Brazilian dentists' knowledge regarding immediate treatment of traumatic dental injuries

Abstract –  The objective of this study was to assess the knowledge of dentists working in the city of Tubarão, southern Brazil, about the immediate treatment of traumatic dental injuries. A cross-sectional study was carried out involving all dentists who were working in the city in 2004 ( n  = 108). Data were collected through self-applied questionnaires with questions about sex, time elapsed since graduation, whether the dentists had attended postgraduate courses and also four questions about traumatic dental injuries in which the dentists selected the best answer. The response rate was 86.1%. For the two questions related to dental avulsion, 36.6% and 16.1% of professionals respectively, chose the correct answer according to the literature. For the question related to coronal fracture, 75.3% chose the correct answer. For the questions related to an incident without dental avulsion or fracture, 73.1% chose the correct answer. Time elapsed since graduation was the only variable statistically associated with the correct answer for the question related to coronal fracture. A significantly greater number of professionals with ≤10 years of experience chose the correct answer when compared with professionals with >10 years experience ( P  < 0.001). It can be concluded that the great majority of professionals would not intervene according to the literature in the cases of avulsion. Less time elapsed since graduation was statistically associated with the correct answer in the coronal fracture case.     

Incisal overjet and traumatic injuries to upper permanent incisors: A retrospective study

Järvinen, S. Incisal ovejet and traumatic injuries to upper permanent incisors. A retrospective study.

The relationships between traumatic injuries to upper incisors and incisal overjet were studied in a sample of 1445 orthodontically untreated children aged 7 to 16 years. Traumatic injuries of the hard dental tissues and exarticulations of teeth were recorded. The frequency of injuries was 14.2 7% in children with normal ovejet (0–3 mm), 28.4 % in children with increased ovejet (3.1–6 mm), and 38.6% in children with extreme ovejet (>6 mm). The severity of injuries was also greater in children with extreme ovejet than in children with overjet ranging from 0 to 6 mm. Furthermore, the range of injuries increased in relation to the overjet. Two or more injured incisors were found in 19.2% of the children with normal overjet, in 22.2% of the children with increased overjet, and in 46.7 % of those with extreme ovejet.

Partly published in Finnish in Proc. Finn. dent. SOC. 73:Suppl. V, 1977.     

Prevalence of traumatic injuries to the permanent incisors in candidates for orthodontic treatment

Abstract  – The dental records made on presentation of 1367 consecutive patients (731 females and 636 males) for orthodontic treatment at a private orthodontic practice between 1998 and 2002 were examined for data relating to trauma to the permanent incisors. The results showed that 10.3% of these patients had suffered from dental trauma before the onset of orthodontic treatment. The highest prevalence of dental trauma was determined in the 11–15 years age group, corresponding to the dental developmental stage of the late mixed dentition. The most frequently affected teeth were the maxillary central incisors (79.6%), and the most common types of trauma were fracture of enamel–dentin without pulpal involvement (42.7%) and fracture of enamel (33.8%). Compared to patients with normal overjet and adequate lip coverage, the frequency of dental trauma was significantly higher in patients with increased overjet and adequate lip coverage ( P  = 0.028) or with increased overjet and inadequate lip coverage ( P  = 0.003). The results of the present study indicate that a significant percentage of candidates for orthodontic treatment, and especially those with increased overjet and inadequate lip coverage, suffer trauma to their permanent incisors before the onset of orthodontic treatment. It might also be concluded that preventive orthodontic treatment of such patients should be initiated and completed before the age of 11, i.e. in the early to middle mixed dentition.     

Incisal overjet and traumatic injuries to upper permanent incisors. A retrospective study.

