Traumatic dental injuries in Brazilian children and oral health‐related quality of life

Background/Aims

Population‐based studies that investigate the impact of TDI on oral health‐related quality of life (OHRQoL) among school children and its association with socioeconomic factors are scarce and offer conflicting results. The aim of this study was to evaluate the impact of TDI on OHRQoL among school children and its association with socioeconomic status.

Materials and Methods

A cross‐sectional study was conducted with 588 12‐year‐old children enrolled in public and private schools in the urban areas in the city of Diamantina (southeastern Brazil). Clinical examinations were performed for the diagnosis of traumatic dental injury based on Andreasen's classification. The Child Perceptions Questionnaire (CPQ_11–14), which has been validated for the population in Brazil, was employed to evaluate oral health‐related quality of life. Socioeconomic status and overjet were also analyzed. Statistical analysis involved the chi‐square test and logistic regression.

Results

A total of 29.4% of the students exhibited some type of trauma to at least one tooth. A negative impact on oral health‐related quality of life was found in 53.1% of the sample. Traumatic dental injury was associated with a high impact on oral health‐related quality of life [OR = 1.61 (95% CI: 1.08‐2.39)] and overjet >3 mm [OR = 5.42 (95% CI: 3.66‐8.02)]. However, no statistically significant associations were found between TDI and socioeconomic status.

Conclusions

Prevalence of traumatic dental injury was high among the children who participated in the study, and it was associated with a high impact on oral health‐related quality of life as well as overjet >3 mm.     

Dental anxiety and quality of life: the effect of dental treatment

Abstract – Objective: The aim of the present study was to determine the association between dental anxiety and quality of life (QoL) and to test the hypothesis that treatment of highly anxious patients would significantly enhance QoL. Material and methods: Subjects were 35 highly anxious dental patients of a Dutch dental fear clinic who were assessed on dental trait anxiety (DAS and S‐DAI) and QoL (oral health‐related QoL with the use of OHIP‐14, dental anxiety‐related QoL with the SADAS, and general aspects of QoL using Global Assessment of Functioning, while five different aspects of life satisfaction were quantified on a VAS‐scale) both prior to and after treatment (an average of six sessions of 45–60 minutes each). Also, both objective (DMFT and dentists’ judgement) and subjective (patients’ judgement) indices of oral health status were recorded. Results: Higher dental anxiety was significantly associated with lower OH‐QoL as indexed by the OHIP‐14 (r = 0.51–0.56, P < 0.01). Treatment was associated with marked improvement on oral health status, reduction of dental anxiety, and improvements regarding a variety of aspects of QoL (all Ps < 0.001). Reduction of dental anxiety, rather than improved oral health, was found to predict enhanced OH‐QoL. Conclusion: The results underline the importance of applying effective treatment methods for dentally anxious patients, not only with the purpose to alleviate their dental anxiety and to improve their oral health, but also because it contributes to an enhancement of their QoL.     

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.     

Impact of traumatic dental injuries on the quality of life of schoolchildren

Abstract – Background: Knowledge of the impact of traumatic dental injuries (TDI) on children’s quality of life is sparse. Aim: To determine the association between TDI and oral health–related quality of life (OHRQoL) among schoolchildren aged 11–14 years. Material and methods: A cross‐sectional study was carried out involving a representative sample of 409 schoolchildren from 13 municipalities in the Midwest Region of the Brazilian Southern State of Santa Catarina. Clinical examination included the presence and type of TDI and the treatment provided (or needed) according to criteria used in the UK Children’s Dental Health Survey. Dental caries in anterior teeth and malocclusion status were also collected according to WHO criteria. OHRQoL was assessed using the short form of the Child Perceptions Questionnaire (CPQ11–14), and the outcome was the prevalence of one or more adverse impacts on quality of life occurring often/very often. Results: The prevalence of TDI was 16.6% (95% CI 13.0–20.2). The prevalence of one or more adverse impacts occurring often/very often was 46.6% (95% CI 41.7–51.5). Logistic regression modeling for the outcome indicated an independent and significant association between the prevalence of one or more adverse impacts occurring often/very often and the presence of TDI even after adjustment for gender, presence of dental caries in anterior teeth and malocclusion. A prevalence ratio of 1.79 (95% CI 1.16–2.76) of one or more adverse impacts occurring often/very often in schoolchildren with TDI was found, compared to those without TDI. Conclusions: Traumatic dental injuries appear to affect schoolchildren’s OHRQoL.     

