The consequences of living with a severe malocclusion: A review of the literature.

AIM: To facilitate the orthognathic shared decision-making process by identifying and applying existing research evidence to establish the potential consequences of living with a severe malocclusion. METHODS: A comprehensive narrative literature review was conducted to explore the potential complications of severe malocclusion. A systematic electronic literature search of four databases combined with supplementary hand searching identified 1024 articles of interest. A total of 799 articles were included in the narrative literature review, which was divided into 10 themes: Oral Health Related Quality Of Life; Temporomandibular Joint Dysfunction; Masticatory Limitation; Sleep Apnoea; Traumatic Dental Injury; Tooth Surface Loss; Change Over Time; Periodontal Injury; Restorative Difficulty; and Functional Shift and Dual Bite. A deductive approach was used to draw conclusions from the evidence available within each theme. RESULTS: The narrative literature review established 27 conclusions, indicating that those living with a severe malocclusion may be predisposed to a range of potential consequences. With the exception of Oral Health Related Quality Of Life, which is poorer in adults with severe malocclusion than those with normal occlusions, and the risk of Traumatic Dental Injury, which increases when the overjet is >5 mm in the permanent and 3 mm in the primary dentition, the evidence supporting the remaining conclusions was found to be of low to moderate quality and at high risk of bias. CONCLUSION: This article summarises the findings of a comprehensive narrative literature review in which all of the relevant research evidence within a substantive investigative area is established and evaluated. Notwithstanding limitations regarding the quality of the available evidence; when combined with clinical expertise and an awareness of individual patient preferences, the conclusions presented may facilitate the orthognathic shared decision-making process and furthermore, may guide the development of the high-quality longitudinal research required to validate them.

Does dental trauma in early childhood have the potential to affect the quality of life of children and families? / Os traumatismos dentários na primeira infância têm potencial para afetar a qualidade de vida das crianças e das famílias?

ABSTRACT Objective: To evaluate the influence of dental trauma on oral health-related quality of life (OHRQoL) of children and their families. Methods: A total of 571 children aged five years were randomly selected at public schools. Trauma was clinically evaluated in accordance with the Andreasen classification. Caries experience in the anterior region and increased overjet were determined according to the World Health Organization criteria. The Early Childhood Oral Health Impact Scale (ECOHIS) was answered by the parents and used to evaluate OHRQoL. In addition, this questionnaire has aspects related to socioeconomic status. Simple logistic regression was performed, and the raw Odds Ratios with the respective 95% confidence intervals (95%CI) were estimated. The variables with p<0.20 were tested in multiple logistic regression models, and those with p≤0.05 remained in the model and the adjusted odds ratio with respective 95%CI was estimated. Results: Income showed a magnitude of association of 1.56 and 2.70 with the OHRQoL of children and families, respectively. The avulsion variable showed 9.65- and 8.25-times greater chance of influencing the OHRQoL of children and families, respectively. The experience of caries showed 3.80- and 2.42-times greater chance of influencing the OHRQoL of children and families, respectively. Conclusions: Dental trauma did not influence OHRQoL of children and their families negatively. However, avulsion and caries experience in low-income families was associated with a negative perception of OHRQoL.

RESUMO Objetivo: Avaliar a influência do traumatismo dentário na qualidade de vida relacionada à saúde bucal (QVRSB) de crianças e suas famílias. Métodos: 571 crianças de 5 anos de idade foram aleatoriamente selecionadas de escolas públicas. O trauma foi avaliado clinicamente de acordo com a classificação de Andreasen. A experiência de cárie na região anterior e a presença de overjet foram determinadas com base nos critérios da Organização Mundial da Saúde. A versão brasileira do questionário ECOHIS (Escala de Impacto na Saúde Oral na Primeira Infância) avaliou a QVRSB e foi respondida pelos pais; além disso, foram avaliados aspectos socioeconômicos. Realizou-se uma regressão logística simples, bem como as razões de chances brutas com os respectivos intervalos de confiança de 95%. As variáveis ​​com p <0,20 foram testadas nos modelos de regressão logística múltipla, e aquelas com p≤0,05 permaneceram no modelo. Resultados: A renda mostrou uma magnitude de associação de 1,56 e 2,70 com a QVRSB das crianças e famílias, respectivamente. A variável avulsão apresentou chance 9,65 e 8,25 vezes maior de influenciar a QVRSB de crianças e famílias, respectivamente. A experiência de cárie mostrou chance 3,80 e 2,42 vezes maior de influenciar a QVRSB de crianças e famílias, respectivamente. Conclusões: O trauma dental não influenciou negativamente a QVRSB das crianças e suas famílias. Entretanto, especificamente a avulsão, e a experiência de cárie nos dentes anteriores em famílias de baixa renda estiveram associadas a uma percepção negativa da QVRSB.

