Impact of case complexity on paediatric dentists' ability to radiographically diagnose traumatic dental injuries.

BACKGROUND/AIMS: Being able to correctly interpret radiographs after a traumatic dental injury is an essential skill for providing appropriate and timely treatment. The aim of this study was to assess the impact of case complexity on paediatric dentists' performance when radiographically diagnosing traumatic dental injuries (TDI) and to investigate a possible added value of cone-beam computed tomography (CBCT) when compared with digital intra-oral radiography (2D vs 3D). MATERIALS AND METHODS: A test panel of paediatric dentists was instructed to detect, identify and interpret radiographic findings using either 2D or 3D images. Intra-oral radiographs and CBCT images of 20 trauma cases were presented in random order, and the findings were recorded using structured scoring sheets. Case complexity was determined by two experienced benchmark scorers. Results were analysed using generalized linear mixed modelling. RESULTS: In general, performance for detection, identification and interpretation of findings was low, both with 2D and 3D images, with significantly lower values for difficult cases (p < 0.05). For easy as well as for difficult cases, 3D imaging resulted in a significantly better performance for detection and identification of findings (P < 0.001). This was not the case for correct interpretation, where significantly poorer performance was seen when using 3D images for difficult cases (p < 0.05). CONCLUSION: This study provides evidence that case complexity of traumatic dental injuries influences diagnostic performance. The use of CBCT enhanced detection and identification of findings but when case complexity increased, 3D imaging adversely affected correct interpretation.

Does clinical experience with dental traumatology impact 2D and 3D radiodiagnostic performance in paediatric dentists? An exploratory study.

BACKGROUND: The aim of this study is to evaluate the impact of experience with traumatic dental injuries (TDI) on paediatric dentists' performance and self-assessed confidence when radiodiagnosing traumatic dental injuries (TDI) and to explore whether this is influenced by the imaging technique used (2D versus 3D). MATERIALS AND METHODS: Both 2D and 3D radiological images of young anterior permanent teeth having experienced dental trauma were assessed randomly by a panel of paediatric dentists using structured scoring sheets. The impact of level of experience with dental traumatology on radiological detection, identification and interpretation of lesions and on observer's self-assessed confidence was evaluated. Findings were compared to benchmark data deriving from expert consensus of an experienced paediatric endodontologist and dentomaxillofacial radiologist. Results were analysed using generalized linear mixed modelling. RESULTS: Overall, observers performed moderately to poor, irrespective of their level of TDI experience and imaging modality used. No proof could be yielded that paediatric dentists with high TDI experience performed better than those with low experience, for any of the outcomes and irrespective of the imaging modality used. When comparing the use of 3D images with 2D images, significantly higher sensitivities for the detection and correct identification of anomalies were observed in the low experienced group (P < 0.05). This was not the case regarding interpretation of the findings. Self-assessed confidence was significantly higher in more experienced dentists, both when using 2D and 3D images (P < 0.05). CONCLUSION: There was no proof that paediatric dentist's higher experience with TDI is associated with better radiodiagnostic performance. Neither could it be proven that the use of Cone Beam Computed Tomography (CBCT) contributes to an improved interpretation of findings, for any experience level. More experienced dentists feel more confident, irrespective of the imaging modality used, but this does not correlate with improved performance. The overall poor performance in image interpretation highlights the importance of teaching and training in both dental radiology and dental traumatology.

Dental Trauma on whole Body Trauma CT-An underreported finding.

BACKGROUND: The prevalence of dental injuries (DI) in polytrauma patients is unknown. The purpose of our study was to identify the frequency of dental injuries on whole body CTs acquired in a trauma setting and to estimate how often they are correctly reported by the radiologist. METHODS: In the time period between 2006 and 2018 the radiological database of one university hospital was screened for whole-body trauma CTs. A total of 994 CTs were identified and re-evaluated. RESULTS: Dental injuries were identified in 127 patients (12.8% of patients). There were 27 women (21.3%) and 100 men (78.7%) with a mean age of 51.0 ± 18.9 years (range 10-96 years). Regarding localization, most findings involved the molars (n = 107, 37.4%), followed by the incisors (n = 81, 28.3%), premolars (n = 59, 20.6%) and canines (n = 39, 13.7%). Most common findings were as follows: luxations (n = 49, 45.8%), followed by crown fractures (n = 46, 43%), root fractures (n = 10, 9.3%), extrusions (n = 1, 0.9%), and intrusions (n = 1, 0.9%). Only 15 findings (11.8% of all patients with dental injuries) were described in the original radiological reports. CONCLUSION: DI had a high occurrence in polytrauma patients. A high frequency of underreported dental trauma findings was identified. Radiologists reporting whole-body trauma CT should be aware of possible dental trauma to report the findings adequately.

