A 14-Year Follow-Up Study of Sequelae in Primary Teeth and Permanent Successors After Dental Trauma

ABSTRACT Objective: To evaluate the presence of sequelae in primary teeth and their permanent successors, as well as associations between TDI and the presence of sequelae in both teeth. Material and Methods: In this 14-year retrospective study, 2.290 records were reviewed, 192 patients who suffered dental trauma in primary teeth were followed until the eruption of successor teeth were included. Descriptive, chi-square, and regression logistic with generalized estimating equations tests were performed (p<0.05). Results: 362 primary and successor teeth were followed. Sequelae were present in 71.8% of primary teeth and 25.7% of their successors. Teeth with complicated fracture (100%), extrusion (100%) and avulsion (100%) resulted in the largest amounts of sequelae in primary teeth and intrusion (61%) on their successors. Age was associated with sequelae in permanent teeth (p<0.01). Extrusion (OR 10.06; CI 2.12-47.63) and intrusion (OR 7.51; CI 2.73-20.70) had a higher risk to cause sequelae in primary and permanent teeth, respectively. Conclusion: The type of injury involved influenced the sequelae in traumatized teeth and their successors, and the age of the child influenced the presence of sequelae in permanent teeth.

Frequency of pulp canal obliteration in primary teeth after traumatic dental injury and its association with related variables / Frequência de obliteração do canal pulpar nos dentes decíduos após traumatismo dentário e sua associação com variáveis relacionadas

ABSTRACT Objective The aim of this study was to determine the frequency of pulp canal obliteration (PCO) after traumatic dental injury (TDI) of primary anterior teeth and to investigate its relation with the related variables. Methods This retrospective study has been done with dental records of patients selected from the Paediatric Dental Trauma Clinic between 2006 and 2016. Those who had PCO in the primary anterior teeth and were aged 0-108 months at the time of trauma were considered eligible. Data related to patients and TDI, such as sex, the child's age at the time of trauma, aetiology, affected teeth, the child's age at the time of the eruption of the permanent successor as well as the presence of crown discoloration were extracted from the dental records. Results Among the 483 children with traumatised teeth, 14.9% had PCO and the most of them exhibited crown discoloration. The average age of the children at the time of the trauma was 38 months and the most common aetiology of the TDI was falls. The average time for the beginning of the PCO process was 13.5 months. There was no statistically significant association between the child's age at the time of trauma and the types of TDI, PCO and the presence of crown discoloration. Conclusions The frequency of PCO was relatively low though the presence of crown discoloration was considerable. There was no association between the child's age at the time of trauma and the studied variable.

RESUMO Objetivo O objetivo desse estudo foi determinar a frequência de obliteração do canal pulpar (OCP) após traumatismo dos dentes decíduos anteriores e investigar sua associação com variáveis relacionadas. Métodos Este estudo retrospectivo foi realizado com base nos prontuários odontológicos de pacientes selecionados da Clínica de Trauma Dentário Pediátrico entre 2006 e 2016. Aqueles que tinham OCP nos dentes decíduos anteriores e tinham entre 0-108 meses no momento do traumatismo foram considerados elegíveis. Dados dos pacientes e dos traumatismos, tais como, sexo, idade da criança no momento do traumatismo, etiologia, dente afetado, idade da criança na época no momento da erupção do sucessor permanente, bem como presença de alteração de cor da coroa foram extraídos dos prontuários. Resultados Dentre as 483 crianças com dentes com traumatismos, 14.9% tinham OCP e a maioria delas apresentava alteração de cor da coroa. A média de idade da criança no momento do traumatismo foi de 38 meses e a etiologia mais comumente associada ao TD foram as quedas. O tempo médio decorrido para o início do processo de OCP foi de 13,5 meses. Não houve associação estatisticamente significativa entre a idade da criança no momento do traumatismo e os tipos de TD, OCP e presença de alteração de cor da coroa. Conclusão A frequência de OCP foi relativamente baixa, embora a presença de alteração da coroa tenha sido considerável. Não foi encontrada associação entre a idade da criança no momento do trauma e as variáveis estudadas.

Oral status, sense of coherence, religious-spiritual coping, socio-economic characteristics, and quality of life in young patients.