DOES DENTAL TRAUMA IN EARLY CHILDHOOD HAVE THE POTENTIAL TO AFFECT THE QUALITY OF LIFE OF CHILDREN AND FAMILIES?

OBJECTIVE: To evaluate the influence of dental trauma on oral health-related quality of life (OHRQoL) of children and their families. METHODS: A total of 571 children aged five years were randomly selected at public schools. Trauma was clinically evaluated in accordance with the Andreasen classification. Caries experience in the anterior region and increased overjet were determined according to the World Health Organization criteria. The Early Childhood Oral Health Impact Scale (ECOHIS) was answered by the parents and used to evaluate OHRQoL. In addition, this questionnaire has aspects related to socioeconomic status. Simple logistic regression was performed, and the raw Odds Ratios with the respective 95% confidence intervals (95%CI) were estimated. The variables with p<0.20 were tested in multiple logistic regression models, and those with p≤0.05 remained in the model and the adjusted odds ratio with respective 95%CI was estimated. RESULTS: Income showed a magnitude of association of 1.56 and 2.70 with the OHRQoL of children and families, respectively. The avulsion variable showed 9.65- and 8.25-times greater chance of influencing the OHRQoL of children and families, respectively. The experience of caries showed 3.80- and 2.42-times greater chance of influencing the OHRQoL of children and families, respectively. CONCLUSIONS: Dental trauma did not influence OHRQoL of children and their families negatively. However, avulsion and caries experience in low-income families was associated with a negative perception of OHRQoL.

Gingivitis influences oral health-related quality of life in adolescents: findings from a cohort study.

INTRODUCTION: Oral health-related quality of life (OHRQoL) is affected by different clinical conditions. The aim of this study was to evaluate the impact of gingivitis on OHRQoL in adolescents. METHODOLOGY: This cohort study consisted of a random sample of 1,134 schoolchildren enrolled during 2012, in Santa Maria, Brazil. After two years, 743 adolescents were follow-up (response rate: 65.5%). Clinical, socioeconomic and OHRQoL data were collected. OHRQoL was assessed by the short Brazilian version of the Child Perceptions Questionnaire 11-14 (CPQ11-14), and gingival bleeding through Community Periodontal Index. Gingivitis was considered with the presence of 15% or more bleeding sites. Poisson regression models were used to evaluate the association between gingivitis and overall and domain-specific CPQ11-14 scores. Prevalence of gingivitis at baseline was considered the main predictor for the OHRQoL at follow-up. RESULTS: Gingivitis at baseline was associated with higher overall CPQ 11-14 score (RR = 1.07; 95%CI 1.01 - 1.14), and emotional well-being (RR = 1.17; 95%CI 1.04 - 1.31), independently of other oral conditions and socioeconomic variables. CONCLUSIONS: The findings indicate that gingivitis negatively impacts the adolescents' OHRQoL. Moreover, gender, maternal schooling and household income were also associated with OHRQoL.

Subjective versus objective dental side effects from oral sleep apnea appliances.

