Video Laryngoscopy vs Direct Laryngoscopy for Endotracheal Intubation in the Operating Room: A Cluster Randomized Clinical Trial.

Importance: Endotracheal tubes are typically inserted in the operating room using direct laryngoscopy. Video laryngoscopy has been reported to improve airway visualization; however, whether improved visualization reduces intubation attempts in surgical patients is unclear. Objective: To determine whether the number of intubation attempts per surgical procedure is lower when initial laryngoscopy is performed using video laryngoscopy or direct laryngoscopy. Design, Setting, and Participants: Cluster randomized multiple crossover clinical trial conducted at a single US academic hospital. Patients were adults aged 18 years or older having elective or emergent cardiac, thoracic, or vascular surgical procedures who required single-lumen endotracheal intubation for general anesthesia. Patients were enrolled from March 30, 2021, to December 31, 2022. Data analysis was based on intention to treat. Interventions: Two sets of 11 operating rooms were randomized on a 1-week basis to perform hyperangulated video laryngoscopy or direct laryngoscopy for the initial intubation attempt. Main Outcomes and Measures: The primary outcome was the number of operating room intubation attempts per surgical procedure. Secondary outcomes were intubation failure, defined as the responsible clinician switching to an alternative laryngoscopy device for any reason at any time, or by more than 3 intubation attempts, and a composite of airway and dental injuries. Results: Among 8429 surgical procedures in 7736 patients, the median patient age was 66 (IQR, 56-73) years, 35% (2950) were women, and 85% (7135) had elective surgical procedures. More than 1 intubation attempt was required in 77 of 4413 surgical procedures (1.7%) randomized to receive video laryngoscopy vs 306 of 4016 surgical procedures (7.6%) randomized to receive direct laryngoscopy, with an estimated proportional odds ratio for the number of intubation attempts of 0.20 (95% CI, 0.14-0.28; P < .001). Intubation failure occurred in 12 of 4413 surgical procedures (0.27%) using video laryngoscopy vs 161 of 4016 surgical procedures (4.0%) using direct laryngoscopy (relative risk, 0.06; 95% CI, 0.03-0.14; P < .001) with an unadjusted absolute risk difference of -3.7% (95% CI, -4.4% to -3.2%). Airway and dental injuries did not differ significantly between video laryngoscopy (41 injuries [0.93%]) vs direct laryngoscopy (42 injuries [1.1%]). Conclusion and Relevance: In this study among adults having surgical procedures who required single-lumen endotracheal intubation for general anesthesia, hyperangulated video laryngoscopy decreased the number of attempts needed to achieve endotracheal intubation compared with direct laryngoscopy at a single academic medical center in the US. Results suggest that video laryngoscopy may be a preferable approach for intubating patients undergoing surgical procedures. Trial Registration: ClinicalTrials.gov Identifier: NCT04701762.

Risk factors associated with traumatic dental injuries in individuals with special healthcare needs-A systematic review and meta-analysis.

BACKGROUND/AIM: Individuals with special healthcare needs (SHCN) are more likely to sustain traumatic dental injuries (TDIs) due to distinct risk factors. The aim of this review was to assess various risk factors associated with TDIs in individuals with SHCN. MATERIALS AND METHODS: The protocol was designed according to the recommendations of the Cochrane-handbook, Joanna Briggs Institute, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in PROSPERO (CRD42022357422). A comprehensive search was performed in PubMed, LILACS, Web of Science, EMBASE and Scopus using a pre-defined strategy without any limitation of language and year of publication. It was last updated on 25 April 2023. Studies addressing the TDIs in individuals with SHCN were included. Data extraction and analyses were performed, risk of bias (ROB) assessment was done using the Joanna Briggs Institute's critical appraisal tool, and a meta-analysis was performed using random-effects model. RESULTS: A total of 21 studies were included in the review. They were categorized according to the target disease/condition: cerebral palsy (n = 5), ADHD and autism spectrum disorders (n = 5), visually impaired (n = 4), and multiple disorders (n = 7). The studies showed variability in the design and methods; however, 17 out of 21 studies showed moderate to low ROB. Increased overjet and lip incompetence were the main risk factors reported in the studies. The commonest injuries were observed to be enamel and enamel and dentine fractures. CONCLUSION: The overall pooled prevalence of TDI in individuals with special healthcare needs was 23.16% with 20.98% in males and 27.06% in females. Overjet >3 mm and inadequate lip coverage were found to be associated with a higher risk of TDI in all the categories of individuals with special healthcare needs except ADHD and ASD. Falls at home in cerebral palsy, falls while walking and self-harm in ADHD and ASD, falls at home and collision in visual impairment, and unspecified falls in multiple disorders could be identified as the most common cause of TDI.

