Avulsión dental y mantenedor de espacio estético-funcional y correctivo en Odontopediatría / Dental avulsion and esthetic-functional and corrective retainers use in Pediatric Dentistry / Avulsão dentária e mantenedor do espaço estético-funcional e corretivo em Odontopediatria

RESUMEN Se presentó el caso de un niño de 8 años que acudió al Servicio de Estomatología del Policlínico Universitario "Chiqui Gómez Lubián", de Santa Clara, provincia Villa Clara. En el mismo se observó avulsión del incisivo central superior derecho, fractura no complicada de la corona en incisivo central superior izquierdo y una marcada vestibuloversión. Se confeccionó un aparato placa Hawley de acuerdo a las características y necesidades del paciente, con el fin de lograr la recuperación estética, mantener la longitud del arco y corregir la vestibuloversión en el mismo. El aparato permitió obtener un resultado satisfactorio, que ha influido psicológicamente en el paciente al elevar su autoestima y salud bucal.

ABSTRACT A boy of 8 years old was seen in the dental service at the Policlínico Universitario "Chiqui Gómez Lubián", in Santa Clara, Villa Clara. Examination revealed avulsion in the right upper central incisor, uncomplicated crown fracture in left upper central incisor and an improper alignment of the teeth. Taking into account patients´ characteristics and requirements, it was fabricated a Hawley´s retainer in order to achieve a better aesthetic outcome, maintain the length of the dental arch and correct the improper alignment of the teeth. The appliance has achieved a satisfactory outcome, which has had a psychological influence on the patient by improving his self-esteem and oral health.

RESUMO Foi apresentado o caso de um menino de 8 anos que veio ao Serviço de Estomatologia do Policlínico Universitario "Chiqui Gómez Lubián", em Santa Clara, província de Villa Clara. Neste, observou-se avulsão do incisivo central superior direito, fratura não complicada da coroa em incisivo central superior esquerdo e vestibuloversão acentuada. Um dispositivo de placa de Hawley foi confeccionado de acordo com as características e necessidades do paciente, a fim de se obter recuperação estética, manter o comprimento do arco e corrigir a vestibuloversão nele. O dispositivo permitiu obter um resultado satisfatório, o que influenciou psicologicamente o paciente, elevando sua autoestima e saúde bucal.

Awareness of Parents About the Emergency Management of Avulsed Tooth in Eastern Province and Riyadh.

Objective: To assess the level of parents knowledge about the emergency management of tooth avulsion in Eastern Province and Riyadh. Methods: A cross-sectional study was carried out by means of a questionnaire-based internet survey in which 1201 parents from Eastern Province and Riyadh participated. The questionnaire contained 10 closed-ended questions and was used to assess the knowledge of parents about the emergency management of avulsed teeth in Eastern Province and Riyadh. Chi-square test was used for data analysis. Results: In response to closed-ended questions, the statistically significant result was obtained for the history of child dental trauma in which 35% (P=0.04) of parents reported history of dental trauma in their children. These parents were belong to Eastern province (51%) and Riyadh (49%). Furthermore, only 31.3% of the parents were aware of possible storage media for transportation of avulsed tooth while 68.7% (49.5% in Eastern Province and 50.5% in Riyadh) were unaware (P=0.02) of it. Conclusion: That the majority of the parents were unaware of emergency management for tooth avulsion in two densely populated regions of Saudi Arabia. Education of parents should be initiated at a national level.

What do polish parents know about dental trauma and its management in children's treatment? A questionnaire study.

