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PubMed2000

Risk evaluation and type of treatment of multiple dental trauma episodes to permanent teeth.

Studies have shown that some children and adolescents are effected only once with a dental trauma, while others seem to be accident-prone and suffer from multiple dental trauma episodes (MDTE). Studies have also shown that dental traumas mostly affect upper permanent and medial incisors. Less is known about treatment consequences related to teeth with repeated dental trauma episodes. The aim was therefore to evaluate the risk of MDTE to permanent teeth among children and adolescents by age and gender and to compare types of dental treatment modalities used for patients with one episode and those with MDTE and with single and repeated traumatized teeth. The study was based on a random sample of 83 Danish 6-18-year-old children and adolescents born in 1970 who suffered from dental trauma episodes. All patients were followed during a 12-year period (1976-1988). Forty-one of the patients were registered with MDTE with a range of 2-7 episodes and a mean of 2.9 episodes/patient (SD = 1.1). The mean age at single and MDTE was 11.4 years (SD = 3.6) and 8.6 years (SD = 2.1), respectively. No significant differences were found between age at first episode and the number of MDTE per patient. The number of patients with MDTE was significantly higher among those who suffered their first trauma episode in the age interval 6-10 years than in the age interval 11-18 years (P < 0.001). A survival analysis showed that the risk of sustaining another trauma episode increased by 14.9-30.3% when the first trauma occurred before the age of 11, compared to 0-7.4% after the age of 10. The risk of sustaining multiple injuries was 8.4 times higher when the first trauma episode occurred at 9 years of age, compared with those occurring at age 12. The survival analysis also showed that for every new trauma episode, the interval between them became closer. Forty-five per cent of the MDTE affected teeth had already sustained an injury. With an increased number of trauma episodes per patient followed an increase in the number of follow-ups, filling therapy, information and prosthetics, whereas the rates of endodontics, surgery, and consultations were unchanged or even decreased.

Accident Proneness↗
PubMed2005

Activation of the Notch signaling pathway in response to pulp capping of rat molars.

Notch signaling is an evolutionarily conserved pathway that controls the developmental choices made by individual cells. Cells communicate via Notch receptors and their ligands, which direct decisions on the fate of stem cells according to the states of their neighbors. In this study we explored Notch signaling after the pulp capping of adult first upper rat molars. The wound was capped with calcium hydroxide. In situ hybridization revealed an increased expression of Notch signaling genes on day 1, which showed a tendency to decrease on day 3. Notch1 increased in the subodontoblast zone and close to the lesion limited to a few cells. Notch2 increased in pulp stroma surrounded by coronal odontoblasts. Notch1 and, especially, Notch3 expression increased, corresponding to perivascular cell groups. A low increase of ligand expression was observed near the injury with Delta1 expression along the dentin wall and Jagged1 in the stroma. Expression of the downstream target, Hes1, was observed along the lesion and adjacent dentin walls. Hes5 expression was not observed. The results indicate that Notch signaling is activated in response to injury and associated with the differentiation of pulp cells into perivascular cells and odontoblasts. The findings are consistent with the concept that the Notch pathway controls stem cell fate during pulp regeneration.

Animals↗
PubMed2001

Long-term clinical evaluation of fracture and pulp injury following glass-ionomer cement or composite resin applied as a base filling in teeth restored with amalgam.

The aim of this research was to analyse the long-term clinical behaviour of two dental materials applied as filling under silver amalgam restorations: glass-ionomer cement (GIC) and composite resin with adhesive system (CR). In this study, 117 posterior teeth (29 premolars and 88 molars) were selected with carious lesions which resulted in great loss of dentin and cusps with unsupported enamel. After caries removal, cavities were prepared and totally filled with GIC or with CR. In a following visit, new cavities were prepared, leaving the employed filling material as a base and support for the enamel, which were then restored with silver amalgam. Restorations were evaluated periodically after 6 months and up to 5 years. Both fracture and pulpal involvement rates were low. Although differences could be observed in the behaviour of the materials, statistical survival estimation showed that the performances of GIC and CR as filling material were similar. There was a significant association both between kind of tooth (molar or premolar) and long-term survival of the restorations; and between degree of unsupported enamel and the same long-term survival. Our results confirmed that the technique in which GIC or CR are used as filling under silver amalgam restorations is clinically acceptable.