Avulsão de dentes permanentes e seu manejo: conhecimento de estudantesde Odontologia, Medicina e Enfermagem / Avulsion of permanent teeth and their management: knowledge of students of Dentistry, Medicine and Nursing students

O objetivo do presente estudo foi avaliar o conhecimento de estudantesdos cursos da área da saúde (Odontologia, Medicina e Enfermagem) de uma instituição pública de ensino superior sobre avulsão de dentes permanentes, bem como sobre as condutas de urgência a serem tomadas frente à lesão. Foram coletadas informações, por meio de um questionário estruturado autoaplicável, sobre dados pessoais, experiências anteriores, conhecimento sobre avulsão dentária e sobre as principais condutas a serem tomadas frente a este tipo de traumatismo. Foi realizada análise descritiva e análise estatística, utilizando o teste de Qui-quadrado de Pearson. O nível de significância adotado foi de 5% (p<0,05). A amostra, selecionada por conveniência, foi composta por 390 acadêmicos daUniversidade Federal de Juiz de Fora, sendo 154 do curso de Odontologia, 93 de Enfermagem e 143 de Medicina. Menos da metade dos entrevistados relataram ter recebidoanteriormentealguma informação sobre traumatismos dentoalveolares, sendo que a maioria que recebeu informação era do curso de Odontologia (p<0,01). A maioria também não teve nenhuma experiência anterior com esse tipo de traumatismo, sem diferença entre os cursos (p≥0,05). O estudo revelou que há falta de conhecimento sobre o manejo da avulsão de dentes permanentes pelos estudantesavaliados, principalmente os dos cursos de Medicina e Enfermagem. Desta forma, existegrande necessidade dodesenvolvimento de programas de educação, informação e treinamento, que enfatizem o tratamento emergencial para avulsão dentária, dirigidos aos alunos desses cursos (AU).

The aimof the present study was to evaluate the knowledge of undergraduate students ofhealth care courses (dentistry, medicine and nursing) from a public higher education institution about theavulsion of permanent teeth, as well as on emergency procedures to be taken in the occurrenceof this type of injury. Information was collected through self-administered structured questionnairecontainingpersonal data, previous experiences, knowledge about dental avulsion and about the main proceduresto be taken in the occurrenceof this type of trauma. Descriptive and statistical analysis was performed using Pearson's chi-square test. The significance level adopted was 5% (p <0.05). The sample, selected for convenience, was composed of 390 students from the Federal University of Juiz de Fora, 154 of them dentistrystudents,93 nursing studentsand 143 medicinestudents. Less than half of interviewees reported having previously received anyinformation about dentoalveolar trauma, and the majority who received some information were dentistrystudents (p <0.01). The majority also had no previous experience with this type of trauma, with no difference between courses (p≥0.05). The study revealed that there is lack of knowledge about the management of avulsion of permanent teeth by evaluatedstudents, especially those enrolled in medicine and nursing courses. Thus, there is great need for the development of education, information and training programs emphasizingthe emergency treatment for dental avulsion aimed at students of these courses (AU).

Long term clinical result of implant induced injury on the adjacent tooth.

The purpose of the retrospective study was to investigate the long-term result of implant-induced injury on the adjacent tooth. The subjects of this retrospective study were patients who had received implants and had tooth injury; direct invasion of root (group I), root surface contact (group II), or < 1 mm distance of the implant from the root (group III). Clinical and pathological changes were periodically examined using radiographs and intra-oral examinations. Paired t-tests and chi-square tests were used to evaluate the implant stability quotient (ISQ) of implant and tooth complications, respectively (α = 0.05). A total of 32 implants and teeth in 28 patients were observed for average 122.7 (± 31.7, minimum 86) months. Seven teeth, three of which were subsequently extracted, needed root canal treatment. Finally, 90.6% of the injured teeth remained functional. Complications were significant and varied according to the group, with group I showing higher events than the others. The ISQs increased significantly. One implant in group I resulted in osseointegration failure. The implant survival rate was 96.9%. In conclusion, it was found even when a tooth is injured by an implant, immediate extraction is unnecessary, and the osseointegration of the invading implant is also predictable.