A two-year retrospective study on traumatic dental injury in the primary dentition.

The aim of this study was to analyze the causes, clinical characteristics, social factors, and current status of treatment of traumatic dental injury (TDI) in the primary dentition. A retrospective analysis was performed on 144 children (213 teeth) with TDI in the primary dentition from our hospital between December 2017 and June 2020. Data were analyzed using the chi-square test and the Mann-Withney-Wilcoxon test. Boys accounted for 68.1% (98/144) and girls for 31.9% (46/144) of all 144 children with TDI in the primary dentition, with a boy-girl ratio of 2.13:1. The primary age of TDI in deciduous teeth was 2 to 4 years old, accounting for 59% of all cases. Collision with others and fall were the 2 main causes of trauma to the deciduous teeth, making up 52.1% and 44.4% of all causes, respectively. Crown fracture injury was the most common type of TDI in the primary dentition, accounting for 37% of all cases (53/144). Of the 144 cases, 17.4% (25/144) was accompanied by soft tissue laceration, while 22.2% (32/144) by swelling or contusion of tissue. Maxillary teeth (92.4%) were more vulnerable to injury than mandibular teeth (7.5%), with maxillary incisor being the most vulnerable 1 (91.5%). The percentage of children arrived at the hospital for treatment 24 hours after the injury was the highest (57.0%, 82/144). After the hospital visit, 74.3% of children received treatment for the dental trauma. In terms of the treatment modalities, extraction of the traumatized teeth (27.1%) and pulpectomy + resin filling (or preformed crown) restoration were predominant. Approximately 28.5% (41/144) of cases were reviewed within 2 years, with the proportion of children with pulpitis or periapical infection being the highest (29.3%, 12/41). Age, gender, collision, and fall are the factors linked to a higher risk of TDI in the primary dentition in children under the age of 7. Resin filling (or preformed crown) restoration and pulpectomy are effective in preserving the affected tooth and controlling infection. However, the preservation of the affected tooth and the prevention of infection may be hampered by late visits and low follow-up rates.

Random tree algorithm to analyse the relation between type of traumatic dental injuries and its demographic and predisposing factors - A cross-sectional study.

Background and Aim: Traumatic dental injuries (TDIs) have become the public dental health problem worldwide in children and adolescents. These injuries are complex and multifactorial in aetiology. This study was done with the aim to analyse the association of 'type of TDI' with its demographic and various predisposing factors in children by an advanced statistical method of machine learning (ML) of artificial intelligence (AI). Materials and Methods: The present study's data were gathered by conducting the observational cross-sectional study among index age-groups 12 and 15 years children of randomly selected schools of different geographical regions. Structured interviews and dental examinations performed were done to record the variables of TDIs in self-constructed proforma. The gathered data were analysed by employing the random-tree model of machine learning algorithm of IBM SPSS Modeler version-18 software. Results: Molar-relationship (2.5), age (1.75), sex (1.5) and geographical region/area (~1.5) were the most important predictors (factors) for the determination of type of dental injury as shown by the random tree model, whereas clinical factors like overjet (0.75), lip-competence (0.5) and overbite (0.5) showed lesser importance in the determination of type of TDIs. Conclusion: Demographic factors (age, sex and geographical region) and one clinical factor (molar-relation) were found as the stronger factors for determining the type of traumatic dental injury in children.

Epidemiological aspects of dental trauma associated with maxillofacial injures: Ten years of clinical experience in Trieste, Italy.

