Traumatic dental injuries in Brazilian children and oral health-related quality of life.

BACKGROUND/AIMS: Population-based studies that investigate the impact of TDI on oral health-related quality of life (OHRQoL) among school children and its association with socioeconomic factors are scarce and offer conflicting results. The aim of this study was to evaluate the impact of TDI on OHRQoL among school children and its association with socioeconomic status. MATERIALS AND METHODS: A cross-sectional study was conducted with 588 12-year-old children enrolled in public and private schools in the urban areas in the city of Diamantina (southeastern Brazil). Clinical examinations were performed for the diagnosis of traumatic dental injury based on Andreasen's classification. The Child Perceptions Questionnaire (CPQ11-14 ), which has been validated for the population in Brazil, was employed to evaluate oral health-related quality of life. Socioeconomic status and overjet were also analyzed. Statistical analysis involved the chi-square test and logistic regression. RESULTS: A total of 29.4% of the students exhibited some type of trauma to at least one tooth. A negative impact on oral health-related quality of life was found in 53.1% of the sample. Traumatic dental injury was associated with a high impact on oral health-related quality of life [OR = 1.61 (95% CI: 1.08-2.39)] and overjet >3 mm [OR = 5.42 (95% CI: 3.66-8.02)]. However, no statistically significant associations were found between TDI and socioeconomic status. CONCLUSIONS: Prevalence of traumatic dental injury was high among the children who participated in the study, and it was associated with a high impact on oral health-related quality of life as well as overjet >3 mm.

Dental injuries in young athletes, a five-year follow-up study.

AIM: The aim of this study is to produce a clinical therapy protocol for a group of 20 athletes between the ages of 8 and 14, who all suffered traumas affecting hard dental and periodontal tissues. MATERIALS AND METHODS: This study involves a group of 20 athletes (10 male and 10 female) who had suffered dental traumas of varying severity. In order to collect the data, two classification systems were used: one for hard tissue traumas and another for periodontal lesions. The athletes were subdivided into lesion groups, treated depending on the type of lesions and then followed-up over a period of 5 years. A statistical analysis was carried out to study the association between type of lesions, types of sports and the number of teeth involved. RESULTS: We found that recovery time ranged from 3 to 5 days for uncomplicated fractures and up to 14 days for luxations. Only four complications were registered during the follow-up period and these were most likely due to the severity of the trauma. Out of the 20 athletes, 16 had begun and maintained the habit of using mouth protection devices when practicing their sport. The statistical analysis focused on the possible association between the risk levels of a sport and the typical lesions and complications that usually occur. Due to their high frequency, the two types of lesions taken into account in our study were complicated fractures (FP) and luxated/fractured teeth (LF). The average number of teeth involved varied according to the sport's risk level (medium or high) with averages of 1.6 teeth involved for medium-risk sports and 2.0 teeth for high-risk sports. CONCLUSIONS: What emerged in particular was the regular progress in the recovery time needed for the injuries sustained, with few complications or delays in rehabilitation; we also noted that the numerous athletes who habitually used mouthguards while competing during the recovery period did not suffer any recurrences of injuries or further complications. Regarding the results of our statistical analysis, no association was found between the sport's risk, the types of lesions and the occurrence of complications. In addition, analysis of the average number of teeth involved showed that there is no statistical evidence to reject the hypothesis that the ratios remain the same in the two groups.

Management of dental trauma by general practitioners.

BACKGROUND: Patients who sustain dental trauma commonly present to their general practitioner (GP) or the emergency department, especial-ly to seek help after hours. It is important, therefore, for medical practitioners to correctly diagnose and manage these patients. OBJECTIVE: The purpose of this paper is to familiarise GPs with different presentations of dental-related trauma, and a brief management plan for each condition. DISCUSSION: Time is of the utmost importance when dealing with trauma in the dentition. Initial management of dental trauma, primarily by GPs working in rural or remote areas, can have a significant impact on the prognosis of oral hard and soft tissues.

