Family structure and social vulnerability as risk factors for traumatic dental injuries in children and adolescents: a systematic review and meta-analysis.

OBJECTIVE: To investigate the associations between family structure and social vulnerability with TDIs in children and adolescents. METHODS: An electronic search was conducted in seven databases (PubMed, Scopus, LILACS, Embase, Web of Science, ProQuest, and Google Scholar) to retrieve observational studies that evaluated the prevalence of TDIs. The risk of bias was assessed using the JBI Critical Appraisal Tools. Meta-analyses were also conducted using odds ratios (ORs) and 95% confidence intervals (CIs). The certainty of evidence was evaluated using the GRADE approach. RESULTS: Out of 7,424 records, seventeen articles were included (n = 18,806 children and adolescents aged between 0 and 19 years). Only two studies had a low risk of bias. Children and adolescents from nonnuclear families were more likely to suffer from TDIs (OR: 1.39; 95% CI: 1.17; 1.66). On the other hand, the level of social vulnerability did not show a positive association with TDIs (OR - 1.21; 95% CI: 1.00; 1.47). The GRADE approach assessed the certainty of evidence as low. CONCLUSION: Despite the uncertainty of the evidence, children and adolescents from nonnuclear families are more likely to have TDIs than are those from nuclear families. On the other hand, social vulnerability does not seem to be associated with episodes of TDIs in children and adolescents. CLINICAL RELEVANCE: Through knowledge of the risk factors for TDIs, it is possible to develop public policies for their prevention.

Knowledge and attitude of traumatic dental injuries in Mongolian schoolteachers.

BACKGROUND: Traumatic dental injury (TDI) is a growing public health concern worldwide, and children and adolescents are commonly affected. Because TDI often occurs at school, the response of teachers to these injuries is crucial. However, teachers in various countries have been shown to lack knowledge of effective TDI first-aid response and need an intervention to improve their knowledge. The aim of the study presented here was to ascertain and analyze teachers' knowledge of and attitude about TDI in Mongolia. MATERIALS AND METHODS: A cross-sectional study of full-time teachers in Mongolia was performed using an online questionnaire (compiled from relevant studies) from September 2022 to December 2022. The questionnaire consists of 47 items and among them 14 were used to assess the teacher's knowledge, and 5 were for attitude towards TDI. The maximum possible score was 14 points and grouped as follows good, moderate, and poor. T-test, ANOVA test (post-hoc) and linear regression analysis were performed. RESULTS: The online survey provided quantitative data from 2821 participants: 28% were elementary school teachers, 29% middle school teachers, and 42% high school teachers. Their mean age was 36.7 ± 9 years, and 2433 (86%) were female. The mean score of the TDI knowledge of the teachers was 5.3 ± 2.1 out of 14. The ANOVA test showed that older (p < 0.01) and more experienced teachers (p < 0.01) had higher scores. Teachers in the eastern (5.46 ± 2.2) and southern (5.49 ± 2.2) provinces had higher mean scores than in the other provinces (p < 0.02). Teachers majored in natural sciences (5.4 ± 2.2) had a higher score than those in the social sciences (5.2 ± 2.1) and difference were significant (p < 0.02). The multiple regression model statistically significantly predicted a one-year increase in experience, the TDI score increased 0.034 (95% CI 0.026, 0.043) unit. CONCLUSIONS: The knowledge regarding TDI and effective first-aid response to such injury is low in teachers in Mongolia. However, the teachers' attitude about TDI was positive and they wanted to learn and improve their knowledge. Therefore, further education and training programs are advised.

Un "boxing" the reality: Knowledge, attitude, and perception of orthodontists, dental practitioners, and orthodontic patients toward mouthguards' wear during contact sports-A cross-sectional study.

INTRODUCTION: Mouthguards (MGs) have the potential to prevent contact sport-related dental injuries. However, varying perceptions of their effectiveness persist, influencing recommendations by dental professionals. AIM: To assess the attitudes, knowledge, and perceptions of orthodontists, other dental practitioners (general dentists and other dental specialists), and orthodontic patients involved in contact sports regarding the use of MGs. METHODOLOGY: A cross-sectional survey was designed to collect information from dental clinicians (orthodontists and other dental practitioners) and their orthodontic patients about using MGs during sports participation. A convenience sampling technique was used to recruit the participants for an online survey. A total of 107 (32 males/75 females) dental clinicians and 147 (75 males/72 females) orthodontic patients (mean age 17.5 ± 5.84 years) participated in the study. Pre-validated questionnaires, specifically designed for dental clinicians and orthodontic patients, were used. Data were analyzed using SPSS software (version 28.0; SPSS). RESULTS: Nearly 50% of dental clinicians have recently recommended MGs to their patients in their clinical practice out of which 59% preferred the stock type; 33% of dental clinicians enquired their patients about involvement in contact sports during initial visits. The majority of orthodontic patients acquired knowledge about MGs through the Internet. More than half of orthodontic patients expressed unwillingness to pay for MGs, and 89% of orthodontic patients found using MGs during contact sports uncomfortable. CONCLUSION: The findings provide valuable insights into the practices and attitudes of dental clinicians and orthodontic patients regarding MGs, their recommendations, and the comfort levels associated with using them during contact sports.