BACKGROUND/AIMS: The prevalence of dental injuries in patients with facial fractures is relevant. Epidemiologically, dental trauma in association with facial fractures generally affects the age group between 20 and 40 years old, with a higher prevalence in males. The aim of this retrospective study was to identify the incidence and etiology of dental trauma associated with facial fractures over a 10-year period. METHODS: From January 2009 to April 2019, among 381 patients with facial fractures, 353 were included in this study. Age, gender, trauma etiology, injured teeth and dental treatment were investigated. RESULTS: From 353 patients, with a mean age of 49.7 ± 19.9 years, 247 (70%) were males and 106 (30%) were females. Accidental falls were the most common type of injury (n = 118, 33.4%), followed by road accidents (n = 90, 25.5%), assaults (n = 60, 17%) and sports trauma (n = 37, 10.5%). Fifty-five subjects (15.60%) had dental injuries associated with facial fractures. Of the 145 teeth involved, 48 (33.1%) were diagnosed with luxation, 22 teeth (15.2%) were avulsed, 11 teeth (7.5%) suffered a concussion and there were 10 (6.8%) alveolar wall fractures.Uncomplicated enamel-dentin fracture was the more frequent hard tissue injury (n = 21, 14.5%), followed by complicated crown-root fracture (n = 10, 6.9%), infraction (n = 8, 5.5%), enamel fracture (n = 3, 2%) and complicated enamel-dentin fracture (n = 3, 2%). There was a peak in incidence between 21 and 40 years (42%). Males had a significantly higher risk of facial fractures with dental injury (75%). Maxillary incisors and canines (62.8%) were the most affected teeth. CONCLUSIONS: There was a high prevalence of dental injuries associated with facial fractures. Maxillary incisors were the most injured teeth, with a higher prevalence in males.

Post traumatic stress disorder following facial and dental trauma: preliminary findings from a study conducted in India.

This study was conducted to identify and study the prevalence of post traumatic stress disorder (PTSD) in patients, who had sustained traumatic facial and dental injuries along with other variables that may affect the psychological response. MATERIAL AND METHODS: 241 patients suffering from traumatic facial and dental injuries presenting to the Ahmadabad Municipal Dental College and Hospital were included in the study. 110 patients (males - 87, females - 23) suffered disfiguring injuries and/or loss of multiple front teeth (DF). 131 patients (males - 102, females - 29) suffered no disfigurement (NDF). Assessment was carried out on day of discharge (D.O.D), 1 month, and 6 months. Impact of Event Scale (I.E.S-R) was used to assess the presence of post traumatic stress disorder in the patients. RESULTS: Patients with DF injuries had statistically significant higher mean scores than patients suffering NDF injuries. Female patients had comparatively higher scores at D.O.D, 1 month, and 6 months. Patients treated with maxillomandibular fixation and between ages 18 and 40 years also had significantly higher scores. CONCLUSION: Patients with DF facial injuries including multiple anterior teeth loss had significantly higher mean (I.E.S-R) scores for PTSD in comparison with patients with NDF facial injuries.

Attitudes and emotional status of parents regarding traumatic dental injuries.

BACKGROUND/AIMS: Traumatic dental injuries have different effects on children and their parents, depending on the type of trauma and whether it is in primary or permanent teeth. Parents do not always seek immediate intervention for their children after each traumatic dental injury unless accompanied by conditions such as pain or bleeding that will increase emotional stress. The aim of this study was to evaluate the emotional status of parents and parents' attitudes toward urgent intervention for different traumatic dental injuries in both primary and permanent teeth. MATERIAL AND METHODS: A questionnaire consisting of two parts was designed with a reliability coefficient of 0.87 according to the results of a pilot study. The questionnaire was sent to parents as a Google Form via online communication methods such as WhatsApp and e-mail. The first part included questions about the demographic data of the parents and children, and the second part consisted of images of traumatic dental injuries of primary and permanent teeth with questions to evaluate the emotional state of the parents and awareness of the necessity for urgent intervention. The Visual Analog Scale (VAS) was used to evaluate the emotional state, and "Absolutely yes;" "Yes;" "I don't have an idea;" "No;" and "Absolutely no" statements were used to evaluate parents' attitudes about urgent intervention. Categorical variables were shown as numbers and percentages and analyzed with Pearson chi-square. Statistical significance was evaluated for p < .05, and correlations between variables were calculated with Pearson correlation. RESULTS: The survey was completed by 845 parents. All traumatic injuries except extrusion (p = .202; p ≥ .05) had statistically different VAS scores for primary and permanent teeth (p < .05). Parents' attitudes for urgent intervention were statistically significant for all traumatic injuries (p < .05) except 4-mm intrusion (p = .062; p ≥ .05), alveolar fracture (p = .282; p ≥ .05), complicated crown fracture (p = .136; p ≥ .05), and non-traumatized healthy teeth (p = .110; p ≥ .05). CONCLUSIONS: Traumatic dental injuries with excessive bleeding or tissue loss affect the emotional status of parents more than simple injuries, and they prefer to refer to dentists immediately. Parents responded with higher VAS scores and stronger desires for urgent intervention for permanent teeth injuries compared with primary teeth injuries which shows that parents still do not care about primary teeth as much as permanent teeth.

