Knowledge of Brazilian Dentists about Dentoalveolar Trauma Care and their Experiences during the COVID-19 Pandemic

ABSTRACT Objective: To assess dentists' knowledge from Minas Gerais, Brazil, about dentoalveolar trauma (DT) and their experiences during the COVID-19 pandemic. Material and Methods: An online questionnaire with 34 questions was applied to collect personal data, professional training, self-assessment of experience/knowledge about DT, experience in care provided during the social distancing, and knowledge/conduct. The specific responses were evaluated based on the guidelines of the International Association of Dental Traumatology (IADT). Descriptive analysis and Pearson's chi-square test were performed. The level of significance was set at p≤0.05. Results: Most professionals (97.7%) had received information on DT, and only 4.6% of the participants considered their knowledge poor or very poor. However, 92.7% felt the need for more information on the subject. Regarding experiences during the pandemic, 55.7% provided trauma care during that period. Forty percent of the consultations were performed in person, and 33.3% of the professionals noted an increase in cases during the pandemic; 56.6% reported that the frequency did not change. The overall mean number of correct answers about DT was 5.29±2.11, indicating an acceptable level of knowledge. The mean percentage of hits for the specific questions was 44.1%. Conclusion: Although the level of knowledge of the dentists evaluated was acceptable, some aspects were deficient, with the need for more information about the IADT guidelines.

Trauma dental y lesiones faciales por armas de aire comprimido: reporte de un caso / Dental trauma and facial injuries by airguns: a case report

Las armas de aire comprimido son utilizadas desde hace muchos años con distintos usos que van desde el tiro recreativo hasta el control de plagas. Las más comunes son aquellas que disparan ''balines" o esferas metálicas que pueden llegar a tener capacidad de penetrar tejidos dependiendo del tipo de carga y de la longitud del cañón. Se presenta un caso clínico de un masculino que fue agredido con un arma tipo pistola con carga de CO2 que recibió un impacto a nivel facial y sufrió laceración en piel de labio y fractura dental complicada.

Air guns have been used for many years for a variety of purposes ranging from recreational shooting to pest control. The most common are those that shoot "pellets" or metallic spheres that can penetrate tissues depending on the type of load and the length of the barrel. A clinical case is presented of a male who was assaulted with a CO2-loaded pistol-type weapon, hit at facial level, and suffered laceration of the lip's skin and complicated dental fracture.

The consequences of Dental trauma.

Traumatic dental injuries pose a variety of complex ongoing issues to the dental practitioner. As dental injuries are commonly experienced at a young age, the treatment often takes place during adolescence or early in adulthood years at crucial development stages and very early in the life of the permanent successor. Therefore, the ability to correctly diagnose the injury, and follow an appropriate management plan should increase practitioners' ability to improve both the outcomes of dental trauma and long-term prognosis of the tooth.The consequences of dental trauma can be explored by taking into consideration the type of injury, which enables an assessment of the degree of insult to the pulpal tissues, neurovascular bundle, periodontal ligament and cemental cells. This has a direct influence on post-trauma complications. Early intervention, where indicated, and appropriate follow-up utilising international guidelines is imperative to identify changing diagnoses and act accordingly. This review paper will discuss the classification of traumatic injuries and their associated outcomes with management strategies for emerging disease including potential endodontic and restorative complexities and when to refer to secondary care.

Special considerations in paediatric dental trauma.

Traumatic dental injuries (TDIs) in the paediatric population are common and frequently seen in general dental practice. The management of TDIs can be challenging and, in most cases, the General Dental Practitioner is tasked with the initial assessment and emergency treatment. Patients and their families typically attend with elevated levels of distress, which is complicated by the limited dental experience of some children. Behaviour management is essential and helps prepare patients for dental care at both their emergency and follow-up appointments. Early and accurate diagnosis in combination with appropriate treatment contributes to favourable outcomes for traumatised teeth. Early discussions with or referral to paediatric dental teams for management of complex TDIs is encouraged, however shared follow-up care is beneficial over the long-term. In specific cases, initial dental treatment can be delayed by a few days to a subsequent appointment, allowing the dental team to book sufficient time for the treatment and for the patient and their families to prepare. Education of the patients and adults with parental responsibility is essential to manage expectations, explain likely complications and encourage attendance for long-term follow-up visits. This paper discusses the management of paediatric patients to aid the primary care practitioner in providing effective immediate and long-term care.

