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Traumatic injuries to the teeth in young individuals with cerebral palsy.

The purpose of the study was to assess the characteristics of dental trauma in individuals with cerebral palsy (CP). The study group consisted of 68 individuals (36 boys and 32 girls) who visit daily a school dedicated for children with CP. Their age ranged between 7 and 21 years with a mean age of 12.6 years. The majority (74%) required a wheel chair for mobility, 13% used a walker and the others were able to walk with crutches or without aid. The parents were asked to complete a questionnaire regarding their child's age, gender, medical history, and history of dental trauma. The teeth were evaluated clinically for evidences of past injuries to the teeth, enamel defects in the permanent incisors, scars on the chin and size of overjet. Thirty-nine individuals (57%) had signs of trauma to the permanent teeth. Sixty-eight teeth, mostly the maxillary central incisors, were injured. Boys were slightly less affected than girls, 56% (20/36) and 59% (19/32), respectively. Fracture of enamel and dentine was the most common type of injury (62%). Scars on the chin were detected in 28% of the individuals but only one had fractures of the molar (primary) teeth. The overjet ranged between -3.0 and +14 mm but no correlation could be found between the size of the overjet and tendency to injure the teeth. Localized enamel defects were detected on the labial surface of 13 teeth in nine individuals, probably due to luxation injuries to the primary incisors. The prevalence of dental injuries in a group of individuals with CP was found to be much higher than that of healthy populations despite the fact that CP individuals do not take part in violent sport activities as healthy children do. This should alert caregivers to carry out a profound investigation of the events that result in dental injuries in disabled individuals and suggest methods to reduce this type of morbidity.

Adolescent↗

Dental injuries in association with mandibular condyle fractures.

A total of 356 patients with mandibular condyle fractures were studied regarding associated dental injuries. One third of the patients had injured teeth, on average, 3.7 teeth had been injured per accident. Dental traumas were distributed equally between the anterior (incisors and canines) and posterior teeth (premolars and molars) in both jaws. In unilateral condylar fracture cases maxillary dental injuries involved more often premolars and/or molars of the fracture side than those of the nonfracture side. The mean number of dental traumas in the mandible was higher in cases of simultaneous mandibular body fracture than without, whereas the presence of mandibular body fracture did not affect number of associated dental injuries in the maxilla. The dental injuries were mostly to hard tissue (78%), which were commonest in men, 20 to 29 years of age, and in victims of violence or fall accidents. Severe dental injuries in association with mandibular condyle fractures were more common in accidents due to traffic and miscellaneous causes than in those due to violence. Severe dental injuries were more often encountered when simultaneous mandibular body fracture was present than when it was not and more so in bilateral than unilateral condylar fracture cases. The most important factor correlating with the severity of dental injuries was the presence of bilateral condylar fracture.

Accidental Falls↗

Prevalence of orofacial injuries and use of mouthguards in high school Rugby Union.

In Australia there is a tradition of early involvement of children in contact sports. Mouthguards are known to reduce the risk of dental and associated injuries--however, Australian studies of the use of mouthguards in contact sports and the prevalence of dental and associated injuries have only focused on adult participants. Previous studies of high school Rugby Union players in New Zealand have shown that between 13 and 15 per cent had previously sustained dental injury while between 30 and 37 per cent wore mouthguards regularly. One hundred and thirty Rugby Union football players attending a large high school in Brisbane participated in this survey. All believed in the safety value of mouthguards in football. All of the players in the four open teams and the majority of players in the four under-age teams wore mouthguards, and the incidence of dental injury was very low, approximately 4 per cent. These and other results will be presented and compared with previous similar studies.

Adolescent↗

Changes in prevalence and treatment need for traumatic dental injuries among 14-year-old children in Newham, London: a deprived area.

OBJECTIVE: The study was carried out to assess the prevalence of traumatic injuries to the permanent incisors of 14-year-old schoolchildren in Newham in 1998-99, the treatment needed and to compare the results with data from 1995-96. Also, to test whether different levels of deprivation within an area would increase the risk of dental injury. BASIC RESEARCH DESIGN: A cross-sectional study was carried out. One dentist (SM) carried out all dental examinations. Upper and lower permanent incisors were examined for dental injuries. The examiner recorded the type of damage sustained, any treatment carried out and the treatment need. PARTICIPANTS: 411 14-year-old schoolchildren in Newham in 1998-99. Results The prevalence of traumatic injuries was 43.8% (95% CI 39.0, 48.7) in 1998-99, compared to 23.7% (95% CI 22.0, 25.5) in 1995-96. Boys sustained statistically significantly more dental injuries than girls, 50.2% and 37.1% respectively (P<0.01). In 1998-99 92.7 per thousand incisors were damaged, 6.7 per thousand incisors were treated and 28.9 per thousand incisors needed treatment. Two components of the Jarman Index were associated with dental injuries. Overcrowded household was statistically significantly related to dental injuries in both studies. Ethnicity was associated with dental injury in 1998-99, but not tested in 1995-96. CONCLUSIONS The prevalence of traumatic dental injury in Newham increased from 23.7% to 43.8% between 1995-96 and 1998-99, it was higher than the overall prevalence in the United Kingdom (17%) and its treatment had been neglected. Area-based measures of deprivation such as an overcrowded household and ethnicity were predictors of traumatic dental injuries.