Classification and Epidemiology of Traumatic Dentoalveolar Injuries in Dogs and Cats: 959 Injuries in 660 Patient Visits (2004-2012).

The objective of this study was to determine the epidemiology of traumatic dentoalveolar injuries (TDI) in dogs and cats and to evaluate the applicability of a human classification system for TDI in dogs and cats. All patients diagnosed with a TDI were identified from the University of Wisconsin-Madison School of Veterinary Medicine Dentistry and Oral Surgery Service case log and the hospital patient processing software. The study population consisted of 621 dogs and cats, in a total of 660 patient visits from 2004 to 2012, admitted for oral treatment and subsequently diagnosed with at least one TDI Medical records including diagnostic imaging studies were reviewed to group the injury according to a classification system used in humans for TDI. Patient signalment, tooth injured, and number of injuries per patient were recorded and tabulated. The overall prevalence of TDI was 26.2%. The mean +/- SD number of TDI per patient was 1.45 +/- 0.85. All 14 classes of TDI recognized by the classification system utilized in humans were identified, and all (100%) TDI identified in this study were classifiable using this system. Enamel-dentin-pulp fracture was the most common TDI (49.6%). The most commonly injured teeth were the mandibular or maxillary canine teeth (35.5%). The most common age for dogs and cats with TDI were 3-6 years (33.0%) and 7-10 years (31.3%). With a frequency of 1 in 4 animals, TDI are common and represent a significant pet health concern. Most TDI are considered severe and require timely, and sometimes immediate, treatment. The adoption and utilization of a complete classification system, such as the one used in this study, is recommended in order to improve future epidemiological study of TDI in animals.

Traumatic dental injuries in Turkish children, Istanbul.

AIM: Some of the commonly encountered dental emergencies are traumatic dental injuries. The aim of this study was to evaluate traumatic dental injuries with regard to age, gender, etiology, classification of trauma, teeth involved, place of injury, and treatment received by patients who were referred over a 2-year period to the Istanbul University, Faculty of Dentistry, Clinics of Pedodontics, Istanbul, Turkey. MATERIALS AND METHODS: The study was based on the clinical data of 154 patients (337 traumatized teeth). The children were examined clinically for dental injuries by the same investigator. The following information was recorded: age, gender, etiology, localization, place, number of injured teeth, type of trauma, type of tooth, time elapsed between injury and treatment, and treatment provided. Traumatized teeth were assessed according to the classification of the World Health Organization slightly modified. RESULTS: A total of 154 patients aged 1-13 years presented a total of 337 traumatized teeth (255 permanent and 82 primary). 94 boys (61%) and 60 girls (39%) with a mean age of 7.91 ± 3.15 years participated in the study. Dental injuries were frequent in the 6-12 year age group. The most common type of dental injuries recorded was luxation injuries (43.3%), uncomplicated crown fractures (20.5%), and complicated crown fractures (19.4%). The main causes were falls (55.2%) and being struck by an object (22.1%). The most frequent treatment was examination only (31.8%). CONCLUSIONS: In childhood, a correct diagnosis may affect the management methods and prevent the occurrence of complications after treatment for traumatic dental injuries. Therefore, continuing education programs offering the latest updates in the management of traumatized teeth should be provided for dental and medical practitioners.

Management of traumatic tooth injuries in the dental office.

Dental trauma is sudden, unscheduled, and the dentist and staff must be adequately equipped to expeditiously and properly treat the patient to assure the best possible outcome. This paper reviews current dental trauma guidelines to provide the correct treatment protocol to ensure the best prognosis. The case report illustrates the technique of avulsion care, RCT care, and functional splinting in a successful manner.

Frequency and characteristics of occupational dental trauma.