Displacement Injuries: Assessment and Management.

This paper aims to aid clinicians in the assessment and immediate management of dental trauma displacement injuries to permanent teeth. Long term sequelae, the impact of such injuries, and the evidence-base for managing these are discussed.Clinical cases are provided to illustrate management challenges and highlight where further evidence-based guidance is needed. The role of the general dental practitioner in the immediate management and follow-up of traumatic dental injuries is outlined and sequelae, worthy of potential referral, described.

Emergency Facial Injuries in Athletics.

Dental and oral injuries are a common occurrence in sport. Initial evaluation should always begin with an assessment of the patient's airway, breathing, circulation, as well as identification of associated injuries. Tooth avulsions are the only true dental emergency. Oral lacerations frequently do not require repair; however, special attention should be paid to lip lacerations involving the vermillion border. Most tooth and oral lacerations can be treated on the field with urgent referral to a dentist.

Management of traumatic dental injuries: a survey of paediatric emergency department health professionals.

OBJECTIVE: To assess paediatric emergency department (PED) health professionals' confidence, experience and awareness in managing traumatic dental injuries (TDIs). DESIGN: A cross-sectional online survey. SETTING: PED at Alder Hey Children's Hospital and Birmingham Children's Hospital. RESULTS: 94 ED health professionals responded. One-third of responders (n=26) encounter children with dental trauma daily or weekly. TDI teaching during undergraduate training was received by 13% (n=12) of responders, and 32% (n=30) had never received training. Responders thought they would benefit from online resources and regular teaching on paediatric TDIs, in addition to an easy-to-use decision-making tool to signpost families.ED health professionals' confidence in giving advice to families following a TDI, and in recognising types of TDIs, was notably low; -79 and -76 Net Promotor Score, respectively.Responders' awareness of how to recognise and manage TDIs was varied. Majority were aware of the need to attempt to reimplant an avulsed permanent tooth, and the need to refer a child presenting with a complex permanent tooth injury to the oncall dentist. However, very few responders commented on the importance of follow-up. Responders also raised concerns about the lack of dental services to treat TDIs in children. CONCLUSIONS: There is a need to enhance dental trauma teaching for all ED health professionals who encounter TDIs to increase their confidence and enable them to triage and advise patients appropriately. Additionally, increased signposting for families to the appropriate service could in turn improve outcomes and experience for children who experience a TDI.

Assessment of the validity and reliability of a novel dental trauma index.

BACKGROUND/AIMS: Traumatic dental injuries (TDI) are one of the most commonly encountered dental health complications. In order to standardize the evaluations and compare the findings of TDI, a carefully defined dental trauma index may serve as a good tool for the correct recording of dental trauma. A new dental trauma index, the Modified Eden & Baysal dental trauma index (MEBTI), has been introduced. It is an expanded index to record soft tissue injuries in addition to dental injuries. The aim of this study was to assess the validity and reliability of the MEBDTI. MATERIALS AND METHODS: The archival data of 20 patients with different traumatic injuries were selected. A web-based form including the radiographs and photographs of selected cases was created. Following a training session, 12 dentists with a minimum of 10 years of clinical experience were asked to score the cases using the MEBDTI on an online form. The Kolmogorov-Smirnov test was used to test the normality. The Kruskal-Wallis Test was used for intergroup comparisons. Inter-observer agreement was investigated by reliability analysis. The intraclass correlation coefficient (ICC) was used to evaluate the agreement among observers. The Chi-Square test of independence was used to determine if there is a significant relationship between two nominal variables (p < .05). RESULTS: The rate of correctly assessing the alveolar bone fracture was 96.9% followed by apex maturity (92.7%), root fracture (85.4%), luxation injury (76.5%), crown fracture (76.2%), and soft tissue injury (50%). Considering all parameters, the soft tissue injuries were statistically different in terms of the answers given by the 12 dentists (p < .05). CONCLUSION: The accuracy of the scores of participants was high and in accordance with each other except for the identification of soft tissue injuries. In favor of this novel index, the data on dental trauma cases could be recorded practically and reliably.