General and dental injuries sustained at concerts: A questionnaire-based study.

BACKGROUND/AIM: Evidence on the risk of injury at concerts is scant. The aim of this study was to collect data on general and dental injuries incurred by concertgoers in Switzerland and to investigate whether the frequency of accidents was related to music genre, gender and consumption of alcohol. MATERIALS AND METHODS: A questionnaire-based, cross-sectional study comprising 451 concertgoers in Switzerland was conducted on the timeframe January 2019 to February 2021. The survey gathered data on general and dental injuries, alcohol consumption and drug use. The statistical analysis included Fisher's exact tests, chi-squared tests, rank sum tests and logistic regressions (α = .05). RESULTS: There were 28.8% of respondents who reported an injury incurred at a concert. Contusion was the most prevalent injury, accounting for 33.8% of all injuries. Legs were the most commonly injured body part (34.6%). Injuries to their mouth/lips/teeth were reported by 17.7% of respondents. Dental injuries, accounting for 4.6% of all reported injuries, comprised four tooth fractures, one lateral luxation and one avulsion. The risk of injury while attending punk rock concerts was 8.6 times higher than for pop concerts (p < .001). In comparison with pop concerts, metal and rock concerts had an increased risk of injury by factors of 5.1 and 2.3, respectively (p ≤ .029). Neither gender nor drug use had a significant effect on the injury risk (p ≥ .3). Heavy alcohol consumption (>5 standard glasses) increased the risk of injury by a factor of 2.3 (p = .028). CONCLUSIONS: This study suggests that concert attendees at rock, metal and punk concerts face an increased risk of injury, which is likely due to the frequency of aggressive dance styles such as moshing. Heavy alcohol consumption leads to a greater risk of injury at concerts.

Traumatic dental injuries in adults attending a London-based trauma clinic in the UK: a seven-year survey.

Introduction This survey reports the incidence of traumatic dental injuries in an adult population attending an adult dental trauma clinic in a London teaching hospital.Materials and methods Retrospective data were collected from patients attending an adult dental trauma clinic between 2012 and 2018.Results In total, 1,769 patients attended, with more men seen (1,030; 58.2%) compared to women (739; 41.8%) and this was statistically significant (p <0.05). The most common aetiological factor was an accidental fall (728; 41.15%), followed by assaults (413; 23.35%), bicycle accidents (253; 14.3%), sports injuries (132; 7.46%) and road traffic accidents (84; 4.75%). Lateral luxation (833) was the most common traumatic injury and this was followed by avulsions (362; 17%). Enamel-dentine fractures were the most common type of fracture injury (1,273; 64%).Discussion This retrospective survey attempts to report on the incidence of traumatic dental injuries in a London-based cohort of patients attending a specialised dental trauma clinic. In line with other reports, there were more men than women affected, which is probably attributed to behavioural activities.Conclusion(s) Accidental falls are the most common cause of a traumatic dental injury, lateral luxation was the most common type of displacement injury and enamel-dentine fractures were the most common type of fracture injury.

Dental Caries, Traumatic Dental Injuries and Gingivitis among Street-Children in Kano, Nigeria.

