Clinical investigation of traumatic injuries in Yeditepe University, Turkey during the last 3 years

Abstract – The aim of this study was to evaluate etiology, types of traumatic dental injuries, treatment and to determine the incidence of complications according to dental injuries in patients who referred to Yeditepe University, Faculty of Dentistry, Istanbul, Turkey. The study was based on the clinical data of the 161 traumatized teeth in 92 patients. WHO classification slightly modified by Andreasen & Andreasen for dental trauma was used. The causes and localization of trauma, traumatized teeth classification, treatment and complications were evaluated both primary and permanent teeth. The distribution of complications according to diagnosis and treatment of the injured teeth were evaluated. Of 35 (38%) girls and 56 (72%) boys with a mean age 7.6 ± 3.5 (ranging 1–14.2) participated to study and the mean followed up was 1.72 ± 1.28 years (ranging 0.10–3.8 years). From the 161 affected teeth, 69 (42.9%) were in primary teeth and 92 (57.1%) in permanent teeth. The highest frequency of trauma occurred in the 6–12 year age group. Overall boys significantly outnumbered girls by approximately 1:1.6. The most common type of injury in the primary and permanent teeth was seen as luxation (38%) and enamel fracture (20%) of the maxillary central incisors, respectively. Falls were the major sources of trauma both the primary (90%) and the permanent teeth (84%). In the primary dentition, the most common type of soft tissue injury is contusion (62.5%) and in the permanent dentition, it is laceration (49%). The most of the treatment choice was determined as examination only and extraction in primary teeth (58 and 24.6%, respectively) while it was applied as restoration and pulpectomy in permanent teeth (31.5 and 18.5%, respectively). Complications were recorded on 37 teeth (23%) with a most common type of necrosis (10.5%) and dental abscess (7.4%). Necrosis was more frequent in luxation whereas dental abscess were in crown fracture with pulpal involvement in both dentitions. The study showed that boys were more prone to dental traumas than girls. Falls were more frequent trauma type with a high complication risk. It reveals that the time of the immediate treatment showed the important predisposing factors that increase the success of treatment and decrease the risk of complication. The correct diagnosis of dental injuries is more important for eliminating the occurrence of complications.     

Prevalence and handedness correlates of traumatic injuries to the permanent incisors in 13–17-year-old adolescents in Erzurum, Turkey

Abstract – The objectives of the present study were to explore the relationship between dental trauma and handedness, and to assess the prevalence of traumatic injuries to the permanent incisors of 13–17‐year‐old patients, seeking treatment for various dental conditions in Erzurum, Turkey. A questionnaire focusing on handedness was administered to these patients. Handedness was assessed by the Edinburgh Handedness Inventory (Oldfield, 1971). Hand preference was divided into two classes for convenience in data analysis: (i) right‐handers (GSc from 80 to 100); and (ii) left‐handers (GSc from ?80 to ?100). This study included the 13–17‐year‐old group patients who had GSc as described above. Thus, the present study was carried out on 2180 (1252 male and 928 female, with a mean age of 14.9 years) out of 2392 patients. The clinical examinations and radiographic assessments were performed in full‐designed dental chairs. Preliminary analysis showed no differences in rates of handedness with respect to sex and age. Overall, 10.4% of the patients were left‐handers. A total of 292 (13.4%) of 2180 patients examined had one or more traumatized permanent incisors. The proportion of dental trauma was significantly higher in males than in females, 17.41% in males as compared to 7.97% in females; and ratio of the affected males to females was about 2.18. Sex difference in the prevalence of traumatized permanent incisors was statistically significant (P < 0.001). That is, males had a significantly higher risk of dental trauma than females (P < 0.001; odds ratio: 2.49; 95% confidence interval (CI) 1.88, 3.23). There was a higher level of traumatized permanent incisors among left‐handers than among right‐handers. 28.3% of left‐handers and 11.7% of right‐handers had dental trauma. This difference in the prevalence of traumatized permanent incisors for handedness was statistically significant (P < 0.001). Indeed, left‐handers had a significantly higher risk on dental trauma than right‐handers (P < 0.001; odds ratio: 3.09; 95% CI 2.23, 4.29). The primary causative factor in the occurrence of trauma was the fall (27.7%). Then came violence and fight as the second most frequent cause of trauma (24%), followed by sports injury (18.8%). Trauma resulting from collisions and traffic accidents were accounted as 13.7 and 11.3% of all cases, respectively. The other causes were 4.5%. In conclusion, the present study suggests that left‐handed adolescents have more frequent permanent incisor tooth trauma than right‐handed adolescents. Left‐handedness, therefore, appears to be a risk factor for trauma in 13–17‐year‐old adolescents.     