Individual and contextual determinants associated with traumatic dental injuries in children eight to ten years of age: a multilevel analysis.

OBJECTIVE: Investigate individual and contextual determinants associated with traumatic dental injuries in schoolchildren. METHODS: A cross-sectional study with 739 pairs of parents and children. Parents answered a sociodemographic questionnaire, the Family Adaptability and Cohesion Evaluation Scale and a questionnaire on the child's use of electronic devices. Examinations of the children were conducted at the school by calibrated examiners using the diagnostic criteria proposed by Andreasen. Contextual variables of the school were also collected. Multilevel Poisson regression for complex samples was performed (p < 0.05). RESULTS: The individual factors associated with the outcome were children of single parents (PR = 2.33; 95% CI: 1.79-2.66), practice of sports (PR = 2.46; 95% CI: 1.70-3.22), the daily use of electronic devices (PR = 1.78; 95% CI: 1.31-1.81), more than 2 h per day of screen time (PR = 3.84; 95% CI: 1.94-4.28) and chaotic family adaptability (PR = 4.22; 95% CI: 3.44-4.99). The contextual variables were studying at a public school (PR = 1.77; 95% CI: 1.02-3.05) and the presence of rigid floor in the school courtyard (PR = 1.99; 95% CI: 1.15-3.15). CONCLUSION: Individual determinants, studying at a public school and the presence of rigid floor in the school courtyard were associated with traumatic dental.

What are the Characteristics of Oral Injuries Caused by Playground Equipment?

PURPOSE: Studies regarding oral injuries from playground equipment in children remain limited. This study aimed to clarify the characteristics of oral injury caused by playground equipment and identify associations with concomitant head injury. METHODS: Children treated between 2011 and 2021 at an oral surgery clinic for oral injuries from playground equipment were retrospectively investigated. The following factors were analyzed: demographic characteristics, mechanism of injury, type of equipment causing the injury, classification of oral injury, and whether the Department of Emergency and Critical Care Medicine was consulted regarding the head injury. The data collected were statistically analyzed using the Fisher-Freeman-Halton test with significance adopted at the 5% level. RESULTS: This study analyzed data from 82 children. Injuries were concentrated in age groups of 2 to 3 years (32.9%), 4 to 5 years (28.0%), and 6 to 7 years (25.6%). Regarding the mechanism of injury, falls were more common (89.0%) than impact/striking (11.0%). The type of equipment most frequently causing injury was slides (29.3%), followed by swings (23.2%) and iron bars (18.3%). Injuries were classified as soft tissue injury alone (56.1%) or tooth injury and/or jaw fracture (43.9%). Consultation with the Department of Emergency and Critical Care Medicine for head injury was uncommon (13.4%), and all consultations for brain injury diagnosed minor injuries. CONCLUSION: Oral injuries caused by playground equipment were frequent between 2 and 7 years old. The most common cause was falls, with most injuries caused by slides, swings, or iron bars. Approximately half of the oral injuries were soft tissue injuries only, while the other half were associated with tooth and/or jaw injuries. Department of Emergency and Critical Care Medicine consultations for head trauma were uncommon and consistently confirmed minor injuries.

Dental injuries in Swiss children - an analysis of Swiss national health insurance data from the year 2019.

This study, the first to analyze accident data from a major compulsory Swiss health insurer (Concordia), reviewed 5,063 dental accident reports of 122,370 children under the age of 16. The predominant cause of injury was a "fall," with "playing" being the foremost activity mentioned and "ground" identified as the primary object of impact. The analysis of the involved objects showed that dental injuries occur most frequently with scooters, bicycles, and stairs. In 2019, 8.14% of children aged one and insured by Concordia suffered a dental injury. By age 16, 58.8% of all children had experienced a dental injury. 0.72% had suffered a primary dentition crown fracture with pulp involvement. Regarding their permanent teeth, 0.21% suffered an avulsion, 0.84% another luxation injury, 0.65% a crown fracture with pulp involvement, and 0.16% a root fracture. A significant increase in injuries per day was observed after the summer holidays. On weekends, there were 28% fewer injuries per day on average than on weekdays. Despite differences among the cantons, the dataset can be considered to be representative for Switzerland. Accident descriptions were often too brief for detailed prevention strategies. Detailed accident information is essential for effective structural measures, which are more effective than promoting behavioural changes. A detailed recording could also be used to draw up a list of the objects frequently involved in accidents. An updated insurance form with an improved nomenclature, the option of digital submission, photo uploads and AI-supported data recording could greatly improve the quality and interpretability of injury data.