Introducing dental trauma (a non-curricular topic) into medical education: A viewpoint.

The aim of this paper is focused on expanding medical students' knowledge and understanding of a non-core curricular subject not normally offered in the medical curriculum. The critical juncture explored how to introduce a health-related subject into medical education that complements without competing for space/time in medical students' core studies. Using dental trauma as an example, this paper supports the opportunity for medical students to learn online about managing dental injuries and to raise their awareness of the need for accurate diagnosis and treatment of traumatic dental injuries before they graduate as medical doctors.

The East of England dental trauma service.

BACKGROUND: Current evidence suggests traumatic dental injuries can be difficult to manage in primary care due to uncommon occurrence and challenging patient presentations. Such factors may contribute to general dental practitioners lacking experience and confidence in the assessment, treatment and management of traumatic dental injuries. Furthermore, there are anecdotal accounts of patients presenting to accident and emergency (A&E) services with a traumatic dental injury, which could be placing avoidable strain on secondary care services. For these reasons, a novel primary care-led dental trauma service has been established in the East of England. METHODS: This brief report shares our experiences of establishing this dental trauma service, titled 'Think T's'. It aims to provide effective trauma care across an entire region by a dedicated team of experienced clinicians from primary care settings to reduce inappropriate attendance to secondary care services and upskill colleagues in dental traumatology. FINDINGS AND CONCLUSIONS: Since its inception, the dental trauma service has been public-facing and has managed referrals from a range of sources which include general medical practitioners, A&E clinicians and ambulance services. The service has been well received and has been seeking to integrate with the Directory of Services as well as NHS 111.

Comparison of Different Clinical Decision Support Tools in Aiding Dental and Medical Professionals in Managing Primary Dentition Traumatic Injuries.

BACKGROUND: Many patients are taken to the emergency room for dental trauma treatment, but studies reveal that medical professionals do not feel confident in diagnosing and treating children with traumatic dental injuries. The purpose of this study was to determine if a clinical decision support tool (CDST) would improve dental trauma knowledge of primary teeth in medical students and pediatric dentists. Another purpose was assessing effectiveness of print and mobile app CDSTs. METHODS: Medical students (n = 100) and pediatric dentists (n = 49) were given a pretest to assess baseline dental trauma knowledge. All subjects were randomly assigned to 1 of 3 groups for the posttest: no CDST, print CDST, and mobile app CDST. Test scores and total time spent on each test were recorded and analyzed. RESULTS: Compared with medical students, pediatric dentists scored significantly higher in both pretest (8.57 ± 0.96 vs 4.20 ± 1.58; P < 0.001) and posttest (8.37 ± 1.09 vs 4.96 ± 1.99; P < 0.001). There was no significant difference in time spent to complete the 2 tests between both groups. Medical students and pediatric dentists who utilized the mobile app CDST had scored highest (P = 0.028) but took the longest time (P < 0.001) on the posttest. CONCLUSIONS: Both print and mobile app CDSTs improved diagnosing and managing traumatic dental injuries in primary dentition significantly compared with those without aid. Medical students with CDSTs showed significant improvement in managing primary dental trauma; therefore, it is recommended for better, more accurate diagnosis and treatment in patients.

