the treatment of permanent anterior dental trauma with evidence-based quality control methods.

METHODS

The CNKI (Chinese National Knowledge Infrastructure) and Wanfang electronic database with key words "permanent anterior dental trauma " were searched. Two hundred and forty-five papers were obtained during recent 10 years, 46 key papers about the treatment of permanent anterior dental trauma were retrieved. The quality of the Chinese clinical trials according to the consolidated standards of reporting trials (CONSORT) and strengthening the reporting of observational studies in epidemiology (STROBE) statement were assessed.

RESULTS

Within the 46 key papers, there were 8 randomized controlled clinical trials, while the other 38 papers were observational studies. It was hard to evaluate precisely due to the lack of scientific information. The randomized controlled trials lacked details for randomization, allocation concealment and blinding compromised the quality.

CONCLUSIONS

For the clinical studies about the effects of stabilization of permanent anterior dental trauma, the study quality needs to be improved, and progress should be made both in the clinical study design and the paper writing. Supported by Grants for Selecting and Training Outstanding Faculty in Shanghai Universities(jdy10048).

[The study of emergency facial trauma in children and parents' cognition on it]

OBJECTIVE

To analyze the characteristics of emergency facial trauma in children and mother's cognition on it.

METHODS

Descriptive analysis was undertaken for 216 children with maxillofacial trauma. The analysis included age distributions of the children, reasons and places for the trauma, and positions and severity degrees of the trauma. The questionnaires were carried out for the patients' mothers, to understand the cognition degrees and prognosis factors.

RESULTS

Most of the patients with facial trauma were aged 1-6, with the male and female ratio of 1.4:1. Falls were the leading cause for the maxillofacial injuries(83.33%). The most common types of injury were the soft tissue injuries (63.43%) and the teeth injuries (31.94%), the jaw fractures were least. 50.00% accidents occurred at home. 97.22% mothers had no knowledge of the facial injuries in children. 69.44% mothers thought it avoidable. It were relevant between mothers' educations and injuries times (chi2 = 18.16, P < 0.05).

CONCLUSION

Mothers lack the knowledge is one of the most important reasons for the maxillofacial injuries in children. Propaganda should be increased among them to reduce risks of maxillofacial injuries.

Right handed Neandertals: Vindija and beyond

Seven Vindija (Croatia) Neandertal teeth, dated about 32,000 years ago, were analyzed to determine patterning of scratches on the anterior teeth. Oblique scratches exclusively on the labial faces of incisors and canines represent a distinctive pattern, characteristic of hand directed, non-masticatory activities. At Vindija and elsewhere these scratches reveal activities, which were performed primarily with the right hand. The late Neandertals from Vindija, combined with other studies, show that European Neandertals were predominately right-handed with a ratio 15:2 (88.2%), a frequency similar to living people. Studies of teeth from Atapuerca extend this modern ratio to more than 500,000 years ago and increase the frequency of right- handers in the European fossil record to almost 94%. Species-wide, preferential right-handedness is a defining feature of modern Homo sapiens, tied to brain laterality and language with the 9:1 ratio of right- to left- handers - a reflection of the link between left hemispheric dominance and language. Up-to-date behavioral and anatomical studies of Neandertal fossils and the recent discovery of their possession of the FOXP2 gene indicate Neandertals (and, very likely, their European ancestors) had linguistic capacities similar to living humans.