Adolescent↗

Radiation-induced hypoplasia of the teeth and mandible. A case report.

Hypoplasia of the mandible and teeth is reported in a 4-year-old boy who had cystic hygroma. At age 7 months he had been treated with 60Co-gamma-radiation (24 Gy to the head and neck, 45 Gy to the mediastinum) followed by surgery. Panoramic and periapical radiographs showed hypoplasia of the roots of the primary canines, molars, and permanent teeth and no evidence of tooth germs. The patient was followed up to age 13 years.

Bone Development↗

Evaluation of the effect of delayed management of traumatized permanent teeth.

This investigation studied the complication that could arise from delayed management of traumatized permanent teeth. Patients reported to the primary care clinic at the College of Dentistry, King Saud University, seeking treatment of traumatized anterior teeth were evaluated. Esthetic consideration (64 patients) and pain, swelling, or discomforts (50 patients) were the main reasons the patients came to the clinic. Clinical and radiographic examinations, as well as history of the trauma, were recorded. It was found that most of the patients had a treatment delay exceeding 1 month. Initial pulp exposure resulted in 100% pulp necrosis. When a fracture involved both enamel and dentin, the frequency of pulp necrosis was 53%. External root resorption and pulp calcification were seen in few teeth. It was concluded that the figures for pulp necrosis could be misleading, because there might have been a bias when only patients with problems sought treatment. In addition, a trauma awareness educational program should be developed to encourage parents and the public to seek immediate dental treatment. Furthermore, a proper diagnostic test for pulp and periodontal complication should be done in patients with initially nontreated dental injuries.

Accidental Falls↗

The reliability of electric pulp test after concussion injury.

Traumatic injuries to teeth present a difficult diagnostic problem with respect to determining the vitality of the affected teeth. Conventionally, a latency period of 4 to 6 weeks is proposed as the amount of time required for the return of a positive electric pulp test (EPT) response; however, this has been based on empirical data. The purpose of this study was to 1) determine a time frame during which a return of a reliable response to EPT may be measured, and 2) correlate this time frame with pulpal vascular changes that occur after traumatic injuries. Four canines from each of nine ferrets were used for this experiment (18 traumatized and 18 control teeth). A reproducible concussion injury was devised by releasing a known weight at a constant height above the facial surface of the experimental teeth. The EPT response was confirmed by the use of an EMG muscle recorder. Animals were killed at 24, 48 and 72 h and 6, 12 and 28 days after the injury and the teeth analyzed histologically. The histological sections showed an absence of inflammatory cells in both groups; however, according to the NIH image system, an increase in the number of vessels was detected in the experimental group when compared to the controls. In a majority of the cases, a positive response to the EPT returned within 12 days post concussion injury and as early as 10 days. In addition, a significant vascular change was accompanied with the loss of the EPT response. This study provided a reliable method by which concussion injuries may be studied using an animal model.

Analysis of Variance↗

Dental injuries of permanent teeth treated in private practice in Athens.

Although there are several epidemiological studies on dental trauma internationally, there are not many studies that record, analyse 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 369 injured teeth treated within a period of 5 years. All the case were treated by the first author and were followed for at least 3 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, pulpotomy, 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 I 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% exarticulation. The highest incidence of dental trauma was observed at the age of 10. Sixty eight percent of the patients sought treatment 3 days or more after the trauma had occurred delayed treatment), while only 32% within the first 3 days (immediate treatment). The main reasons for delayed treatment were neglect (50%) and unawareness 37%). Of the teeth with delayed treatment 43% became necrotic, while only 28% of the teeth that were treated on time needed pulpectomy. 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, b) 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 dental injuries since 10.3% of the cases were mistreated.

Adolescent↗

Urinary catecholamine levels and incidence of dentofacial injuries in children: a 2-year prospective study.

Urinary catecholamines have been used to measure emotionally stressful states which may have an impact on dentofacial injuries. This prospective study investigated the hypothesis that urinary catecholamines such as epinephrine, norepinephrine and dopamine do not affect significantly the incidence of dentofacial injuries in children. As a test of this hypothesis 204 children, males and females, aged 8 to 10 years, were included in the study. After a first examination, each subject was re-examined, at one-year intervals, over a period of two years. Dentofacial injuries were recorded by a clinical examination and a questionnaire. Three 24-h urine samples, with an interval of one year between each, were collected and analyzed by the high performance liquid chromatography technique to assay the catecholamine content. Socio-economic factors were recorded by a questionnaire. Using the panel of data collected, the logistic multiple regression model was employed to test whether the incidence of dentofacial injuries was affected by the studied variables. The 95% probability level was used. Specificity and sensitivity as well as the positive and negative predictive rates were computed. The results showed that epinephrine had a significant correlation with the incidence of dentofacial injuries. Other factors found to have a significant impact were child's age and gender. The values of sensitivity and specificity were 81% and 69% respectively, while the positive and negative predictive rates were 68% and 82% respectively. The data, therefore, provided evidence that emotionally stressful states measured by the urinary catecholamines were prominent etiologic factors of dentofacial injury.

