Early-life socioeconomic status and malocclusion in adolescents and young adults in Uruguay.

This study aims to estimate orthodontic treatment need among 15-24 year-old individuals in Montevideo, Uruguay, and the association of occlusal traits with demographic, clinical and socioeconomic factors, considering a life course approach. A cross-sectional study using data from the First National Oral Health Survey in Uruguay was conducted. A two-stage cluster procedure was used to select a sample of 278 individuals in Montevideo. Household interviews and oral examinations were performed by six dentists. Dental Aesthetic (DAI) and Decayed Missing and Filled Teeth Indices (DMFT) were used to assess orthodontic treatment need and dental caries, respectively. Early life and current socioeconomic factors were obtained from the interview. Ordinal logistic regression was used to model the DAI index. Prevalence of definite malocclusion was 20.6%, followed by severe (8.2%) and very severe (7.6%). In the adjusted analysis, individuals with untreated dental caries (OR = 1.11; 95%CI: 1.03-1.20) and those who reported a lower socioeconomic level at 6 years of age (OR = 5.52; 95%CI: 1.06-28.62) had a higher chance of being a worse case of malocclusion. Current socioeconomic position was not associated with orthodontic treatment need. Individuals aged 22-24 years (OR = 1.59; 95%CI: 1.05-2.41) had a lower chance than those aged 14-17. This study shows that orthodontic treatment need is relatively high in Uruguayan adolescents and young adults. There is a potential relationship between early life socioeconomic status and the occurrence of malocclusion in adolescents and young adults under a life course approach.

Early-life socioeconomic status and malocclusion in adolescents and young adults in Uruguay / Estatus socioeconómico durante la primera infancia y maloclusión en adolescentes y adultos jóvenes en Uruguay / Nível socioeconômico na primeira infância e oclusopatia em adolescentes e adultos jovens no Uruguai

This study aims to estimate orthodontic treatment need among 15-24 year-old individuals in Montevideo, Uruguay, and the association of occlusal traits with demographic, clinical and socioeconomic factors, considering a life course approach. A cross-sectional study using data from the First National Oral Health Survey in Uruguay was conducted. A two-stage cluster procedure was used to select a sample of 278 individuals in Montevideo. Household interviews and oral examinations were performed by six dentists. Dental Aesthetic (DAI) and Decayed Missing and Filled Teeth Indices (DMFT) were used to assess orthodontic treatment need and dental caries, respectively. Early life and current socioeconomic factors were obtained from the interview. Ordinal logistic regression was used to model the DAI index. Prevalence of definite malocclusion was 20.6%, followed by severe (8.2%) and very severe (7.6%). In the adjusted analysis, individuals with untreated dental caries (OR = 1.11; 95%CI: 1.03-1.20) and those who reported a lower socioeconomic level at 6 years of age (OR = 5.52; 95%CI: 1.06-28.62) had a higher chance of being a worse case of malocclusion. Current socioeconomic position was not associated with orthodontic treatment need. Individuals aged 22-24 years (OR = 1.59; 95%CI: 1.05-2.41) had a lower chance than those aged 14-17. This study shows that orthodontic treatment need is relatively high in Uruguayan adolescents and young adults. There is a potential relationship between early life socioeconomic status and the occurrence of malocclusion in adolescents and young adults under a life course approach

El objetivo de este estudio es estimar el tratamiento de ortodoncia que necesitan jóvenes entre 15 y 24 años en Montevideo, Uruguay, y la asociación de los rasgos oclusores con factores demográficos, clínicos y socioeconómicos, considerando el ciclo vital. Se trata de un estudio transversal que maneja datos de la Primera Encuesta Nacional de Salud Bucal en Uruguay. Se utilizó un procedimiento de análisis de clúster en dos fases para seleccionar una muestra de 278 personas en Montevideo. Se realizaron entrevistas domiciliarias y exámenes bucales por parte de seis dentistas. Se usaron también datos de índices de cirugías estéticas (DAI) y del número de dientes cariados, perdidos y obturados (DCPO), con el fin de evaluar el tratamiento necesario ortodóntico y las caries dentales, respectivamente. La primera infancia y la situación socioeconómica actual fueron factores que se obtuvieron de la entrevista. Se usó una regresión logística ordinaria para modelar el índice DAI. La prevalencia de la maloclusión definitiva fue de un 20,6%, seguida por la severa (8,2%) y la muy severa (7,6%). En el análisis ajustado, las personas que no se habían tratado las caries dentales (OR = 1,11; IC95%: 1,03-1,20), y quienes informaron de un nivel socioeconómico bajo a los 6 años de edad (OR = 5,52; IC95%: 1,06-28,62), tenían una mayor probabilidad de sufrir un caso de maloclusión. La posición socioeconómica actual no se asoció con el tratamiento ortodóntico necesitado. Las personas con 22-24 años (OR = 1,59; IC95%: 1,05-2,41) tenían una probabilidad más baja que aquellos con una edad entre 14-17. Este estudio muestra que el tratamiento ortodóntico necesario es relativamente alto en adolescentes uruguayos y adultos jóvenes. Hay una relación potencial entre el estatus socioeconómico en la primera infancia y la ocurrencia de maloclusión en adolescentes y jóvenes adultos desde una perspectiva del ciclo vital.