OBJECTIVES: To evaluate the knowledge of Polish parents concerning traumatic dental injuries (TDIs) and their management in children and to assess the influence of TDI experience on parents' knowledge. METHODS: A questionnaire study conducted from May 2014 to February 2015 involved 741 randomly selected individual parents of children aged 1-17 receiving treatment at the Department of Pediatric Dentistry at the Medical University of Warsaw. The questionnaire consisted of 28 questions concerning TDI management. RESULTS: The study included 600 questionnaires subjected to statistical analysis using a χ2 independence test and Spearman's rank correlation (p < .05). Results show that 68% of parents have never received information about TDI management. As many as 80.5% were unaware of the possibility of immediate replantation of an avulsed tooth; over 60% would not be capable of choosing a suitable transport medium for such a tooth. Over 12% of TDI-experienced parents were unaware of a suitable transport medium for an avulsed tooth. Three times as many inexperienced parents as parents with TDI experience would place an avulsed tooth in saline solution. The independence test presented a strong correlation between parents' education and their knowledge about TDI management. As many as 80% of parents assessed their knowledge about TDI as inadequate. CONCLUSIONS: It appears necessary to introduce programmes for parents to raise their level of awareness concerning this topic.

Oral Health Knowledge of Pregnant Women on Pregnancy Gingivitis and Children's Oral Health.

OBJECTIVE: Pregnancy gingivitis and early childhood caries remain prevalent in Hong Kong. The aim of this study was to assess pregnant women's knowledge and beliefs related to pregnancy gingivitis and children's oral health. STUDY DESIGN: An outreach survey was carried out in a clinic that provided antenatal examination. A written oral health questionnaire related to pregnancy gingivitis and early childhood caries was administered to pregnant women. Of the 106 pregnant women who enrolled in the study, 100 completed the questionnaires. RESULTS: Among the 100 subjects, only 39% correctly identified that hormonal changes contribute to pregnancy gingivitis. Only 36% identified red and swollen gums as signs of gingivitis. Furthermore, 53% of the surveyed pregnant women were not sure about the amount of toothpaste to administer to a child aged 18 months to 5 years. Almost 50% assumed that a replanted avulsed tooth would probably not survive within a short extra-alveolar period of less than 60 minutes. CONCLUSION: Prenatal women generally lack knowledge of a common oral disease that occurs during pregnancy and of what constitutes adequate oral health care for children. Oral health care education should be implemented as part of a prenatal care program.

The impact of tooth avulsion on daily life performance using the Brazilian OIDP index in children and young adults.

INTRODUCTION: The evaluation of orofacial damage is an emerging branch in the forensic sciences, specifically in forensic odontology and medicine. One of the major limitations during the evaluation of forensic orofacial damages is establishing the consolidation date of acquired lesions. The consolidation date is defined as the moment from which orofacial damages are considered irreversible. AIM: To stress the relevance of knowing the consolidation date in children who underwent orofacial trauma, and to enhance forensic expertise on the evaluation of dentomaxillofacial damages. MATERIAL AND METHODS: Ninety-six patients, aged between 11 and 31 years old, treated at the dental clinics of the Federal University of Minas Gerais, Brazil, were selected for forensic orofacial evaluation. All the patients presented at least one traumatically avulsed tooth and a temporary partial denture. RESULTS: The mean age for the traumatic avulsion was 10,3 years old. The mean time for the placement of a prosthesis was 2,9 years after the initial consultation. The mean time for the use of prosthesis was 2,2 years. No significant differences were observed regarding orofacial damage outcomes between patients younger or older than 18 years of age. It was observed that patients using temporary removable partial dentures presented a 3,6-fold greater possibility of developing socially significant sequels if compared with patients using temporary fixed partial dentures. CONCLUSION: Knowing the consolidation date of orofacial damageenables the prediction of the potential development of social sequels in children and adolescents who isaster victim identification (DVI) is an intensive and demanding task involving specialists from various disciplines. The forensic dentist is one of the key persons who underwent traumatic dental avulsion.

Prehospital emergency management of avulsed permanent teeth: Knowledge and attitude of school teachers.