Shame from Smiling and Speaking Due to Oral Health Problems in Brazilian Adolescents: A Nationwide Population-Based Study

Abstract Objective: To investigate the association between oral health problems and being ashamed of smiling or speaking among Brazilian adolescents. Material and Methods: This was a population-based cross-sectional study carried out with secondary data from 7,328 12-year-old Brazilian adolescents from the latest Brazilian national oral health survey (SB Brasil 2010). The question "In the previous 6 months, have you been ashamed of smiling or speaking due to your teeth?" was the outcome variable. Calibrated examiners performed clinical examinations on adolescents for the diagnosis of dental caries (DMF-T), dental trauma, dental fluorosis and occlusal alterations. Data were analyzed descriptively and by Poisson unadjusted and adjusted Poisson regression analysis (p<0.05). The final model was controlled by family income. Results: The prevalence of being ashamed of smiling or speaking was 13.6%. The following variables were associated with the outcome: female sex (PR= 1.33; 95% CI: 1.17-1.53), cavitated dental caries on upper incisors (PR= 1.81; 95% CI: 1.51-2.15), dental trauma (PR= 1.36; 95% CI:1.16-1.60), increased maxillary overjet (PR= 1.36; 95% CI:1.18-1.57), dental crowding (PR= 1.60; 95% CI:1.40-1.83), midline diastema (PR= 1.30; 95% CI:1.11-1.44), tooth loss (PR= 1.45; 95% CI:1.16-1.80), mild/questionable dental fluorosis (PR= 1.23; 95% CI:1.06-1.44) and moderate/severe dental fluorosis (PR= 1.67; 95% CI:1.15-2.44). Conclusion: Oral health problems that impact dental aesthetics were predisposing factors for being ashamed of smiling or speaking in Brazilian adolescents (AU).

Extension of a novel diagnostic index to include soft tissue injuries: Modified Eden Baysal Dental Trauma Index.

AIM: Accurate records of traumatic dental injuries are important for clinical management and data collection for research. Soft tissue injuries often accompany dental trauma and should be appropriately recorded. The Eden Baysal Dental Trauma Index (EBDTI) provides an easy recording system of useful information about traumatic dental injuries on a tooth basis. The aim of this study was to extend the EBDTI index to record soft tissue injuries in a concise format and to approve the face and content validity of this version as the modified EBDTI (MEBDTI). MATERIALS AND METHODS: An extension to EBDTI was developed by adding superscript numbers from 0 to 8 to represent soft tissue injuries related to dental trauma. The Rand e-Delphi method was used to evaluate this version of the index. A definition and two statements about the index were sent to 15 international panel experts to be assessed independently on a 9-point Likert scale where 1 represented "total disagreement," and 9 indicated "total agreement." The panel needed to reach a 75% consensus for validation. A numerical code was suggested using zero to depict no soft tissue injury; 1-4 to record extra-oral injuries; and 5-8 to record intra-oral injuries (for example, gingiva, frenulum, and palate). Traumatic dental injury of the tooth/teeth is recorded using EBDTI in square brackets, and soft tissue codes are used as superscript numbers outside the brackets on a patient basis. RESULTS: The panel reached a consensus on the definition (86.7%) and two statements (86.7% and 93.3%) in one round. Various cases are presented to demonstrate the application of the index. CONCLUSION: The Modified Eden Baysal Dental Trauma Index was developed to record soft tissue. injuries on a patient basis and was approved for face and content validity.

Tertiary survey by trauma nurse specialist at a paediatric trauma centre.