Effect of electronic book "Traumatic dental injury to children's permanent teeth" on primary school teacher's knowledge.

Most dental trauma in children aged 8-12 years occurs in schools. Teachers should properly and timely manage the emergency pertaining to traumatic dental injuries before paying visit to dental health center. Studies had revealed that the elementary school teachers carried poor knowledge of managing the dental trauma. Electronic books were the easily accessible digital and visual educational media for the users through internet-connected devices. This study compared the knowledge of primary school teachers before and after reading the innovative electronic book "Traumatic Dental Injury to Children's Permanent Teeth". The questionnaire was shared via a link, before and after reading this electronic book. The contents of electronic book included the kinds of trauma, management, and preventive measures as explained via appealing illustrations. The median score of knowledge before the intervention was 6 (poor), and afterwards it was 13 (good). Wilcoxon test on scores before and after reading this book resulted in statistically significant difference p-value ≤ 0.05. The electronic book "Traumatic Dental Injury to Children's Permanent Teeth" was innovative, and effective educational media having high impact of increasing the dental trauma knowledge among primary school teachers.

Attention deficit hyperactivity disorder and dental traumatic injuries: a systemic review and meta-analysis.

OBJECTIVE: The objective of this study was to assess whether individuals with attention deficit hyperactivity disorder (ADHD) exhibit a higher prevalence of traumatic dental injuries (TDIs) compared to those without ADHD through a systematic review and meta-analysis of the existing literature. MATERIALS AND METHODS: A search strategy using the Medical Subject Heading (MeSH) vocabulary was employed for a comprehensive search across various databases, including PubMed, Scopus, Web of Science, Cochrane Library, and Embase. The Joanna Briggs Institute Summary was utilized for data collection. Additionally, quality assessment, meta-analysis, and bias control were conducted to ensure the reliability of the included studies. A meta-analysis was performed to consolidate the findings of the individual studies. RESULTS: The prevalence of TDIs among individuals with ADHD ranged from 9.6% to 68.2%, while in the healthy control group, it ranged from 0.8% to 44.7%. The meta-analysis findings revealed that individuals with ADHD had 1.98 times higher odds (OR = 1.98, ranging from 1.51 to 2.59 with 95% CI) of experiencing TDIs compared to individuals without ADHD. CONCLUSIONS: The findings of this study suggest a significant association between ADHD and an increased risk of TDIs. Individuals with ADHD were found to be nearly twice as likely to experience TDIs compared to those without ADHD. Efforts should not only be directed towards improving the oral health of this vulnerable group of individuals, but also healthcare practitioners need to be provided with opportunities to create awareness and implement preventive measures to mitigate the risk of TDIs among individuals with ADHD.

Traumatic dental injuries among children attending the public after-hours emergency dental clinic in Bergen, Norway.

OBJECTIVES: To investigate traumatic dental injuries (TDIs) among children who for 1 year attended a Norwegian public after-hours emergency public dental (EPD) clinic. MATERIALS AND METHODS: The study included 7-18-year-olds (n = 312) who presented at the EPD clinic, underwent a clinical dental examination, and consented to the disclosure of clinical information. Recording of TDIs was restricted to anterior permanent teeth. Potential TDI predictors were also analysed. RESULTS: Almost half (n = 148) of the children were assessed with TDIs in permanent teeth, showing a mean age of 11.0 (standard deviation [SD]: 3.5) years. Males constituted 54.7%. The children experienced TDIs often outside school hours (43.9%), and the majority (58.1%) were caused by falls/accidents. Sixty of them experienced only one TDI. The most common location was the maxillary central incisors. Assessment of TDIs according to severity, could only be done in 131 individuals, involving 253 TDIs. Of these, 81.8% were mild. The odds of visiting the emergency clinic for a TDI were higher (odds ratio [OR] = 2.64, confidence interval [CI]: 1.61-4.31) among children with previous TDIs and lower (OR = 0.28, CI: 0.12-0.68) among those with poor dental attendance. CONCLUSIONS: Traumatic dental injuries were a common reason for seeking emergency care. Milder injuries dominated and involved mostly one maxillary central incisor. Previous episodes of TDIs and attendance patterns seemed to be associated with seeking care for TDIs.

