Risk factors associated with the occurrence of avulsion in the primary incisors: A case-control study.

BACKGROUND: Identifying factors associated with the occurrence of primary tooth avulsion is essential to promote prevention strategies. AIM: To investigate the risk factors associated with primary incisor avulsion and variables associated with post-avulsion sequelae in the permanent successor. DESIGN: This case-control study comprised 407 children (cases) with primary incisor avulsion and 407 children (controls) with other traumatic dental injuries (TDI). The association between explanatory variables and avulsion was evaluated through logistic regression. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated. Poisson regression analyses between potential explanatory variables and sequelae were run, from which relative risks (RR) and corresponding 95% CI were estimated. RESULTS: TDI caused by moderate falls (OR = 2.20; 95% CI = 1.47 to 3.27), affecting lateral incisors (OR = 10.10; 95% CI = 3.89 to 26.54) and the lower arch (OR = 9.54; 95% CI = 3.15 to 28.85), were associated with primary incisor avulsion. Moreover, children with previous severe TDI, anterior open bite, and anterior crossbite had higher odds of primary incisor avulsion. Children who suffered from any primary tooth avulsion (RR = 2.68; 95% CI = 1.82 to 3.95) had a higher risk of sequelae in the permanent successors. The risk for sequelae in the permanent teeth was significantly greater for younger children under age 2 years than for children ages 3 to 5 years. CONCLUSION: Risk factors for primary incisor avulsion are related to the severity of the fall, tooth position, history of previous TDI, and malocclusion. Furthermore, avulsion increases the risk of sequelae in the permanent successors.

Traumatic dental injuries in the primary lower incisors.

BACKGROUND: Primary lower incisors are susceptible to traumatic dental injury (TDI), which may affect both primary and permanent dentitions. AIM: This study aimed to evaluate the prevalence of TDIs in the primary lower incisors and the factors associated with their occurrence and with the incidence of sequelae in the permanent successor teeth. DESIGN: Dental files (n = 2926) from patients who attended a reference center for dental trauma in the primary teeth, from 1998 to 2020, were screened. Multilevel Poisson regression analyses were conducted between exploratory variables related to the traumatized teeth and outcome variables: occurrences of severe TDI and sequelae in the permanent successor. Prevalence ratios (PRs), relative risks (RRs), and respective 95% confidence intervals (95% CIs) were calculated. RESULTS: One hundred and thirteen (3.9%) children and 208 teeth presented with TDIs in the primary lower incisors. The prevalence of severe TDI was lower in 4-year-olds (PR = 0.43; 95% CI = 0.19-0.94) than in 2-year-olds. Moreover, severe TDI was significantly associated with the occurrence of sequelae in the permanent successors (RR = 3.97; 95% CI = 1.72-9.18), when compared to not severe TDI. CONCLUSIONS: The prevalence of TDI in the primary lower incisors is low, with a higher prevalence in children younger than 3 years. Older children also present less frequently with severe TDI, and the risk of sequelae in permanent teeth is higher following severe TDI.

Influence of school environment on occurrence of traumatic dental injuries in 12 years old children.

BACKGROUND/AIM: Since children spend most of their time in school, some environmental characteristics of the schools may influence the occurrence of traumatic dental injuries (TDI). Therefore, the aim of this cross-sectional study was to assess the prevalence of TDI in 12 years old children in Quito, Ecuador, and its association with some school environmental aspects. MATERIAL AND METHODS: Six calibrated examiners evaluated 998 children from 31 public schools of Quito, to evaluate the occurrence of TDI in anterior teeth. School coordinators answered questionnaires on school physical conditions, promotion of health practices and the occurrence of negative episodes in school. The occlusion and socioeconomic status of the participants were also evaluated. Prevalence of TDI, unadjusted and adjusted by the design effect was calculated. Association between individual and contextual explanatory variables and presence of TDI were evaluated using multilevel Poisson regression analysis (P < .05). RESULTS: TDI prevalence adjusted by design effect was 20.7%. Children studying in schools with patio floor of grass and with access ramps had significantly lower prevalence of TDI than children studying in schools with patio floor of cement and with only stairs, respectively. The prevalence of TDI was also lower in children from schools that offered healthy meals or that had a proper place for oral hygiene. CONCLUSIONS: Schools with adequate physical structures and that promote health practices to their students have a lower prevalence of TDI.

Rare sequelae in the permanent successor due to trauma in the primary incisor: a case report.

