The impact of crown fracture in the permanent dentition on children's quality of life.

BACKGROUND/AIM: Among the diseases related to oral health, traumatic dental injuries (TDI) can lead to pain, loss of function and aesthetic problems, with physical, emotional and social consequences for children and their families. The aim of this study was to investigate the relationship between enamel fracture and enamel-dentin fracture with oral health-related quality of life (OHRQoL). MATERIAL AND METHODS: This cross-sectional study had a representative sample of 1589 children between 8-10 years of age from public schools. The OHRQoL was obtained through the Child Perceptions Questionnaire (CPQ8-10 ), which is a questionnaire validated for Brazilian children. Clinical data were collected by 4 calibrated examiners (Kappa > 0.7) using the Decay, Missing, Filled Teeth (DMFT) Index, Dental Aesthetic Index (DAI) and TDI. A socio-economic questionnaire was sent to the caregivers to be answered at home. Descriptive statistics and Poisson regression with prevalence ratio (PR) and 95% confidence interval (CI) were used for statistical analysis. RESULTS: The prevalence of TDI was 10.6%, and among these 10.3% who had an impact on the OHRQoL, it was due to enamel-dentin fracture. Children with enamel-dentin fracture had (PR 1.35; 95% CI 1.07-1.70) higher prevalence of impact on the OHRQoL. Children with enamel fracture had no impact on the OHRQoL (P = .254). CONCLUSION: Enamel fracture had no significant impact on children's quality of life, while enamel-dentin fracture did have an impact on quality of life.

Effect of dark discolouration and enamel/dentine fracture on the oral health-related quality of life of pre-schoolers.

AIM: To determine the effect of different types of dental trauma on oral health-related quality of life (OHRQoL) among pre-school children. METHODS: Four hundred fifty-nine Brazilian pre-schoolers aged 3-5 years were submitted to an oral examination in the school environment for the evaluation of dental trauma using the criteria proposed by Andreasen et al. (2007). Parents answered a questionnaire on the OHRQoL of the children using the Early Childhood Oral Health Impact Scale (ECOHIS) and another one on socio-demographic characteristics of the children and their families. The questionnaires were sent to the parents to be answered at home. Descriptive statistics, Mann-Whitney test and Poisson regression were used for statistical analysis. RESULTS: Children with dark discolouration and enamel-dentine fracture without pulp exposure had higher mean ECOHIS scores than those without these alterations. The multivariate regression analysis demonstrated that pre-school children with dark discolouration (PR 1.79; 95% CI 1.24-2.58) and enamel-dentine fracture without pulp exposure (PR 1.89; 95% CI 1.22-2.92) had a higher impact on quality of life than those without these alterations. CONCLUSION: Dark discolouration and enamel-dentine fracture without pulp exposure were associated with a negative impact on the life of pre-schoolers.

Malocclusion and related quality of life among 13- to 19-year-old students in Mysore City - a cross-sectional study.

PURPOSE: To assess malocclusion and related quality of life among 13- to 19-year-old students in Mysore City. MATERIALS AND METHODS: A total of 900 students aged 13-19 years selected based on multistage stratified random sampling were included in this cross-sectional study. A pre-designed format was used to record the sociodemographic details, oral hygiene practices, personal habits, malocclusion and oral health related quality of life. Malocclusion was assessed using Dental Aesthetic Index (DAI ) and quality of life using Oral Health Impact Profile-14 (OHIP-14). Further, the association between malocclusion and related quality of life was assessed. RESULTS: Normal or slight malocclusion was seen in 79.2% (n = 713). Definite malocclusion was seen in 12.8%, severe malocclusion in 5.7% and handicapping malocclusion in 2.3% of the subjects. The overall prevalence of malocclusion was found to be 20.8%. Out of the 900 study subjects 46.6% (n = 419) reported that malocclusion had some impact on their oral health related quality of life. The results of logistic regression demonstrated that those with malocclusion experienced a significant impact on quality of life (OR = 16.07, CI = 9.17-28.17). CONCLUSION: Malocclusion has an impact on the oral health related quality of life among 13- to 19-year-old students in Mysore City.

Prevalence of persistent pain 3 to 5 years post primary root canal therapy and its impact on oral health-related quality of life: PEARL Network findings.