BACKGROUND: Street-children (Almajirai) constitute a significant proportion of the adolescent population in northern Nigeria. They face health challenges, especially oral health, from being inadequately protected, supervised or directed by responsible adults. OBJECTIVES: The objective of the study was to determine the prevalence of dental caries, dental trauma, gingivitis and oral hygiene scores in street-children. METHODOLOGY: Three hundred and sixty-six school-aged children were selected through a multi-stage sampling of 10 to 12-year-old children from four modern and traditional qur'anic schools, and examined for oral conditions using the WHO protocol. The DMFT index, the modified Ellis criteria, the Gingival Bleeding Index and the Oral Hygiene Index-Simplified (OHI-S) were used to assess dental caries, traumatic dental injuries, gingivitis and oral hygiene scores respectively. Chi-squared tests and Odds Ratio were used to compare the difference and test the association between Almajirai groups. Data analysis was carried out using the Statistical Package for the Social Sciences (SPSS version 20). Statistical significance was considered when p < 0.05. RESULTS: One hundred and sixty eight (45.9%) traditional Almajirai and 198 (59.4%) modern-type Almajirai, participated in the study. Their mean age was 10.8(±0.8) years. The prevalence of dental caries was 25.4% with mean DMFT and SiC scores of 0.6 (±1.3) and 1.7 respectively. DMFT scores ranged from 0 to 12. The prevalence of traumatic dental injuries and gingivitis were 8.7% and 82.2% respectively, while the OHI-S score was 3.0. The odds for traumatic dental injuries were 41% less in the modern-type Almajirai (p=0.02); the modern-type Almajirai were twice as likely to develop gingivitis (aOR 95%CI =2.0, p=0.01). OHI-S scores showed poorer oral hygiene levels in the modern Almajirai (p=0.02). CONCLUSION: Dental caries, traumatic dental injuries, gingivitis and poor oral hygiene were prevalent among street-children in Kano. There is a high level of untreated dental disease in the study population.

CONTEXTE: Les enfants des rues constituent une proportion importante de la population adolescente du nord du Nigeria. Ils sont confrontés à des problèmes de santé, notamment de santé bucco-dentaire, du fait qu'ils ne sont pas suffisamment protégés, supervisés ou dirigés par des adultes responsables. OBJECTIFS: L'objectif de cette étude était de déterminer la prévalence des caries dentaires, des traumatismes dentaires, de la gingivite et des scores d'hygiène buccale chez les enfants des rues. MÉTHODOLOGIE: Trois cent soixante-six enfants d'âge scolaire ont été sélectionnés par un échantillonnage à plusieurs degrés d'enfants de 10 à 12 ans dans quatre écoles qur'aniques modernes et traditionnelles, et ont été examinés pour les conditions bucco-dentaires en utilisant le protocole de l'OMS. L'indice CAOD, les critères d'Ellis modifiés, l'indice de saignement gingival et l'indice d'hygiène buccale simplifié (IOB-S) ont été utilisés pour évaluer les caries dentaires, les lésions dentaires traumatiques, la gingivite et les scores d'hygiène buccale, respectivement. Les tests du chi carré et l'Odds Ratio ont été utilisés pour comparer les différences et tester l'association entre les groupes Almajirai. L'analyse des données a été réalisée à l'aide du progiciel statistique pour les sciences sociales (SPSS version 20). La signification statistique a été considérée lorsque p < 0,05. RÉSULTATS: Cent soixante-huit (45,9%) Almajirai traditionnels et 198 (59,4%) Almajirai de type moderne ont participé à l'étude. Leur âge moyen était de 10,8 (±0,8) ans. La prévalence de la carie dentaire était de 25,4 % avec des scores moyens de CAOD et de SiC de 0,6 (±1,3) et 1,7 respectivement. Les scores CAOD variaient de 0 à 12. La prévalence des lésions dentaires traumatiques et de la gingivite était de 8,7 % et 82,2 % respectivement, tandis que le score OHI-S était de 3,0. Les risques de lésions dentaires traumatiques étaient 41 % moins élevés chez les Almajirai de type moderne (p=0,02) ; les Almajirai de type moderne étaient deux fois plus susceptibles de développer une gingivite (aOR 95%CI =2,0, p=0,01). Les scores OHI-S ont montré des niveaux d'hygiène buccale plus faibles chez les Almajirai de type moderne (p=0,02). CONCLUSION: Les caries dentaires, les lésions dentaires traumatiques, les gingivites et une mauvaise hygiène bucco-dentaire étaient prévalentes chez les enfants des rues de Kano. Il existe un niveau élevé de maladies dentaires non traitées dans la population étudiée. Mots clés: Caries, enfants des rues, Almajirai, Adolescents, Hygiène buccale, Gingivite.

Prevalence, Etiology, and Types of Dental Trauma in Self-Assessment of 18-Year-Olds in Poland.