Maxillofacial injury related to an exploding e-cigarette.

Electronic cigarettes (also known as e-cigarettes or electronic nicotine delivery systems) were invented in China in 2003 then introduced to the British market in 2007. They remain popular among the public and are deemed to be effective in reducing tobacco smoking (the UK being one of the first countries to embrace them in a harm reduction policy). However, reports in the media of e-cigarettes exploding are of concern, considering the potential functional and psychological impairment that lifelong disfigurement will cause, especially given their uptake among people of any age. We present a case of this rare, but dramatic, effect of e-cigarette use as a warning to the public.

Accidental dental displacement into the maxillary sinus during extraction maneuvers: a case series

BACKGROUND: The aims of this study were to describe the clinical findings of patients that suffered teeth displacement into the maxillary sinus, and to report the surgical technique used to solve this complication. MATERIAL AND METHODS: A retrospective observational study was conducted involving patients that suffered a displacement of teeth into the maxillary sinus. Demographic and clinical data were recorded from the affected patients and a descriptive statistical analysis was made of the study variables. RESULTS: A total of nine patients were enrolled, six males (66.7%) and three females (33.3%), with a mean age of 36.0 years (range 22-54). In five patients (55.5%) the displaced teeth remained asymptomatic; however, dental fragments were retrieved from the maxillary sinus using Caldwell-Luc technique or endoscopic approach. CONCLUSIONS: Dental displacement into the maxillary sinus during the extraction manoeuvres is an uncommon finding. Even in asymptomatic cases, these displaced teeth should be extracted in order to avoid the development of sinus pathology

No disponible

Occurrence of Dental Trauma in a Group of Children with Autistic Spectrum Disorder

ABSTRACT Objective: To assess the occurrence of dental trauma in a group of children with Autistic Spectrum Disorder (ASD) in comparison to children without the disorder. Material and Methods: This is a cross-sectional study conducted at the Department of Children and Adolescents Health in the Department of Health of Juiz de Fora, Brazil. The study included individuals with and without ASD, between three and 16 years old, and their parents/caregivers. Children/adolescents were assessed for dental trauma by clinical examination. All exams were performed by a trained and calibrated examiner (MCT), and intra-examiner reliability was previously established (Kappa=0.93). The Socio-demographic status was reported by parents/caregivers. Data analysis included descriptive statistics and generation of frequency distributions. Fisher's exact test was used to evaluate the association between groups of children/adolescents with and without ASD about the presence of dental trauma. The significance level was set at p < 0.05. Results: Sixty children of both sexes participated in the study, thirty with a diagnosis of ASD and thirty without. The age ranging from 3 to 13 years, with an average of 7.5 ± 3.2 years. Children with ASD had a higher frequency of dental trauma than children without ASD (p=0.02), and the most frequent type of trauma was enamel fracture (57.10%), followed by enamel/dentin fracture without pulp exposure (42.90%). Conclusion: Children with ASD, when compared to children who did not have ASD, had a higher occurrence of dental trauma.

Facial and Dental Trauma.

Dental and facial trauma are very common in a daily routine radiology practice. Knowledge of the functional anatomy of the mandibulofacial and maxillofacial regions forms the cornerstone of a thorough full radiologic evaluation of the patient with a dental and/or facial trauma. Cone beam computed tomography and multidetector computed tomography are currently considered the imaging modalities of choice. There are several patterns and classification systems for the various subtypes of mandibulofacial and maxillofacial fractures. They are discussed separately in this article with special attention to the types of dental trauma and orbital trauma.