The relationships between traumatic injuries to upper incisors and incisal overjet were studied in a sample of 1445 orthodontically untreated children aged 7 to 16 years. Traumatic injuries of the hard dental tissues and exarticulations of teeth were recorded. The frequently of injuries was 14.2% in children with normal overjet (0--3 mm), 28.4% in children with increased overjet (3.1-6mm), and 38.6% in children with extreme overjet (greater than 6 mm). The severity of injuries was also greater in children with extreme overjet than in children with overjet ranging from 0 to 6 mm. Furthermore, the range of injuries increased in relation to the overjet. Two or more injured incisors were found in 19.2% of the children with normal overjet, in 22.2% of the children with increased overjet, and in 46.7% of those with extreme overjet.     

Traumatic injuries to permanent incisors

Abstract The prevalence of traumatic injuries to permanent incisors and their distribution according to type and some clinical factors, were analysed in a total population of 2798 patients, aged 6–21 years, examined over a 5-year period in the Dental Clinic of the University of Verona, Italy. The material consisted of case histories and radiograms taken during the examination of injured teeth. The number of injured patients was 178 (131 males and 47 females), the number of injured incisors was 326. The prevalence of injuries was 7.3%. A very large number of dental injuries occured to children aged between 6 and 13 years. The ratio of boys to girls was 2.7:1. Most frequent causes of injuries were falls and traffic accidents. Most injuries involved two teeth. About 80% of the teeth were maxillary central incisors. The most common type of injury was non complicated crown fracture. In 87 cases (48%) there was an associated injury to soft tissue. Alveolar fractures occurred in 22 cases (12%). Traumas involving periodontal ligament constituted nearly 40% of the total. This study noted the following points: 1) preventive education programs should be instituted in the region, directed at parents and school teachers, to inform them about the problems of dental trauma and to obtain cooperative attitude to treatment and good motivation in controls; 2) the necessity to unify the diagnostic and therapeutic protocol to provide reliable information in clinical investigations, to permit valid comparison with other studies and to improve the long-term prognosis of many cases.     

An investigation into dentists' management methods of dental trauma to maxillary permanent incisors in Victoria, Australia

Abstract –  Trauma to anterior teeth in children could become a long-term problem to dental health. To a large extent, the management actions of the dentists involved will determine the clinical outcome and, in turn, these actions will be related to their levels of knowledge. The aim of this study was to investigate dentists' knowledge of managing traumatic injuries to maxillary permanent incisors in children. A self-completion questionnaire containing 19 questions on management methods of treating dental trauma was mailed to 693 dentists in Victoria, Australia. The response rate achieved was 61%. This survey found that some of the respondents had adequate management knowledge for the different types of traumatic injuries, while others did not have the correct information. Approximately half the dentists considered milk as the preferred extraoral storage medium of choice for avulsed teeth and a period of 7–10 days splinting after replantation. A large proportion of dentists showed inadequate knowledge with regard to understanding the biological mechanisms causing replacement root resorption (61%) and external inflammatory root resorption (74%). Overall, the respondents to this survey demonstrated only a moderate level of knowledge in management of traumatic injuries to maxillary permanent incisors in children. Continuing professional development programmes may be a means of improving this deficient knowledge base.     

Longitudinal study of electrometric sensitivity of young permanent incisors

Abstract – Electrometric sensitivity of permanent maxillary central incisors was studied longitudinally in 34 children at 6-month intervals over 2½ yr (mean age of the children at the beginning of the study: 94.6 months). Root development stages were determined from radiographs obtained at the beginning of the study, after 1 yr, and after 2½ yr. An increase in sensitivity was found over the study period, but large variations were found from child to child and even within the same child. Especially at the first examinations a few children showed very low sensitivity. Statistical analysis showed that examination number, root development and side of the mouth (right or left central incisor) all were statistically significantly related to sensitivity. Statistically significant differences were also found between the individuals.     