[Pulp revascularization procedure for external inflammatory dental root resorption treatment]. / Primenenie metodiki regeneratsii pul'popodobnoi tkani dlya ostanovki naruzhnoi vospalitel'noi rezorbtsii kornya zuba.

THE AIM OF THE STUDY: To assess the effectiveness of pulp revascularization procedure in children with external inflammatory root resorption (EIRR) after constant teeth injury. MATERIALS AND METHOS: The study comprised 17 children aged 6-10 years diagnosed with EIRR as a long-term complication of dental trauma in 19 teeth. EIRR was diagnosed with periapical radiographs and CBCT was performed to further assess the pathology extension. Pulp revascularization was carried out in all 19 teeth. RESULTS: There was no resorption progression in all cases. EIRR areas were substituted by bone. In 10 from 19 teeth with early stages of root development bone or cement-like tissue ingrowth into the root canal was observed radiologically. In cases of severe EIRR this ingrowth may partially compensate for lost tissues which is confirmed by a high percentage (94.7%) of functional teeth during mean follow up time of 38±10 months. CONCLUSION: Pulp revascularization is an effective method for retaining teeth with EIRR for a relatively long period of time and allows maintaining alveolar bone volume both due to functional tooth preservation and healing of bone lesions in periapical and resorption areas.

Traumatic dental injuries: Knowledge assessment of dentists in the Norwegian Public Dental Service of Vestland.

BACKGROUND/AIM: Most children and adolescents in Norway attend the Public Dental Service (PDS) where they are treated free-of-charge until the age of 19 years. Thus, general dentists employed in the PDS are the primary care providers for traumatic dental injuries (TDI) in young patients. This cross-sectional study assessed the knowledge of PDS general dentists on the acute management and follow-up of TDI and its socio-demographic and attitudinal covariates. MATERIALS AND METHODS: All general dentists employed in the Vestland County PDS, Western Norway, (N = 170) received an online questionnaire. Socio-demographic and professional profiles of respondents as well as attitudinal indicators were queried. Clinical case scenarios on emergency treatment and further follow-ups of TDI were used to calculate a dental trauma knowledge score (DTKS; range: 0-21). Mann-Whitney U tests and Kruskal-Wallis tests determined differences between the demographic subgroups. Logistic regressions determined the potential of single factors in explaining the variability in dental trauma knowledge. RESULTS: The response rate was 46%. Most participants (60.5%) had not participated in a TDI course after graduation but would like such a course (84.2%). Mean DTKS was 13.82 (±2.6). Knowledge scores differed significantly between age groups (p = .014) and years since graduation (p = .0018). Younger dentists and recently graduated dentists scored highest. Dentists under the age of 30 years scored higher than 30-39- and 40-49-year-old dentists in these areas: emergency treatment of crown fractures with pulp exposure, identification of complications after avulsion, and management of severe intrusive luxation injury. CONCLUSION: Younger dentists had a higher theoretical knowledge of TDI. Continuing professional development among dentists in the Norwegian PDS is needed for emergency treatment and complication management after TDI.

Video Laryngoscopy vs Direct Laryngoscopy for Endotracheal Intubation in the Operating Room: A Cluster Randomized Clinical Trial.