CONTEXT: Tooth avulsion is one of the most serious dental emergencies in children. Often these injuries occur in school and, therefore, the knowledge of school teachers regarding the appropriate measures to be taken immediately after tooth avulsion is crucial to good prognosis. AIMS: The purpose of the present study was to evaluate school teachers' knowledge and attitudes regarding immediate management of avulsed teeth in children. MATERIALS AND METHODS: A total of 177 teachers from seven schools of Garhshankar town, Hoshiarpur District, Punjab, India, formed the sample of the study. A self-administered questionnaire consisting of 16 questions was used to assess the knowledge and attitudes of school teachers about tooth avulsion and its management. STATISTICAL ANALYSIS: The chi-square test and one-way analysis of variance (ANOVA) were used for analysis. Pair-wise comparison was done using Tukey's honestly significant difference (HSD) test. P ≤ 0.05 was considered to be statistically significant. RESULTS: Markedly low knowledge levels were noted among the school teachers. The mean knowledge score was 5 (of a maximum possible score of 10). Only 0.6% of the teachers answered correctly that they would use milk as a transport medium. The number of correct responses was not affected by previous experience with tooth avulsion, sex, educational level, teaching experience, or teacher training. Overall, 85.9% of teachers showed a positive attitude towards this campaign. CONCLUSIONS: Knowledge regarding emergency management of dental trauma is poor amongst school teachers. Therefore, we suggest that orientation to management of avulsed tooth be part of the teacher training education.

Young people's perceptions of photographs of dental trauma.

BACKGROUND/AIM: Few studies have investigated how patients feel about traumatic injuries to teeth. Dentists may focus on treating an injury and neglect to address how the patient views the severity, or aesthetics. Addressing these issues may improve trauma management and communication between dentists and patients. The aim of the study was to compare children's, adolescents' and young adults' perceptions of common dental injuries to the maxillary central incisor teeth. MATERIALS AND METHODS: A cross-sectional study was conducted with 138 participants selected by convenience sampling and divided into 6- to 10-year, 11- to 17-year and 18- to 24-year age groups. Participants were shown six coloured photographs of traumatic injuries to central incisors and asked four questions. Data were analysed using SPSS. Group differences were evaluated using Mann-Whitney U and Kruskal-Wallis H tests. RESULTS AND CONCLUSIONS: There were statistically significant differences between the 6- to 10-year and 18- to 24-year age groups as to which traumatic injury would hurt the most (P < 0.05). Responses from younger participants appeared to be affected by the presence of blood in photographs, while young adults were more 'tooth-focused.' Younger children selected extrusion as the most painful injury, and the oldest group selected the complicated crown fracture. For the youngest age group, a missing anterior tooth was least concerning aesthetically, while young adults were most likely to choose discolouration (P < 0.05). Most in each age group thought crown fractures (particularly complicated ones) would be the most difficult for a dentist to treat. CONCLUSIONS: Statistically significant differences (P < 0.05) were found among the youngest and oldest age groups in their perceptions of which type of injury would hurt most and which injury was the least attractive. This study suggests that children and young adults may perceive the significance of their dental injuries quite differently than dental professionals.

Public school educator's knowledge of initial management of dental trauma.

OBJECTIVES: To compare the level of knowledge of physical education teachers/athletic coaches (PETs) and academic teachers (ATs) regarding dental trauma management. METHODS: Surveys were sent to all high schools (17) and all middle schools (23) in the Milwaukee public school system. All PETs and approximately 20 ATs at each school were invited to participate. The survey evaluated knowledge of dental trauma management via two case scenarios. RESULTS: Survey was completed by 140 ATs and 119 PETs. For the urgency of treatment for tooth fractures 81% of ATs and 53% of PETs responded correctly, a significant difference (P < .0001). With regards to avulsions, 56% of ATs and 46% of PETs responded that immediate professional assistance was needed. Only 7% of PETs would replant an avulsed tooth compared with 12% of ATs, a difference that was significant (P = .0062). Milk was chosen as a transportation medium for an avulsed tooth by 25% of ATs and 23% of PETs. CONCLUSIONS: Knowledge regarding the initial management of dental trauma was low for both groups. Educational campaigns regarding dental trauma should be targeted at all teachers.

Knowledge of the management of paediatric dental traumas by non-dental professionals in emergency rooms in South Araucanía, Temuco, Chile.