BACKGROUND: Several factors can influence the oral health. AIM: To explore the clinical factors, individual characteristics, and environmental factors (religious-spiritual coping-RSC, sense of coherence [SOC], and socio-economic status) related to oral status and impact on oral health-related quality of life (OHRQoL) of children/adolescents (C/A). DESIGN: This study evaluated C/A up to 15 years old and their caregivers. Number of decayed (NDT) and missing teeth (NMT); history of dental trauma; caregiver's RSC and SOC, socio-economic factors, and OHRQoL were evaluated. Theoretical model exploring the direct and indirect effects was tested using a structural equation analysis. RESULTS: For younger group (0-6 years), having more NDT or more NMT had a greater impact on the OHRQoL (ß = 0.382, ß = 0.203, respectively). In the oldest group (7-15 years), a higher SOC had an inverse relationship with the impact on the family OHRQoL (ß=-0.201). The higher the age of the C/A, the lower the NDT (ß=-0.235), and the higher the family income the lower, the need for social benefit (ß = 0.275). Indirect relationships were observed between schooling with social benefit and OHRQoL in younger group. The family income indirectly influenced the OHRQoL in oldest group. CONCLUSIONS: Quality of life is affected directly and indirectly by environmental characteristics, oral status, and the age of patients.

Oral healthcare management of a child with phakomatosis pigmentovascularis associated with bilateral Sturge-Weber syndrome.

The aim of this report was to describe an approach for a child with phakomatosis pigmentovascularis Type IIb associated with bilateral Sturge-Weber syndrome and autistic spectrum disorder. A 6-year-old boy was referred to the Special Care Dental Clinic with the main complaints of "damaged teeth and pain." The physical examination revealed bilateral port-wine staining on the face, neck, and upper and lower limbs, congenital dermal melanocytosis on the back, and dilated blood vessels in the sclera. Intraoral examination revealed hypertrophy of the maxillary bone, diffuse and intense redness of the oral mucosa, crowding, anterior open bite, and carious lesions in the left and right upper second primary molars. The medical team was consulted prior to dental treatment to assess the risk of bleeding, and anesthesia was contraindicated. Instruction about brushing technique and procedures for a suitable oral environment were then carried out using a minimally invasive restorative treatment. The patient did not exhibit collaborative behavior, and follow up continues with the patient receiving preventive treatments. Therefore, a multidisciplinary approach to these patients is fundamental to avoid complications during dental intervention. Moreover, regular visits to the dentist reduce the need for invasive treatments and improve the well-being of these individuals.

Profiles of Trauma in Primary and Permanent Teeth of Children and Adolescents.

This retrospective study aimed to evaluate the dental trauma profile in primary and permanent teeth from patients between 0 and 15 years old who attended the Faculty of Dentistry of the Federal University of Rio de Janeiro. Data regarding gender, age, trauma classification, tooth type, and affected tissues were obtained from dental records. The data were analyzed descriptively and by the χ2 test (p < 0.05). Data associated with 333 traumatized teeth (70% primary and 30% permanent teeth) were included. The mean ages of children with affected primary and permanent teeth were 3.35 ± 2.02 and 9.09 ± 2.43 years, respectively. Males presented more permanent teeth with trauma (64.4%) than primary ones (55.6%; p = 0.085). The upper central incisors, both primary (68.9%) and permanent (69.4%), were the teeth most commonly affected. Primary teeth showed a higher frequency (p < 0.001) of supportive tissue trauma (73.3%) and lower frequency (p = 0.001) of hard tissue trauma (40.7%) than those in permanent ones (51.5% and 60.6%, respectively). The most frequent trauma in the supportive tissue was subluxation (27.2%) and permanent lateral luxation (42.0%). In the hard tissues, permanent teeth presented a higher prevalence of trauma than primary ones (p = 0.001), however this difference was not statistical significant when each type of fracture injury was evaluated individually (p > 0.005). With affected primary teeth, there was a greater frequency of trauma in the gingival mucosa (31.0%; p = 0.022); in the permanent ones, traumatic lesions in the chin region were the most prevalent (20.8%; p = 0.009). Trauma was recurrent in 26.3% of primary teeth and in 20.2% permanent teeth. Therefore, primary and permanent teeth showed distinct trauma profiles, suggesting that distinct preventive and therapeutic approaches are needed for these two groups.

Trauma in primary teeth and its effect on the development of permanent successors: a controlled study.