Self-reported dental and oral injuries in a population of adults aged 18–50 years

Abstract – Few population‐based studies of traumatic dental injury in adults have been undertaken. The objective of this study was to assess the prevalence and severity of injuries to the mouth and teeth among adults aged 18–50 years living in the Canadian province of Ontario. A telephone survey was undertaken based on random digit dialling and 2001 adults in the target age range were interviewed. Overall, 15.5% reported a history of injury to the mouth and teeth. Of these, one‐third reported two or more episodes of injury. Males were more likely than females to report injury and to have experienced more than one injury. There was no association with age but a U‐shaped relationship with education. When asked about the nature of the worst injury experienced, 85% with a history of trauma reported damage to the teeth and of these, 38.5% reported one or more teeth were chipped and 26.0% broke one or more teeth. One quarter (25.4%) reported avulsions and 6.5% reported luxations. Other types of injury were reported by 3.5%. Two‐thirds of the injuries reported occurred before the age of 18 years and one‐third after this age. One‐fifth of those with tooth injuries had not been treated by a health professional. This was not associated with the nature of the damage that occurred; rather subjects from the lower educational groups were less likely than those from higher educational groups to have received treatment. There was a significant association between injuries to the mouth and teeth and injuries in other body locations. One‐third of those reporting two or more episodes of the latter reported having experienced injuries to the mouth and teeth. The results of this self‐report study indicate that dental trauma constitutes a significant health issue among adults and that a minority may be injury prone. Health promotion programmes to reduce the incidence of injury among lower socioeconomic groups are needed since these have high rates of injury and the lowest rate of receipt of treatment.     

Causes and prevalence of traumatic injuries to the permanent incisors of school children aged 12 years in Jaragua do Sul, Brazil

AIM: To assess the causes and the prevalence of traumatic injuries to the permanent incisors of 12-year-old schoolchildren in Jaragua do Sul, Brazil. DESIGN: Cross-sectional survey. SETTING: Public and private primary schools. PARTICIPANTS: 476 children of both sexes, selected by multistage sampling technique. METHODS: Clinical examination of upper and lower permanent incisors. MAIN OUTCOME MEASURES: Incisal overjet, lip coverage, traumatised anterior teeth, cause of trauma. Parents' levels of education and employment status and family income. RESULTS: Boys experienced double the percentage of injuries compared to girls. Children with incisal overjet greater than 5 mm (P = 0.077) and inadequate lip coverage (P = 0.667) were not more likely to have experienced dental injuries. The main causes of injuries to the permanent incisors were falls (26 per cent), traffic accidents (20.5 per cent), sports (19.2 per cent), violence (16.4 per cent) and collisions with people or inanimate objects (6.8 per cent). Socio-economic measures had no significant effect on prevalence of trauma. CONCLUSIONS: Policy makers must take the causes of trauma into account when developing a strategy for the prevention of dental injuries. The role of violence in causing traumatic dental injuries has been underestimated.     