AIM: The objective of this study was to investigate the level of knowledge and attitudes regarding first aid for dental trauma in children (TDI) by non-dental professionals and paramedical technicians of hospital emergency rooms in the South Araucanía Health Service, Chile, which was attained through application of a survey. MATERIALS AND METHODS: Samples were collected from people with occupations in the respective emergency rooms. The participants were 82 people that were interviewed using a questionnaire regarding management of dental trauma. Paramedic technicians, general and specialist doctors, and nurses were included in this survey. The appraisal covered diverse aspects: birth date, age, sex, years of experience in the emergency room, and questions regarding specific dental trauma topics, which focused on crown fractures, luxation injuries in permanent dentition, avulsion in primary and permanent teeth, and the respective emergency treatments. RESULTS: Of the participants, 78.1% reported to have been presented with a TDI patient. The majority (90.2%) had not received formal training on TDI. These results revealed a wide distribution of responses. The overall dental trauma knowledge among the participants was relatively poor. For crown fractures management 54.9% indicated that they would ask the affected child about the crown remnants. In regard to transport and storage medium of avulsed permanent teeth, only 9.8% of the participants answered correctly and 43.9% of respondents stated that they would not replant an avulsed permanent tooth, since that procedure is considered the responsibility of a dentist. CONCLUSIONS: The majority of the respondents were not knowledgeable regarding TDI or the management and benefits of timely care, particularly in cases of avulsed permanent teeth. Therefore, formal education and training on the topic is suggested during undergraduate studies.

Evaluation of sixth grade primary schoolchildren's knowledge about avulsion and dental reimplantation.

Dental trauma, particularly tooth avulsion, is a frequent cause of tooth loss in children, adolescents, and young adults. The avulsed tooth should be immediately reimplanted in its alveolus. This procedure can be performed by anyone at the accident site and not only by dental surgeons. Therefore, the purpose of this study is to evaluate the knowledge of sixth graders of the city of Araçatuba, SP, about dental avulsion and tooth reimplantation through a structured and standardized survey. Our sample consisted of 778 students. The data collected was processed using the program EPIINFO 2000. Most students were around 12 years of age and 94.5% related to practice some kind of sports. Results demonstrated that the possibility of tooth reimplantation after dental avulsion is not acknowledged among these students and dental traumatism was associated to caries, toothache, and use of orthodontic appliances. Only 18.9% of the students associated dental traumatism to an impact trauma; 3.6% would store the tooth in milk, and 3.1% believed the tooth could be reimplanted by anyone present at the accident site. In summary, the results show an overall the lack of knowledge about dental traumatism and highlight the need of special programs designed to educate school-aged students about emergency procedures to handle cases of dental traumatisms.

Dental injuries in mountain biking--a survey in Switzerland, Austria, Germany and Italy.

Mountain biking is considered an extreme sport, causing not only head and neck injuries, but also injuries to every part of the body. Using standardised interview, the aim of this work was to survey the frequency of dental injuries in mountain biking, as well as the behaviour of athletes after experiencing dental trauma, depending on their intensity level. Furthermore, habits of wearing helmets and mouthguards as well as knowledge about the tooth rescue kit were investigated. A total of 423 male mountain bikers from Germany, Italy, Austria and Switzerland were surveyed for this study, including 50 juniors from Switzerland. 27 athletes (5.7%) had endured tooth accidents in mountain biking. Only 246 (52%) were aware of the fact that avulsed teeth can be replanted, and only 30 individuals knew about the tooth rescue kit (6.3%). 71.9% (n=340) were familiar with mouthguards; however, only 21 individuals (4.4%) used mouthguards while mountain biking. The results show that where mountain biking is concerned, more information about prevention is required.

Attitude of Pilsen primary school teachers in dental traumas.

