The prevalence of traumatic injuries treated in the pedodontic clinic of Ankara University, Turkey, during 18 months

Abstract  – The purpose of this study was to evaluate the type and prevalence of dental injuries referred to Ankara University, School of Dentistry, Department of Pedodontics, Turkey. One hundred and forty-seven patients with 234 traumatized teeth presented during 18-month interval. Of the 147 patients, 85 were boys and 62 were girls. The most frequent trauma occurred in the age of 11 years. The maxillary central incisors were found to be the most affected tooth in both primary and permanent dentition injuries. The maxillary arch is involved in a higher percentage of trauma cases (95.72%). The most common cause of injuries are falls (67.34%). In the primary dentition, the most common type of injury is extrusive luxation (38.23%) and in the permanent dentition, it is fracture of enamel–dentin without pulpal involvement (50.5%). From 147 patients, only 82 presented to our clinic within 1 h and 10 days after the injury time. It reveals that there is a need to inform the public of what they should do in cases of dental trauma, and how important it is to contact a dentist immediately.     

Influence of the type of dental trauma on the pulp vitality and the time elapsed until treatment: a study in patients aged 0–3 years

Abstract  – The purpose of the present study was to determine the influence of the type of trauma on the pulp vitality and the time elapsed until seeking dental care in children aged 0–3 years seen at the Baby Clinic of the Araçatuba Dental School, UNESP. A total of 1813 records were analyzed. Two hundred and three patients, corresponding to 302 traumatized teeth, were assessed clinically and radiographically. Hard-tissue injuries were the most frequent (52%), with a predominance of enamel crown fractures (41.4%), followed by concussions (12.6%) and intrusions (11.6%). Clinical and radiographic examination revealed that 72% of the traumatized teeth maintained pulp vitality. In the case of supporting-tissue lesions, 51.1% of the patients sought care within 1–15 days after injury, while in the case of hard-tissue injuries, 52.7% sought care only after 16 days. The results showed that supporting-tissue injuries had a significant influence on the faster seeking of dental care.     

Prevalence of crown fractures in 8–10 years old schoolchildren in Canoas, Brazil

Abstract –  The objective of this work was to evaluate the prevalence of children with crown fractures in permanent anterior teeth in 206 schoolchildren (104 girls and 102 boys) between the ages of 8 and 10 years, enrolled in three public schools in the city of Canoas, Brazil. The prevalence found was 17% with no significant difference between boys and girls, as well as between the ages. The most affected tooth was the maxillary central incisor, and a majority of the children showed only one affected tooth (88.6%). The types of fracture most commonly found were oblique and horizontal, and the portions of dental structures most affected were 'enamel only' and 'enamel and dentin'. Only seven children (20%) sought out dental treatment.     

Primary tooth injuries in Norwegian children (1–8 years)

Abstract –  This prospective study examined the yearly incidence of traumatic injuries to primary teeth. The aim of the study was to find out more about dental injuries to primary teeth in Norwegian children. The study was performed in one county of Norway involving approximately 20 000 children in the age group 1–8 years. Twenty-seven public dental clinics and 42 dentists participated. The dentists attended information and calibration meetings and received illustrations of the classification of dental trauma as well as examples of how to fill in the forms correctly. Two hundred and sixty-six children were involved, including 447 primary teeth, recorded during a 1-year registration period (2003). The dental trauma incidence was 1.3% with 3.5-year old being the most accident-prone. Boys were significantly more often injured than girls, 164 versus 102 ( P  < 0.001). The upper central incisors were most involved (92%), with a non-significant difference between the right and left side. The minor periodontal injuries dominated (59%). Hard tissue injuries were far less frequent (13%). Avulsions were observed in 6.5% and intrusions in 7.5% of the injured children, being 5.5% and 5% of the injured teeth. Most of the injuries occurred either at home (38%) or at kindergarten (32%). Sixty-two percentage were falling accidents often sustained during children's play, and 25% were pure playing accidents.
Conclusion:  In Norwegian children aged 1–8 years, with a predominance of boys, the most common primary tooth injuries were minor luxations of the maxillary central incisors, sustained at an age of 3.5 years. As the traumas often occurred during children's play and/or were the consequence of falls, these are difficult to prevent. However, follow ups should be carried out to disclose pulpal or periodontal complications and/or developmental disturbances of the permanent successors.     