BACKGROUND: Dental trauma at the workplace may have important clinical and occupational consequences, but little is known about its profile. AIMS: To describe the frequency and characteristics of work-related dental injuries. METHODS: For all patients with occupational dental trauma seen at the FREMAP Hospital of Barcelona (Spain) between January 2000 and December 2006, we recorded their characteristics, type of work and nature of the trauma, including cause of the accident, extent of trauma, reason for referral to a dentist, and days of sick leave. RESULTS: The frequency of dental trauma was 1.71 per 1000 occupational accidents attended and was related to the worker's occupation. In security services, it was 7.37 per 1000 and 2.01 in transport services. The frequency was similar in both genders. The most common causal mechanisms were direct impact (38%), traffic accidents (29%) and falls at the same level (16%). Causal mechanisms differed according to gender and type of job. Most injuries consisted of dental fracture (54%), and 67% of the patients required referral to a dental surgery. Injuries were limited to the mouth in 52% of cases, 8% of which required sick leave, with a mean duration of 23.0±21.8 days. CONCLUSIONS: The frequency of dental trauma in this working population was low and was related to the worker's occupation. Causal mechanisms differed according to gender and type of job. Most dental injuries were severe and required referral to a dental surgery. Frequency of sick leave was low.

Massachusetts emergency departments' resources and physicians' knowledge of management of traumatic dental injuries.

BACKGROUND: Hospital emergency departments (ED) are confronted with triaging and managing dental emergencies of both traumatic and non-traumatic origin. However, the literature suggests that there exists inadequate knowledge of the management of traumatic dental injuries (TDI) among medical professionals who must be knowledgeable and have the appropriate resources needed to triage or treat patients presenting with TDI. AIM: The aims of this study were to (i) evaluate the resources of Massachusetts emergency departments (MEDs) for TDI, (ii) determine the knowledge of management of TDI among MED physicians, and (iii) investigate potential factors that affect their knowledge. MATERIALS AND METHODS: Surveys were mailed to MED directors and their physicians. The director survey contained questions regarding institutional information for each emergency department (ED). The physician survey contained questions about physician characteristics and tested their knowledge of managing dental trauma. RESULTS: A total of 72 surveys (16 MED directors and 56 physicians) were returned and included in the analysis. Only 50% of the MEDs had on-site dental coverage, 43.8% had 24-h off-site dental coverage, and none had a formal written dental trauma protocol. MED physician's knowledge of the appropriate management of luxations and avulsions was generally good, but poor for dental fractures. The MED physician's knowledge for the emergent nature of the various injuries was generally good with that of avulsions being the best. Physicians were more likely to have a better knowledge of managing dental trauma if they were specialists in pediatric emergency medicine (P = 0.001) or their hospitals had an academic affiliation (P = 0.05). CONCLUSIONS: Based on the findings from this study, educational campaigns must be undertaken to improve both the resources available to the ED, and the knowledge of physicians regarding emergency management of TDI. In addition, efforts should be made by local dental organizations to provide ED with lists of dentists who are knowledgeable and willing to be available 24 h day⁻¹ to consult with and, if necessary, treat TDI. These efforts would enhance the long-term outcomes for patients sustaining dental trauma who present to hospital ED.

Dental trauma in patients with maxillofacial fractures.

PURPOSE: The purpose of this study was to analyze and evaluate the correlation between dental injuries and the pattern of maxillofacial fractures. The correlation with age, gender, trauma mechanism and type of maxillofacial fracture was also investigated. MATERIALS AND METHODS: From January 2000 to December 2009, 1131 patients with facial fractures were registered. Of these, 473 presented with associated dental trauma. The information and data collected and analyzed included: age, gender, mechanism of injury, type of facial fracture, type of dental injury, and the relationship between dental injury and facial fracture. RESULTS: Dental injury was sustained by 473 patients (41.8%), with a total of 2215 injured teeth. Of the 2215 injured teeth, 1191 (53.8%) were in the maxilla and 1024 (46.2%) in the mandible. Fall from a height had the highest risk of dental injuries (OR = 4.145, P = 0.002). The central incisor was the most injured tooth for both the maxilla (388, 36.2%) and mandible (284, 27.7%). The most common type of dental injury was avulsion (1070, 47.4%). More anterior teeth in the maxilla were of crown fracture, avulsion, and intrusion than that in the mandible, whereas more anterior teeth in the mandible were of subluxation and concussion than that in the maxilla. Dental injuries were more prone to occur in patients who sustained only symphysis fractures (OR = 2.817, P < 0.001), only 0.236-fold risk in patients who sustained only mandible angle fracture (P < 0.001). CONCLUSIONS: The occurrence of dental trauma is significantly related to the pattern and position of the maxillofacial fractures.