Dental injuries are rather common during sport activities and at schools where children spend most of their time every day. The purpose of this study was to evaluate the knowledge of primary school teachers in Pilsen, Czech Republic, of how to provide first aid in cases of one of the most serious dental injuries, the tooth avulsion. To this end, a questionnaire which contained nine questions about avulsion of permanent teeth was prepared. The questionnaires were distributed in nine primary schools in Pilsen where almost 300 teachers are employed. Seventy-four percent of the teachers replied. Sixty-eight percent had never received any information about providing first aid in cases of dental injuries and 81% would place the avulsed tooth in a dry handkerchief until the transfer of the patient to dentist. Prevention of tooth injuries is very important, as they may result even in tooth loss. This demands an effort to properly inform and educate sport trainers and primary school teachers about providing first aid in dental trauma situations; this effort should be intensive and continuous.

Dental avulsion: therapeutic protocols and oral health-related quality of life.

AIM: The aim of this study is to describe oral health-related quality of life (OHRQoL) among patients who have had a complete dislocation of the tooth out of its socket (tooth avulsion). The study also sought to identify clinical evidence, associated with OHRQoL, of the ideal therapeutic choice after tooth avulsion among these patients under 18 years old. STUDY DESIGN: 73 patients under 18 year old were selected between 101 studied; they received different treatments, after one year adverse impacts on OHRQoL were measured using the 14-item OHIP. RESULTS: Our findings show that if patients got into tooth avulsion their quality of life is adversely affected. In this study, 21.2% of subjects reported 1 or more of the 14 OHIP items during the preceding 12 months, which is significantly high. In group A just 4% of subjects reported 1 or more of the 14 OHIP items, while in the other groups the percentage rose, reaching 50% in group F. Group C D G reported a value of 20%, while in group E this is 12%. CONCLUSION This study shows how different treatment options have different effects on quality of life; the ideal one is the immediate replantation, when this is not possible, RPD or functional appliance seem to be the best choice.

Knowledge and attitude of mothers with regards to emergency management of dental avulsion.

UNLABELLED: Traumatic injuries to the teeth and their supporting structures are frequent in children. Among the traumatic injuries, dental avulsion results in the major functional and esthetic disturbances for patients. PURPOSE: The present study's aim was to assess the mothers' level of knowledge and attitude concerning dental avulsion. METHODS: A questionnaire contained 6 objective questions for the assessment of the mothers' knowledge and attitude regarding the management of dental avulsion and emergency procedures. RESULTS: A total of 242 mothers participated in the study. A lack of technical information was observed among the mothers. CONCLUSION: This study showed the need of a more effective communication between dental professionals and mothers to better handle dental emergencies. Educational campaigns and preventive programs on dental trauma must be organized to improve the emergency management of dental avulsion.

Knowledge of Jordanian mothers with regards to emergency management of dental trauma.

Studies in Jordan indicated that delay in seeking emergency management of dental trauma leads to unfavorable outcome of even mild forms of trauma. The purpose of this cross-sectional study was to assess, by means of a structured questionnaire, the level of general knowledge of mothers in Jordan with regards to the immediate emergency management of dental trauma, and its relation to socioeconomic variables. The questionnaire surveyed mothers' demographic data, basic knowledge of immediate management of tooth fracture, avulsion, and loss of consciousness. It also investigated the participants self assessed knowledge, attitude to public education, and knowledge of availability and priority of emergency services for trauma in Jordan. The sample consisted of 2215 mothers who attended mother and child care centers in the capital Amman, and in Irbid (the second largest city in Jordan) over a period of 3 months (July to September, 2003). Overall the participants' basic knowledge with regards to the emergency management of the trauma cases presented in the questionnaire was deficient regardless of age, level of education, socioeconomic class, or number of previous encounters with dental trauma. Generally, the attitude to public education on the topic was positive and chi-square test indicated that the level of education of mothers positively affected their knowledge of 'during working hour' emergency services and the importance of immediate management of dental trauma. Educational programs that can be added to the mother and child care advice protocols may help improve the knowledge and awareness of mothers and therefore improve the outcomes of dental trauma.

Knowledge and attitude of 2,000 parents (urban and rural - 1,000 each) with regard to avulsed permanent incisors and their emergency management, in and around Davangere.