PURPOSE: Occlusal changes are common during long-term treatment with oral appliances (OAs) for sleep apnea. The aim of the present study was to compare subjectively reported bite changes with objective findings. METHODS: Consecutive adherent treated patients were asked to participate in this study. The patients responded to two questionnaires using numeric visual analogue scales (VAS), ranging from 0 (not at all) to 10 (very much). The first questionnaire included open questions and the second questionnaire comprised specific questions about side effects. Measurements of overjet, overbite, and space for the teeth were made on plaster casts taken before treatment start and at follow-up. RESULTS: Thirty-eight (12 women) patients with a median age of 64 years (interquartile range (IQR) 57 to 69 years) and a median treatment time of 9.5 years (IQR 5.8 to 14.3 years) were included. Overjet, overbite, the molar relationship, and the irregularity of the lower front teeth had changed significantly during treatment. There were no associations between any of the patients' responses and the objectively measured bite changes. Younger patients, those with a small baseline overjet or overbite and those who developed an anterior crossbite were more likely to report bite changes. CONCLUSIONS: Patients who choose to continue long-term treatment with oral appliances for sleep apnea are unaware of various types of bite changes. Such changes will, however, progressively increase in magnitude and be more difficult to take care of, if needed. It is therefore important continuously to follow up patients in regard to bite changes.

Gingivitis influences oral health-related quality of life in adolescents: findings from a cohort study / A gengivite influencia a qualidade de vida relacionada à saúde bucal de adolescentes: achados de um estudo de coorte

ABSTRACT: Introduction: Oral health-related quality of life (OHRQoL) is affected by different clinical conditions. The aim of this study was to evaluate the impact of gingivitis on OHRQoL in adolescents. Methodology: This cohort study consisted of a random sample of 1,134 schoolchildren enrolled during 2012, in Santa Maria, Brazil. After two years, 743 adolescents were follow-up (response rate: 65.5%). Clinical, socioeconomic and OHRQoL data were collected. OHRQoL was assessed by the short Brazilian version of the Child Perceptions Questionnaire 11-14 (CPQ11-14), and gingival bleeding through Community Periodontal Index. Gingivitis was considered with the presence of 15% or more bleeding sites. Poisson regression models were used to evaluate the association between gingivitis and overall and domain-specific CPQ11-14 scores. Prevalence of gingivitis at baseline was considered the main predictor for the OHRQoL at follow-up. Results: Gingivitis at baseline was associated with higher overall CPQ 11-14 score (RR = 1.07; 95%CI 1.01 - 1.14), and emotional well-being (RR = 1.17; 95%CI 1.04 - 1.31), independently of other oral conditions and socioeconomic variables. Conclusions: The findings indicate that gingivitis negatively impacts the adolescents' OHRQoL. Moreover, gender, maternal schooling and household income were also associated with OHRQoL.

RESUMO: Introdução: Qualidade de vida relacionada à saúde bucal (QVRSB) é afetada por diferentes condições clínicas. O objetivo deste estudo foi avaliar o impacto da gengivite na QVRSB de adolescentes. Metodologia: Este estudo de coorte consistiu em uma amostra aleatória de 1.134 escolares iniciado em 2012, na cidade de Santa Maria, Brasil. Após dois anos, 743 adolescentes foram acompanhados (taxa de resposta: 65,5%). Dados clínicos, socioeconômicos e de QVRSB foram coletados. A QVRSB foi avaliada pela versão brasileira curta do Child Perceptions Questionnaire 11-14 (CPQ11-14) e o sangramento gengival foi coletado através do Índice Periodontal Comunitário. Gengivite foi considerada com o indivíduo apresentando 15% ou mais locais de sangramento. Os modelos de regressão de Poisson foram utilizados para avaliar a associação entre gengivite e os escores total e específico do domínio do CPQ11-14. A prevalência de gengivite na primeira avaliação foi considerada o preditor principal para a QVRSB no acompanhamento. Resultados: A gengivite no baseline foi associada à maior pontuação geral do CPQ 11-14 (RR = 1,07; IC95% 1,01 - 1,14) e ao domínio de bem-estar emocional (RR = 1,17; IC95% 1,04 - 1,31), independentemente das outras condições orais e variáveis socioeconômicas. Conclusão: Os achados indicam que a gengivite impacta negativamente a QVRSB de adolescentes. Além disso, sexo, escolaridade materna e renda familiar mensal também foram associados à QVRSB.

Dental evaluation specificity in orofacial damage assessment: A serial case study.