O estudo teve como objetivo estimar a necessidade de tratamento ortodôntico na faixa etária de 15 a 24 anos em Montevideo, Uruguai, e a associação entre características oclusais e fatores demográficos, clínicos e socioeconômicos, com base na trajetória de vida. Foi realizado um estudo transversal, utilizando dados da 1ª Pesquisa Nacional de Saúde Oral do Uruguai. Foi utilizado um procedimento de cluster em dois estágios para selecionar uma amostra de 278 indivíduos em Montevideo. Entrevistas domiciliares e exames odontológicos foram realizados por seis odontólogos. O índice de estética dentária (DAI) e o índice de dentes cariados, perdidos e obturados (DMFT/CPOD) foram usados para avaliar a necessidade de tratamento ortodôntico e de cárie dentária, respectivamente. Foram obtidos dados socioeconômicos da primeira infância e atuais, a partir de entrevistas. Foi utilizada a regressão logística ordinal para modelar o índice de estética dentária. A prevalência de oclusopatia definida era 20,6%, seguida pela forma grave (8,2%) e muito grave (7,6%). Na análise ajustada, indivíduos com cárie dentária não tratada (OR = 1,11; IC95%: 1,03-1,20) e aqueles de nível socioeconômico mais baixo aos 6 anos de idade (OR = 5,52; IC95%: 1,06-28,62) mostravam chances mais altas de apresentar oclusopatia mais grave. O nível socioeconômico atual não mostrou associação com necessidade de tratamento ortodôntico. Os indivíduos na faixa etária de 22-24 anos (OR = 1,59; IC95%: 1,05-2,41) mostraram probabilidade menor de oclusopatia quando comparados com a faixa etária de 14-17 anos. O estudo mostra que a necessidade de tratamento ortodôntico é relativamente alta entre adolescentes e adultos jovens uruguaios. De acordo com a abordagem de trajetória de vida, existe uma relação potencial entre nível socioeconômico na primeira infância e oclusopatia em adolescentes e adultos jovens.

Clinical and Individual Variables in Children's Dental Fear: A School-Based Investigation

Abstract This cross-sectional study evaluated the prevalence of dental fear and associated factors in schoolchildren aged 8 to 12 years old, in Pelotas, southern Brazil. Schoolchildren enrolled in 20 public and private schools were selected using a multi-stage sample design. Sociodemographic characteristics, children's dental visit and oral hygiene habits were assessed by questionnaires. The Dental Anxiety Question was used to measure dental fear prevalence. Children's clinical examination evaluated presence of dental caries (DMFT/dmft index) and gingival bleeding. Data were analyzed using Poisson regression with robust variance (prevalence ratio; 95% confidence interval). One thousand two hundred and two children were included. Dental fear prevalence was 24.6%. After the adjustment, girls [PR=1.71 (CI 95%: 1.31-2.22)], children from poorer families [PR=1.96 (CI 95%: 1.36-2.83)], those who had decayed teeth (D/d index>0)[PR=1.32 (CI 95%: 1.01-1.72), and who had never been at the dentist [PR=1.85 (CI 95%: 1.42-2.41) remained significantly associated with dental fear. The prevalence of dental fear indicates that it is a common problem among schoolchildren. Early dental care and dental caries prevention are important factors to prevent dental fear.