The aim of the study is to determine the occurrence and etiology of traumatic dental injuries of permanent teeth and to evaluate the relationship between diagnosed injuries and selected socio-economic indicators. In total, 1741 students aged 18 years, representing all the regions of Poland, took part in the survey. Questionnaires for monitoring studies were prepared in accordance with the criteria of the World Health Organization. Among the respondents, tooth trauma was reported by 18% of adolescents. The most common trauma occurred during other activities (e.g., playing) (64%). The most common direct cause of injury was a fall (43%) or a collision with an object or another person (36%). Risk of injury was increased by a low level of parents' education and poor financial situation of the family. Playing sports is important in the etiology of injuries. The incidence of injuries was highest in school, demonstrating the need for school education in injury prevention and first aid. Occurrence of injuries, their causes, therapy, and post-traumatic complications were similar in respondents of both genders, which can be explained by secularization trends. Risk of injury was increased by parents' low level of education and poor economic status. The research demonstrates the need for universal education on treatment of dental injuries.

Traumatic dental injuries in 6 to 12 years old schoolchildren: a multicenter cross-sectional study in Mexico.

The aim of this study was to determine the prevalence of dental trauma in schoolchildren 6 to 12 years of age and associated clinical, sociodemographic, and socioeconomic variables. A cross-sectional study was conducted in 477 children from public elementary schools in four locations in Mexico. The dependent variable was dental trauma, which was dichotomized in 0 = without dental trauma and 1 = with dental trauma. For the statistical analysis, a multivariate binary logistic regression model was generated in Stata. Average age was 9.06±1.94 years and 51.1% were girls. The prevalence of dental trauma was 18.2%. Falls, automobile accidents and sports had the highest number of instances (p < 0.01). In the multivariate model, it was observed that the risk of dental trauma increased with age (OR = 1.28) and among boys (OR = 1.45). Schoolchildren with decreased overjet (OR = 0.38) had lower dental trauma. Father's age (OR = 1.03) and educational level (OR = 1.78) were associated with dental trauma. Schoolchildren without health insurance (OR = 0.62) presented dental trauma less often. This study provided important information regarding the association of different sociodemographic, socioeconomic and clinical variables with dental trauma in Mexican schoolchildren. Identifying factors associated with dental trauma may support health promotion opportunities to ameliorate the prevalence of dental trauma.

Prevalence and Risk Factors of Dental Trauma in Ha'il, Saudi Arabia.

AIM: This study will aid in determining the prevalence and risk factors for dental trauma. This will assist in developing a treatment budget plan, thereby, fend off complications. MATERIALS AND METHODS: This study was an observational study, having a cross-sectional design, in which information was obtained from 555 participants. Data were obtained using a non-probability convenient sampling technique. A validated questionnaire was used as a study tool. Data were analyzed using the statistical package for the social sciences (SPSS, version 20). Descriptive and inferential statistics were used. Data were displayed as numbers and percentages, and the Chi-squared test was used to measure the association. RESULTS: Dental trauma was found to be 44% prevalent. Most of the injuries occurred in the 6-9-years age-group (19.1%) and were more common in boys (54.13%) than in girls. The majority of respondents (61%) identified "falls" as the most common cause of dental trauma, and the frequent location for the occurrence of dental injuries was found to be "home" (64.44%). Only 18% of parents reported that their kid's experienced nail-biting concerns, with the majority claimed that their kids never developed oral habits. Most dental injuries occurred during the summer season (48%). CONCLUSION: Young aged group and male gender group were more prone to dental injuries; dental injuries along with fall were found as the most common cause of dental trauma, whereas most of the dental traumas were reported to have occurred at home. CLINICAL SIGNIFICANCE: The study evaluated risk factors and the prevalence of dental trauma in the population of Ha'il, Saudi Arabia. It will be an effective tool for determining the need for treatment facilities.

The risk factors and pattern of traumatic dental injuries in 10-12-year olds in Kano, Nigeria.