Dental trauma in patients with single mandibular fractures.

PURPOSE: The purposes of this study were to investigate the occurrence and patterns of dental trauma in patients with single mandibular fracture and to evaluate the relationships between dental injury and fracture site of mandible. MATERIALS AND METHODS: From January 2000 to December 2009, 869 patients with mandibular fractures were registered. Only the patients with single mandibular fracture were included. The information and data collected included age, gender, mechanism of injury, type of mandibular fracture, and type of dental injury. RESULTS: Single mandibular fractures were sustained in 294 (33.8%) patients. Of these, 43.5% (128 patients) presented with associated dental injuries (509 injured teeth). The patients' male/female ratio was 2.46:1 (91 males and 37 females). Patients in 30-39 year age group possessed the highest risk of suffering dental trauma (odds ratio = 2.004, P = 0.014). Road traffic accidents were the most common mechanism of injury (54, 42.2%). Lower-anterior teeth were more often injured in patients with symphysis fracture (P < 0.001), and patients with condylar fracture more frequently sustained upper-posterior teeth injury (P < 0.001). Lower-posterior teeth injury was mostly found in patients with mandibular body fracture (P < 0.001) or angle fracture (P < 0.001). Dental injuries were more prone to occur in patients who sustained only symphysis fractures (odds ratio = 3.283, P < 0.001), and the risk was only 0.193-fold in patients who sustained only mandible angle fractures (odds ratio = 0.193, P < 0.001). CONCLUSIONS: The occurrence and type of dental injury were significantly related to the fracture site of mandible.

Dental injuries in pediatric patients with facial fractures are frequent and severe.

PURPOSE: This study was carried out to identify the occurrence, type, location, and severity of dental injuries (DIs), as well as predictors for DIs, in pediatric patients with facial fractures. MATERIALS AND METHODS: This study examined the files of patients aged 16 years or less who had sustained facial fractures during a 12-year period. The outcome variable was DI. The explanatory variables included gender, age, trauma mechanism, and type of facial fracture. Data analysis was carried out with the χ(2) test and logistic regression analysis. RESULTS: A total of 200 patients, 119 (59.5%) of whom were boys, met the inclusion criteria. The mean age was 12.6 years. A total of 45 patients (22.5%) had DIs. Crown fracture, the most common type of DI, occurred in 59.9% of all DIs. The most common location of crown fractures was in the premolars (37.4% of all crown fractures). Multiple DIs occurred in 71.1% of those with DIs and severe DI in 66.7%. DIs were significantly associated with motor vehicle collision (MVC) (P = .02) and mandibular fracture (P = .03). CONCLUSIONS: DIs are common in pediatric patients with facial fracture, often being both multiple and severe. In association with pediatric facial fracture, facial surgeons should be especially alert for crown fractures in the lateral parts of the jaws.

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition.

Traumatic injuries to the primary dentition present special problems and the management is often different as compared with the permanent dentition. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialities were included in the task group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care for management of primary teeth injuries. The IADT cannot and does not guarantee favorable outcomes from strict adherence to the guidelines, but believe that their application can maximize the chances of a positive outcome.

Initial assessment of responsiveness of the P-CPQ (Brazilian Version) to describe the changes in quality of life after treatment for traumatic dental injury.