INTRODUCTION: The frequency of persistent pain 3-5 years after primary root canal therapy and its impact on the patient's perceived oral health-related quality of life was determined in a practice-based research network. METHODS: All patients presenting to participating network practices who received primary root canal therapy and restoration for a permanent tooth 3-5 years previously were invited to enroll. Persistent pain was defined as pain occurring spontaneously or elicited by percussion, palpation, or biting. The patient also completed an oral health-related quality of life questionnaire (Oral Health Impact Profile-14). RESULTS: Sixty-four network practices enrolled 1323 patients; 13 were ineligible, 12 did not receive a final restoration, and 41 were extracted, leaving 1257 for analysis. The average time to follow-up was 3.9 ± 0.6 years. Five percent (63/1257) of the patients reported persistent pain, whereas 24 of 63 (38%) exhibited periapical pathosis and/or root fracture (odontogenic pain). No obvious odontogenic cause for persistent pain was found for 39 of 63 (62%). Teeth treated by specialists had a greater frequency of persistent pain than teeth treated by generalists (9.3% vs 3.0%, respectively; P < .0001). Sex, age, tooth type, type of dentist, and arch were not found to be associated with nonodontogenic persistent pain; however, ethnicity and a preoperative diagnosis of pulpitis without periapical pathosis were. Patients reporting pain with percussion tended to experience pain with other stimuli that negatively impacted quality of life including oral function and psychological discomfort and disability. CONCLUSIONS: These results suggest that a small percentage (3.1%) of patients experience persistent pain not attributable to odontogenic causes 3-5 years after primary root canal therapy that may adversely impact their quality of life.

Traumatic dental injury with treatment needs negatively affects the quality of life of Brazilian schoolchildren.

BACKGROUND: Traumatic dental injury (TDI) has been considered a significant problem in youth, not only because of its consequences to the craniofacial structures but also for its potential impact on the quality of life of affected individuals. AIM: The aim of this study was to investigate the impact of TDI with treatment needs on the oral health-related quality of life (OHRQoL) of South Brazilian schoolchildren. DESIGN: A cross-sectional study was performed in Porto Alegre, Brazil, using a multistage probability sampling strategy. Of 1837 eligible 12-year-old schoolchildren attending public and private schools, 1528 were examined. OHRQoL was assessed by the Brazilian version of the Child Perceptions Questionnaire for 11-to 14-year-old children (CPQ11-14) - 16-item short form. Clinical examination was conducted to assess the presence of TDI in permanent incisors (Children's Dental Health Survey criteria), malocclusion, and dental caries. Parents/legal guardians answered questions on socioeconomic status. Statistical analyses were performed using Poisson regression models. RESULTS: The overall CPQ11-14 score was not associated with TDI. In the functional limitations domain, individuals presenting TDIs with treatment needs experienced significantly higher mean CPQ11-14 than individuals with no TDI or without treatment needs (RR = 1.21; 95% CI = 1.05-1.39), after adjusting for malocclusion, dental caries, gender, and socioeconomic status. No other domains were associated with TDI. CONCLUSIONS: This study revealed that TDI with treatment needs negatively affects the OHRQoL in this population of 12-year-old schoolchildren and that this impact is related to oral functions.

Impact of oral conditions on the quality of life of secondary schoolchildren in Nigeria.

PURPOSE: Oral health problems have been increasingly recognized as important factors causing a negative impact on daily performance and quality of life. The purpose of this study was to assess the impact of tooth extraction with no replacement, untreated fractured anterior teeth, malocclusion, dental restorations, and orthodontic braces on the quality of life in Nigerian schoolchildren. METHODS: A total of 197 9- to 17-year-old schoolchildren completed the Oral Health Impact Profile (OHIP) index/questionnaire. RESULTS: Students who had tooth extraction with no replacement and untreated fractured incisors had significantly higher mean OHIP scores for functional limitations, physical pain, psychological discomfort, physical, psychological, and social disabilities, and handicaps (P<.001) when compared to other groups and the control. The mean OHIP scores of students with features of malocclusion were significantly higher for functional limitations, psychological discomfort, and psychological disability compared to the control group (P<.001). CONCLUSIONS: Untreated dental problems had some negative impact on the quality of life on the 7 subscales of the OHIP.

Perceptions of dental esthetics among older African Americans.

Older adults have greater potential for issues with the appearance of their teeth than other age groups. Conditions including missing teeth, fractured or missing restorations, and excessive tooth wear are common and may potentially affect individuals' perceptions of their dental esthetics. These perceptions about dental conditions may be significant because previous research suggests that they may impact elders' quality of life. The purpose of this study was to investigate the esthetic ranking of specific dental conditions by a population of African American elderly, utilizing methods similar to those of an earlier study of older Caucasians. These methods were designed to determine whether specific oral/facial and dental conditions were associated with similar perceptions of esthetics in a series of computer-adjusted images regardless of gender or any other facial characteristics. Our results suggest that, among the conditions studied, perceptions of dental esthetics of elderly African Americans were similar to those of Caucasians.

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.

Impact of traumatic dental injuries with unmet treatment need on daily life among Albanian adolescents: a case-control study.