Background: Traumatic dental injuries (TDIs) rank among the most common conditions in children and adolescents. Nigerian dental trauma data are largely based on studies that were conducted in the southern parts of Nigeria. This study was designed to identify the risk factors and the pattern of TDIs among school-age children in northern Nigeria. Objectives: The objective of the study was to identify the risk factors for and to determine the pattern of dental injuries among 10-12-year-old males in Kano, northern Nigeria. Materials and Methods: Six hundred and ninety-six 10-12-year olds were selected through a multistage sampling of school children, street children and rehabilitated children in Kano and examined for TDIs using the WHO protocols. Data analysis was carried out using SPSS version 20. Statistical significance was considered when P < 0.05. Results: Six hundred and ninety-four 10-12-year olds participated in the study; The prevalence of TDIs was 6.6%. Being a street-child was associated with 30% higher risk for dental injuries (adjusted odds ratio [aOR] = 1.3; 95% confidence interval [CI] = 0.60 - 3.1; P = 0.48), whereas living as a rehabilitated street child (aOR = 0.41; 95% CI = 0.19 - 0.88; P = 0.02) and older age were associated with a reduced risk (aOR = 0.63; 95% CI = 0.39 - 1.01; P = 0.06) to injuries. The most common type of trauma was enamel-dentine injuries or Ellis II, and the most common cause was falls. Street children and low-age groups had more single-tooth injuries (85.7% and 85.0%, respectively). The commonly injured teeth were the maxillary right and left central incisors. Conclusion: Living on the street and young age were associated with the likelihood for injuries in male adolescents in Kano. The maxillary central incisors were the commonly affected teeth.

Traumatic dental injuries - practical management guide.

Traumatic dental injuries (TDIs) with a prevalence of 25% among school children and 33% among adults are a public health problem and can have a negative influence on the quality of life. The treatment prognosis of some teeth injuries is heavily dependent on the actions taken at the place of injury. The objective was to summarize evidence-based knowledge on the topic of TDIs and present a practical management guide for first aid in an accessible way. The authors searched the PubMed and Google Scholar databases. The review included only papers published in 2013 or later. Tooth injuries are proven to cause physical, social as well as economic consequences. The most frequent type of injury in primary dentition is avulsion, whereas crown fractures are most common in permanent dentition. TDIs occur most often at home and in school. Certain risk factors for TDIs were identified which include, among others, male gender, younger age, obesity. The general community knowledge of correct first aid in case of dental trauma is limited. Guidelines published by the International Association of Dental Traumatology include practical recommendations for first aid after avulsion. Permanent teeth should be replanted immediately at the accident site, whereas primary teeth should not be replanted when avulsed. Broken teeth fragments ought always to be collected if possible. After dental trauma it is vital that the patients seek professional help. Measures preventing TDIs (e.g., mouthguards) should be encouraged. It is of great importance that parents, teachers, guardians or bystanders witnessing a TDI are equipped to assist after a dental trauma or give advice on first aid when needed. Raising public awareness on the topic of dental injuries is a strongly advised general objective.

Anaesthesia related complications - a single centre data analysis at a tertiary hospital in central Switzerland.

AIMS: Anaesthesia safety has improved over time with severe anaesthesia-related complications and death becoming rare events. We investigated anaesthesia-related complications over a period of 17 years in this single centre retrospective observational cohort study. The main aims were to assess the temporal trends of anaesthesia-related complications, their distribution among clinics and their relation to emergency versus non-emergency interventions. METHODS: In this retrospective, observational cohort study, anaesthesia and event protocols of patients who suffered from an anaesthesia-related complication were collected in the period from 1 January 2003 to 31 December 2019. These data sets were anonymised and grouped into demographic information, ASA physical status, information about dental status and hospital department. Out of the total of 257 cases that were reported to the department of anaesthesia at the Luzerner Kantonsspital, 110 were excluded as they were not anaesthesia-related and 14 because of incomplete reporting forms. The different complications were categorised by the severity injury scale score. The total number of anaesthetics during the study period amounted to 399,583. RESULTS: 133 patients with complications were included. Six patients died owing to a partially anaesthesia-related complication, two suffered from permanent damage, 62 had temporary symptoms and in 63 patients dental damage occurred. The temporal trend showed a major decrease in severe anaesthesia complications and deaths, whiledental injuries were the main complications after 2010. Most of the complications were reported in the orthopaedic department, whereas dental injuries were predominantly reported in the otorhinolaryngology department. The majority of complications occurred during elective surgery although this was not significant (p = 0.53). CONCLUSIONS: Severe anaesthesia-related complications and death decreased dramatically during the study period. Anaesthesia complications are not more frequent in emergency surgeries. Overall, complications occurred more frequently in orthopaedics, and dental injuries predominated in otorhinolaryngology.

Medicolegal issues of peri-anaesthetic dental injuries: A 21-years review of liability lawsuits in France.