Resumo Este estudo transversal avaliou a prevalência do medo odontológico e fatores associados em escolares de 8 a 12 anos de idade, na cidade de Pelotas, RS, Brasil. Alunos matriculados em 20 escolas públicas e privadas foram selecionados através de um delineamento de conglomerado em duplo estágio. As características sociodemográficas, a experiência odontológica da criança e os hábitos de higiene bucal foram avaliados por meio de questionários. O medo odontológico da criança foi avaliado através da Dental Anxiety Question. Examinadores calibrados avaliaram a presença de cárie dentária (CPOD) e o índice de sangramento gengival. Os dados foram analisados por meio de regressão de Poisson com variância robusta (razão de prevalência; 95% intervalo de confiança). No total, 1202 crianças foram incluídas. A prevalência medo odontológico foi de 24,6%. Após o ajuste, as meninas [RP=1,71 (IC 95%: 1,31-2,22)], as crianças de famílias mais pobres [RP=1,96 (IC 95%: 1,36-2,83)], com lesões de cárie (D/d index>0) [RP=1,32 (IC 95%: 1,01-1,72) e as que nunca tinham ido ao dentista [RP=1,85 (IC 95%: 1,42-2,41) permaneceram significativamente associadas ao medo dental. A prevalência de medo odontológico encontrada indica que este é um problema comum em escolares. O atendimento odontológico precoce e a prevenção de cárie são fatores importantes para evitar o medo.

Clinical and Individual Variables in Children's Dental Fear: A School-Based Investigation.

This cross-sectional study evaluated the prevalence of dental fear and associated factors in schoolchildren aged 8 to 12 years old, in Pelotas, southern Brazil. Schoolchildren enrolled in 20 public and private schools were selected using a multi-stage sample design. Sociodemographic characteristics, children's dental visit and oral hygiene habits were assessed by questionnaires. The Dental Anxiety Question was used to measure dental fear prevalence. Children's clinical examination evaluated presence of dental caries (DMFT/dmft index) and gingival bleeding. Data were analyzed using Poisson regression with robust variance (prevalence ratio; 95% confidence interval). One thousand two hundred and two children were included. Dental fear prevalence was 24.6%. After the adjustment, girls [PR=1.71 (CI 95%: 1.31-2.22)], children from poorer families [PR=1.96 (CI 95%: 1.36-2.83)], those who had decayed teeth (D/d index>0)[PR=1.32 (CI 95%: 1.01-1.72), and who had never been at the dentist [PR=1.85 (CI 95%: 1.42-2.41) remained significantly associated with dental fear. The prevalence of dental fear indicates that it is a common problem among schoolchildren. Early dental care and dental caries prevention are important factors to prevent dental fear.

Validation of the digital photographic assessment to diagnose traumatic dental injuries.

INTRODUCTION: Alternatives for monitoring dental trauma in epidemiological surveys may be useful, as data collection of epidemiological investigation can be jeopardized due to several conditions. AIM: To investigate the validity of standard digital photographs to determine the occurrence of anterior dental trauma compared to the clinical examination in an epidemiological survey. METHODS: Participants were children aged 8-12 years old attending both private and public schools; children were clinically evaluated for the assessment of dental trauma, and standard photographs were taken from maxillary and mandibular permanent incisors of each child. Validity was determined by calculating the percentages and respective 95% confidence interval of sensitivity, specificity, positive predictive value, and negative predictive value. Cohen's kappa statistic was also used. RESULTS: A total of 412 children were included, totaling 3296 teeth assessed for dental trauma presence. The prevalence of dental trauma was 11.2% (95% CI 8.29-14.61) and 10.2% (95% CI 7.45-13.53), respectively, for the clinical examination and the photographic method. Agreement between the gold standard and the photographic diagnosis was good: 0.64 for the prevalence of dental trauma and 0.66 for diagnosis of dental trauma on a tooth basis. The diagnosis through the photographic method had higher specificity (96.7%) than sensitivity (65.2%). High positive likelihood ratio and low negative likelihood ratio were also observed. CONCLUSION: The photographic assessment method of dental trauma was valid and reliable as compared to the oral clinical examination.

Iniquidades em saúde bucal: escolares beneficiários do Bolsa Família são mais vulneráveis? / Inequalities in oral health: are schoolchildren receiving the Bolsa Família more vulnerable? / Inequidades en salud bucal: escolares beneficiarios de la Beca Familia son más vulnerables?