INTRODUCTION: The evaluation of medico-legal post-traumatic events has been increasing over the last decades. This study analysed the input of dental evaluation in orofacial damage assessment, highlighting the individual's biopsychosocial model, by a serial case study. It is aimed to analyse the physical as well as the psychological repercussions of traumatic events. It also aimed to relate the type of trauma impact with the individual's sequelae. MATERIAL AND METHOD: An observational and retrospective study was carried out of Portuguese medico-legal database. A serial case study was distinguished by the direction of the impact: frontal striking, lateral striking and clashing with a bidirectional (frontal-lateral). RESULTS AND DISCUSSION: 7 cases fulfilled the inclusion criteria, as a pilot study. They have in common the involvement of the 2 lower thirds of the face, including the temporomandibular joint. The consolidation of the maxillary bone fractures does not always correspond to restituto ad integrum. CONCLUSION: The impact direction may guide clinical examination in detecting permanent impairment, emphasizing temporomandibular joint disorders, as well as their association with psychosocial repercussions. The medical-dental examination is differentiating and relevant to the accomplishment of the general objective of damage assessment.

Evaluation of the impact of early childhood caries, traumatic dental injury, and malocclusion on oral health-Related quality of life for Turkish preschool children and families.

AIM: The aim of this study was to assess the impact of the presence of early childhood caries (ECC), traumatic dental injury (TDI), and malocclusion, as well as severe conditions, on the oral health-related quality of life (OHRQoL) of preschool children and families. MATERIALS AND METHODS: A cross-sectional survey was conducted in children aged 1 to 6 years old, who attended to the Department of Paediatric Dentistry, Gazi University. The questionnaires were adapted to Turkish, and OHRQoL was measured using the Turkish version of Early Childhood Oral Health Impact Scale (T-ECOHIS). Children were classified into four main groups, two subgroups in each group based on their severity conditions-Group 1: ECC group; Group 2: TDI group; Group 3: Malocclusion group; Group 4: Control group. Parents answered the questions about sociodemographic conditions and T-ECOHIS. The Kolmogorov-Smirnov test was used for non-normal distribution and Kruskal-Wallis and Mann-Whitney tests were used to compare T-ECOHIS score regarding ECC, TDI, and malocclusion. RESULTS: Both simple and severe conditions of TDI showed a negative impact on the family and child based on T-ECOHIS scores (P < 0.05). The severe condition of ECC and malocclusion showed significantly negative impact on family (P > 0.05) but not on child (P > 0.0.5). CONCLUSION: The presence of ECC, TDI, and malocclusion has a negative effect on OHRQoL of Turkish preschool children and specially their families. So, public health programs should be carried out about oral health for raising parents' and children's awareness and increasing OHRQoL.

Impact of treated and untreated traumatic dental injuries on oral health-related quality of life among 12-year-old schoolchildren in Amman.

BACKGROUND/AIMS: Traumatic dental injuries (TDI) could have negative effects on the physical and psychosocial well-being of children. The aim of this study was to assess the prevalence of TDI and the impact of treated/untreated TDI on the quality of life of children among 12-year-old schoolchildren in Amman. MATERIALS AND METHODS: A cross-sectional study was conducted with 1652 schoolchildren aged 12 years enrolled in schools in Amman. OHRQol was assessed using the Arabic version of the Child Perceptions Questionnaire (CPQ11-14 ). Diagnosis of traumatic dental injury was based on Andreasen's classification. Dental caries and malocclusion were also recorded and analyzed along with social class. Statistical analysis included ANOVA and multiple logistic regression. RESULTS: The prevalence of TDI was 14.6%. There was a statistically significant impact of untreated TDI on all items of CPQ11-14 . When children with treated TDI were compared with those who had not suffered TDI, the only statistically significant impact was difficulty in chewing. Compared to children with treated TDI and those who had not suffered TDI, children with untreated TDI experienced significantly higher impacts related to the overall OHRQol, oral symptoms, the emotional and social well-being domains. Regarding functional limitation domain, children with untreated TDI experienced a significantly higher impact than children who had not suffered TDI, but children with treated TDI still had some limitations. CONCLUSIONS: The prevalence of TDI was 14.6%. Untreated TDI had a negative impact on OHRQol compared to absence of or treated TDI among 12-year-old schoolchildren in Amman.

