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.

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.

Fatores associados à necessidade de exodontia de incisivos centrais superiores decíduos traumatizados / Associated factors with extraction of traumatized deciduous upper central incisor

O objetivo deste estudo longitudinal foi avaliar os fatores associados à necessidade de exodontia de incisivos centrais superiores decíduos traumatizados. Os dados foram coletados por um único examinador por meio de exame de fotografias, radiografias e informações presentes nos prontuários de 1734 pacientes atendidos na clínica do Centro de Pesquisa e Atendimento de Traumatismo em Dentes Decíduos da Disciplina de Odontopediatria da Faculdade de Odontologia da Universidade de São Paulo, entre os anos de 1998 e 2009. O critério utilizado para a inclusão do prontuário no estudo foi a presença de fotografias e/ou radiografias que comprovassem a presença de incisivos centrais superiores permanentes erupcionados ou em processo de erupção, onde os incisivos centrais decíduos não estivessem mais presentes na cavidade oral. Foram avaliados 521 prontuários de pacientes e 988 incisivos centrais superiores decíduos traumatizados. A unidade experimental para o estudo foi o dente. Três desfechos foram analisados: exodontia devido ao traumatismo dental em si, exodontia por sinais de infecção e exodontia por retenção prolongada. Todos os desfechos foram comparados aos incisivos centrais superiores decíduos que apresentaram exfoliação fisiológica. As variáveis independentes foram divididas em grupos: relacionadas à criança, ao traumatismo e ao dente.

Os dados foram tabulados e a análise de Regressão de Poisson foi realizada para avaliar a associação entre as variáveis. O dente apresentar luxação lateral (RR=4,73; 2,06 10,98), intrusiva (RR=4,18; 1,74 10,07) ou extrusiva (RR=9,57; 4,22 21,67), trauma com envolvimento pulpar (RR=17,89; 8,02 39,88) ou fratura radicular (RR=2,74; 1,06 7,07), além de trauma com envolvimento de mais de 2 dentes (RR=1,33; 1,12 1,57) foram positivamente associadas à necessidade do dente traumatizado ter exodontia em decorrência do traumatismo dental. O dente com trauma de alta severidade (RR= 1,75; 1,05 2,93) e apresentar sinais de necrose pulpar (RR=25,86; 13,4 49,6) foram fatores positivamente associados à necessidade de exodontia por sinais de infecção. Por outro lado, a presença de tratamento endodôntico (RR=0,50; 0,34 0,74) e de restauração (RR=0,33; 0,11 0,99) foram fatores negativamente associados ao mesmo desfecho. O dente ter recebido tratamento endodôntico (RR=3,04; 1,97 4,69) foi positivamente associado a necessidade de exodontia por retenção prolongada, enquanto ter apresentado uma luxação lateral ou extrusiva (RR=0,27; 0,74 0,96) e apresentar espaço pericementário aumentado (RR=0,45; 0,21 0,95) foi negativamente associado. Conclui-se que a luxação lateral, intrusiva e extrusiva, fraturas com exposição pulpar, fratura radicular e o envolvimento de mais de 2 dentes aumentam a probabilidade de exodontia devido ao traumatismo dental em si. A exodontia por sinais de infecção está associada a traumas severos e o desenvolvimento de sinais de necrose pulpar. No entanto, a realização de tratamentos conservadores como endodontia e restauração podem evitar a exodontia precoce do dente decíduo. O tratamento endodôntico aumenta a possibilidade do dente necessitar de exodontia por retenção prolongada.

The purpose of this historical cohort study was to evaluate factors associated with the necessity of extraction of traumatized deciduous central incisors. Data were collected by a single examiner by taking photographs, radiographs and present information in the medical records of 1734 patients seen at the Research and Clinical Center of Dental Trauma in Primary Teeth of the School of Dentistry of the University of São Paulo, from 1998 to 2009. The criterion for inclusion in the study of medical records was the presence of photographs and / or X-rays showing the presence of central incisors erupted or in eruption process, where the deciduous central incisors already are no longer present in the oral cavity. It was evaluated records of 521 patients and 988 traumatized deciduous maxillary central incisors. The experimental unit for the study was the tooth. Three outcomes were analyzed: extraction as a result of the trauma in itself, extraction as a result of signs of infection, and extraction after prolonged retention. All the outcomes were compared to upper deciduous central incisors that had physiological exfoliation. The independent or explanatory variables were divided into groups: related to the patient, to the trauma, and to the tooth.