Severe dental trauma-such as intrusion or avulsion-to the primary dentition in infants and toddlers may cause developmental disturbances in the permanent successor. In this case, a 9-year-old boy was referred for treatment due to the absence of his permanent maxillary right central incisor. The mother reported avulsion of the corresponding primary tooth when the patient was 2 years old. The radiographic examination revealed impaction and root dilaceration of the permanent tooth; therefore, the treatment plan was tooth extraction. The extracted tooth presented multiple abnormalities, including enamel discoloration, enamel hypoplasia, root dilaceration, and root duplication. Several factors need to be considered when treatment of traumatic sequelae to a permanent successor is planned, including the age of the patient, the developmental stage of the permanent successor at the time of trauma, and the type of trauma to the primary tooth.

Pulp Calcification in Traumatized Primary Teeth - Classification, Clinical And Radiographic Aspects.

OBJECTIVE: The aim of this study was to standardize the nomenclature of pulp alteration to pulp calcification (PC) and to classify it according to type, quantity and location, as well as relate it to clinical and radiographic features. STUDY DESIGN: The dental records of 946 patients from the Research and Clinical Center for Dental Trauma in Primary Teeth were studied. Two hundred and fifty PC-traumatized upper deciduous incisors were detected. RESULTS: According to radiographic analysis of the records, 62.5% showed diffuse calcification, 36.3% tube-like calcification, and 1.2% concentric calcification. According to the extension of pulp calcification, the records showed: 80% partial calcification, 17.2% total coronal calcification and partial radicular calcification, and 2.8 % total coronal and radicular calcification. As for location, only 2.4% were on the coronal pulp, 5.2% on the radicular pulp and 92.4% on both radicular and coronal pulp. Regarding coronal discoloration, 54% were yellow and 2% gray. In relation to periradicular changes, 10% showed widened periodontal ligament space, 3.1% internal resorption, 10% external resorption, 10.4% periapical bone rarefaction. CONCLUSIONS: Since PC is a general term, it is important to classify it and correlate it to clinical and radiographic changes, in order to establish the correct diagnosis, treatment and prognosis of each case.

Pulp polyp in traumatized primary teeth--a case-control study.

AIM: To assess clinical characteristics and other factors associated with the occurrence of pulp polyp in traumatized primary teeth as well to evaluate the impact of pulp polyp occurrence on clinical decision-making after traumatic injuries. MATERIAL AND METHODS: This study was divided into three phases. First, occurrence and clinical characteristics of pulp polyp were assessed followed by a descriptive analysis and categorical tests of association. Secondly, a case-control design was used, and the occurrence of pulp polyp was set as the outcome. In third phase, the occurrence of pulp polyp after fracture with pulp exposure was investigated as a variable possibly associated with clinical decision-making (dental extraction/endodontic treatment). Logistic regression analyses were used, and odds ratios and 95% confidence interval (OR; 95% CI) were calculated in second and third phases. RESULTS: Occurrence of pulp polyp in traumatized primary teeth was of 2.3%. Hyperplastic tissue color and proliferation size were not associated with the time to seek treatment after injury (P > 0.05). Children up to 2 years of age had more chance of having pulp polyp in comparison with older children (3.15; 1.15-8.64). Teeth with crown-root fracture had more chance of dental extraction in the therapeutic approach than the teeth with only crown fracture (4.36; 1.10-17.32). Presence of pulp polyp was not associated with the treatment carried out. CONCLUSIONS: Occurrence of pulp polyp in traumatized primary teeth is not frequent and is associated with the age when traumatic dental injury occurs but does not interfere directly with the therapeutic approach.

Predictive factors for pulp necrosis in traumatized primary incisors: a longitudinal study.

BACKGROUND: This study aimed to assess factors associated with occurrence of pulp necrosis (PN) in traumatized primary incisors, which may contribute to the prognosis of this outcome. DESIGN: Data were collected by single examiner through the analysis of clinical files of traumatized patients. The occurrence of PN in traumatized teeth was the evaluated outcome. Poisson regression analysis was applied to calculate the relative risk (RR) and the respective 95% confidence interval. RESULTS: Five hundred and twenty-one files were assessed, summing up 727 traumatized primary incisors. The proportion of teeth affected by PN was 23.8%. Multiple regression analysis indicated the following factors as positively associated with PN: trauma with displacement, pulp exposure fracture, self-report of pain, yellow, grey and brown crown discoloration, internal root resorption, and bone loss. Trauma in 4- to 5-year old and more than 5-year-old children, pulp canal obliteration, and external root resorption with bone formation were negatively associated with PN. CONCLUSIONS: Teeth that suffered more aggressive injuries, pain, some types of discoloration, and other radiographic findings (for instance, internal root resorption) are positively associated with the occurrence of PN. On the other hand, trauma in older children, canal obliteration, or external resorption show less probability of PN.