Dental trauma with intrusive luxation and six-year monitoring: clinical case report / Traumatismo dentário com luxação intrusiva com acompanhamento de seis anos: relato de caso clínico

Objective: this study is designed to report a clinical intrusion case, which exhibited enamel hypoplasia on the crown of tooth 11 and which underwent clinical and X-ray monitoring for six years. Case report: A threeyear- old female patient exhibited intrusion of deciduous teeth 51, 52, 61, and 62. After X-ray, it was detected that teeth 51 and 61 had perforated the nasal cavity floor, but all four teeth had re-erupted and began to be monitored. After six months, teeth 51 and 61 exhibited bone loss in the interproximal area, as well as mobility, which led to tooth extraction. Teeth 52 and 62 re-erupted in a satisfactory position, and exhibited no signs and symptoms of infection, periapical alteration, or mobility. These teeth were therefore maintained in the arch. After six years, it was detected that tooth 11 had erupted with enamel hypoplasia. Final considerations: Longterm clinical and X-ray control proved essential, as it allowed for the early diagnosis of potential alterations, and minimized potential sequelae to the permanent teeth.(AU)

Objetivo: relatar um caso clínico de intrusão com acompanhamento clínico e radiográfico de 6 anos, que apresentou hipoplasia de esmalte na coroa do dente 11. Relato de caso: paciente de 3 anos, sexo feminino, apresentou intrusão dos dentes decíduos 51, 52, 61 e 62. Após radiografia, foi detectado que os dentes 51 e 61 tinham perfurado o soalho da fossa nasal, porém, ocorreu re-erupção dos 4 dentes e foi realizado acompanhamento. Após 6 meses, nos dentes 51 e 61, foram observadas perda óssea na região interproximal e mobilidade, optando-se pelas exodontias. Os dentes 52 e 62 re-erupcionaram em posição satisfatória e com ausência de sinais e sintomas de infecções, alterações periapicais e mobilidade, sendo mantidos no arco. Após 6 anos, foi observado que o dente 11 erupcionou apresentando hipoplasia de esmalte. Considerações finais: mostrou-se essencial o controle, clínico e radiográfico, em longo prazo, diagnosticando precocemente possíveis alterações e minimizando sequelas que podem acometer os dentes permanentes.(AU)

Evaluation of teeth injuries in Beagle dogs caused by autoclaved beef bones used as a chewing item to remove dental calculus.

Dental calculus (DC) is the most widespread oral problem in domestic dogs. Chewing items are used to remove DC from the tooth surface; they also favor oral health and animal welfare. Raw beef bone mastication also shortly reduces DC in adult dogs. However, it can cause oral lesions and hence is not popular. This study evaluated the impact of bone mastication on the dental roots, enamel, and gingiva of dogs. Twelve adult Beagle dogs were randomly divided into 2 treatment groups in a completely randomized block design: cortical bone (CB) or spongy bone (SB). Intraoral radiographs were obtained on days 0 and 14, and calculus assessment was performed using images captured on days 0, 3, 6, 9, 12, and 14; an integration program was used to measure the proportion between the area covered by calculus and the total area of teeth. DC was completely removed from the first and second premolars and molars from both the arcades in less than 3 days of supplementation, indicating that these teeth were frequently used for chewing (P < 0.10). Bones were highly effective for DC removal and gingival inflammation reduction. Despite the hardness of bones, no lesions or teeth root and enamel fracture, or esophageal or intestinal obstructions-complications related to bone ingestion-were noted. However, SB showed some gingival lesions (n = 4) and bone remnants between teeth (n = 2). Gingival lesions were caused by the daily and continuous supply of new pieces of bone for 13 days. Specific pieces of bone should be used for oral home care programs because they shortly remove almost 90% of DC, allowing longer intervals between periodontal cleaning procedures. Long-term studies are required to evaluate the use of bones and evaluate their impact on teeth and periodontium after prolonged supplementation.

Methods in population study of orofacial injuries in Victorian family violence homicides.

This study standardized the methods used in the determination of orofacial injuries in Victorian family violence homicides and informed potential control selection for an analytic study. Dental service contacts with family violence victims may be intervention avenues due to the presence of abusive injuries in the orofacial region. All Victorian family homicides from January 2000-September 2018 were identified by determining the kinship/relationship and grouped by age. A 20% random sample of adult cases, aged 18-64 years was selected. The median number of orofacial injuries in categories of injury mechanisms/age/gender and the nature of abusive orofacial injuries was reported for the sample. Of 357 closed cases of family homicide, 261 were adults aged 18-64 years. Offender information and injury mechanism data was available for all closed cases, enabling case selection. Of a random sample of 50 adults, 8 cases were excluded. After 2006, CT scans and photos were present in 20 (91%) and 19 (86.4%) of 22 cases, respectively. The nature and median number of orofacial injuries showed correlation to the reported injury mechanism. Strengths and limitations of the used methods were assessed. Not all cases were compatible for assessment of orofacial injuries, thus serving as an additional criterion for exclusion in our methodology. Further detailed study of the whole population of adults should be limited to the period 2006-2018 where the data is more complete. The mechanism of injury may influence control selection for analytic studies. We present preliminary evidence of the frequent occurrence of orofacial injuries in family violence homicides.