This study aimed to assess the responsiveness of the Brazilian version of the Parental-Caregiver Perception Questionnaire (B-P-CPQ) to describe changes in quality of life (QoL) after treatment for traumatic dental injury (TDI). After eligibility criteria were applied, 42 of 255 patients who went to a dental trauma center for TDI treatment were included. QoL was evaluated in two different appointments: A1 (after TDI) and A2 (after TDI treatment). The B-P-CPQ scores were calculated using the additive method. Psychometric properties like internal consistency (Cronbach's Alpha), test-retest reliability, intraclass correlation coefficient (ICC), and construct validity (Spearman's correlations) were assessed, and, mainly, the responsiveness was analyzed by standardized response means (SRM). Mean B-P-CPQ scores were 30.05 (1.74 SD) and 2.67 (4.05 SD), while the median scores were 17.39 and 2.00 (P < 0.01), respectively in A1 and A2. Cronbach's Alpha was 0.87 in A1 and 0.66 in A2. ICC was 0.90. B-P-CPQ scores were correlated with overall well-being (P < 0.01; rho: 0.71). The B-P-CPQ responsiveness scores declined 27.38 points, and a perfect SRM of 1.76 was achieved. The B-P-CPQ scores indicated changes in QoL following TDI. The change was observed as an impact decrease after TDI treatment, demonstrating positive reduction and improvement on QoL. The responsiveness of the P-CPQ (Brazilian version) in detecting change on QoL after TDI treatment was confirmed by SRM assessment. The findings represent an evidence of the importance of professional care and treatment of TDI.

Dental Trauma Guide: a source of evidence-based treatment guidelines for dental trauma.

Diagnosis and treatment for traumatic dental injuries are very complex owing to the multiple trauma entities represented by six luxation types and nine fracture types affecting both the primary and the permanent dentition. When it is further considered that fracture and luxation injuries are often combined, the result is that more than 100 trauma scenarios exist, when the two dentitions are combined. Each of these trauma scenarios has a specific treatment demand and prospect for healing. With such a complexity in diagnosis and treatment, it is obvious that even experienced practitioners may have problems in selecting proper treatment for some of these trauma types. To remedy this situation, an Internet-based knowledge base consisting of 4000 dental trauma cases with long-term follow up is now available to the public and the professions on the Internet using the address http://www.DentalTraumaGuide.org. It is the aspiration that the use of this Guide may lead the practitioner to offer an evidence-based diagnosis and treatment.

Assessment of dental trauma among cerebral palsy individuals in Udaipur city.

OBJECTIVE: (i) To assess the prevalence of traumatic dental injuries (TDI) in individuals with cerebral palsy and its possible relationship with type of palsy at Udaipur city, Rajasthan, India. (ii) To assess the prevalence of temporomandibular joint symptoms in cerebral palsy individuals. MATERIALS AND METHODS: The total sample comprised of 281 cerebral palsy individuals in the age group of 10-35 years. Clinical examination for dental trauma was performed on the basis of Andreasen & Andreasen classification (1994). Chi-square test, multiple logistic and stepwise linear regression analyses were carried out to find out the relationship between cerebral palsy individuals with different independent variables. RESULTS: Findings of the study indicated that there was highest prevalence of TDI in cerebral palsy patients with hemiplegia (40.6%) (P = 0.00). Stepwise and multiple logistic regression analyses showed that the best predictors for dental traumatic injuries was overjet and type of cerebral palsy. CONCLUSION: It was concluded that hemiplegic cerebral palsy patients were most prone to TDI.

Dental trauma: review of common dental injuries and their management in primary and permanent dentitions.

Management of dental trauma in children can be a challenging problem in dental practices. Knowledge of current trauma guidelines is vital in effectively managing dental trauma so that favorable outcomes are achieved. The purpose of this paper is to review the current guidelines and management strategies of dental trauma in primary and permanent dentitions. When planning emergency treatment for a primary tooth, it is important to consider the lifespan of the tooth, the potential damage to the permanent dentition, and the behavior of the child. After injury to permanent teeth, the treatment strategy is dictated by the concern for vitality of the periodontal ligament and pulp of the injured tooth. The emergency nature of dental trauma requires that the dentist be knowledgeable and readily available during and after office hours to provide care.