INTRODUCTION: Tertiary surveys aim to detect injuries missed in the initial assessment of trauma. We introduced a process by which the trauma nurse specialist performed a number of the tertiary surveys (NTSs) at our paediatric trauma centre. METHODS: Data from the first six months following introduction of the NTS were compared to retrospective data from the six months prior to NTS implementation (pre-NTS), when trauma surveys were completed by medical staff. RESULTS: Over the 12-month period, 130 children met the criteria for a tertiary survey. Pre-NTS, 57/62 eligible patients received a tertiary survey, compared to 61/68 during NTS (p=0.77). There were significantly more road traffic crash patients in the NTS group (p=0.008) but no significant differences by demographics, injury pattern, injury severity score or outcomes. New injuries were found in three patients pre-NTS compared to five patients during NTS (odds ratio 1.3 (95%CI 1.3-2.0, p=0.73)). CONCLUSION: This study conservatively supports the hypothesis that, with training and support, a trauma nurse specialist can perform tertiary surveys as effectively as doctors. A larger study is required to confirm these findings.

Adolescent Orofacial Trauma.

Facial and dental-related trauma is common in the pediatric population. Appropriate evaluation and management techniques should be followed. Initial evaluation of the medical condition of the patient should be completed with acute management of any medical-related problems as a priority. ABCDEs of pediatric trauma should be followed and a thorough head and neck and oral examination completed with appropriate imaging if indicated. Newer dental trauma treatment protocols developed by the International Association of Dental Traumatology should be followed for best outcomes. Pediatric traumatic dental injuries generally have good prognosis by attempting to retain and stabilize teeth.

Introduction of an interactive tool (the Dental Trauma Guide) in the undergraduate dental teaching to manage traumatic dental injuries.

BACKGROUND/AIMS: Traumatic dental injuries (TDI) are complex problems where lack of proper care may result in serious complications. The need to improve the management of TDI is a frequently addressed concern. Methods of improvement in their diagnosis and management are continuously evolving. The interactive Internet tool, the Dental Trauma Guide (DTG), helps to simplify diagnostic and management dilemmas. However, it is not a freely available tool. The aim of the current study was to assess the knowledge and diagnostic skills of undergraduate dental students with access to the DTG compared with students without such access, in order to validate and promote this tool in dental education. MATERIALS AND METHODS: Two groups of students were randomly selected where one group of final year dental undergraduate students were exposed to lectures, demonstrations, discussions and tutorials on the management of TDI according to the standard undergraduate curriculum in Sri Lanka. Another test group of 21 students were provided with access to DTG during their training in paediatric dentistry. At the end of the study period, students were assessed on their knowledge of TDI using MCQs (Multiple Choice Questions) and OSCEs (Objective Structured Clinical Examination), based on the DTG. RESULTS: The students with access to the DTG were more knowledgeable in providing the correct answers to three out of the seven OSCE questions. Evaluation based on the MCQs did not reveal a significant difference (p = .913). However, users of the DTG showed a statistically significant difference with better overall knowledge based on their answers (p = .028). Following this period of evaluation, all of the students were provided with access to the DTG to supplement their learning experience. CONCLUSION: The Dental Trauma Guide is a useful supplementary tool for undergraduate students to arrive at a correct diagnosis and treatment plan for TDI.

Knowledge of Avulsion of Permanent Teeth Emergency Management Among Undergraduate in Brazilian Health Care Students

ABSTRACT Objective: To assess the knowledge of undergraduate health care students, about avulsion of permanent teeth. Material and Methods: It is a cross-sectional study. The sample consisted of Brazilian undergraduate students of the nursing, medicine, and dentistry degree programs. A structured questionnaire developed by the researchers, containing 18 objective questions about avulsion of permanent teeth was used as the data collection. Data analysis included Pearson's Chi-square and Fisher's Exact. Results: A total of 82.7% dental students, 22.9% nursing students, and 23% medical students had previously received some information about dental trauma. Students in the second half of the dentistry program had a higher percentage of correct answers in all questions (p<0.05). Being in the first or second half of the nursing program had no relation to the percentage of correct answers by students for any questions (p>0.05). Students in the first half of the medical program had a higher percentage of correct answers for six of these questions (p<0.05). Dentistry students had the highest percentage of correct answers in all the questions (p<0.001). Conclusion: Although students from the dentistry degree program report having information on avulsion of permanent teeth, their practical experience was considered low. Upon comparing students from the dentistry, nursing, and medical degree programs regarding their learning about avulsion of permanent teeth, dentistry students had greater knowledge on the subject.