Clinical investigation of traumatic injuries of permanent incisors in Izmir, Türkiye

Abstract 470 injured teeth of 370 patients who consulted the Dental Clinic of Ege University, Izmir, Turkiye for examination of treatment between 1981–1993 were evaluated. Information concerning sex, age of patients at the time of injury, cause of trauma, number of injured teeth, type of tooth and type of trauma were recorded. More boys suffered traumatic injuries (64.8%) than girls (35.2%). Patients aged 11–15 years old exhibited the highest number of injuries (37.4%) followed by the 6–10 years old group (24.5%). Most injuries involved one tooth (60%) and maxillary central incisors were the most often affected teeth (66.2%). The leading cause of injury was undefined falls (45.1%). The most common type of trauma was non-complicated crown fracture (40.4%). At the initial examination, cases seen after a long posttraumatic period showed more complications than those presented within a short time period. Educational programs about the importance of dental trauma, ways of preventing from trauma, the benefits of immediate attendance and conservation of avulsed and fractured teeth would be very helpful for patients. Additionally improving the knowledge of the dental practitioner about trauma would be another important point in solving the 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.     

Traumatic injuries to upper permanent incisors related to age and incisal overjet. A retrospective study.

The relationship between traumatic injuries to upper permanent incisors and incisal overjet, with special reference to the age at which the trauma occurred, was studied in a sample of 1437 orthodontically untreated children aged 7--16 years. Traumatic injuries to hard dental tissues and exarticulations of teeth were recorded. Before 10 years of age, the increase of the prevalence rates was most rapid in the extreme (greater than 6 mm) overjet group in both sexes; the ratios between the extreme and normal (0--3 mm) overjet groups being 6.5/1 in girls and 5.0/1 in boys. According to the estimate, about 50% of the girls and 70% of the boys in this overjet group with injuries were affected before the age of 10 years.     

Recent trends in the management of dentoalveolar traumatic injuries to primary and young permanent teeth

Abstract – One of the commonly encountered dental emergencies is dentoalveolar traumatic injuries (DTIs). Unfortunately, DTIs result in fractured, displaced, or lost anterior teeth and this could have significant negative functional, esthetic, speech, and psychological effects on children thus affecting their quality of life. Although it is impossible to guarantee permanent retention of a traumatized tooth, patient age, severity of injury, and timely treatment and follow up of the tooth using recommended procedures can maximize the chances for success. This review examines the recent trends in the management of DTI to primary and young permanent teeth. Electronic search of scientific papers written in English from 1990s to 2009 was accomplished using Pub Med search engine. Dental practitioners should follow current literature and consider carefully evidenced‐based recommendations that may enhance periodontal healing and revascularization of avulsed permanent teeth.     

Epidemiology of traumatic injuries to the permanent incisors of 9-12-year-old schoolchildren in Damascus, Syria.

This cross-sectional survey was carried out to assess epidemiological 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.     

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.     

An investigation into dentists' perceptions of barriers to providing care of dental trauma to permanent maxillary incisors in children in Victoria, Australia

BACKGROUND: Perceived barriers in the treatment of dental trauma may influence the optimum management of dental trauma. Any hesitation that dentists might have in managing dental trauma is important to investigate. The aim of this study was to investigate dentists' perceptions of barriers to providing care of dental trauma to permanent maxillary incisors in children. METHODS: A self-completion questionnaire survey containing six questions on demographic data and 15 questions relating to barriers to treating dental trauma was mailed to 693 dentists in Victoria, Australia. RESULTS: The response rate achieved was 61 per cent. Of the respondents, 90 per cent had no hesitation in treating dental injuries and 80 per cent of these frequently agreed that dentists should treat all dental trauma. Approximately half the dentists (51.5 per cent) frequently found uncooperative children to be the main barrier to providing care. CONCLUSION: The overall consensus from the present study was that treating dental trauma is not unappealing for dentists in general practice.     

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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。     

部分活髓切断术应用于年轻恒牙冠折露髓的临床研究

目的 观察部分活髓切断术治疗年轻恒牙冠折露髓的临床效果。方法 对采用部分活髓切断术治疗的44例冠折露髓患者的46颗年轻恒前牙进行1～6年的临床回顾性观察。结果 其中一颗牙齿在治疗后一年因修复体脱落而致牙髓坏死。其余45颗牙齿均治疗成功，成功率为97．81％。结论 对于冠折露髓的年轻恒牙，部分活髓切断术是成功而有效的治疗方法。