Impact of avulsion of the primary incisors on the occurrence of sequelae in the permanent teeth: A retrospective cohort study.

OBJECTIVES: The purpose of this retrospective cohort study was to investigate the occurrence of sequelae in the permanent teeth after avulsion of their primary antecessors and to evaluate the factors associated with this occurrence. METHODS: We screened 2922 records of patients with photographic and radiographic images who attended a reference centre for dental trauma in the primary teeth from 1998 to 2019. Among them, 240 were eligible records of children who had suffered avulsion of the primary incisors and were followed up until complete eruption of the permanent successors. Multilevel Poisson regression analyses were conducted between the explanatory variables related to children and avulsed teeth; outcome variables were occurrences of any type of sequelae in the permanent teeth, opacities, hypoplasia and malformation. Relative risks (RRs) and respective 95% confidence intervals (95% CIs) were calculated. RESULTS: Among the 240 children's records, 194 fulfilled the inclusion criteria. Finally, we found 266 primary avulsed teeth and 115 (43.2%) permanent teeth presenting with sequelae. Avulsion occurring when children were older than 4 years (RR = 0.48; 95% CI = 0.24-0.95) had lower risks for developing sequelae than children aged 0-2 years of age. Additionally, when avulsion occurred in the lower dental arch (RR = 1.45; 95% CI = 1.06-1.99) and when three or more teeth were affected (RR = 1.57; 95% CI = 1.02-2.41), the occurrence of sequelae in the permanent teeth was more probable than if avulsion occurred in the upper arch and affected only a single tooth. Age older than 3 years was a protective factor for the occurrence of hypoplasia and age older than 4 years protective for the occurrence of opacities. CONCLUSIONS: The risk of sequelae in the permanent teeth after avulsion of their antecessor is higher when the trauma occurs in young children (<2 years) and in patients with avulsions of greater magnitude, such as when it affects the lower jaw, and more teeth are involved.

Effectiveness of triple-headed toothbrushes and the influence of the person who performs the toothbrushing on biofilm removal.

PURPOSE: The objectives of this study were 1) to compare the efficacy of biofilm removal with conventional (Bitufo 22) and triple-headed (DenTrust) toothbrushes on smooth and occlusal surfaces, and 2) to verify the influence of the person who performs the toothbrushing (mother vs dentist). MATERIALS AND METHODS: Twenty children aged 4 years old with sound, complete primary dentition participated in this crossover study. The quantity of biofilm was evaluated using the bacterial plaque revealer Plaque Test (Vivadent) before and after toothbrushing by the mother or dentist for 1 minute per arch. This was done at two separate appointments, one week apart, with one type of toothbrush at the first and the other type at the second appointment. The Green & Vermillion index (1960) was used for smooth surfaces and Rodrigues et al (1999) indexes for the occlusal surfaces. Data were submitted to analysis of variance. RESULTS: A statistically significant difference was observed on biofilm removal on occlusal and smooth surfaces, regardless of the toothbrush used or who performed the brushing (P < 0.0001). The triple-headed toothbrush showed a better performance than the conventional one on smooth and occlusal surfaces when the mother had brushed the teeth. The conventional toothbrush showed a better performance only on occlusal surfaces when the dentist performed the brushing (P < 0.0001). The dentist removed significantly more biofilm than the mother, 76% and 53%, respectively (P < 0.0001). CONCLUSION: It was concluded that effective biofilm removal was achieved with both toothbrushes; however, the tripleheaded type had a better performance on surfaces when the mother brushed the teeth. The dentist removed more biofilm than the mother.

Occlusal and orofacial myofunctional evaluation in children with anterior open bite before and after removal of pacifier sucking habit.

The aim of this study was to evaluate occlusal and orofacial myofunctional characteristics in children with primary dentition and anterior open bite, before and after removal of pacifier sucking habit. A dentist checked anterior open bite, overjet and upper intercanine distance and a speech therapist evaluated posture and tonus of lips and tongue, cheek tonus, swallowing, breathing and speech of twenty-seven 3-5 year-old children at baseline and 3 months later. Habit removal propitiated a mean reduction of 1.97 mm on anterior open bite (P < .001), promoted improvement of lip posture (P = .03), favored nasal breathing (P =. 008) and reduced the occurrence of tongue interposition during swallowing (P = .008). Lack of proper tongue rest posture was capable of preventing spontaneous correction of anterior open bite (odds ratio 17.50).