OBJECTIVE: To evaluate the association between being a recipient of the Bolsa Família program and oral health conditions in Brazilian schoolchildren.METHODS: A cross-sectional study was conducted with 1,107 schoolchildren aged between eight and 12 years from 20 public and private schools in Pelotas, RS, Southern Brazil. A list of all children receiving the Bolsa Família program was provided by the participant schools. Demographic, socioeconomic and oral hygiene information were assessed using a questionnaire completed by the schoolchildren and their parents. Dental exams were performed to assess the presence of dental plaque and prevalence of dental caries. Data were analyzed by Chi-square test, Chi-square test for linear trend and multivariate Poisson Regression (prevalence ratio; 95% confidence interval).RESULTS: Schoolchildren from non-nuclear families, with a DMFT ≥ 1 and who had never visited a dentist were associated with receiving the Bolsa Família. Final model showed that caries prevalence was twice as high (PR 2.00; 95%CI 1.47;2.69) in schoolchildren benefiting from the Bolsa Família . It was also showed that schoolchildren benefiting from the program presented greater severity of dental caries compared to school children from private schools (RR 1.53; 95%CI 1.18;2.00). After final adjustments, the prevalence of schoolchildren who have never visited a dentist was six times higher in children who received the government benefit (PR 6.18; 95%CI 3.07;12.45) compared to those from private schools.CONCLUSIONS: Schoolchildren benefiting from the Bolsa Família program experienced more caries lesions and have less frequently accessed dental care services, which suggest the need to include oral health in the program.

OBJETIVO: Analisar a associação entre ser beneficiário do Programa Bolsa Família e condições de saúde bucal entre escolares.MÉTODOS: Estudo transversal com 1.107 escolares entre oito e 12 anos de idade, provenientes de 20 escolas públicas e particulares da cidade de Pelotas, RS, em 2010. Os beneficiários do Programa Bolsa Família foram verificados por meio de lista fornecida pelas escolas participantes do estudo. Informações demográficas, socioeconômicas, de uso de serviço odontológico e de higiene bucal foram obtidas por meio de questionários respondidos pelos escolares e por seus pais. O exame clínico avaliou a presença de placa dental e experiência de cárie. Os dados foram analisados por meio dos testes do Qui-quadrado e Qui-quadrado de tendência linear e por regressão de Poisson (razão de prevalência; intervalo de confiança de 95%).RESULTADOS: Crianças de família não nuclear, que apresentavam CPOD ≥ 1 e que nunca haviam feito uso de serviço odontológico na vida estiveram associadas ao recebimento do Programa Bolsa Família. O modelo final mostrou que a prevalência de cárie foi duas vezes maior (RP 2,00; IC95% 1,47;2,69) em alunos beneficiários do Programa que também apresentaram maior severidade da doença, quando comparados aos alunos de escolas particulares (RM 1,53; IC95% 1,18;2,00). A prevalência de escolares que nunca haviam ido ao dentista foi mais de seis vezes maior em beneficiários do Programa Bolsa Família (RP 6,18; IC95% 3,07;12,45), em comparação com aqueles das escolas privadas, após ajustes.CONCLUSÕES: Escolares beneficiários do Programa Bolsa Família possuem maior carga de cárie e são os que menos acessam os serviços odontológicos. Esses achados sugerem a necessidade de incorporação da saúde bucal nas condicionalidades do Programa Bolsa Família.