Cross-cultural adaptation and psychometric evaluation of the early childhood oral health impact scale (ECOHIS) in chilean population.

BACKGROUND: The Early Childhood Oral Health Impact Scale (ECOHIS) measures the impact of dental diseases on Oral Health-Related Quality of Life both in children and their families. The aim of this study was to develop a Chilean Spanish version of the ECOHIS that is conceptually equivalent to the original and to assess its acceptability, reliability and validity in the preschool population of Chile. METHODS: The Chilean version of the ECOHIS was obtained through a process including forward and back-translation, expert panel, and cognitive debriefing interviews. To assess metric properties, a cross-sectional study was carried out in Carahue, Southern Chile (April-October 2016). Children younger than six years old without systemic diseases, disabilities or chronic medication from eleven public preschools were included. Parents were invited to complete the Chilean version of the ECOHIS, PedsQL™4.0 Generic Core and PedsQL Oral Health scales, and to answer global questions about their children's general and oral health. A subsample was administrated ECOHIS a second time 14-21 days after. A clinical examination was performed to assess dental caries, malocclusion, and traumatic dental injuries. Reliability was evaluated using measures of internal consistency (Cronbach's alpha) and reproducibility (Intraclass correlation coefficient - ICC). Construct validity was assessed by testing hypotheses based on available evidence about known groups and relationships between different instruments. RESULTS: The content comparison of the back-translation with the original ECOHIS showed that all items except one were conceptually and linguistically equivalent. The cognitive debriefing showed a suitable understanding of the Chilean version by the parents. In the total sample (n = 302), the ECOHIS total score median was 1 (IQR 6), floor effect was 41.6%, and ceiling effect 0%. Cronbach's alpha was 0.89 and the ICC was 0.84. The correlation between ECOHIS and PedsQL™4.0 Generic Core was weak (r = 0.21), while it was strong-moderate (r = 0.64) with the PedsQL Oral Health scale. In the known groups comparison, the ECOHIS total score was statistically higher in children with poor than excellent/very good oral health (median 11.6 vs 0, p < 0.01), and in the high severity than in the caries-free group (median 8 vs 0.5, p < 0.01). No differences were found according to malocclusion and traumatic dental injuries groups. CONCLUSIONS: These results supported the feasibility, reliability and validity of the Chilean version of ECOHIS questionnaire for preschool children through proxy.

Understanding patients' and dentists' perspectives in dental trauma management: A mixed-methods study.

BACKGROUND/AIM: Patients suffering dental trauma are unprepared for the disability challenge and necessary rehabilitation, while a traumatic event places an expanded demand on the dentist who is focused on treating disease. The aim of this study was to examine the impact of traumatic dental injuries (TDI) on patients and to compare patients' and dentists' perceptions of the event. MATERIAL AND METHODS: TDI patients (aged ≥ 21 years) attending a tertiary dental hospital from 2011 to 2013, and their dentists were recruited with informed consent. An exploratory sequential mixed-methods design was adopted. The Oral Health Impact Profile (OHIP-14) quantitatively identified patients with "very often," "fairly often" or "occasionally" in at least one of the OHIP-14 questions (Phase 1) to participate in the qualitative phase of the study through focus group discussions (FGD) (Phase 2). FGD for dentists was conducted separately. RESULTS: Quantitative analysis showed 28%-55% of TDI patients had "occasional" to "very often" discomfort during eating, increased self-consciousness and embarrassment. Qualitative analysis showed patients were concerned with aesthetic disability, treatment cost and potential tooth loss but overcame their negative outlook and accepted prescribed protective measures. Dentists appreciated patients' concerns about aesthetics and functional disruptions but were less attuned to patients' sense of guilt and fear of judgement. CONCLUSIONS: TDI exert functional, psychological and social impacts on patients. Patients' and dentists' perspectives were useful for understanding the need for continuity of care, and the findings could contribute to effective TDI management.

Bones heal, teeth don't! The involvement of dentists in the acute and long-term management of patients injured in the Manchester Arena Bomb.