Comprehensive management of a complex traumatic dental injury

A 24‐year‐old female patient presented with complaint of palatal swelling and a sinus tract facial to tooth #22. She reported an injury to the tooth 15 years earlier and no recollection of treatment, although there was evidence of an endodontic access into the crown. Radiographically the root appeared to have stopped developing, and it was associated with a large periapical lesion. After 3 unsuccessful attempts at apexification using calcium hydroxide (CH), further examination including use of cone‐beam computed tomography (CBCT) was carried out. The latter allowed for better evaluating the situation and for better planning a more comprehensive treatment plan to include surgical removal of the apical lesion. The large radiolucent area extended from tooth #21 to #23. Using a dedicated software tool developed to be used in conjunction with CBCT, volumetric assessment of the lesion was carried out for healing follow up. The root end was filled from the apical direction with newly developed accelerated silicate cement 4–5 mm into the apical part of the canal. Subsequently, the rest of the canal was filled with the same type of cement. At the 1‐year postsurgical follow up, the tooth remained asymptomatic, and using the CBCT volumetric program, bony healing could be demonstrated.     

Reasons for seeking treatment after traumatic dental injuries

Abstract The purpose of this study was to determine the reasons why parents of children seek treatment after traumatic injuries to primary teeth. The sample consisted of 114 5-month to 8-year-old children with 196 injured primary teeth. The reason for parents seeking treatment varied according to the type of injury. Parents of children with enamel fractures and enameldentin fractures without pulpal exposure were more concerned about esthetics. Of the patients presenting concussions, parents were more responsive to color change of the tooth and to the tooth response to the trauma, mainly abscess formation. In luxations and lateral displacements, the parents sought dental treatment because of their own reaction to the clinical situation, i.e., blood, crying. Very few were concerned with possible consequences to the primary and/or permanent teeth. In no category of injury were the parents most concerned about the consequences to the primary and/or permanent teeth.     

Oral impact on daily performance: need and use of dental prostheses among Brazilian adults

Although there is a large amount of evidence that demonstrates the relationship between oral health status and oral impact daily performance, there are few studies that have evaluated the impact of prosthetic status, particularly the need for a dental prosthesis. Therefore, the aim of this study was to investigate the relationship between need and use of dental prostheses and the prevalence of oral impact on daily performance. A sample of 720 subjects, aged between 50 and 74 years, was evaluated using a cross‐sectional study. Participants were selected through a multistage proportional random sampling. The impact of oral health status on daily performance (oral impact on daily performance – OIDP) and socio‐demographic data was assessed using a standardised questionnaire, and clinical data were assessed by oral examination. The outcome was the prevalence of impact. The association between the explanatory variables and the outcome was analysed through two models of multivariate Poisson regression. In the adjusted model, the variables need of upper and lower prosthesis and use of lower prosthesis maintained a statistically significant association. No statistically relevant relation between socio‐demographic variables and outcomes was found. Findings show that the need and use and of a prosthesis are related to oral health quality of life.     

Effect of a consensus statement on initial treatment for traumatic dental injuries

Abstract – The aim of this study was to investigate the influence of a consensus statement on dental practitioners' choice of initial treatment for traumatic dental injuries. Dental practitioners working at government dental clinics in eight cluster sample regions of mainland Tanzania were requested to participate in the study; that is, to record the treatment they provided to children aged 1–17 years seeking dental consultation after injury for a period of 12 months. Six months after the beginning of data collection, a consensus statement was introduced. After the dental practitioners received the consensus statement, the correct treatment they provided increased from 51% to 57%. The unnecessary treatments increased from 54% to 59%, while wrong treatments decreased from 55% to 42%. Only a small improvement was observed in the percentage of correct treatments, but there was a slightly significant improvement in the percentage of wrong treatments provided before and after introduction of the consensus statement. We conclude that the consensus statement had a slight influence on the dental practitioners' choice of initial treatment for dental trauma in the desired direction.