Trends in the prevalence of traumatic dental injuries in Brazilian preschool children

Abstract –  Objective: The aim of this paper was to report trends in traumatic dental injuries (TDI) in preschool children in Brazil between 2002 and 2006, and assess whether gender, family structure, and socio-economic differences in TDI are significant, and confirm the relationship between TDI and anatomic predisposing factors such as overjet and lip coverage.
Methods:  Three cross-sectional surveys were conducted in 2002, 2004 and 2006 in Diadema using the same protocol. It was estimated that a minimum sample size of 778 5–59 months old children was required to achieve a level of precision with a standard error of <2% Participants were systematically selected from all children attending the National Day of Children's Vaccination carried out in the city of Diadema. The criteria used to assess TDIs were a modified version of Ellis' classification.
Results :  There was a significant increase in TDIs between 2002 and 2006 (47.9%, P  = 0.002). The prevalence of TDIs was 9.4% (95% CI 7.63, 11.42) in 2002, 12.9% (95% CI 11.06, 14.96) in 2004, and 13.9% (95% CI 12.03, 15.84) in 2006 in 5–59 months old children and the treatment of TDI was seriously neglected. There was no significant gender, family structure, and socio-economic differences in the prevalence of TDIs. The relationship between TDI and anatomic predisposing factors such as overjet, lip coverage, and anterior overbite was highly statistically significant ( P  < 0.01).
Conclusion :  The prevalence of TDIs in preschool children in Diadema increased between 2002 and 2006, the treatment of TDIs was neglected, thus it is crucial to generate considerable efforts to implement health promotion strategies to reverse the observed trends and to provide treatment to TDIs to prevent their biologic and psychologic consequences.     

Dental attendance in preschool children – a prospective study

International Journal of Paediatric Dentistry 2013; 23: 84–93 Background. At present, our understanding of the use of dental care services is incomplete, certainly where preschool children are concerned. Objectives. To investigate what proportion of 3‐ and 5‐year‐olds living in Flanders (Belgium) have already visited the dentist, to describe parents’ experience about their child’s dental visit, and to explore factors that may have an impact on children’s early dental visit. Design. Data were collected from 1057 children; validated questionnaires were completed, and children were examined by trained dentist at ages 3 and 5. Logistic regression analyses were performed to explain dental attendance. Results. At the age of 3, 62% and by 5 years, 21% had never visited the dentist. The first dental visit was considered a pleasant experience for the majority of children. Multivariable regression analyses revealed that children who were not first born, whose mothers had a higher educational level and whose parents had recently visited the dentist, had significantly higher odds for having visited the dentist at young age. Conclusions. Parents of young children need to be informed about and motivated for an early dental visit. Promotion campaigns should focus on firstborn children, children from less educated parents, and parents who do not regularly see a dentist.     

Prevalence and determining factors of traumatic injuries to primary teeth in preschool children

Abstract –  The objective of the study was to assess the prevalence of dental injuries and the influence of determining factors in preschool children from Belo Horizonte, Brazil. A cross-sectional survey was carried out through clinical examinations and the application of a questionnaire to the parents of 419 children aged 0 to 5 years attending preschool. The sample was stratified by region, type of institution and age. The eighteen preschools visited were chosen randomly. The prevalence of traumatic injury to primary teeth was 39.1%. Enamel fractures were the most common traumatic injury (49.7%). Boys were 1.62 times more likely to have dental injuries than girls. Children with inadequate lip coverage were 3.75 times more likely to have a traumatic dental injury than those with adequate lip coverage. Children attending state preschools had nearly two times greater chances of having dental trauma than children attending private preschools. It was concluded that the prevalence of dental injuries in preschool children is high in Belo Horizonte, Brazil and constitutes a public health problem.     

Epidemiology of traumatic dental injuries – a 12 year review of the literature

Abstract – Background/Aim: A traumatic dental injury (TDI) is a public dental health problem because of its frequency, occurrence at a young age, costs and that treatment may continue for the rest of the patient’s life. The aim of this paper is to present a12‐year, international review of the prevalence and incidence of TDIs including some background factors and a quick, easy method in registering TDIs to receive a primary understanding of the extent and severity of dental trauma. Material and method: The databases of Medline, Cochrane, SSCI, SCI and CINAHL from 1995 to the present were used. Result: The results indicate a high prevalence of TDIs in primary and permanent teeth and that TDIs exists throughout the world. The prevalence show that one third of all preschool children have suffered a TDI involving the primary dentition, one fourth of all school children and almost one third of adults have suffered a trauma to the permanent dentition, but variations exist both between and within countries. Activities of a person and the environment are probably more determining factors of TDIs than gender and age. A risk profile why some patients sustain multiple dental trauma episodes (MDTE) is necessary to present. All dental clinics should have a prospective ongoing registration of TDIs. The NUC method (N = no TDI, U = uncomplicated TDI, C = complicated TDI) presents if there has been any TDI and the severity of that trauma. Conclusion: The trend of TDIs seems to be stable on a high level with variations largely reflecting local differences. Because of the complexity of TDIs, every dental clinic should have a prospective ongoing registration of number and severity of TDIs.     