This paper outlines the involvement of dentists in the treatment of patients following the terror attack at Manchester Arena on 22 May 2017. It predominantly describes the role of the authors - a paediatric dental consultant and maxillofacial surgery dental core trainee (DCT). As a result of the incident a number of patients suffered oro-facial injuries, with many treated at Central Manchester Foundation Trust Hospitals' Manchester Royal Infirmary and Royal Manchester Children's Hospital. The major incident response of the trust is discussed, as are the presentation of blast injuries and corresponding NHS guidance. Two paediatric cases present the role of the paediatric dental consultant in the acute, intermediate and long-term management of these patients. The presentation of unique dento-alveolar injuries in the context of other trauma and their subsequent treatment demanded true multidisciplinary management. The importance of teeth and oral health to physical and psycho-social wellbeing and recovery was clear and recognised by other teams involved in the patients' management. The experience reinforced the overall impact dental health has on physical and psycho-social health, and how a holistic approach is integral to treatment of major trauma.

Impact of traumatic dental injuries on quality of life in preschoolers and schoolchildren: A systematic review and meta-analysis.

OBJECTIVES: Traumatic dental injuries (TDIs) in childhood and adolescence are a potential public health problem given their prevalence and consequences. The aim of this study was to assess the impact of TDIs on the oral health-related quality of life (OHRQoL) of preschoolers and schoolchildren, by synthesizing the available evidence. METHODS: A systematic search was conducted in MEDLINE, EMBASE, Cochrane, ScieLo and Lilacs databases since January 1966 until March 2016. The included studies compared OHRQoL between groups with and without TDIs, using validated instruments. The selection process and data extraction were carried out by two researchers independently. A third reviewer resolved discrepancies. Methodological quality was assessed with the Effective Public Health Practice Project's Quality Assessment Tool. Meta-analyses were performed using random effect models, separately for preschoolers and schoolchildren. RESULTS: Of 213 identified articles, 26 studies (involving a total of 4582 patients and 13 601 controls between the ages of 1 and 15 years) met the inclusion criteria. Most of the studies had been published in the last 5 years, and their methodological quality was judged to be moderate. The TDIs group had a significantly higher chance of reporting any impact on OHRQoL than controls for both preschoolers (OR = 1.44; 95% confidence interval [CI]: 1.28-1.63; I2 = 0%) and schoolchildren (OR = 1.31; 95% CI: 1.04-1.66; I2 = 70%). In preschoolers, the OR for OHRQoL impact for complicated vs uncomplicated TDIs was 1.53 (95% CI: 1.04-2.26; I2 = 0%). The social domain was the most affected one in schoolchildren (standard mean difference = 0.34; 95% CI: 0.13, 0.55; I2 = 68%). CONCLUSION: Traumatic dental injuries have a negative impact on OHRQoL of both preschoolers and schoolchildren. Outcome standardization to measure OHRQoL impact, such as mean score differences and cut-off points, is needed. Prospective cohort studies are recommended to confirm these findings and to understand how TDIs' impact changes with time.

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

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

Oral Problems and Self-Confidence in Preschool Children.

The aim of the present study was to evaluate the impact of clinical oral factors, socioeconomic factors and parental sense of coherence on affected self-confidence in preschool children due to oral problems. A cross-sectional study with probabilistic sampling was conducted at public and private preschools with 769 five-year-old children and their parents/caretakers. A questionnaire addressing socio-demographic characteristics as well as the Scale of Oral Health Outcomes for Five-Year-Old Children (SOHO-5) and the Sense of Coherence Scale (SOC-13) were administered. The dependent variable was self-confidence and was determined using the SOHO-5 tool. Dental caries (ICDAS II), malocclusion and traumatic dental injury (TDI) were recorded during the clinical exam. Clinical examinations were performed by examiners who had undergone training and calibration exercises (intra-examiner agreement: 0.82-1.00 and inter-examiner agreement: 0.80-1.00). Descriptive statistics and Poisson regression analysis were performed (a=5%). Among the children, 91.3% had dental caries, 57.7% had malocclusion, 52.8% had signs of traumatic dental injury and 26.9% had bruxism. The following variables exerted a greater negative impact on the self-confidence of the preschool children due to oral problems: attending public school (PR=2.26; 95% CI: 1.09-4.68), a history of toothache (PR=4.45; 95% CI: 2.00-9.91) and weak parental sense of coherence (PR=2.27; 95% CI: 1.03-5.01). Based on the present findings, clinical variables (dental pain), socio-demographic characteristics and parental sense of coherence can exert a negative impact on self-confidence in preschool children due to oral problems.