Epidemiology of traumatic injuries to the permanent incisors of 9–12-year-old school children in Damascus, Syria

Abstract— This cross-sectional survey was carried out to assess epi-demiological data concerning dental injuries to the permanent incisors of Syrian children. It included 1087 children aged 9 to 12 years, of both sexes, randomly selected from public and private primary schools in Damascus. The response rate was 100%. The prevalence of traumatic injuries to the permanent incisors rose from 5.2% at the age of 9 years to 11.7% at the age of 12 years ( P= 0.007). The difference in prevalence between boys and girls was not statistically significant ( P>0.05 ). The majority (59.8%) of children who had experienced injuries to the permanent incisors reported that they were not taken to the dentist for evaluation or treatment of the damage. Among those children who had experienced traumatic injuries to the teeth 93.1% presented with untreated damage. Because some injuries were minor, such as small enamel fractures, the proportion of children who needed treatment was 63.2%. There was a tendency for children with an incisal overjet greater than 5 mm to have experienced dental injuries ( P=0.06 ). Children with inadequate lip coverage were more likely to have experienced dental injuries than those with adequate lip coverage (P=0.000). The most common reported cause of injuries to the permanent incisors was violence (42.5%), followed by traffic accidents (24.1%), collisions with people or inanimate objects (16.0%) and falls (9.1%). In conclusion, traumatic dental injury may pose a serious dental public health problem.     

Prevalence and correlates of traumatic injuries to the permanent teeth of school-children aged 9–14 years in Belo Horizonte, Brazil

Abstract – A cross-sectional survey was carried out on 3702 boys and girls aged 9–14 years, attending public and private primary schools in Belo Horizonte, Brazil. A multi-stage sampling technique using an equal probability scheme was adopted to select the children. The response rate for the total sample was 97%. Dental examinations were carried out by one dentist (MISC). Intra-examiner agreement was very good. The prevalence of dental injuries increased from 8% at the age of 9 years to 13.6% at 12 and 16.1% at 14 years. Adjusted results showed that children from high socio-economic backgrounds were 1.4 (95% CI=1.15–1.79) times more likely to present with a dental injury than children with low SES. Boys were 1.7 times (95% CI=1.41–2.16) more likely to have dental injuries than girls. Children with an overjet size greater than 5.0 mm were 1.37 times (95% CI=1.06–1.80) more likely to have a dental injury than children with an overjet size equal or lower than 5.0 mm. Finally, children with an adequate lip coverage were 0.56 times (95% CI=0.44–0.72) less likely to have a traumatic dental injury than those with inadequate lip coverage.     

A retrospective study of traumatic dental injuries in a Brazilian dental trauma clinic

Abstract – The purpose of this retrospective study was to analyse data from the records of patients seen in the dental trauma emergency clinic in a general hospital in the city of Recife, Brazil, during the years 1997–1999, according to sex, age, cause, number of injured teeth, type of tooth and type of trauma. The records of all patients seen by dentists were collected. Altogether, 250 patients from 1 to 59 years of age presenting 403 dental injuries were examined and/or treated. The causes of dento-alveolar trauma were classified in five categories: home injuries, street injuries, school injuries, sports activities, violence. The type of trauma was classified by dentists working at the dental trauma clinic on the basis of Andreasen's classification. The gender difference in the number of cases of trauma was statistically significant (males 63.2% vs females 36.8) ( P <0.0001). Fracture in enamel only (51.6%) and fractures in dentine (40.8%) were the most commonly occurring types of injury. Injuries were most frequently diagnosed as serious among the youngest patients (up to 15 years of age); 82.4% of intrusive luxation cases were diagnosed in the 1–5 years age group. The main causes of tooth injury were falls (72.4%), collisions with objects (9.2%), violence (8.0%), traffic accidents (6.8%) and sports (3.6%). Trauma caused by violence was found to be statistically significant in the 6–15 years age group ( P <0.0005).     