Exploring factors associated with traumatic dental injuries in preschool children: a Poisson regression analysis

Abstract – Objective: This cross‐sectional study aimed to investigate the factors associated with dental trauma in preschool children using Poisson regression analysis with robust variance. Subjects and methods: The study population comprised 888 children aged 3‐ to 5‐year‐old attending public nurseries in Canoas, southern Brazil. Questionnaires assessing information related to the independent variables (age, gender, race, mother’s educational level and family income) were completed by the parents. Clinical examinations were carried out by five trained examiners in order to assess traumatic dental injuries (TDI) according to Andreasen’s classification. One of the five examiners was calibrated to assess orthodontic characteristics (open bite and overjet). Multivariable Poisson regression analysis with robust variance was used to determine the factors associated with dental trauma as well as the strengths of association. Traditional logistic regression was also performed in order to compare the estimates obtained by both methods of statistical analysis. Results: 36.4% (323/888) of the children suffered dental trauma and there was no difference in prevalence rates from 3 to 5 years of age. Poisson regression analysis showed that the probability of the outcome was almost 30% higher for children whose mothers had more than 8 years of education (Prevalence Ratio = 1.28; 95% CI = 1.03–1.60) and 63% higher for children with an overjet greater than 2 mm (Prevalence Ratio = 1.63; 95% CI = 1.31–2.03). Odds ratios clearly overestimated the size of the effect when compared with prevalence ratios. Conclusions: These findings indicate the need for preventive orientation regarding TDI, in order to educate parents and caregivers about supervising infants, particularly those with increased overjet and whose mothers have a higher level of education. Poisson regression with robust variance represents a better alternative than logistic regression to estimate the risk of dental trauma in preschool children.     

Traumatic dental injuries in Brazilian preschool children

Abstract  – The purpose of this study was to determine the prevalence and distribution of traumatic injuries to primary anterior teeth in children from zero to 6 years old, all attendees in 28 public nursery schools in Canoas (Brazil). A total of 1545 boys and girls participated in the study. The children were clinically examined for signs of trauma according to Andreasen's classification. Traumatic injuries were identified in 35.5% of children. The largest percentage of injuries was demonstrated by 3–4-year-old child, with no significant difference between boys and girls. The maxillary central incisor was the most vulnerable to injury, without differences between the right and the left side. Single tooth injury was predominant in all age groups. Crown fractures represented 83% of all traumatic injuries. Our findings emphasize the importance of encouraging parents to visit the dentist with their child at an early stage. Furthermore, parents and educators should be advised about prevention of traumatic injuries and actions to be taken in case of an accident.     

Effects of traumatic dental injuries to primary teeth on permanent teeth – a clinical follow‐up study

Abstract – Aim: This study evaluated the prevalence of developmental sequelae to permanent teeth (DSP) after traumatic dental injuries to primary teeth (TDI‐1) and their association with age, gender, type of injury, recurrence of injury and post‐traumatic damage to primary teeth. Materials and methods: Dental records of 2725 children treated from February 1993 to December 2008 in a private pediatric dental clinic were examined. A total of 308 records had 412 primary teeth that sustained traumatic injuries. Age at the time of injury ranged from 4 months to 7 years. A chi‐squared test and logistic regression were used for statistical analyses. Results: One hundred forty‐eight children (241 teeth) were followed up until the eruption of the permanent successor. The prevalence of DSP was 22.4%. Discoloration and hypoplasia were the most frequent abnormalities (74.1%), followed by eruption disorders (25.9%). Age at the time of TDI‐1 was the only variable significantly associated with DSP. Sequelae were most prevalent among children who suffered an injury between 1 and 3 years of age. Conclusions: Children who sustain traumatic dental injuries should be followed up regularly for an early diagnosis and treatment of possible DSP.     