Oral Problems and Self-Confidence in Preschool Children

Abstract The aim of the present study was to evaluate the impact of clinical oral factors, socioeconomic factors and parental sense of coherence on affected self-confidence in preschool children due to oral problems. A cross-sectional study with probabilistic sampling was conducted at public and private preschools with 769 five-year-old children and their parents/caretakers. A questionnaire addressing socio-demographic characteristics as well as the Scale of Oral Health Outcomes for Five-Year-Old Children (SOHO-5) and the Sense of Coherence Scale (SOC-13) were administered. The dependent variable was self-confidence and was determined using the SOHO-5 tool. Dental caries (ICDAS II), malocclusion and traumatic dental injury (TDI) were recorded during the clinical exam. Clinical examinations were performed by examiners who had undergone training and calibration exercises (intra-examiner agreement: 0.82-1.00 and inter-examiner agreement: 0.80-1.00). Descriptive statistics and Poisson regression analysis were performed (a=5%). Among the children, 91.3% had dental caries, 57.7% had malocclusion, 52.8% had signs of traumatic dental injury and 26.9% had bruxism. The following variables exerted a greater negative impact on the self-confidence of the preschool children due to oral problems: attending public school (PR=2.26; 95% CI: 1.09-4.68), a history of toothache (PR=4.45; 95% CI: 2.00-9.91) and weak parental sense of coherence (PR=2.27; 95% CI: 1.03-5.01). Based on the present findings, clinical variables (dental pain), socio-demographic characteristics and parental sense of coherence can exert a negative impact on self-confidence in preschool children due to oral problems.

Resumo O presente estudo teve como objetivo avaliar a interferência de fatores clínicos bucais, socioeconômicos e senso de coerência (dos pais) no prejuízo de autoconfiança devido alterações de saúde bucal em pré-escolares. Um estudo transversal com amostra probabilística foi realizado em pré-escolas públicas e privadas com 769 crianças de 5 anos de idade e seus responsáveis. Questionários de variáveis sociodemográficas, o Scale of Oral Health Outcomes for Five-Year-Old Children (SOHO-5) e Sense of Coherence Scale (SOC-13) foram aplicados na amostra. A variável dependente foi autoconfiança e coletada a partir do questionário SOHO-5. Cárie dentária (ICDAS II), má oclusão e traumatismo dentário foram registrados durante o exame clínico. Exames clínicos foram realizados nos pré-escolares por examinadores previamente calibrados (acordo intra-examinador: 0,82-1,00 e acordo inter-examinador: 0,80-1,00). Análise descritiva e Regressão de Poisson foram aplicadas (a=5%). Entre as crianças avaliadas, 91,3% apresentaram cárie dentária, 57,7% maloclusão, 52,8% traumatismo dentário e 26,9% bruxismo. As seguintes variáveis mostraram uma maior média de prejuízo na autoconfiança dos pré-escolares devido alterações de saúde bucal: frequentar pré-escola pública (PR=2,26; 95% CI: 1,09-4,68), histórico de dor de dente (PR=4,45; 95% CI: 2,00-9,91) e fraco senso de coerência dos pais (PR=2,27; 95% CI: 1,03-5,01). Com base nos resultados, pode-se concluir que variáveis clínicas, como a dor de dente, sociodemográfica e senso de coerência dos pais podem interferir na autoconfiança devido a alterações de saúde bucal em pré-escolares.

Impact of traumatic dental injuries on oral health-related quality of life of preschool children: A systematic review and meta-analysis.