The attention‐deficit/hyperactivity disorder model for traumatic dental injuries: a critical review and update of the last 10 years

It has been more than 10 years since the proposal of attention‐deficit/hyperactivity disorder (ADHD) model as an explanatory construct for traumatic dental injuries (TDIs) in children. The aim of this review was to address developments in the study of the issue after 2005–2016. A systematic literature search covering the period from 2005 to 2016 was conducted on PubMed, the Cochrane library and Google Scholar using relevant keywords. Fourteen studies exploring the relationship between ADHD and TDIs from 2005 and onward (including the proposal paper) were identified. Of the 12 controlled studies, nine reported confirming findings for a link with ADHD in the occurrence of TDIs. More than one‐third of all children with ADHD may suffer from TDIs. In ADHD children, the most common types of injury were uncomplicated/complicated crown fractures and subluxation of maxillary central incisors resulting from falls and collisions. There is also evidence that ADHD represents an independent risk factor other than the well‐established risk factor of incisor overjet. Over the last 10 years, convincing evidence has accumulated that ADHD is an important and common risk factor for TDIs. Increased awareness and side‐by‐side work of medical, dental and mental professionals at both clinical and research settings are necessary.     

Work‐related traumatic dental injuries: Prevalence,characteristics and risk factors

Background/Aims

The prevalence of work‐related oral trauma is underestimated because minor dental injuries are often not reported in patients with several injuries in different parts of the body. In addition, little data are available regarding their characteristics. The aim of this epidemiological study was to determine the prevalence, types, and characteristics of occupational traumatic dental injuries (TDIs) in a large working community.

Materials and Methods

Work‐related TDIs that occurred during the period between 2011 and 2013 in the District of Genoa (Northwest of Italy, 0.86 million inhabitants) were analyzed. Patients’ data were obtained from the National Institute for Insurance against Accidents at Work database.

Results

During the 2 year period, 112 TDIs (345 traumatized teeth) were recorded. The prevalence was 5.6‰ of the total amount of occupational trauma. The highest prevalence was found in the fourth and fifth decades of life (OR=3.6, P < .001), and males were injured more often than females (70.5% vs 29.5%, OR=2.8, P < .001). Service and office workers represented 52% of the sample, and construction/farm/factory workers and craftsmen were 48%. TDIs involved only teeth and surrounding tissue in 66% of cases, or in combination with another maxillofacial injury in 34%. They were statistically associated with construction/farm/factory workers group (Chi squared P < .01). Crown fracture was recorded in 34.5% of cases, subluxation/luxation in 10.7%, avulsion in 9%, root fracture in 3.8%, and concussion in 3.5%. Thirty‐two subjects (28.6%, 133 teeth, OR=4.3, P < .001) presented at least 1 traumatized tooth with previous dental treatment. Among 212 (61.4%) traumatized teeth, 67.5% were upper incisors, 17.5% were lower incisors, 3.3% were upper canines, 1.9% were lower canines, and 9.9% were bicuspids and molars.

Conclusions

Work‐related TDIs had a low overall prevalence, and fractures were the most frequent dental injury. Age, gender, and preexisting dental treatments represented risk factors for work‐related TDIs.     

Mouthguard utilization rates during sport activities in Ankara, Turkey

Abstract –  The objective of this study was to determine the attitudes towards mouthguard use in Ankara, Turkey. In the first part of this study, an eight-item questionnaire was distributed to 22 coaches from 15 secondary schools randomly selected from five municipalities of Ankara, Turkey. The questionnaire sought information on how much coaches know regarding mouthguards and how often children and adolescents of the ages 11–18 use mouthguards. The second part of the study was based on the data obtained from direct interviews answered by 121 university athletes of three different sport modalities (football, ice hockey and martial arts). The purpose of this part of the study was to determine the rate of mouthguard use and the frequency and type of oral trauma in these athletes. The result of the coaches' questionnaires revealed that; none of the 11–18 years old children and adolescents used mouthguards while participating in sports. Of the coaches, 77.2% had seen orofacial trauma in this age group during sport activities and 95.5% of the coaches believed that mouthguards prevented oral injuries. Of the coaches, 72.7% reported that children and adolescents should use mouthguards in sport activities. The second part of the study showed that although all of the athletes owned mouth-formed type of mouthguards, the utilization rate was 74.4%. Of all players, 13.2% had suffered from one or more form of oral injury while not wearing mouthguards. The results show that in Turkey, the use of mouthguards has not become widespread in sports. It can be concluded that regular mouthguard use in sports should be encouraged in Turkey.     