BACKGROUND: Traumatic dental injuries (TDI) are common in children and adolescences. Neglected or inadequate treatment may lead to psychosocial distress during late adolescence. AIM: To investigate the potential impact of traumatic dental injuries (TDI) with unmet treatment need, on the quality of life of 16-19 year-olds in Tirana, Albania. MATERIAL AND METHODS: A case-control survey (1:2) was conducted in public high schools in Albania, comprising 95 subjects affected by TDI with unmet treatment need based on objective clinical signs. Controls (n = 190) with no history of TDI were matched by age, sex and belonging to the same school class and group of friends as the respective case. The Oral Impact on Daily Performances (OIDP) index was used to measure the impacts. DMFT, Community Periodontal Index and the Aesthetic Component of the Index of Orthodontic Treatment Need as well as social parameters were recorded. RESULTS: The response rate was 98%. Overall, the impact prevalence of OIDP was 88.4% among the cases, and 58.9% among the controls (P < 0.001). The most prevalent OIDP impact was 'smiling and showing teeth without embarrassment': cases had significantly higher values than controls (78.9% vs 31.6%). Multiple conditional logistic regression analysis was used to disclose the effect of TDI with unmet treatment need on quality of life by adjusting for possible confounders. Compared to the control group, TDI cases with unmet treatment need are at greater overall risk of impacts measured as OIDP, with an odds ratio of 3.9 (95% CI: 1.6-9.1). CONCLUSION: TDI with unmet treatment need in this sample of adolescents is associated with reduced OHRQoL. Compared to adolescents with no history of TDI, those affected by TDI with unmet treatment need are at greater risk of suffering impacts on OHRQoL in the form of OIDP.

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.

Patients' ranking of interdental "black triangles" against other common aesthetic problems.

The purpose of this study is to assess patients' aesthetic perceptions of interdental "black triangles", both in terms of the number of triangles visible and their severity; and to ascertain how patients rank the presence of "black triangles" against other aesthetic problems. It is based on a questionnaire of 80 randomly selected individuals who were asked to rate the aesthetics of digitally-manipulated images. Patients'perceptions of interdental "black triangles" were compared with their perceptions of other 'non-aesthetic' features. Interdental "black triangles" were rated as the third most disliked aesthetic problem below caries and crown margins. This study demonstrates the importance of interdental "black triangles" to patients, and therefore, as they can occur during prosthetic treatment, must be discussed with patients prior to commencing therapy.

The impact of treatment of dental trauma on the quality of life of adolescents - a case-control study in southern Brazil.

The aim of this study was to investigate the impact of treatment for Enamel-Dentin Fracture (EDF) on the daily activities of adolescents. This was a case-control study (1:4). The case group was composed of 40 adolescents from 11 to 17 years of age, presenting definitive restoration treatment for EDF for over 6 months. The control group was made up of 160 adolescents with no history of dental trauma and belonging to the circle of friends of the participants of the case group, matched by gender, age, and socioeconomic level. The outcome variable 'impact' was assessed through the Oral Impact on Daily Performances (OIDP). The independent variables were collected for being of interest to the study (dental trauma) or for acting as potential confounding factors (malocclusion, decay, and mother's education). Descriptive, univariate, simple and multiple logistic regression analyses were performed. Among the cases, the impact prevalence was 40.0%, whereas among the controls it was 16.9%. The more affected daily activities were showing the teeth (18.0%), eating (6.5%), speaking (2.0%), and cleaning the mouth (0.5%). The odds ratio of adolescents treated for EDF of presenting an impact on daily activities was 3.3 times (confidence interval 95%: 1.4-7.7) greater than among adolescents without dental trauma, controlling for mother's education, decay and the presence of malocclusion. Adolescents whose teeth have been esthetically treated for EDFs run a greater risk of presenting OIDP when compared to adolescents that have never suffered dental injuries.

The relevance of oral health for attenders and non-attenders: a qualitative study.

BACKGROUND: Low expectations of health mean that oral health becomes a low priority for some people, an appreciation of which would help dentists when a non-attender does come to the surgery. OBJECTIVE: To provide an insight into why oral health is not important to some people and how this attitude might hinder access to dental care. METHOD: In this qualitative study, purposive sampling was used to recruit two groups of participants with sociably visible missing, decayed or broken teeth but apparently differing responses to that status. The data analysis used social systems theory as operationalised by grounded theory techniques. RESULTS: The core category that emerged from the data was that people constructed their own 'margins of the relevance' of oral health. For some people oral health was highly relevant whilst for others it was not very relevant. The degree of relevance of oral health was organised along seven dimensions: the perceived 'normal' state of oral health, the perceived causes of oral health and disease, the degree of trust held in dentistry, perceptions of oral 'health' as a commodity, perceptions of the accessibility of oral health care, perceptions of 'natural' oral health and judgements of character. CONCLUSIONS: If certain aspects of oral health are not relevant, little that is said about those aspects will be meaningful to people. The key is to either emphasize or gently challenge those ideas and beliefs that allow or hinder the margins of relevance.

