Traumatic injuries to anterior teeth in Italian schoolchildren: prevalence and risk factors

Abstract In the present study, the prevalence of traumatic injuries to anterior teeth in 824, 6- to I 1-year-old, schoolchildren from Rome (Italy) and the relationship between injuries and predisposing factors were evaluated. Prevalence value of the study-population was 20.26%. This value is higher than those reported in surveys performed in Italian emergency dental services, but it is similar to those of retrospective studies from other countries. The highest prevalence was found among 9-year-old boys (33.69%); the M/F ratio was 1.64. The percentage of injuries with unknown cause (21.46%) was higher than that of other studies. This may be because most of injuries were slight (64.39% of injuries were enamel fractures) and it is likely that children and their parents were not worried about them, when they happened, so that they did not seek urgent dental care - this helps to explain the prevalence values of this and other retrospective studies, which are higher than those from emergency services - and, when interviewed, they did not remember the circumstances of the traumatic event. Using the Mantcl-Haenszel's Odds Ratios stratified for age and sex, injuries were related to individual predisposing factors (overjet larger than 3 mm: OR=2.57, p = 0.0001, short upper lip: OR=2.23, p=0.0001 and upper medial incisor protrusion: OR=3.95. p = n.s.), but not to children's trauma predisposing behaviour (OR=0.92, p = n.s.). Serious injuries, however, happened lo children without predisposing factors and were caused by strong impacts, suggesting that individual risk factors may not affect these type of injuries.     

Clinical and epidemiological study of traumatic root fractures

Abstract    The aim of this work was to study the prevalence and clinical presentation of root fractures in a series of patients with dental trauma. Treatment strategies were classified and outcomes after a 6-month period presented. The study population comprised 76 patients (between the ages of 2 and 55 years) with 93 root fractures in their teeth (18 primary, 75 permanent). Data were collected following the taking of a detailed clinical history, objective clinical examination and photographic and radiological investigation. Since most of the primary teeth were extracted, only cases with root fracture of permanent teeth were followed-up: in all, 24 patients with 31 teeth with root fractures. The prevalence of root fractures in permanent teeth was 7.7% of all injuries, while in primary teeth it was 3.8%. The most frequently involved teeth were the maxillary incisors with a percentage of 75% in permanent teeth. Moreover, 40% of root fractures in permanent teeth were associated with fracture of the alveolar bone and of the soft tissues and in 45% of cases, the adjacent teeth were also injured. The results of this study reaffirm the necessity for scrupulous diagnosis of teeth after a traumatic injury. Adjacent teeth and those in the opposing arch should not be ignored. Treatment is multi-disciplinary, requiring surgical, orthodontic, operative and prosthetic compliance. Periodic check-up is essential.     

Necrotizing sialometaplasia in two patients with bulimia and chronic vomiting

The purpose of this report was to present two unusual cases of necrotizing sialometaplasia of the hard palate, in which the patients were suffering from bulimia and chronic self-induced vomiting. It emphasizes the importance of confirming the diagnosis by incisional biopsy and discusses local mucosal trauma as a possible etiologic factor.     

Acute phase protein levels as an index of severity of physical injury

Inflammation resulting from any form of tissue injury causes an increase in plasma concentration of a number of liver-derived proteins (the acute phase reactant proteins), the measurement of which provides an indication of the magnitude of the inflammatory response. C reactive protein (CRP) is an example of an acute phase protein. Although concentrations increase particularly dramatically in response to inflammation and reflect the degree of ongoing tissue damage, this method has yet to be used to assess severity of injury in traumatology and forensic medicine. The rate at which the acute phase protein response occurred after injury was therefore explored in a series of 16 patients with maxillofacial skeletal injuries and in a series of 22 age- and sex-matched control patients. Increases in the plasma concentration of CRP were not detected until 6-12 h after injury and peaked at 48-72 h. Concentration of CRP was less than 10 mgm/l in all control patients. There was significant relation between peak levels and Abbreviated Injury Scale and Injury Severity scores. Results suggest that this method of assessing the severity of traumatic injury deserves further investigation and may be of use clinically, medico-legally and in relation to compensation awards.     

Longitudinal study on types of injury, complications and treatment in permanent traumatized teeth with single and multiple dental trauma episodes

Abstract –  The purpose of this study was to compare the type of injuries, complications and treatment in permanent traumatized teeth with single and multiple dental trauma episodes (MDTE). One hundred and fifty-five children, aged 6–14 years, sustaining one or more traumatic episodes to permanent teeth were included in this investigation. After the medical and dental history the patients were examined clinically and radiographically and the diagnosis of trauma, the treatment plan and the applied treatment were recorded. Also, information regarding the number of traumatic episodes, the number of injured permanent teeth and the vitality of the pulp was collected. In follow-ups, traumatized teeth were examined clinically and radiographically to evaluate the treatment applied and to detect any complication. The t -statistic was used to test differences in the mean number of teeth per patient with different types of injury, complications and treatment between permanent traumatized teeth with single and multiple trauma episodes. A 95% probability level was used. The results showed that MDTE significantly affected the mean number of teeth per patient with fractured restoration, root fracture, concussion, pulp canal obliteration, root replacement resorption, filling therapy, surgery and prosthetic treatment. It was concluded that MDTE increase the risk of having certain types of injury, complications and treatment.     