Occlusal and orofacial myofunctional evaluation in children with primary dentition, anterior open bite and pacifier sucking habit.

The aim of this study was to evaluate occlusal and orofacial myofunctional characteristics in children three to five years of age with anterior open bite related to a pacifier sucking habit. Sixty-nine children participated in this study: 35 with anterior open bite (Anterior Open Bite Group - AOBG) and 34 with normal occlusion (Control Group - CG). In AOBG, the mean anterior open bite was 2.96 mm, the mean overjet was 4.1 mm and the mean upper intercanine distance was 28.7 mm. In the CG, the mean overjet was 2.6 mm and the upper intercanine distance was 30.3 mm. The mean overjet was greater (p=0.001) in AOBG than in CG, and the mean upper intercanine distance was smaller (p<0.001) in AOBG. The number of children with a canine Class II relationship was greater in AOBG than in CG (p<0.001). Simple logistic regression analysis showed that greater overjet, smaller upper intercanine distance and Class II canine relationship coexisted with anterior open bite. In AOBG, the number of children with incompetent lips, inadequate lip tonus, lack of proper tongue rest position, inadequate cheek tonus, anterior tongue interposition during swallowing and speech was greater (p<0.05) than in CG. Multiple logistic regression analysis identified anterior tongue interposition during swallow and speech, as well as incompetent lips, as the main orofacial myofunctional characteristics in children with anterior open bite.

Human enamel veneer restoration: an alternative technique to restore anterior primary teeth.

Restoration of severely decayed primary teeth is a clinical challenge in Pediatric Dentistry. Among the restorative treatment options, the use of prefabricated crowns and resin composite restorations, either by means of direct or indirect techniques is mentioned in the literature. The purpose of this article is to describe the rehabilitation of primary anterior teeth in a 5-year-old patient. Dental treatment consisted on an anterior space maintainer prosthesis made with natural primary teeth, plus human dental enamel veneer (facet) restorations. The advantages of this technique are better esthetics and the natural enamel has physiologic wear and offers superficial smoothness and cervical adaptation compatible with those of the surrounding teeth.

Bleaching non vital primary teeth: case report.

Trauma and pulpal infections in primary dentition are part of the routine of the pediatric dentist. Common consequences in these cases are alterations in dental color, compromising patient's esthetics and his interaction in social environment. Bleaching intends to preserve dental structure already weakened and to show immediate esthetic results. This clinical case shows a bleaching technique in devitalized primary teeth using bleaching agent with 35% hydrogen peroxide activated by photo polymerizer. This technique is simple and shows immediate satisfactory results.

Giant Cell Fibroma in a Two-Year-Old Child.

The giant cell fibroma is a benign nonneoplastic fibrous tumor of the oral mucosa. It occurs in the first three decades of life in the mandibular gingiva, predominantly, showing predilection for females. This article reports a case of giant cell fibroma in a 2-year-old girl, which is an uncommon age for this lesion. The patient was brought for treatment at the Research and Clinical Center of Dental Trauma in Primary Teeth, where practice for the Discipline of Pediatric Dentistry (Faculty of Dentistry, University of São Paulo, Brazil) takes place. During clinical examination, a tissue growth was detected on the lingual gingival mucosa of the lower right primary incisors teeth. The lesion was excised under local anesthesia and submitted to histological examination at the Oral Pathology Department of the Faculty of Dentistry, University of São Paulo, which confirmed the diagnosis of giant cell fibroma. There was no recurrence after 20 months of monitoring. This instance reinforces the importance of oral care from the very first months of life in order to enable doctors to make precocious diagnosis and offer more appropriate treatments for oral diseases, as well as to promote more efficient oral health in the community.

Does the Decline in Caries Prevalence of Latin American and Caribbean Children Continue in the New Century? Evidence from Systematic Review with Meta-Analysis.