Objective: This controlled study investigated the occurrence of sequelae to permanent successors (SPS) following traumatic dental injury in primary teeth (TDIp). Additionally, this study evaluated whether TDIp is a risk factor for SPS, with a focus on an association between SPS and the child's age and type of trauma. Materials and methods: The trauma group (TG) consisted of permanent teeth, whose antecessors had suffered TDIp, in a population of children with complete eruption of permanent teeth. The control group (CG) consisted of permanent teeth from the same individuals, whose antecessors had not suffered TDIp. There were 214 cases of TDIp with their respective permanent teeth. In the CG 247 permanent teeth, whose antecessor had not suffered TDIp, were included. Data concerning such teeth and when TDIp occurred (in terms of the child's age) and types of SPS were collected. The chi-square test, regression logistic with generalized estimating equations (GEE) test, and risk analyses were applied to investigate the associations. Results: Overall, 29% of the permanent teeth in the TG presented SPS. This was compared to the development disturbances in the CG, which was 7%. The TG demonstrated the highest risk for SPS (OR, 5.388; p = .0001). The discolouration of enamel (37%) was the most common type of SPS found. SPS was more prone to occur in permanent teeth whose antecessors had been intruded (39%; p < .001). TDIp when the child was 1-year old was associated with SPS (p < .001). Moreover, children who had TDIp had a 4.1 times higher risk of presenting SPS. Conclusions: TDIp is a risk factor for the development of SPS. All types of TDIp caused SPS in this research. Additionally, the younger ages at the time of the injury and intrusions were related to SPS.

Impact of crown fracture treatment on oral health-related quality of life of children, adolescents, and their families: A prospective clinical study.

BACKGROUND: Enamel-dentin fracture causes impact on the oral health-related quality of life (OHRQoL) of children. AIM: To evaluate the impact of treatment of crown fracture involving enamel and dentin (CFED) in the permanent dentition on the OHRQoL of children and adolescents (C/As) and their families. DESIGN: This prospective clinical study included C/As between 8 and 14 years who presented anterior CFED treated thought direct composite resin restoration. Their parents/caregivers (P/Cs) were also invited to take part of the study. The quality of life was evaluated thought the Child Perceptions Questionnaires (CPQ8-10  and CPQ11-14 ), Parental-Caregiver Perceptions Questionnaire (P-CPQ), and Familiar Impact Scale (FIS), applied before and 3 months after the restorative procedure. T test for dependent samples and Wilcoxon test were applied(P < 0.05). RESULTS: Of 32 C/As included, 30 completed the study. The treatment of CFED reduced the negative impact in OHRQoL of C/As (CPQ8-10 P = 0.0065; CPQ11-14 P = 0.0486; P-CPQ, P = 0.0259), specially for "oral symptoms" (CPQ8-10 , P = 0.0003; P-CPQ, P = 0.0455) and "emotional well-being" (CPQ11-14 , P = 0.0431). Concerning the families' perceptions, the treatment did not influence OHRQoL both in terms of the domains and total FIS score (P > 0.05). CONCLUSION: Restorative treatment of CFED increases the OHRQoL of C/As but not influence the OHRQoL of their families.

Does trauma in the primary dentition cause sequelae in permanent successors? A systematic review.

This systematic review sought scientific evidence (in the literature) that trauma in the primary incisors cause sequelae in permanent successors. Also this work verified whether there was a relation between the presence and type of sequelae in permanent teeth with the child's age at the time of injury and type of trauma. Electronic databases, including the PubMed, Scopus, The Cochrane Library, LILACS, and Web of Science were used to search for original articles up to June 2013. Prospective and retrospective studies that assessed the association of trauma in deciduous incisors and developmental disturbances in permanent successors were selected. Two authors independently reviewed and extracted the data from the included studies. A methodological quality assessment evaluation of the selected studies was performed. The search retrieved 258 citations. Initially, 19 studies fulfilled the selection criteria; however, one (1) was excluded, leaving 18 for the final selection. Despite some limitations in the study designs were observed, especially the lack of a control group in most studies, the evidence found suggests that individuals with trauma in their primary incisors have more developmental disorders in the permanent successors than individuals without a previous trauma. Furthermore, the younger the child is at the time of injury, the more frequent and more severe are the sequelae to the permanent successor incisors. More severe traumas such as intrusion and avulsion are associated to more serious developmental disorders. These results should be analyzed carefully because very few studies evaluated had a control group.