Accidents↗

Attitudinal factors influencing mouthguard utilization.

From the introduction of a protective mouthpiece in the sport of boxing, the evidence for the importance of this piece of athletic equipment in injury prevention has grown. Yet, despite this knowledge, only five amateur sports and one professional sport have regulations requiring the use of mouthguards. Even in the sports that require their use, compliance is not universal. Attitudes of coaches, officials, parents, and players about wearing mouthguards all influence their usage. Studies of the attitudes of these groups reveal that coaches are perceived as the individuals with the most impact on whether or not players wear mouthguards. There is reluctance among college football officials to enforce mouthguard violations that they believe are inappropriate. Parents see themselves as having responsibility in determining mouthguard use; however, their views about when and for whom mouthguards are necessary reveal a lack of complete understanding of the benefits. Resistance on the part of players stems from the physical characteristics of the mouthguard, interference with breathing and speech, and the effect on the players' image. Education on the effectiveness of properly fitted mouthguards for injury prevention, information on the risk for injury, availability of more comfortable and appealing mouthguards, and development of an approach for expanding regulations are all tools that can lead to the development of more positive attitudes and increased usage.

Athletic Injuries↗

Neuropeptide Y-like immunoreactive primary afferents in the periodontal tissues following dental injury in the rat.

The distribution of neuropeptide Y (NPY)-like immunoreactive (-IR) nerve fibers in the periodontal tissues following dental injury to the rat maxillary first molar was examined with a combination of dental injury and surgical sympathectomy of the superior cervical ganglion (SCGx). In normal animals, NPY-IR nerve fibers were observed around the blood vessels of the trigeminal ganglion, dental pulp and periodontal tissues. These nerve fibers completely disappeared following SCGx. Fourteen days following dental injury of the maxillary first molar combined with SCGx, a small number NPY-IR cells was observed in the dorsal to middle portion of the maxillary division of the trigeminal ganglion. These were mostly medium- to large-sized cells with a mean +/- SD cross-sectional area of 541.4 +/- 239.3 microns 2. Approx. 50% of these cells had the cross-sectional areas between 400-600 micron 2. In the periodontal tissues of injured first molar, thick NPY-IR nerve fibers showing an irregular appearance were detected in the apical region. Immunoelectron microscopy showed that most NPY-IR nerve fibers near the lower half of the injured periodontal ligament had an axonal diameter of approx. 7-8 microns, and lacked apparent myelin sheaths. Near NPY-IR nerve fibers, many macrophages with phagosomes containing debris of the myelin sheaths were observed. At the oral epithelium covering the injured roots of the maxillary first molar, thick NPY-IR nerve fibers were recognizable and some penetrated the epithelium. No NPY-IR nerve fibers were observed in the dental pulp or periodontal tissues in second and third molars, and ultrastructural views of nerve fibers were almost intact following combined SCGx and dental injury to the first molar. The present results indicate that NPY-IR primary afferents appeared in the periodontal tissues following dental injury, and that NPY may be closely associated with the regeneration process of injured primary afferents.

Animals↗

Oral trauma in Brazilian patients aged 0-3 years.

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%).

Accidental Falls↗

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.

Accidental Falls↗

Treatment delays in paediatric dento-alveolar trauma at a tertiary referral hospital.

BACKGROUND: Paediatric dento-alveolar trauma is a common event. Delays in treatment can have adverse effects on long term outcomes and the aim of this study was to quantify the treatment delays in paediatric dento-alveolar trauma in a tertiary referral hospital. METHODS: All cases of paediatric dento-alveolar trauma over a two year period from July 2000 to June 2002 were identified and the charts were reviewed retrospectively. All children presenting to the emergency department with dento-alveolar trauma within 48 hours of injury during the time period were included. RESULTS: Forty-three patients were identified. The average age was 5.51 years, though there was a bias towards one and two year olds. Males were injured 1.5 times more frequently than females. There was an average delay of 9.6 hours between injury and treatment for all patients. Transit time from outside practitioners to hospital and waiting times in hospital made up the greatest delays. Children injured an average of 2.37 teeth and only 14 per cent were uncomplicated crown fractures. CONCLUSIONS: Children who present to children's hospitals for treatment of dento-alveolar trauma have more severe injuries than those treated elsewhere. They have large but potentially reducible delays between injury and treatment.

Adolescent↗

Sports dentistry in general practice.

The sports dentistry movement in the United States and worldwide is experiencing new momentum. Much of this is generated by general dentists working in conjunction with like-minded specialists as well as with dental hygienists, dental laboratory technicians, and dental assistants. This article explores several issues of relevance to stimulate the interest of general dentists to become involved in private practice and community service activities in sports dentistry.

Adolescent↗

Management of dental injuries.

Dental-related injuries, which range from chipped teeth to fractured jaws, are among the most common injuries seen in schools. This article describes the various injuries and provides guidelines, for the nurse's actions at the scene, to ensure the greatest potential for successful treatment. Guidelines are also given for informing other school and associated health personnel about dental emergencies.

Child↗