Pattern of traumatic dental injuries in the permanent dentition among children,adolescents, and adults

Abstract – Background: Traumatic dental injuries (TDI) comprise six types of luxation and seven types of tooth fractures. The risk of pulp necrosis is increased in teeth with combination injuries where fractures and luxations occur concomitantly. Aim: To report and compare the distributions of luxations and fracture types among children, adolescents, and adults, and to analyze the distribution and prevalence of combination injuries. Material and method: The study group included 4754 patients (3186 men and 1568 women) with 10 166 traumatized permanent incisors treated at Copenhagen University Hospital, Rigshospitalet. Differences in the distributions of trauma types among age groups (children <12 years, adolescents 12–20 years, and adults >20 years) and distributions of concomitant crown fractures for each luxation type were analyzed with the Chi‐square test. Results: A total of 7464 teeth (73.4%) had suffered a luxation injury and 5914 teeth (58.2%) a fracture. The overall most frequent injuries were crown fractures without pulp exposure (34.9%), concussions (24.2%), and subluxations (22.2%). The relative frequency of crown fractures without pulp exposure decreased across age groups (children 45.2%, adolescents 36.5%, adults 26.3%, P < 0.001), whereas the relative frequencies of other injury types increased across age groups : crown–root fractures (children 1.8%, adolescents 6.3%, adults 9.2%, P < 0.001), root fractures (children 2.5%, adolescents 4.6%, adults 8.7%, P < 0.001), and lateral luxations (children 5.7%, adolescents 10.9%, adults 13.0%, P < 0.001). One‐third of the traumatized teeth (n = 3212) had sustained a combination of a fracture and a luxation injury. The luxation types most frequently presenting with a concomitant crown fracture were concussion (57.9%), intrusion (47.2%), and subluxation (33.4%) (P < 0.001). Conclusion: The majority of TDI were minor injuries. The relative frequencies of injury types varied among age groups. Combination injuries were observed in one‐third of the traumatized teeth and occurred most frequently in teeth with concussion, intrusion, and subluxation.     

Combination injuries 2. The risk of pulp necrosis in permanent teeth with subluxation injuries and concomitant crown fractures

Abstract – Background: The reported risk of pulp necrosis (PN) is generally low in teeth with subluxation injuries. A concomitant crown fracture may increase the risk of PN in such teeth. Aim: To analyse the influence of a concomitant trauma‐related infraction, enamel‐, enamel–dentin‐ or enamel–dentin–pulp fracture on the risk of PN in permanent teeth with subluxation injury. Material and Methods: The study included 404 permanent incisors with subluxation injury from 289 patients (188 male, 101 female). Of these teeth, 137 had also suffered a concomitant crown fracture. All the teeth were examined and treated according to a standardized protocol. Statistical Analysis: The risk of PN was analysed separately for teeth with immature and mature root development by the Kaplan–Meier method, the log‐rank test and Cox regression analysis. The level of significance was set at 5%. Risk factors included in the analysis were gender, patient age, crown fracture type, mobility and response to an electric pulp test (EPT) at the initial examination. Results: Teeth with immature root development: The risk of PN was increased in teeth with a concomitant enamel fracture (log‐rank test: P = 0.002), enamel–dentin fracture (log‐rank test: P < 0.0001), enamel–dentin–pulp fracture (log‐rank test: P < 0.0001) and in teeth with no response to EPT at the initial examination [hazard ratio: 21 (95% confidence interval, CI: 2.5–172.5), P = 0.005]. Teeth with mature root development: the risk of PN was increased in teeth with an enamel–dentin fracture [hazard ratio: 12.2 (95% CI: 5.0–29.8), P < 0.0001], infraction [hazard ratio: 5.1 (95% CI: 1.2–21.4) P = 0.04] and in teeth with no response to EPT at the initial examination [hazard ratio: 8 (95% CI: 3.3–19.5), P < 0.0001]. Conclusion: A concomitant crown fracture and no response to EPT at the initial examination may be used to identify teeth at increased risk of PN following subluxation injury.     