BACKGROUND/AIM: Peri-anaesthetic dental injuries (PDI) represent a major source of potential malpractice claims against anesthesiologists. Studies about the medico-legal aspects of PDI have mainly focused on liability insurance cases thus not encompassing those cases brought to court. The aim of this study was to assess the medico-legal issues of PDI-related liability lawsuits in France. MATERIAL AND METHODS: A review of judicial decisions pertaining to PDI was conducted on a French legal database, spanning the period between January 2000 and October 2021. Characteristics of decisions, patients and anesthesiologists, peri-operative care, dental injuries, and convictions were collected when available for analysis. RESULTS: Twenty-four judicial decisions fulfilled the inclusion criteria and were analyzed. All cases of dental injuries took place during elective surgery, 16 in the private sector and 8 in the public sector. Most injuries concerned two or more teeth and the most predominant dental injuries were luxation or avulsion (70.8% of cases). Eight cases resulted in a final verdict in favor of the plaintiff, four in the private sector (conviction rate: 25%), and four in the public sector (conviction rate: 50%). The causes of conviction were either a lack of information (5/8), a breach in the standard of care or technical negligence (3/8). The average amount of indemnification for the plaintiff was 3614 Euros (3753 Euros in 2022 inflation-adjusted Euros) excluding legal fees. CONCLUSIONS: The analysis of PDI-related liability lawsuits shows that medico-legal issues differ from those of PDI-related insurance claims. Avulsion and luxation of multiple anterior teeth during elective surgery appear to be a risk factor for liability lawsuits. In addition, inadequacy of patient information about PDI-risk seems to be a risk factor for conviction. Lastly, dental injuries are less at risk of civil conviction than other anesthesia-related damages.

Perioperative Dental Injury Associated With Intubated General Anesthesia.

OBJECTIVE: Factors related to perioperative dental injury have likely changed as a variety of airway devices and preventive measures have been introduced. This retrospective chart review used data from an institutional registry to evaluate the incidence, timing, and contributing factors of patient self-reported dental injury and to assess the impact of dental injury on patient satisfaction. METHODS: Multivariate logistic analysis was performed on the records of 14,820 patients using the incidence of dental injury as the dependent variable and covariates in the anesthesia registry and a postoperative questionnaire as independent variables to investigate factors significantly associated perioperative dental injury. In addition, satisfaction with the anesthesia service was compared between patients with and without injury using a matched-pair population. RESULTS: A total of 101 dental injuries were identified. Of those, 25% were associated with intubation and extubation in the operating room, while most other injuries occurred postoperatively. Duration of anesthesia (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.00-1.03) and emergency surgery (OR, 1.92; 95% CI, 1.11-3.30) were independently associated with perioperative dental injury. Dental injury did not significantly decrease a patient's satisfaction with the anesthesia service (P = .441). CONCLUSION: Most perioperative dental injuries are unrelated to anesthesia procedures. However, the duration of anesthesia and emergency surgery were significantly associated with perioperative dental injury, while decreased patient satisfaction was not.

Survey on the prevalence of occupational injuries to the head and teeth in automotive repair and maintenance in Switzerland.

Automotive mechanics are exposed to an increased risk for occupational injuries (OI) to the hands, arms, head and teeth. The aim of this study was to assess the self-reported prevalence of OIs to the head, including traumatic dental injuries (TDIs), among automotive repair and maintenance workers dealing with motorcycles, cars and vehicles over 3.5 tons. We surveyed healthy mechanics in Swiss automotive repair workshops from 2019 to 2021. Overall, 121 automotive repair and maintenance workers responded to our 12-item questionnaire concerning their professional experience, protective measures and occupational injuries to the head and teeth (response rate: 12%). 119 were considered eligible for inclusion and two were excluded. Most persons surveyed (94%) were males with more than 10 years of professional experience. Eighty-five (72%) reported occupational injuries in general, 37 (43.5%) specified OIs to the head or tooth area, and 16 stipulated that these cases teeth were affected. The most common self-reported diagnosis was tooth fracture (p=0.191). Traumatic dental injury in childhood increased the odds ratio (OR) for occupational injury to the head or teeth by a factor of 2.4 (95% CI: 1.1, 5.5, p=0.036). Age, gender and dental trauma in childhood may also influence the prevalence of occupational injuries in general in this cohort. We conclude that occupational dental accidents in automotive repair workshops can be reduced by raising awareness of this issue and by taking effective preventive measures.