Traumatic anterior dental injuries in Cuban preschool children

Abstract –  The purpose of this study was to determine the prevalence and distribution of traumatic dental injuries in 2–5 year-old children. It included 543 children of both sexes, all attending five urban nurseries in San José de las Lajas, Cuba. The prevalence of injuries was 34.2%. Type and prevalence of dental injuries was determined using Andreasen's classification. Enamel fracture was the predominant injury (67.1%). The maxillary central incisor was the most vulnerable to injuries. Boys (41.8%) experience more injuries than girls (26.8%).     

Retrospective study on traumatic dental injuries in preschool children at Kyung Hee Dental Hospital, Seoul, South Korea

Abstract –  The purpose of this study was to analyse the traumatic dental injuries (TDI) of Korean preschoolers by investigating the occurrence, type, area, cause, injured region, seasonal variation and the interval between injury and treatment. In this study, data from 1856 preschoolers aged 4 months to 6 years and 11 months (mean age : 3.6 ± 1.6) were used, out of a total of 2761 patients who attended the Department of Pediatric Dentistry, Kyung Hee Dental Hospital for TDI between January 1998 and December 2007. All the data were statistically analysed using the anova and chi-square statics. Most of the patients were 1–2, 2–3 years old (24.5%, 25.4%) and boys were 1.67 times more likely to have TDI. The most common cause, location and seasonal variation of the trauma, were respectively falling (50.8%), at home (48.8%) and late spring. The treatment intervals usually occurred within a day. Most of the injuries involved single (47%) or double (38%) tooth/teeth. However, car accidents or sports trauma often involved multiple teeth. In both primary and permanent dentition, the most common teeth injured were maxillary central incisors (72.6%), and periodontal injury was caused by subluxation or concussion. Among the various types of hard tissue injuries, enamel fracture in the primary dentition (35.0%) and enamel-dentin fracture in the permanent dentition (45.8%) were the most common types.     

Treatment of traumatic dental injuries in children.

The major emphasis of this review rests on articles written within the past 12 months. Many of these papers comprise comprehensive surveys of treatment of various aspects of dental trauma in the primary and permanent dentition, as well as epidemiologic studies. There have also been some very good experimental studies that have attempted to standardize luxation injuries as well as tooth replantation in order to study pulpal and periodontal healing in reproducible animal models. However, it can been seen from the reference list that 1 year's production in dental traumatology would not suffice to cover the scope of the treatment needs nor to adequately orient the reader to the progress made with respect to our present knowledge of wound healing following injury and the most recent developments in the restoration of the traumatized dentition. To present an overall view of the philosophy that has evolved concerning wound healing in the dental pulp and periodontium following injury as well as innovations in the treatment of acute dental trauma, this review must of necessity delve back into the mid-1980s and probe forward into publications that are on the way in 1991.     

Risk of concomitant traumatic brain injuries in children with traumatic dental injuries in a pediatric emergency department: A case-control study

BackgroundChildren with traumatic dental injuries (TDIs) may simultaneously sustain a traumatic brain injury (TBI). The aim of this study was to investigate the risk of concomitant TBI in children with TDIs.MethodsChildren (≤ 18 years) who sought treatment at the emergency department of a major children’s hospital for TDIs from 2010 through 2019 were identified. Children with a concomitant TBI were assigned as case patients (TDI and TBI). Two control patients (TDI only) were randomly age- and sex-matched with each case patient. Associations between variables of TDI and concomitant TBI were tested using 6 logistic regression models.ResultsOf 2,126 children with TDIs, 119 had concomitant TBIs (case patients). The control group consisted of 238 children with TDIs only who were age- and sex-matched with case patients. Mean (SD) age of children was 8.9 (4.8) years. Twenty-seven percent of case patients were female vs 32% of control patients. There was a statistically significant direct association between total number of injured teeth and concomitant TBIs (P = .01; odds ratio, 2.42; 95% CI, 1.22 to 4.79). For every tooth injured, the odds of concomitant TBI increased by 45% (P < .001; odds ratio, 1.45; 95% CI, 1.18 to 1.79). Number of displaced teeth, presence of avulsion or intrusion, number of fractured teeth, presence of complicated tooth fracture, and presence of alveolar fracture were not significantly associated with the odds of concomitant TBI.ConclusionsThe total number of injured teeth was positively associated with higher odds of concomitant TBI in this setting.Practical ImplicationsIn an emergency department setting, children with various types of TDIs sustained concomitant TBIs. For every tooth injured, the odds of concomitant TBI increased by 45%. Clinicians must systematically evaluate children with any TDI to rule out the possibility of concomitant TBI.