Important considerations for designing and reporting epidemiologic and clinical studies in dental traumatology.

The purpose of this article is to suggest important considerations for epidemiologic and clinical studies in the field of dental traumatology. The article is based on the authors' experiences from research in this field and editorial board work for the scientific journal Dental Traumatology. Examples are given of issues where development is important. The importance of planning ahead of the study and consulting with experts in other fields is emphasized.

Quality of life impacts following childhood dento-alveolar trauma.

BACKGROUND: Dental injuries occur commonly in childhood and may necessitate demanding courses of treatment. The aim of this study was to investigate a variety of clinical and demographic factors that may influence the quality of life impacts experienced by children after a dental injury. METHOD: A total of 244 children who attended a UK dental hospital, for management of traumatised permanent incisors, were invited to participate in the study. Clinical, demographic and psychosocial variables were collected at baseline, and outcome variables were assessed again at a 6-month follow up. Clinical variables included number of teeth injured; severity of the dental injury; visibility of the injury; time since injury; and number of dental appointments attended within the hospital. Psychosocial outcomes assessed included children's oral health-related quality of life (OHRQoL) and health-related quality of life (HRQoL). RESULTS: One hundred and eight children participated in the baseline study (44% response rate), and of this group of children, a total of 70 children completed follow-up questionnaires (65% response rate). The results indicated that the most affected areas of children's OHRQoL and HRQoL were functional limitations and school-related activities, respectively. Of all the demographic and clinical variables, which were investigated within the current study, the only variable that significantly predicted OHRQoL and HRQoL for children was gender. Boys were found to report fewer impacts on their OHRQoL and HRQoL than girls. Interestingly, over two-thirds of children reported fewer impacts at the 6-month follow up. CONCLUSIONS: The results revealed that girls were more likely to report higher level of impacts on their OHRQoL and HRQoL than boys following traumatic injury to their permanent incisors. Clinical variables were not significant predictors of child quality of life outcomes following dento-alveolar trauma at baseline or at the 6-month follow up.

Local accidents in dental implant surgery: prevention and treatment.

Many articles have detailed local accidents and complications in dental implant treatment. Comparisons of the data they report are not always easy because different criteria have been followed in the various classifications and there is confusion between the terms accident and complication. The aim of this paper is to propose a classification that considers the timing of the events and makes a distinction between the two terms. Accidents are events that occur during surgery, and complications are any pathologic conditions that appear postoperatively. The proper diagnostic procedures and surgical techniques for their prevention and treatment are also described.

Dental trauma in adults in Switzerland.

Most epidemiologic studies of dental trauma are restricted to children and sports. The goal of the present study was to collect information on dental trauma in as many Swiss adults as possible. For that purpose data of the largest insurance company of Switzerland (SUVA) were evaluated and compared for the years 1992 and 2002. In these 2 years 23 000 dental injuries were reported to all insurance companies in Switzerland. Most often the upper central incisors were injured. However, in 20% posterior teeth were also affected. In 1992 most of the dental trauma was experienced by 30-39 year olds, in 2002 by 40-49 year olds. Regardless of the year, most of the injuries occurred at home; more than one-fifth of the injuries were sports related. Most common injuries were crown fractures without pulp involvement. In less than 10% of all cases more complicated injuries like avulsions or crown-root fractures occurred. Most traumatic injuries were treated by direct fillings and custom-made crowns; more involved treatments were required less often. Comparison of the years 1992 and 2002 showed that the numbers of and causes for injuries had hardly changed in these 10 years. However, the choice of therapy was related to the general development of dental medicine, which became especially apparent in the fields of adhesive dentistry and implantology.