OBJETIVO: Analizar la asociación entre ser beneficiario del Programa Beca Familia y condiciones de salud bucal entre escolares.MÉTODOS: Estudio transversal con 1.107 escolares entre ocho y 12 años de edad, provenientes de 20 escuelas públicas y privadas de la ciudad de Pelotas, RS, Brasil, en 2010. El beneficiario del Programa Beca Familia fue verificado por medio de lista suministrada por las escuelas participantes del estudio. Informaciones demográficas, socioeconómicas, de uso de servicio odontológico y de higiene bucal fueron obtenidas por medio de cuestionarios respondidos por los escolares y por sus padres. El examen clínico evaluó la presencia de placa dental y experiencia de caries. Los datos fueron analizados por medio de las pruebas de Chi-cuadrado y Chi-cuadrado de tendencia linear y por regresión de Poisson (cociente de prevalencia; intervalo de confianza de 95%).RESULTADOS: Niños de familia no nuclear, que presentaban COPD ≥1 y que nunca habían hecho uso de servicio odontológico en la vida estuvieron asociados al recibimiento en el Programa Beca Familia. El modelo final mostró que la prevalencia de caries fue dos veces mayor (RP 2,00; IC95% 1,47;2,69) en alumnos beneficiarios del Programa que también presentaron mayor severidad de la enfermedad, al ser comparados con los alumnos de escuelas privadas (RR 1,53; IC95% 1,18;2,00). La prevalencia de escolares que nunca habían ido al dentista fue más de seis veces mayor en beneficiarios del Programa Beca Familia (RP 6,18; IC95% 3,07;12,45), en comparación con aquellos de escuelas privadas, posterior a los ajustes.CONCLUSIONES: Escolares beneficiarios del Programa Beca Familia poseen mayor carga de caries y son los que menos tienen hacen uso de los servicios odontológicos. Estos resultados sugieren la necesidad de incorporar salud bucal en las condiciones del Programa Beca Familia.

Methods and logistics of a multidisciplinary survey of schoolchildren from Pelotas, in the Southern Region of Brazil.

This paper describes the methods of a multidisciplinary epidemiological survey conducted in schools in Pelotas, in the Southern Region of Brazil. This cross-sectional study evaluated a representative sample (n = 1,211) of eight to 12-year-old children attending public (15) and private (5) schools. Questionnaires were applied to parents to obtain information about socioeconomic and sociocultural characteristics. Children were interviewed to provide information on demographic characteristics, oral health behavior and physical activity habits. Oral health examinations were performed on the children and anthropometric data was collected to assess nutritional status. School principals responded a questionnaire about the social and physical environment of the school. A total of 1,744 children were eligible for the study; a response rate of 69.4% was achieved, with no significant differences between schools. The method used allowed investigators to obtain data on several health outcomes as well as on possible risk factors. This strategy optimizes the use of financial resources for research and promotes interprofessional collaboration.

Methods and logistics of a multidisciplinary survey of schoolchildren from Pelotas, in the Southern Region of Brazil / Métodos e logística de um estudo multidisciplinar com escolares de Pelotas, Sul do Brasil / Métodos y logística de un estudio multidisciplinar con escolares de Pelotas, sur de Brasil

This paper describes the methods of a multidisciplinary epidemiological survey conducted in schools in Pelotas, in the Southern Region of Brazil. This cross-sectional study evaluated a representative sample (n = 1,211) of eight to 12-year-old children attending public (15) and private (5) schools. Questionnaires were applied to parents to obtain information about socioeconomic and sociocultural characteristics. Children were interviewed to provide information on demographic characteristics, oral health behavior and physical activity habits. Oral health examinations were performed on the children and anthropometric data was collected to assess nutritional status. School principals responded a questionnaire about the social and physical environment of the school. A total of 1,744 children were eligible for the study; a response rate of 69.4% was achieved, with no significant differences between schools. The method used allowed investigators to obtain data on several health outcomes as well as on possible risk factors. This strategy optimizes the use of financial resources for research and promotes interprofessional collaboration.

O artigo detalha os métodos de um estudo epidemiológico multidisciplinar conduzido em escolas em Pelotas, Sul do Brasil. O estudo transversal incluiu uma amostra representativa (n = 1.211) de crianças de 8 a 12 anos, em escolas públicas (15) e privadas (5). Questionários foram aplicados aos pais para obter informações socioeconômicas e culturais. As crianças foram entrevistadas, fornecendo informações demográficas, comportamentos de saúde bucal e prática de atividade física. Exame de saúde bucal foi realizado e medidas antropométricas aferidas para avaliação da condição nutricional. Diretores das escolas forneceram informações sobre o ambiente físico e social das escolas. Das 1.744 crianças elegíveis, a taxa de resposta foi 69,4% sem diferenças entre escolas. A metodologia proposta permitiu a obtenção de dados sobre diversos desfechos de saúde bem como sobre possíveis fatores de risco. Esta estratégia otimiza recursos financeiros de pesquisa e favorece a colaboração interprofissional.

