The management of traumatic dental injuries

Traumatic dental injuries are classified typically as luxation, avulsion, and horizontal root fracture injuries. However, the most confusing aspect of treatment is generally centered on luxation and avulsion injuries. As clinicians, it can be somewhat confusing as to which regime is the most appropriate treatment, since there are a variety of guidelines and treatment modalities.     

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.     

The prevalence of dental fear and avoidance: a recent survey study

This study evaluates the current incidence of dental fear and avoidance in the general population. A telephone survey, using a random dialing procedure, was used as a means of data collection. Results indicated that 11.7% of the respondents reported high dental fear, and another 17.5% reported moderate dental fear. Results also disclosed that 36.5% of those surveyed had not been to the dentist in over a year. Approximately 15.5% of the respondents surveyed had some degree of dental fear and were dental avoiders (using the criterion of no dental visitation for at least one year). These findings highlight the fact that additional attention and research efforts still need to be dedicated to dealing with the highly fearful and avoidant dental patient.     

World traumatic dental injury prevalence and incidence,a meta‐analysis—One billion living people have had traumatic dental injuries

Traumatic dental injuries (TDIs) account for a considerable proportion of bodily injuries. Nevertheless, global TDI frequency is unknown, probably because TDI diagnosis is not standardized. This study estimated world TDI frequency. A literature search (publication years 1996‐2016) was aimed at covering as many countries, communities, ethnic groups as possible, thus achieving high generalizability. In particular, non‐specific keywords, no language restrictions, and large databanks were used. Observational studies reporting proportions of individuals with at least one TDI (prevalence) and who developed TDI (incidence rate) were considered. Prevalence rates to permanent dentition, primary dentition and in 12‐year‐olds, incidence rate to any tooth for any age, male‐to‐female prevalence ratio (PR) in 12‐year‐olds, with 95% confidence intervals (95 CIs), were extracted/calculated. Study quality, Z‐score distribution, funnel plot symmetry analysis, between‐study heterogeneity, sensitivity, and subgroup analyses were performed. Selected primary studies were 102 (permanent dentition; 268 755 individuals; median age, 13.8 years), 46 (primary dentition; 59 436 individuals; median age, 3.4 years), 42 (12‐year‐olds; 33 829 individuals), 11 (incidence rate; 233 480 person‐years; median age, 7.8 years), and 31 (PR; 16 003 males, 16 006 females). World TDI frequency resulted as follows: permanent dentition prevalence 15.2% (95 CI, 13.0%‐17.4%); primary dentition prevalence 22.7% (95 CI, 17.3%‐28.7%); 12‐year‐olds prevalence 18.1% (95 CI, 15.3%‐21.0%); incidence rate, 2.82 (95 CI, 2.28%‐3.42%) per 100 person‐years; PR, 1.43 (95 CI, 1.34%‐1.52%). Differences between WHO Regions were found. This study shows that more than one billion living people have had TDI. TDI is a neglected condition which could rank fifth if it was included in the list of the world's most frequent acute/chronic diseases and injuries.     

Prediction of sports-related dental traumatic injuries

Predicting sports-related traumatic injuries is an important concern for dental health professionals. A predictive index has been developed that determines the likelihood of a sports-related traumatic dental injury in children and adolescents. This index can be used to aid in the prevention of injury by understanding who is most likely to be injured and what factors influence the chance of injury. The index has been designed for ease of use by dental health professionals, and has incorporated data collection and tracking features.     

The dynamics of toothache pain and dental services utilization: 24-month incidence

OBJECTIVES: The aims of this study were twofold: (1) to describe patterns of change in reported toothache pain, and (2) to examine the impact of toothache pain on dental care utilization and vice versa. METHODS: Data from the Florida Dental Care Study (FDCS), a longitudinal study of oral health and dental service utilization conducted in north Florida, were used to measure self-reported toothache pain among dentate adults at baseline and four subsequent times during a 24-month period. Only persons 45 years of age or older with at least one remaining natural tooth at baseline were eligible. A total of 873 subjects participated, 764 of whom participated through 24 months. The analysis is focused on modeling transitions in the reported experience of toothache pain during intervals of six months. RESULTS: At the time of the baseline interview, 11.5 percent of subjects reported current toothache pain. During subsequent six-monthly interviews, from 13.4 percent to 21.6 percent of subjects reported having experienced toothache pain during the prior six-month interval. Among those with no toothache pain at baseline (n = 772), 31.2 percent experienced toothache pain at some time during the 24-month study period. The six-month incidence probability reflects the likelihood of developing toothache pain by estimating the conditional probability of reporting a toothache in a later interval given that this problem was not reported in the earlier one (for consecutive pairs of intervals). Overall, the six-month incidence probability for toothache pain in this study was. 11. Significantly higher 24-month incidence was observed for African-American subjects, those with less formal education, those in poorer financial circumstances, and problem-oriented dental attenders. CONCLUSIONS: In this diverse sample of adults, toothache pain occurs frequently and is quite variable overtime. Toothache occurs in conjunction with various forms of self-reported oral disease (e.g., abscess, cavities) or tissue damage (e.g., loose tooth, broken tooth, bleeding gums). Subjects who experience toothache are slightly more likely than others to utilize dental services in the time period proximate to the toothache pain.     

Prevention of sports-related traumatic dental injuries

Many sports-related traumatic dental injuries are preventable with the use of appropriate, properly fitted athletic equipment such as helmets, facemasks, and mouthguards. This article presents information regarding the current generation of athletic mouthguards, and issues a challenge for the development of future independent scientific research that will transform current clinical empiricism into evidence based knowledge in sports dentistry.     

The importance of soft tissue examination in traumatic dental injuries: a case report

Abstract – Traumatic dental injuries (TDIs) represent one of the main oral health problems in children, with variable prevalence rates. The issue of unmet treatment needs and inadequate emergency management of TDIs have surfaced up lately in dental literature, indicating that some TDIs present late for treatment, which may complicate management of these injuries. Soft tissue injuries usually accompany other dental injuries therefore thorough clinical and radiographic inspection of soft tissue wounds can not be over emphasized, even in late presentation cases. Tooth fragments may be embedded in soft tissues, even in late presentation cases, and may go unnoticed in the presence of urgent situations. This case report presents a child with a fractured tooth fragment embedded in the lower lip for 18 months, which went unnoticed until the child presented later for treatment of the fractured incisor, highlighting the importance of soft tissue exploration even in late presentation trauma cases.