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口腔颌面部外伤是常见的意外伤害,占全身外伤的5%,其中有90%患者伴有牙齿外伤.儿童牙齿外伤的发生率更高,由于儿童外伤患者处于生长发育阶段,其治疗和预后较复杂,治疗计划的制定除急诊处理外,还要考虑牙体牙髓的冶疗、咬合诱导以及进一步的修复治疗等多方面因素.外伤乳牙的治疗除了对症处理外,还应预估外伤对继承恒牙胚的影响.本文依据年轻恒牙及乳牙的特点,结合临床经验,分类总结了儿童牙外伤的治疗方法.     

Combination injuries 1. The risk of pulp necrosis in permanent teeth with concussion injuries and concomitant crown fractures

Abstract – Background: The reported risk of pulp necrosis (PN) is low in teeth with concussion injuries. A concomitant crown fracture may affect the risk of PN. Aim: To analyze the influence of a crown fracture (with and without pulp exposure) on the risk of PN in teeth with concussion injury. Material: The study included 469 permanent incisors with concussion from 358 patients (226 male, 132 female). Among these, 292 had a concomitant crown fracture (70 with and 222 without pulp exposure). All teeth were examined and treated according to standardized protocol. Statistical analysis: The risk of PN was analyzed by the Kaplan–Meier method and Cox regression. Risk factors included in the analysis: gender, age, stage of root development, type of crown fracture, and response to electric pulp test (EPT) at the initial examination. The level of significance was set at 5%. Results: The risk of PN was low in teeth with immature root development [1.1%, 95% confidence intervals (CI): 0–3.4]. The following factors significantly increased the risk of PN in teeth with mature root development: crown fracture without pulp exposure [hazard ratio 4.1 (95% CI: 1.4–11.9), P = 0.01] and no response to EPT at the initial examination [hazard ratio 30.7 (95% CI: 7.7–121), P < 0.0001]. The overall risk of PN increased from 3.5% (95% CI: 0.2–6.8) to 11.0% (95% CI: 5.2–16.7) when a concomitant crown fracture without pulp exposure was present. If the tooth had both a crown fracture and gave no response to EPT, the risk further increased to 55.0% (95% CI: 34.3–75.8). Conclusion: No response to EPT at the initial examination or a concomitant crown fracture significantly increased the risk of PN in teeth with concussion injury and mature root development. If both risk factors were present there was a synergetic effect.     

Dental injuries of permanent teeth treated in private practice in Athens

Abstract Although there are several epidernmogical studies on dental trauma internationally, there arc not many studies dial record, analyses and Follow different kinds of dental trauma treated in a private office, and that evaluate how parameters such as type of dental trauma, as well as time lapse until treatment might influence the final outcome and the prognosis of the teeth. The sample consisted of 242 patients, 6 17 years of age, with injured teeth treated within a period off) years. All the cases were treated by the first author and were followed for at least 5 years. The treatment modalities used were based upon the clinical examination and the history of the case and included direct and indirect pulp capping, partial pulpotomy, pulpotorny, pulpectomy and splinting. The type of trauma was classified based on WHO classification partially modified. Seventy six percent of the teeth suffered only hard tissue injuries and 22% had only periodontal ligament PDL) trauma. Of the total number of teeth class 1 represented 3%, class II 59%, class III 20% and class IV 2%. of the PDL. injuries 14% of the teeth suffered concussion. 69% luxation and 17% exarlicalation. The highest incidence of dental trauma was observed at linage of 10. Sixty eight percent of the patients sought treatment 3 days or more alter the trauma had occurred (delayed treatment. while only 32% within the first 3 days (immediate treatment). Tin-main reasons for delayed treatment were neglect (50%) and 1111-awareness (37%). Of die teeth with delayer! treatment 43% became necrotic, while only 28% of the teeth that were treated on lime needed pulpcclomy. Luxations caused more pulp necrosis (46%) than Class I (0%) Class II (7%) or Class III (34%) type of trauma. the data from this study suggested that a) most of the dental injuries on permanent teeth were class II or III type, by a high percentage (68%) of the patients sought treatment more than 3 days after the injury (delayed treatment), c) delayed treatment caused more necrotic teeth, d) the public should be informed of the importance of immediate treatment in an effort to improve the prognosis of the pulp, e) dentists should be informed of the appropriate treatment of denial injuries since 10.3% of the cases were mistreated.     