OBJECTIVE: To carry out a systematic review with meta-analysis of prevalence of caries in Latin America and Caribbean children considering studies performed in this new century. METHODS: Two reviewers searched PubMed, Embase, LILACS and governmental databases through May 2016 to identify papers published in English, Portuguese or Spanish. Studies in those countries performed with 5-6 or 11-13 year-old children and that presented separate prevalence figures from primary and permanent teeth were selected. We performed a descriptive analysis of studies and meta-analysis to calculate the overall prevalence and 95% confidence intervals (95% CI) in both primary and permanent teeth. We also analyzed the trends of prevalence of caries through the years and influence of other variables on caries prevalence using multilevel analysis. RESULTS: Seventy-five studies were included from the 1,306 articles initially retrieved. The meta-analysis of caries prevalence grouped for Latin American and the Caribbean countries were highly different from Brazil and other investigated countries for primary teeth (5-6 years-old-Brazil: 0.52, other countries:0.70) and permanent teeth (11-12 years-old-Brazil: 0.56, other countries: 0.63). For studies conducted only in Brazil the prevalence was significant lower for primary but not for permanent teeth. In Brazil, a downward trend of caries prevalence was observed in 11-13-year-old children. CONCLUSION: Despite the decline of caries prevalence in permanent teeth, mainly in Brazil, the disease still affects more than half of the children population in Latin American and Caribbean countries in the 21st Century.

Gingival fibrous hamartoma associated with natal teeth.

A variety of gingival enlargements can occur in children, but they are rarely observed in the infant. The aim of this study is to present a case of a ten-month old male patient, with an anterior mandibular hamartoma associated to natal teeth, and to describe the clinical and histological characteristics of this anomaly and the treatment performed.

Intracanal reinforcement fiber in pediatric dentistry: a case report.

A technique for the restoration of carious primary maxillary incisors using indirect resin composite crowns and intracanal reinforcement fiber is described. Endodontic treatment was previously performed on each tooth. The advantages of using an intracanal reinforcement fiber include resin composite crown reinforcement, translucency, and relative manipulation facility. In addition, the use of indirect resin composite crowns provides good shape and esthetics, as well as reduced chair time for the child. The technique is illustrated in a case report in which indirect resin composite crowns and an intracanal reinforcement fiber are placed in a 3-year-old girl.

Resin composite restoration in primary anterior teeth using short-post technique and strip crowns: a case report.

A case report describing a technique for the restoration of endodontically treated primary maxillary incisors with resin composite short posts and celluloid strip crowns in a 3-year-old boy is presented. The technique offers the advantages of using one restorative material, improving esthetics, and reducing chairtime and costs.

Trends and associated factors in prevalence of dental trauma in Latin America and Caribbean: a systematic review and meta-analysis.

OBJECTIVES: This study aimed to perform a systematic review on the prevalence of, and trends in, dental trauma in permanent teeth in 'Latin America and Caribbean' region and possible factors associated with this injury. METHODS: Literature search was carried out, in PubMed database up to 07 July 2011, for articles written in Portuguese, Spanish, or English reporting on dental trauma prevalence in the Latin American and Caribbean countries. Meta-analyses were undertaken by using random effects modeling to satisfy the purposes of this review. Pooled estimates were calculated with a confidence interval of 95% (95% CI) both for prevalence and odds ratios (OR). RESULTS: This online searching strategy collected and listed 2436 articles on this topic. After evaluating their titles and abstracts, only 24 were finally selected for complete review and data collection. All studies had been performed during adolescence, mostly in 12-year-old adolescents. The pooled prevalence of dental trauma in permanent teeth was 18.6%. Positive summary association of dental trauma with boys (pooled OR = 1.72; 95% CI: 1.57-1.89), inadequate lip coverage (pooled OR = 2.26; 95% CI: 1.45-3.52), and increased overjet (>5 mm) (pooled OR = 1.98; 95% CI: 1.61-2.44) were observed across all meta-analysis models. Differences in estimation could be observed when different criteria were used for evaluating dental trauma. On the other hand, prevalence of dental trauma did not tend to show sudden changes over time, despite criteria used. Prevalence of dental trauma after 2000s tended to decrease over time. CONCLUSIONS: Approximately 15-20% of the adolescents in Latin American and Caribbean countries have shown some type of dental trauma in permanent teeth, and it seems there is a trend of decreasing prevalence of dental trauma in the studied areas of this region. Boys, adolescents presenting inadequate lip coverage, or an increased overjet greater than 5 mm are more likely to have traumatic dental injuries.

An unusual case of four simultaneous eruption cysts in an infant.

Eruption cyst is a benign lesion with favorable prognosis that may occur during the primary or permanent dental eruption. The purpose of this paper is to report the case of an infant who presented with multiple eruption cysts (ECs), describe their clinical and histological features, and discuss the treatment performed. The first ECs occurred around the primary mandibular central incisors when the patient was seven months old, which ruptured spontaneously. Ten months later, the patient presented with simultaneous eruption cysts around the primary mandibular and maxillary first molars, making the child very uncomfortable. Radiographically, all the involved molars had two thirds root formation. Two cysts, both on the right side, were surgically removed, and the other two ruptured spontaneously.