Traumatic injuries of the permanent incisors in children in southern Turkey: a retrospective study

Abstract –  The aim of this study is to investigate the incidence, etiologic factors and results of dental trauma and the effects of age and gender on the trauma in permanent incisors. Over a 3-year period, 514 permanent incisor teeth in 317 patients with trauma history, who applied to Süleyman Demirel University School of Dentistry, Department of Pedodontics from the southern cities of Turkey, were evaluated. Standardized trauma forms were filled for each patient. In all age groups, the most frequent cause of trauma was found to be unspecified falls (47.6%). Maxillary teeth (88.5%) and central incisors (87.5%) were the most affected teeth from dental trauma. Ellis class II crown fracture was the most frequently seen type of injury (43.8%). The percent of the patients who applied to a dental clinic in the first 3 days after the trauma occurred (22.8%) was less than the percent of the patients who applied after 3 months and more time period (45.1%). It reveals that it is important to inform the public about dental trauma and the importance of time in these cases.     

Prevalence of traumatic dental injury and associated factors among 12-year-old school children in Florianópolis, Brazil

Abstract  – The objective of this study was to assess the prevalence and type of accidents that resulted in traumatic injuries to the permanent dentition of 12-year-old school children in Florianópolis, Brazil. A dental trauma cross-sectional survey was carried out through clinical examination of upper and lower permanent incisors and interviews with 307 12-year-old school children enrolled in public primary schools. Intra-examiner diagnosis variability was good, measured by kappa values on tooth-by-tooth basis. The prevalence of dental injury was 18.9%. There was no statistical difference in the prevalence between boys and girls ( P  = 0.103). The main types of accidents that resulted in dental injuries were falls and collisions with objects or people. It can be concluded that the prevalence of dental injuries in Florianópolis, Brazil is high and they have a great potential to be considered an emerging public health problem.     

Socio-economic correlates of traumatic injuries to the permanent incisors in schoolchildren aged 12 years in Blumenau, Brazil

Abstract – This study aimed to assess the prevalence of injuries to the permanent incisors in Blumenau, Brazil. In addition, the relationship between dental injuries and socio-economic indicators was examined. A cross-sectional survey was carried out. It included a random sample of 652 children aged 12 years, from both sexes, attending public and private primary schools in Blumenau, Brazil. Multi-stage sampling technique and proportional representation were adopted. A trained and calibrated dentist collected the data through clinical examinations and interviews. Clinical examination included type of damage, treatment provided and needed, size of incisal overjet and type of lip coverage. The response rate was 82.5%. The prevalence of dental injuries was 58.6%. Boys experienced more injuries than girls, 67.2% and 50.2% ( P =0.001), respectively. Children from mothers with higher schooling experienced more dental injuries than those from of mothers with lower schooling, 68.2% and 56.6% ( P =0.03). Father's level of education, parents' employment status and family income were not statistically significantly associated with dental injuries ( P >0.05). There was a tendency for children with incisal overjet greater than 5 mm ( P =0.2) and inadequate lip coverage ( P =0.1) to have more dental injuries, but differences were not statistically significant. Nearly all (97.3%) children who had dental injuries needed treatment. In conclusion, the prevalence of dental injuries in Blumenau, Brazil, was very high, treatment of dental injuries was severely neglected, and boys and children from mothers with high schooling were more likely to have experienced dental injuries.     

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牙外伤包括牙体硬组织损伤、牙髓组织损伤和牙周组织损伤。牙髓损伤常见于牙齿折断、牙齿移位和牙齿全脱出中,可见牙髓损伤几乎在所有的牙齿外伤中都存在。外伤后,牙髓组织的转归可分为牙髓存活、牙髓钙变和牙髓坏死3种。牙髓组织的转归与以下因素有关:(1)外伤冲击力对牙髓组织的损伤;(2)外伤后外界不良刺激;(3)牙齿发育程度、个体差异等。儿童恒牙外伤后牙齿尚处于生长发育中,其治疗和预后远比成人复杂。本文针对年轻恒牙的特点,提出外伤后牙髓损伤判断和处置的对策。