Data were tabulated and analyzed using Poisson regression to assess the relationship between the variables. Having suffered a trauma with displacement (RR=4,73; 2,06 10,98), intrusive (RR=4,18; 1,74 10,07) or extrusive (RR=9,57; 4,22 21,67), with pulp involvement (RR=17,89; 8,02 39,88) or root fracture (RR=2,74; 1,06 7,07), in addition to trauma with more than two teeth affected (RR=1,33; 1,12 1,57), were positively associated to the risk of tooth extraction as a result of trauma. For the loss by infection, the element having suffered trauma (RR= 1,75; 1,05 2,93) and developing high-severity pulp necrosis (RR=25,86; 13,4 49,6) were positively associated with risk of tooth extraction. On the other hand, having undergone endodontic treatment (RR=0,50; 0,34 0,74) and restoration (RR=0,33; 0,11 0,99) factors were negatively associated with the same outcome. Having undergone endodontic treatment (RR=3,04; 1,97 4,69) was positively associated with the necessity of extraction after prolonged retention, whereas a lateral or extrusive displacement (RR=0,27; 0,74 0,96) and presenting an increased pericementary space (RR=0,45; 0,21 0,95) was negatively associated with the same outcome. It is concluded that lateral displacement, intrusive and extrusive, fractures with pulp involvement, root fracture and having more than 2 teeth involved increase the possibility of extraction as a result of the trauma...

Bottle feeding, increased overjet and Class 2 primary canine relationship: is there any association?

The aim of this study was to investigate the association between bottle feeding and prevalence rates of increased overjet and Class 2 primary canine relationship. The sample consisted of 911 children (461 boys, 450 girls) aged 3 (13.9%), 4 (40.8%), 5 (34%) and 6 (11.3%) years, with complete primary dentition. Information about nutritive and nonnutritive (pacifier and/or digit) sucking habits was collected through questionnaires. Three calibrated dentists (κ: 0.9-1.0 and Rs > 0.90) performed the clinical assessments. The children were divided into four groups: G1 - not bottle-fed; G2 - exclusively bottle-fed; G3 - breast- and bottle-fed, bottle feeding ceased before 3 years of age; and G4 - breast- and bottle-fed, bottle feeding ceased between 3 and 4 years of age. Associations between nutritive and nonnutritive sucking behaviors and the malocclusions studied were analyzed by multiple binary logistic regression (α= 0.05). The frequencies of increased overjet were: 25.3% (G1), 38.8% (G2), 39.2% (G3) and 47.8% (G4). The percentages of Class 2 canine relationship were: 27.9% (G1), 48.8% (G2), 43.4% (G3) and 43% (G4). No significant effect of bottle feeding was found. The chances of diagnosing increased overjet (O.R. = 4.42, p < 0.001) and Class 2 canine relationship (O.R. = 4.02, p < 0.001) were greater for children with pacifier and/or digit-sucking habits, compared to those without a history of nonnutritive sucking behavior. It may be suggested that bottle feeding alone is not directly associated with higher prevalence rates of increased overjet and Class 2 canine relationship in the primary dentition.

Bottle feeding, increased overjet and Class 2 primary canine relationship: is there any association?

The aim of this study was to investigate the association between bottle feeding and prevalence rates of increased overjet and Class 2 primary canine relationship. The sample consisted of 911 children (461 boys, 450 girls) aged 3 (13.9 percent), 4 (40.8 percent), 5 (34 percent) and 6 (11.3 percent) years, with complete primary dentition. Information about nutritive and nonnutritive (pacifier and/or digit) sucking habits was collected through questionnaires. Three calibrated dentists (κ: 0.9-1.0 and Rs > 0.90) performed the clinical assessments. The children were divided into four groups: G1 - not bottle-fed; G2 - exclusively bottle-fed; G3 - breast- and bottle-fed, bottle feeding ceased before 3 years of age; and G4 - breast- and bottle-fed, bottle feeding ceased between 3 and 4 years of age. Associations between nutritive and nonnutritive sucking behaviors and the malocclusions studied were analyzed by multiple binary logistic regression (α= 0.05). The frequencies of increased overjet were: 25.3 percent (G1), 38.8 percent (G2), 39.2 percent (G3) and 47.8 percent (G4). The percentages of Class 2 canine relationship were: 27.9 percent (G1), 48.8 percent (G2), 43.4 percent (G3) and 43 percent (G4). No significant effect of bottle feeding was found. The chances of diagnosing increased overjet (O.R. = 4.42, p < 0.001) and Class 2 canine relationship (O.R. = 4.02, p < 0.001) were greater for children with pacifier and/or digit-sucking habits, compared to those without a history of nonnutritive sucking behavior. It may be suggested that bottle feeding alone is not directly associated with higher prevalence rates of increased overjet and Class 2 canine relationship in the primary dentition.