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.

Impact of traumatic injuries to the permanent teeth on the oral health-related quality of life in 12-14-year-old children.

BACKGROUND/AIM: There are no data on the impacts on daily living of traumatic injuries to the permanent teeth. The aim of the present study was to assess the socio-dental impacts of untreated fractured anterior teeth in Brazilian schoolchildren. METHODS: A population-based matched case-control study was used and a 2 : 1 control-to-case ratio was adopted. The cases were 68 children 12-14 years old, having non-restored teeth, with fracture involving dentine. The controls were 136 children without any traumatic dental injury. They were matched by age, sex and socio-economic status. The Oral Impact on Daily Performances (OIDP) index was used to measure the impacts. RESULTS: The response rate was 100%. Results of conditional logistic regression showed that children with fractured teeth were 20 times (95% CI = 2.2-45.6) more likely to report any impact on their daily living than children with no traumatic dental injury. These results remained statistically significant for the items of the OIDP separately, 'smiling' (P < 0.001), 'maintaining emotional state' (P < 0.001), 'eating' (P < 0.01), 'enjoying contact with people' (P < 0.01) and the overall OIDP (P < 0.001), after adjusting for confounding variables such as the Aesthetic Component of the Index of Orthodontic Treatment Need and DMFT index in a multiple conditional logistic regression. CONCLUSIONS: Children with untreated dental fracture of permanent teeth had more impacts on their daily living than children without any traumatic injury.

Patient and parental awareness of the importance of immediate management of traumatised teeth.

The purpose of this study was to assess patient and parental awareness of the importance of immediate management of traumatised teeth. A three-part questionnaire comprising questions on demographic data, attitude and knowledge was distributed to patients or accompanying parents who presented to the principal author for treatment in an 8-week period. One hundred and fifty-seven respondents with a mean age of 31.1 years participated in the study. Only 30% of the respondents recalled having had previous experience of dental trauma. The majority of the respondents, especially those with a higher educational background, had a positive attitude, expressing enthusiasm for public education on emergency management of dental trauma (85%). The availability of an emergency service during office hours was known by 71% of the respondents while only 26% were aware of the after-office-hour emergency service. Participants generally had a better concept of management of avulsed teeth (63%) compared to that of fractured teeth (35%). Knowledge on some critical aspects of the handling of avulsed teeth was poor (6%). Using multiple logistic regression analysis, it was found that the respondents' attitude tended to be influenced by their educational background (P = 0.08). In addition, subjects with higher education were more knowledgeable regarding the emergency service available during office hours (P = 0.05) and the concept of management of fractured teeth (P = 0.02). Educational background appeared to influence the level of awareness of the importance of immediate management of traumatised teeth.

Facial attractiveness and the aged.

This study examined the relationship between dentofacial appearance and judgments of facial attractiveness in a sample of 60 subjects between ages 65 and 75. Subjects completed questionnaires regarding their current dental appearance and level of satisfaction with their facial attractiveness. Subjects then viewed and ranked four sets of five photographs that had been digitally manipulated to simulate common dental defects. Regardless of background facial attractiveness or gender of stimulus photographs, a specific ranking order for dental defects emerged with rank-order correlations in the 90% range. Findings suggest that dental appearance affects judgments of facial attractiveness regardless of gender or background facial attractiveness.

A retrospective evaluation of patients with uncomplicated crown fractures and luxation injuries.

This paper is a review of the clinical findings from my thesis "Pulp survival and hard tissue formation subsequent to dental trauma". Traumatic injuries in children and adolescents are a common problem, and the prevalence of such injuries has increased over the last 10-20 years. The purpose of the present investigations was to evaluate the long-term results following uncomplicated crown fractures and luxations involving subsequent pulp canal obliteration. A total of 241 patients with 545 injured teeth were available for clinical examination, of whom 102 answered a questionnaire and were interviewed before oral examination. In addition, 82 permanent incisors presenting with pulp canal obliteration were followed for a period of 7 to 22 years (mean 16 years). The findings showed little pulpal response to crown fracture and subsequent restorative procedures as long as there was no concomitant periodontal injury (15-year follow-up). Approximately every fourth resin composite filling was rated as unacceptable at clinical examination. The interview showed that half of the individuals were dissatisfied with the color and/or anatomic form of the composite restoration. Pulp canal obliteration was found in all luxation categories, and 69% of the teeth demonstrated yellow crown discoloration. According to the survival curve the 20-year pulp survival rate diagnosed radiographically was 84%. Although the risk of pulp necrosis increased with time, routine endodontic intervention of teeth with ongoing pulp canal obliteration of the root canal did not seem justified.