El artículo detalla los métodos de un estudio epidemiológico multidisciplinar llevado a cabo en escuelas en Pelotas, sur de Brasil. El estudio transversal incluyó una muestra representativa (n = 1.211) de niños de 8 a 12 años, en escuelas públicas (15) y privadas (5). Los cuestionarios fueron administrados a los padres para obtener información socioeconómica y cultural. Los niños fueron entrevistados, proporcionando información demográfica, comportamientos de salud bucal y práctica de actividad física. Se realizaron un examen de salud bucal y medidas antropométricas para la evaluación de la condición nutricional. Directores de escuelas proporcionaron información sobre el ambiente físico y social de las escuelas. De los 1.744 niños elegibles, la tasa de respuesta fue de un 69,4% sin diferencias entre escuelas. La metodología propuesta permitió la obtención de datos sobre diversas soluciones de salud, así como sobre posibles factores de riesgo. Esta estrategia optimiza recursos financieros de investigación y favorece la colaboración interprofesional.

[Inequalities in oral health: are schoolchildren receiving the Bolsa Família more vulnerable?]. / Iniquidades em saúde bucal: escolares beneficiários do Bolsa Família são mais vulneráveis?

OBJECTIVE: To evaluate the association between being a recipient of the Bolsa Família program and oral health conditions in Brazilian schoolchildren. METHODS: A cross-sectional study was conducted with 1,107 schoolchildren aged between eight and 12 years from 20 public and private schools in Pelotas, RS, Southern Brazil. A list of all children receiving the Bolsa Família program was provided by the participant schools. Demographic, socioeconomic and oral hygiene information were assessed using a questionnaire completed by the schoolchildren and their parents. Dental exams were performed to assess the presence of dental plaque and prevalence of dental caries. Data were analyzed by Chi-square test, Chi-square test for linear trend and multivariate Poisson Regression (prevalence ratio; 95% confidence interval). RESULTS: Schoolchildren from non-nuclear families, with a DMFT ≥ 1 and who had never visited a dentist were associated with receiving the Bolsa Família. Final model showed that caries prevalence was twice as high (PR 2.00; 95%CI 1.47;2.69) in schoolchildren benefiting from the Bolsa Família . It was also showed that schoolchildren benefiting from the program presented greater severity of dental caries compared to school children from private schools (RR 1.53; 95%CI 1.18;2.00). After final adjustments, the prevalence of schoolchildren who have never visited a dentist was six times higher in children who received the government benefit (PR 6.18; 95%CI 3.07;12.45) compared to those from private schools. CONCLUSIONS: Schoolchildren benefiting from the Bolsa Família program experienced more caries lesions and have less frequently accessed dental care services, which suggest the need to include oral health in the program.

Prevalence and treatment demand after traumatic dental injury in South Brazilian schoolchildren.

BACKGROUND: Evaluation of the frequency and need for treatment of dental trauma is critical for both planning and establishing dental services and preventive programs. AIM: This cross-sectional study evaluated the prevalence of dental trauma, need for treatment and factors associated with dental visits after an injury. SUBJECTS AND METHODS: A multistage sample of children aged 8-12 years, from 20 private and public schools in Pelotas/Southern Brazil, was considered. Socioeconomic information was collected from parents, and data regarding traumatic events were obtained from the children. Clinical examinations were conducted using validated criteria. Descriptive analysis and logistic regression were used to assess the factors associated with search for treatment after injury. RESULTS: A total of 1210 children were included, 153 (12.6%, 95% CI 10.8-14.6) of whom suffered dental trauma, with a total of 175 traumatized teeth. The most frequently observed type of injury was enamel fracture, affecting 129 (73.7%) teeth, of which 107 did not require restorative treatment. A total of 68 (38.8%) teeth required care, of which 24 (13.7%) received treatment. Of the children who recalled the trauma, 39 (36.5%) sought treatment, which was significantly associated with both higher maternal education (OR 2.75; 95% CI 1.18-6.41) and trauma severity (OR 7.71; 95% CI 3.17-18.75). CONCLUSIONS: The prevalence of traumatic injuries was relatively high in this population. Although most of the traumatized teeth did not require treatment, dental care was neglected, as most of the children were not taken to a dentist for evaluation. Also, there was a considerable demand for treatment, most of them of low complexity. Special attention should be given to children whose mothers have completed fewer years of education, as the mother's level of education was an important predictor of evaluation by a dentist after injury.