Awareness and Preferred Mode of Getting Information on First Aid Management of Avulsed Permanent Teeth: Survey of Nigerian Mothers

ABSTRACT Objective: To determine the awareness and sources of information on first aid management of avulsed permanent teeth in a group of South-western Nigerian mothers. Material and Methods: An 18-item interviewer-administered questionnaire was used to survey 385 mothers attending the antenatal and immunization clinics on their perception towards dental avulsion, its management, sources, and preferred mode of receiving information on first aid. The effect of all significant factors was inferred at p<0.05. Results: Mothers who had previous information on the first aid management of dental avulsion had significantly higher knowledge (p=0.000). Majority (80.8%) of the mothers did not know that an avulsed permanent tooth could be replanted, though mothers whose children had not experienced dental trauma had significantly higher knowledge (p=0.003). The knowledge of first aid management of avulsed permanent tooth was low, regardless of age, education and employment status of the respondents. Conclusion: There was low knowledge among mothers regarding the first aid measures in the management of avulsed permanent teeth. Their main preference for receiving information was through social media and television. There is a need to increase oral health educational campaigns targeted towards mothers.

Prevalence and Associated Factors of Dental Trauma in Six-Year-Old School-Children

ABSTRACT Objective: To estimate the prevalence and associated factors of dental trauma in 6-year-old school children in the city of Palhoça, Brazil. Material and Methods: Cross-sectional study nested in a cohort study. It involved a representative sample of school children born in 2009, residing in the municipality and regularly enrolled in public and private schools (n = 1,102). Clinical data were obtained through oral exams. To evaluate the incisal overjet, the distance in millimeters was measured horizontally from the labial surface of the lower central incisor to the labial surface of the upper incisor. Bivariate analyses were performed using the Chi-square test, with a p-value <0.05 considered statistically significant. Multivariate analyses using Poisson Regression were performed to identify independent associations between the prevalence and the independent variables studied. Results: Prevalence of dental trauma was 4.2% (95% CI 3.0-5.4). Dental trauma was statistically associated with studying in a private school (PR = 1.03; 95% CI 1.01-1.06) (p=0.016) and with inadequate lip coverage (PR = 1.08; 95% CI 1.01-1.14) (p=0.016). Conclusion: The prevalence of 4.2% of dental trauma in six-year-old children, associated with inadequate and greater lip coverage in children from private schools should be taken into account, since most teeth at this stage are newly erupted.

Traumatic Dental Injuries Occurred in Primary Teeth and their Sequel Effects on the Developmental Permanent Successors: A Controlled Study

ABSTRACT Objective: To examine the types of traumatic dental injuries of the primary teeth (TDI-p) and the long-term sequelae on permanent dentition (LSP) comparing with a control group (CG). In addition, a questionnaire that measures parents' knowledge and awareness was used. Material and Methods: The trauma group (TG) consisted of permanent teeth following TDI-p exposed teeth, while the CG consisted of permanent teeth following unexposed teeth with TDI-p of the same patients. In total, 141 teeth were evaluated in 27 patients. Data concerning such as teeth, when TDI-p occurred, types of treatments and types of LSP were collected. Chi-square test was used for intergroup comparison for gender, type of trauma, LSP, age of trauma and parameters in the parental information questionnaire. Significance level was p<0.05. Results: A statistically significant difference was found in the analysis between TG and CG (p<0.001). The prevalence of LSP due to TDI-p was 29.6% and the prevalence of sequelae in CG was 7.4%. The most common LSP was enamel hypoplasia (14.8%). Parents were aware of the importance of TDI-p, and they had insufficient knowledge about its management. Conclusion: TDI-p can be considered a high-risk factor in the development of LSP. Also, the lack of knowledge in parents should be supported by software-based application systems to be developed.