Oral trauma in Brazilian patients aged 0–3 years

Abstract – The aim of the present investigation was to gather data pertaining to dental trauma in 1654 patients aged 0–3 years, attended at the Baby Clinic of the School of Dentistry at Araçatuba – UNESP, Brazil. The prevalence of traumatic injuries was 16.3%. There was greater involvement of boys (62.6%), of children aged 1–2 years (39.9%) and of the maxillary central incisors (86%). Falls were more often the etiology for dental injuries (58.3%). There was a predominance of uncomplicated crown fractures (48.4%).     

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.     

Management of an uncomplicated crown fracture by reattaching the fractured fragment—Case report

Coronal fractures of the anterior teeth are common sequelae of traumatic dental injuries. Reattachment of fractured tooth fragments using dental adhesive techniques offers some advantages, including restoration of the function, esthetics, shape, texture, and brightness of the surface. The present report describes a clinical case of reattachment with a 4‐year clinical and radiographic follow up in a permanent maxillary central incisor with an uncomplicated crown fracture. Fragment reattachment is a conservative procedure, preserving esthetics and functionality, and it can provide an immediate positive emotional response from the patient.     

2015年南京市353例年轻恒牙外伤的临床分析

［摘要］目的 探讨学龄儿童年轻恒牙外伤的临床特点,更好地维护口腔健康。方法 对2015年1月至12月期间在南京医科大学附属口腔医院儿童口腔科就诊的353例5~12岁学龄儿童年轻恒牙外伤病例的年龄、性别、外伤后就诊时间、外伤牙位、外伤类型及Nolla分期进行回顾性分析,总结其临床特点。 结果 男女比例为2.33∶1;12月份最高发;7～9岁为高发年龄;多在外伤后2~24 h就诊;上颌中切牙最多见;釉质-牙本质折断及亚脱位最多;硬组织损伤中以Nolla 9期最常见。 结论 年轻恒牙外伤有其独有的特点,应加强牙外伤的预防保健宣传,提高公众的就诊意识。     

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.     

Combination injuries 3. The risk of pulp necrosis in permanent teeth with extrusion or lateral luxation and concomitant crown fractures without pulp exposure

Abstract – Aim: To analyze the influence of a crown fracture without pulp exposure on the risk of pulp necrosis (PN) in teeth with extrusion or lateral luxation. Material and methods: The study included 82 permanent incisors with extrusion from 78 patients (57 male, 21 female) and 179 permanent incisors with lateral luxation from 149 patients (87 male, 62 female). A total of 25 teeth with extrusion and 33 teeth with lateral luxation had suffered a concomitant crown fracture (infraction, enamel fracture or enamel‐dentin‐fracture). All the teeth were examined and treated according to a standardized protocol. Statistics: The risk of PN was analyzed separately for teeth with immature and mature root development by the Kaplan–Meier method, the log‐rank test and Cox regression (lateral luxation only). The level of significance was set at 5%. Risk factors included in the analysis were gender, age, crown fracture, and response to electric pulp test at the initial examination. Results: A concomitant crown fracture significantly increased the risk of PN in teeth with lateral luxation. For teeth with immature root development (hazard ratio: 10 [95% confidence interval (CI): 1.1–100] P = 0.04), the overall risk increased from 4.7% (95% CI: 0–10.8) to 40% (95% CI: 2.8–77.2). For teeth with mature root development [hazard ratio: 2.4 (95% CI: 1.4–4.2) P < 0.001], the overall risk increased from 65.1% (95% CI: 55.2–75.1) to 93% (95% CI: 85.5–100). In teeth with extrusion and mature root development, the overall risk of PN increased from 56.5% (95% CI: 37.7–75.4) to 76.5% (95% CI: 58.9–94) in case of a concomitant crown fracture, but the difference was not statistically significant (P > 0.05). Conclusion: A concomitant crown fracture without pulp exposure significantly increased the risk of PN in teeth with lateral luxation. This risk factor may be used to identify teeth at increased risk of PN following lateral luxation injury.