It is well recognized today that for long-term success, the management of traumatized teeth optimally should be carried out as soon as possible. Since, majority of traumatic injuries occur at home, the ultimate prognosis of an avulsed tooth may depend on knowledge of the treatment procedure, possessed by his or her parents. The purpose of this study was therefore to evaluate the parental knowledge and attitude regarding the emergency management of avulsed teeth in children (in Davangere--both urban and rural, 1,000 each).

Socio-economic burden of permanent incisor replantation on children and parents.

This study describes the socio-economic burden and attitudes of children and their parents following replantation of avulsed incisors. Records of 80 patients with 99 avulsion injuries treated in a teaching hospital clinic from 1988 to 1999 were reviewed. Mean age at time of injury was 10.6 years (range = 6.6-17.7 years). Complete records for a minimum of 1 year were obtained for 43 patients with 60 replanted incisors. Mean treatment procedures provided during the first year included 5.5 diagnostic periapical radiographs, 1.9 occlusal radiographs, 1.3 pulpectomies, and 2.7 pulp medicament applications. The mean estimated treatment cost and direct time (dentist) for first-year post-trauma management was 1465 dollars CAD and 7.2 h, respectively. Treatment costs were significantly higher during the first year post-trauma for patients who had their incisors extracted (P = 0.04), but there was no significant difference in direct treatment time between the two groups (P = 0.19). Twenty-one patient-parent pairs were surveyed for a number of qualitative factors. Ninety per cent of patients and 86% of parents reported that school and work time was lost. Even after having gone through the painful experience of replantation, the demands of recall, and in some cases, extraction, the majority of patients (67%) and parents (81%) stated that they would have still made the same (replantation) decision. Patient and parent responses were not statistically different (P = 0.453). Almost half the parents stated they would be willing to pay over 2000 dollars CAD to save an incisor. Patients rated retention of an incisor as significantly more important than infraocclusion. This is the first study to quantify the treatment burden of replantation of avulsion injuries exclusively in the pediatric population. This study describes the socio-economic burden and responsibilities of patient/parent and dentist and their role in informed consent.

[Replacement of deciduous incisors in children: psychological aspects]. / Remplacement des incisives temporaires chez l'enfant: intérêt psychologique.

The absence of the temporary incisors could be to a genetic illness or to some multiple premature extractions. These extractions are the aftermaths of the carious lesions or some traumatisms underwent by the temporary incisors. Beyond measure the loss of the space, the premature loss some temporary incisors very often assign the relational development of the child and disturb its psychological development and the aesthetic function. Across some cases clinics, the authors show that the replacement of the temporary incisors is the therapeutic ideal solution. Indeed, the child prosthesis, replacing the temporary absent incisors, solves the psychological, aesthetic and relational problems of the child.

Alteraçöes no comportamento infantil decorrente da perda de dentes anteriores: relato de caso / Disturbance in the child behavior from the loss of anterior teeth: case report

A estética no contexto psicossocial possui relaçäo direta com auto-imagem e auto-estima, influindo no desenvolvimento emocional da criança. A perda precoce de dentes decíduos, com subsequênte comprometimento estético, pode induzir alteraçöes comportamentais e reperecussöes no ajustamento social, fatores estes que devem ser considerados no planejamento do tratamento. Portanto, sob este enfoque, razöes estéticas justificam a reabilitaçäo bucal precoce na criança. Os autores relatam um caso de traumatismo dentário compreendendo diferentes tipos de luxaçöes nos incisivos superiores decíduos, abordando os aspectos funcionais, psicológicos e a instalaçäo de aparelho mantenedor de espaço fixo estético

Rehabilitation of a patient with severe dentoalveolar injuries: a case report with a 10-year follow-up.

This clinical report describes the emotional and physical rehabilitation of a young man. The impact of the injuries sustained and repeated failure of traditional dental treatment methods had caused the patient to become quite withdrawn. A successful outcome followed surgical placement of multiple titanium plasma-sprayed cylindrical fixtures in severely damaged dental supporting tissues to serve as intermediary abutments for complex maxillary and mandibular fixed prostheses. The loss of crestal bone during the postprosthetic years is determined. The advantages only implant dentistry could bring are identified.