Traumatismos dentários na dentição decídua e suas sequelas: estudo longitudinal e retrospectivo / Dental trauma in primary dentition and their sequelae on permanent successors: longitudinal and retrospective study

Os objetivos deste estudo foram estimar as prevalências das lesões nos tecidos moles, dos tipos de traumatismos nos dentes decíduos anteriores por faixa etária e das sequelas nos dentes decíduos traumatizados e em seus sucessores. Também se verificou a existência de associação entre as sequelas nos permanentes e os tipos de traumatismos nos antecessores, em relação a idade de crianças com 0-10 anos. Foram analisados 1230 prontuários de crianças, atendidas no Projeto de Extensão da Disciplina de Odontopediatria da Faculdade de Odontologia da Universidade do Estado do Rio de Janeiro (FOUERJ), no período de março de 1996 a dezembro de 2010. Os responsáveis assinaram o termo de Consentimento aprovado pelo Comitê do Hospital Universitário Pedro Ernesto (HUPE). As análises envolveram estatística descritiva e os testes χ2 e χ2 de Mantel-Haenszel. Foram selecionados 459 (37,3%) prontuários resultando em 764 dentes decíduos anteriores traumatizados. As lesões mais prevalentes dos tecidos moles foram as lacerações em gengiva (9,4%) seguidas pelas lacerações nos lábios (5,6%). A luxação intrusiva (27,8%) foi o tipo de traumatismo mais prevalente na faixa etária de 0-3 anos de idade (71,9%) seguida da avulsão (14,8%). As sequelas mais comuns nos decíduos foram a perda prematura (30,3%) e a alteração de cor do esmalte (26,9%). Nos sucessores, a alteração de cor (26,0%) e a hipoplasia de esmalte (24,5%) foram as sequelas mais prevalentes. O grupo de [0,1] ano de idade apresentou uma diferença significativa (p= 0,007) quando analisado isoladamente. Em uma segunda análise estatística houve diferença para a faixa etária de (5,10] (p=0,023). A laceração na gengiva foi o tipo de lesão mais prevalente. A luxação intrusiva foi o tipo de traumatismo mais prevalente na faixa etária de 0 a 3 anos. A perda prematura foi a sequela mais prevalente na dentição decídua enquanto na permanente predominou a alteração de cor. Houve associação na faixa etária de [0, 1] ano e a luxação intrusiva originou um maior número hipoplasia de esmalte. Também houve associação na faixa etária de (5-10] anos. A luxação intrusiva originou uma maior prevalência da alteração de erupção.

The goal of this study was to estimate the three-fold prevalence of: oral soft tissue lesions, dental trauma to anterior deciduous teeth in relation to the child's age, and sequelae to deciduous teeth and their successors. This research also investigated whether the sequelae in the permanent tooth had an association to the type of dental injury on their predecessor at the time of trauma occurrence in children with 0-10 years of age. Data was obtained from 1230 dental records and clinical exams from children aged 0-10 years at the period of March 1996 to December 2010 that attended the Extension Project in Dental Traumatology on Pedodontics from the University of FOUERJ whose legal guardians signed a consent form approved by the Ethics Committee of HUPE. This sample was constituted of 764 anterior traumatized deciduous teeth obtained from 459 (37.3%) dental records. Statistical analyses χ2 and Mantel-Haenszel's χ2 was performed. Gingival (9.4%) and lip laceration (5.6%) were the most prevalent oral soft tissue lesions. Intrusive luxation (27.8%) was the most frequent type of dental injury on 0-3 years old children followed by avulsion (14.8%). The most common sequelae to deciduous teeth were premature loss (30.3%) and enamel color alteration (26.9%). Succedaneums teeth presented enamel color alteration (26.0%) and enamel hipoplasia (24.5%) in most sequelae cases. The [0,1] year old group registered a statistical significance (P = 0.007) when analyzed separately. A second statistical analysis displayed a significant difference at the (5-10] year old group (P =0.023). Gingival laceration was the most prevalent lesion. Intrusive luxation was the most prevalent type of injury among the 0 to 3 year old children. Premature loss was the most prevalent sequelae in deciduous dentition while in the permanent one enamel color alteration prevailed. An association was detected at the [0-1] year old group and intrusive luxation lead to a great number of enamel hipoplasia. There was also a positive association at the (5-10] year old group. Intrusive luxation leaded to a higher prevalence of eruption alteration.