Avulsion of primary teeth and sequelae on the permanent successors

Abstract –  The purpose of the present study was to determine the frequency of avulsion of primary teeth and the location of the avulsed tooth in a representative population of Danish children. Also, the frequency and the type of developmental disturbances in the permanent successors were assessed and related to age at the time of injury. The material included dental records of 4238 children from three clinics in Municipal Dental Health Services near Copenhagen, Denmark. The children were born between 1 January 1983 and 31 December 2000. Thirty-five children (0.8%) were identified as having avulsed in all 44 primary teeth most frequently the maxillary incisors (89%). Thirty-three fully erupted permanent successors were included in the study, the prevalence of developmental disturbances was 30% (10 teeth). The results showed the risk of developmental disturbances in the permanent successors to be more frequent the younger the age at the time of injury ( P  = 0.04). Discolouration affected all 10 permanent teeth, but also hypoplasia and horizontal enamel hypoplasia were found.     

Developmental disturbances of permanent teeth following trauma to the primary dentition

The topographic relationship of the apices of the primary teeth to the permanent tooth germs explains the potential for possible developmental disturbances of the permanent teeth after injuries to their predecessors. The anatomical, histologic and clinical aspects of permanent tooth malformation following trauma to the primary teeth are described. One hundred and fourteen children with originally 255 traumatized primary teeth have been re-examined (with an average period of 5.1 years after the trauma) to assess any developmental disturbances of the corresponding permanent teeth. Twenty-three per cent of partially or completely erupted permanent teeth showed developmental disturbances. The most frequent malformation was enamel hypoplasia including enamel discoloration and/or enamel defects. The highest prevalence of developmental disturbances of permanent teeth was found after intrusive injuries of primary teeth.     

Influence of different periodontal curette grips on the outcome of mechanical non-surgical therapy

AIM: To determine to whether successful scaling and root planing (SRP) depends upon the grip used on the periodontal curette. METHODS: The hand grips used by dentists for holding periodontal curettes were examined and the dentists were allocated to one of two matched groups, one in which they used a modified pen grip, the other in which they did not. Using a split-mouth technique, patients scheduled for SRP had one quadrant treated by a dentist from each group. Instrument application force was recorded as were periodontal measures at operation and 3-months later. RESULTS: During scaling, forces reached a mean of 0.77N in dentists using a curette with a non-pen grip and 0.54N in those using a pen grip and during root planing, 0.93N and 0.64N respectively. These forces were statistically significantly different between the two groups. Pocket depth reduction in teeth treated by the two groups was similar but attachment levels were statistically significantly different. CONCLUSIONS: Instrument grip had a significant effect on response to SRP, suggesting that dentists using a modified pen grip achieved better clinical results.     

兔咬合创伤时咬肌损伤与线粒体Ca2+载的研究

目的研究咬合创伤导致咬肌损伤的作用和线粒体Ca2+超载在损伤机制中的作用.方法在兔一侧前磨牙粘固(牙合)板造成咬合创伤,皮下注射乙二胺四乙酸(ethylenediarninetetraacetic Acid,EDTA),同时建立对照组,10天后检测兔咬肌线粒体Ca2+含量,观察咬肌的组织学改变,并进行比较分析.结果戴(牙合)板而不注射EDTA兔的(牙合)板侧咬肌线粒体Ca2+含量明显升高,并有明显的超微结构改变;(牙合)板对侧及戴(牙合)板并注射EDTA兔的双侧咬肌线粒体Ca2+含量均与对照组无显著性差异,组织学改变亦不明显.结论咬合创伤是咬肌损伤的致病因素之一,而线粒体Ca2+超载则是咬肌损伤发生机制中的一个重要环节.     

Guidelines for the management of traumatic dental injuries. III. Primary teeth

Abstract –  Trauma to the primary dentition present special problems and the management is often different as compared with permanent teeth. An appropriate emergency treatment plan is important for a good prognosis. Guidelines are useful for delivering the best care possible in an efficient manner. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases in which the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the current best evidence based on literature research and professional opinion. In this third article out of three, the IADT Guidelines for the management of traumatic injuries in the primary dentition, are presented.