The risk of tooth root injuries using cortical screws for intermaxillary fixation and osteosynthesis plates - A retrospective analysis.

Intermaxillary fixation (IMF) and osteosynthesis plates (OP) are widely used for the non-surgical and surgical treatment of mandible and condyle fractures. The aim of this retrospective study was to analyze the frequency of tooth root injuries by IMF and OP screws. Electronic patient reports (2004-2013) were screened for patients treated with either IMF screws and/or OP in the Department of Oral- and Maxillofacial Surgery, University Medical Center Mainz, Germany. The frequency and the position of endangered and injured teeth were analyzed by orthopantomogram (OPTG) and cone beam computer tomography (CBCT). Next, possible predictive factors for tooth root injuries, namely interdental- and crestal distance, screw length and distance between tooth root and screw were evaluated. Further, the accuracy of OPTG vs. CBCT concerning the diagnosis of tooth root injuries was analyzed. Three-hundred sixty-six patients were included and 3388 teeth were defined as endangered by IMF- and OP screws. Overall, 16 injured teeth (0.5%) in 13 patients (3.55%) were detected. Nine injuries (56.3%) were caused by IMF- and seven injuries (43.8%) by OP screws. Three teeth were non-vital, one tooth had to be extracted. No correlation between the predictive factors crestal distance, screw length and tooth root injuries was found. If tooth injury occurred, a significant correlation between the interdental distance and the distance between tooth root and screw was found (κ = 0.48; p < 0,0001). Comparison between OPTG vs. CBCT demonstrated that many of the injuries that were seen in the OPTG (n = 230) could not be verified in the CBCT scans (n = 16) (κ = 0.12). To conclude, screws for IMF and OP can be considered as a safe procedure concerning the risk of tooth root injuries.

Smartphone Photographs to Document Preoperative Dental Examination.

Dental injury is a common cause of malpractice claims involving anesthesiologists. Inadequate preoperative dental evaluations and incomplete documentation are often cited as contributing factors during reviews of closed claims. Point-of-care smartphone photographs are widely used in other medical fields such as dermatology and plastic surgery. We discuss the use of smartphone photographs for documenting preoperative dental examinations.

A Missing Tooth Found in the Nasal Cavity After an Attempt at Insertion of a Nasogastric Tube: A Case Report.

Dental injury is one of the most common complications of tracheal intubation. Although teeth dislodged during tracheal intubation are usually found in the oral cavity, we encountered a case of a missing tooth found in the nasal cavity in an intubated patient. A 62-year-old man with 4 loose teeth in the upper jaw was scheduled for laparoscopic hernia repair. After our second attempt at insertion of a nasogastric tube via the left naris, we discovered that a tooth had been dislodged. A lateral-view radiograph revealed the dislodged tooth in the nasal cavity. The ectopic tooth was removed by an otorhinolaryngologist.

Dental Trauma in Children: A Quick Overview on Management.

Traumatic dental injuries (TDI) or tooth trauma have a global prevalence of 10-15%. These are often the cause of first visit to emergency room. Prognosis of teeth after injury is dependent on type of TDI, emergency treatment and time elapsed till definitive care. The low level of awareness among general public and medical practitioners often leads to delay in seeking treatment which often leads to pain, severe symptoms and poor prognosis. Pediatricians can play a significant role in identification of TDI, health advise, emergency care and referral to dentists. This paper highlights the important features to be noted in children with history of TDI and the key steps which needs to be taken in these situations.