Importance: Endotracheal tubes are typically inserted in the operating room using direct laryngoscopy. Video laryngoscopy has been reported to improve airway visualization; however, whether improved visualization reduces intubation attempts in surgical patients is unclear. Objective: To determine whether the number of intubation attempts per surgical procedure is lower when initial laryngoscopy is performed using video laryngoscopy or direct laryngoscopy. Design, Setting, and Participants: Cluster randomized multiple crossover clinical trial conducted at a single US academic hospital. Patients were adults aged 18 years or older having elective or emergent cardiac, thoracic, or vascular surgical procedures who required single-lumen endotracheal intubation for general anesthesia. Patients were enrolled from March 30, 2021, to December 31, 2022. Data analysis was based on intention to treat. Interventions: Two sets of 11 operating rooms were randomized on a 1-week basis to perform hyperangulated video laryngoscopy or direct laryngoscopy for the initial intubation attempt. Main Outcomes and Measures: The primary outcome was the number of operating room intubation attempts per surgical procedure. Secondary outcomes were intubation failure, defined as the responsible clinician switching to an alternative laryngoscopy device for any reason at any time, or by more than 3 intubation attempts, and a composite of airway and dental injuries. Results: Among 8429 surgical procedures in 7736 patients, the median patient age was 66 (IQR, 56-73) years, 35% (2950) were women, and 85% (7135) had elective surgical procedures. More than 1 intubation attempt was required in 77 of 4413 surgical procedures (1.7%) randomized to receive video laryngoscopy vs 306 of 4016 surgical procedures (7.6%) randomized to receive direct laryngoscopy, with an estimated proportional odds ratio for the number of intubation attempts of 0.20 (95% CI, 0.14-0.28; P < .001). Intubation failure occurred in 12 of 4413 surgical procedures (0.27%) using video laryngoscopy vs 161 of 4016 surgical procedures (4.0%) using direct laryngoscopy (relative risk, 0.06; 95% CI, 0.03-0.14; P < .001) with an unadjusted absolute risk difference of -3.7% (95% CI, -4.4% to -3.2%). Airway and dental injuries did not differ significantly between video laryngoscopy (41 injuries [0.93%]) vs direct laryngoscopy (42 injuries [1.1%]). Conclusion and Relevance: In this study among adults having surgical procedures who required single-lumen endotracheal intubation for general anesthesia, hyperangulated video laryngoscopy decreased the number of attempts needed to achieve endotracheal intubation compared with direct laryngoscopy at a single academic medical center in the US. Results suggest that video laryngoscopy may be a preferable approach for intubating patients undergoing surgical procedures. Trial Registration: ClinicalTrials.gov Identifier: NCT04701762.

Epidemiology and patterns of gymnastics-related head & neck trauma injuries: A NEISS database study.

OBJECTIVE: To describe the epidemiology and patterns of gymnastics-related Head & Neck trauma injuries using the NEISS database from 2001 to 2020. STUDY DESIGN AND SETTING: Cross-sectional analysis of a national database. METHODS: Gymnastics-related ED visits between 2001 and 2020 were queried from the NEISS database. Bivariate chi-squared analyses were used to compare injury demographics, location, type, and disposition. Fracture location was identified using the narrative description of each case and were divided into subtypes for further analysis. RESULTS: 1455 gymnastics-related head and neck traumatic injuries were identified. The majority were in females (65.8%). The most common presenting age group was pediatric (≤18 years) (92.7%), and the largest racial group was Caucasian (51.5%). Of all location subtypes, facial injuries were the most common presenting injury type overall (45.2%). Regarding injury types, lacerations were most common (36.8%), followed by dental injury (30.7%) and fractures (21.2%). The most common location of head and neck fractures was the nose (45.8%), followed by cervical spine (16.7%) and orbit (13.3%). The majority (95.7%) of gymnastics-related head and neck traumatic injuries presenting to the ED were treated and discharged. CONCLUSION: This study characterizes gymnastics-related head and neck injuries which is a topic that is under-studied. The findings from this study are helpful for gymnasts and those who care for them including providers, coaches and guardians, and this data may help inform future guidelines for treatment and injury prevention.

[The quality of dental care in children with permanent teeth trauma according to analysis of medical records in an emergency unit of a municipal dental clinic]. / Kachestvo okazaniya neotlozhnoi pomoshchi detyam s travmami postoyannykh zubov po dannym analiza dokumentatsii otdeleniya neotlozhnoi pomoshchi gorodskoi stomatologicheskoi polikliniki.

THE AIM OF THE STUDY: Was to assess the efficacy and timing of emergency dental care in children with permanent teeth trauma according to analysis of medical records in an emergency unit of a municipal dental clinic. MATERIAL AND METHODS: The study involved 320 medical records of pediatric patients admitted to emergency dental care unit of a municipal dental clinic in 2021 because of maxillofacial trauma from which 221 records of children with acute dental trauma were extracted. The quality of documentation of the medical records, rationale for diagnosis and adequacy of emergency dental treatment were analyzed. RESULTS: No records included diagnosis code according to ICD-10. Trauma history was described in the majority of records by in 67% of them no trauma time was stated with proper precision. In 67.6% of permanent teeth trauma cases emergency aid was carried out inadequately. All patients with uncomplicated crown fractures were dismissed with no treatment. In complicated crown fractures needing pulp vitality preservation the pulp was devitalized or just anesthetized. Tooth replantation in avulsion cases was not performed. In 13.5% of records the treatment was not properly described. In 67.6% of records there were no recommendations for follow-ups. CONCLUSION: There is a strong need for the improvement of knowledge of traumatic dental injuries management among Russian pediatric dentists by elaboration and implementation of protocols for dental traumas treatment.