BACKGROUND: Observational studies have suggested that traumatic dental injuries (TDI) can lead to pain, loss of function and esthetic problems, with physical, emotional and social consequences for children and their families. However, population-based studies that investigate the impact of TDI on oral health-related quality of life (OHRQoL) among preschool children are scarce and offer conflicting results. The aim of the systematic review and meta-analysis was to evaluate the impact of TDI on OHRQoL among preschool children (PROSPERO-CRD42015032513). METHODS: An electronic search of six databases was performed in PubMed (MEDLINE), ISI Web of Science, Scopus, Science Direct, EMBASE and Google Scholar, with no language or publication date restrictions. The eligibility criteria were TDI as the exposure variable, OHRQoL as the outcome and a population of children up to six years of age. RevMan software was used for data analysis. Results are expressed as odds ratios with 95% confidence intervals for the total score of the Early Childhood Oral Health Impact Scale (ECOHIS) as well as the scores of the Child Impact Section (CIS) and Family Impact Section (FIS). The random effect model was chosen and heterogeneity was evaluated using the I2 test. RESULTS: 2,013 articles were initially retrieved; 1,993 articles were excluded based on title and abstracts; 10 articles excluded after full-text analysis. Ten studies comprising a population of 7,461 preschool children were included in the systematic review and nine studies were included in the meta-analysis. TDI caused a negative impact on OHRQoL based on the overall ECOHIS (OR: 1.24; 95% CI: 1.08-1.43) and CIS (OR: 1.23; 95% CI: 1.07-1.41), but not the FIS (OR: 1.09; 95% CI: 0.90-1.32). CONCLUSIONS: TDI negatively impacted on OHRQoL of preschool children. The present findings indicate the need for TDI prevention and treatment programs in early childhood.

Caretaker's caries experience and its association with early childhood caries and children's oral health-related quality of life: A prospective two-generation study.

OBJECTIVES: The first objective of this study is to examine the association between caretakers' caries experience and caries experience of their children. Second, to investigate whether children's and caretaker's caries experience is associated with oral health-related quality of life (OHRQoL) of children and their families. METHODS: This study is based on the prenatal recruitment interviews and the 5-year follow-up of 417 caretaker-children pairs from the Ugandan site of the PROMISE-EBF trial conducted in Mbale, Eastern Uganda. Face-to-face interviews were conducted with caretakers at the household level. Caries experience of caretakers (DMFT >0) and children (dmft >0) were assessed in accordance with the criteria of the World Health Organization. OHRQoL was assessed using an abbreviated version of the Early Childhood Oral Health Impact Scale (ECOHIS). RESULTS: Adjusted negative binomial regression analysis revealed that caretaker's caries experience was positively associated with early childhood caries of their offspring (IRR 2.0, 95% confidence interval (CI) 1.3-3.0). Children's caries experience (IRR 1.8, 95% CI 1.2-3.0), but not caries experience of caretakers, was associated with worse OHRQoL of children and their families. Caretakers who perceived good child oral health were less likely to report OHRQoL impacts (IRR 0.20, 95% CI 0.12-0.35). CONCLUSION: Improving caretaker's caries experience and her perception of child's oral health status could improve children's caries experience and the OHRQoL of children and family. Such knowledge is important and should inform public oral health programs for young children.

Dental Fear in Children with Repeated Tooth Injuries.

Tooth injuries are serious clinical conditions. Some children experience dental trauma only once, while others are more prone to repeated tooth injuries. Repeated dental trauma occurs in 19.4% to 30% of patients. Pain and dental trauma are the most common reasons for fear and anxiety. The main objective of this study was to investigate how dental trauma, as well as repeated dental trauma affects the occurrence and development of dental fear in children. The study was conducted on a random sample of 147 subjects (88 boys and 59 girls) aged 5-8 and 9-12 years. Subjects in both age groups were divided into subroups without dental trauma, with one dental trauma and with repeated dental trauma. The validated Children's Fear Survey Schedule ­ Dental Subscale was used on fear assessment. Results showed that only 12.2% of children without trauma, 33.3% with one trauma and 51.7% with repeated trauma were not afraid of injection. Older children had a significantly lower fear of injections, touch of an unknown person, choking, going to the hospital and people in white uniforms. Dentist was not the cause of fear in 65.5% of patients with repeated trauma. With each repeated injury of teeth, the degree of their fear of dental treatment was lower.