Intrusive Dislocation in Permanent Teeth: Review of Literature and Clinical Case Report / Luxación Intrusiva en Dientes Permanentes: Revisión de Literatura e Informe de Caso Clínico

ABSTRACT: Intrusive dislocation is an unusual and severe trauma, where the tooth is displaced axially into the alveolar bone, causing damage to the periodontal and pulpal tissues. The objective was to report a case of intrusive dislocation on a right maxillary central incisor of a 12-year-old patient, where the proposed treatment was immediate surgical repositioning. Clinical and radiographic examination revealed partial tooth intrusion and complete root formation. The impacted tooth was surgically repositioned and immobilized. Subsequently, the endodontic treatment of the tooth associated with intracanal medication was performed. After 10 months of successive calcium hydroxide changes, the root canal system was filled. Clinical-radiographic follow-ups were performed over 5 years and 7 months, revealing discrete root resorption. It was concluded that immediate surgical repositioning, associated with adequate root canal therapy may be an effective therapeutic option in cases of intrusive dislocation of permanent teeth.

RESUMEN: La luxación intrusiva es un trauma inusual y severo, en el que el diente se desplaza axialmente hacia el hueso alveolar, causando daño a los tejidos periodontales y pulpares. El objetivo fue informar un caso de luxación intrusiva en un incisivo central superior derecho de un paciente de 12 años, donde el tratamiento propuesto fue el reposicionamiento quirúrgico inmediato. El examen clínico y radiográfico reveló una intrusión dental parcial y la formación completa de la raíz. El diente afectado fue reposicionado e inmovilizado quirúrgicamente. Posteriormente, se realizó el tratamiento endodóntico del diente asociado con la medicación intracanal. Después de 10 meses de sucesivos cambios de hidróxido de calcio, se llenó el sistema de conductos radiculares. Los seguimientos clínico-radiográficos se realizaron durante 5 años y 7 meses, revelando la resorción discreta de la raíz. Se concluyó que el reposicionamiento quirúrgico inmediato, asociado con la terapia adecuada del conducto radicular, puede ser una opción terapéutica efectiva en casos de luxación intrusiva de dientes permanentes.

Iodoform Vs Calcium Hydroxide/Zinc Oxide based pastes: 12-month findings of a Randomized Controlled Trial.

This study evaluated clinical and radiographic twelve-month outcomes of root canal treatments (CT) with smear layer removal, performed in primary teeth, using two different root canal filling materials. Pulpectomy was performed on 27 primary teeth with necrosis or irreversible pulpitis, caused by dental caries or trauma, in 23 children (2-7 years old). A single trained operator performed the CT in a single visit in cases without periapical or interradicular radiolucency (PIR) or in multiple visits in cases with PIR. Participants were selected based on specific inclusion and exclusion criteria, and randomly allocated into two groups: Group 1 (G1) - iodoform paste (iodoform + camphorated parachlorophenol + ointment comprising prednisolone acetate 5.0 mg and rifamycin 1.5 mg); Group 2 (G2) - Calen®/ZO paste. Treated teeth were restored with composite resin immediately after the root canal filling. The outcomes were evaluated clinically and radiographically according to specific criteria. Two blinded and standardized evaluators assessed the radiographic outcomes. We used descriptive analyses due to the small sample size. CTs were performed due to caries lesions in 70.4% of the cases and due to trauma in 29.6%. Only one tooth of G1 was unsuccessful; hence, pulpectomy performance in both groups was not influenced by the filling material, nor by any other analyzed variable. The level of the root canal filling was better in the Calen®/ZO group. The clinical and radiographic twelve-month outcomes indicated successful treatment, independently of the root filling material used.

Dental injuries in patients associated with fracture of facial bones.

PURPOSE: To assess different types of dental injuries associated with facial bone fractures. METHOD: One hundred dentate patients were selected randomly of all age and gender who had maxillofacial trauma only and having dental injury in association with facial bones fractures were included. They were thoroughly examined for injury/fracture to facial region as well as for dental injuries (teeth). Tooth injuries were noted according to Ellis classification. The data was collected, compiled, and put to statistical analysis. RESULTS: Dental injuries were more in females than males found to be statistically significant with (p < 0.05).Crown fracture of maxillary teeth was more as compared to mandibular except molars found to be statistically significant (p < 0.05). Root fracture was more in maxillary incisors followed by canine as compared to mandibular incisors and canines found to be insignificant. Avulsion, extrusion and luxation were more in maxilla as compared to mandible found to be significant. CONCLUSION: Different types of tooth injuries associated with facial bone fracture found more in females and maxillary teeth.