Adolescent↗
PubMed1997

An investigation of dento-alveolar trauma and its treatment in an adolescent population. Part 1: The prevalence and incidence of injuries and the extent and adequacy of treatment received.

AIM: To measure the prevalence and incidence of dental trauma and to assess the extent and success of treatment provided. DESIGN: Cross-sectional and one-year incremental study. SUBJECTS AND METHODS: 2022 11-14-year-old pupils were examined in schools for clinical evidence of trauma of anterior teeth. 1891 were examined 15 months later. A history of the trauma and treatment provided were obtained together with some social data. Radiographs were taken of affected teeth. MAIN OUTCOME MEASURES: Degree of trauma, whether treatment was provided and its quality, ACORN classification. RESULTS: 34% had suffered trauma but only 12% needed treatment for 332 teeth. 47% of these teeth had received treatment, of which 59% was inadequate. After 15 months 4% had experienced new injuries. 42% of boys and 28% of girls (P < 0.01) had sustained injuries, as had 38% from ACORN group III and 30% from groups I and II. 67% of those with pain and 40% of those without attended for treatment (P < 0.01), while 69% who were unhappy with the appearance and 35% who were not (P < 0.01) attended. CONCLUSIONS: The primary care services currently available for the treatment of dental trauma are inadequate.

Adolescent↗
PubMed1989

[Accidents in young children in Flanders. Place of dental accidents in epidemiologic studies].

Accidents requiring professional intervention were registered during 1 year in a population of nearly 6,500 Flemish children younger than 3 years. First, some professional records placed the children in their social context. Each month the parents were interviewed about the circumstances of the accidents, the need for professional help, the injuries, etc. Nearly 25% of the children had an accident during this study, needing professional help. The most frequent causes were falling (55.4%), cutting (11.4%), crushing (8.9%) and burning (7.6%). The most dangerous places were the kitchen and the living room (50%); the most frequent injuries were the open wound (42.2%), contusions (20.1%) and burns (7.8%). Only 5.6% needed the help of a family doctor. Only 2.8% of the accidents had consequences for the mouth and teeth, mostly following a fall on a level surface; 75% of these needed a dentist. The records were compared with other studies in Western Europe. Only the structure of the family (one or two parents) had an influence on the records.

Accidents↗
PubMed2006

Incisor trauma and the planning of orthodontic treatment.

Because of the frequency of dental injuries during infancy and adolescence, traumatized teeth with variable long-term prognoses present a problem for orthodontic treatment planning. Orthodontic therapy can remain unaffected, or be complicated, by traumatized teeth. In some cases, following dental injury, orthodontics can also be used to enhance (prosthetic and) restorative treatment results. The orthodontic challenges involved in treating patients with a history of dental trauma are complicated by the consequences of trauma on dentition development and the different treatment options that must be considered. In this paper, we provide actual examples of the effects dental trauma can have on orthodontic treatment planning.

Adult↗
PubMed1999

Bilateral pulmonary aspiration of intact teeth following maxillofacial trauma.

Tooth aspiration is one of the rare sequelae of dental trauma. When this does occur, the right bronchus is usually involved in adults due to the anatomical configuration. In this unusual case, two teeth were aspirated with one entering each lung. While the outcome from cases of aspiration of foreign bodies is usually favourable, this case serves to illustrate one of the possible unfavourable consequences.

Adult↗
PubMed2005

Presenting chief complaints and clinical characteristics among patients attending the Department of Paediatric Dentistry Clinic at the University of Nairobi Dental Hospital.

OBJECTIVES: To evaluate the chief complaints and clinical presentation among patients attending the Department of Paediatric Dentistry clinic at the University of Nairobi Dental Hospital (UONDH). DESIGN: A retrospective survey of hospital records. SETTING: The University of Nairobi Dental Hospital. SUBJECTS: Patients who attended the Department of Paediatric Dentistry clinic during a three year period. MAIN OUTCOME MEASURES: Chief complaint, dental caries, gingivitis, traumatic injuries, treatment at first visit. RESULTS: The records of 800 patients were examined, including 391 male and 400 female. The average age of the patients was 9.0 years. The presenting complaint for most patients was dental pain (31.5%), orthodontic related complaints (25.4%) and dental decay (19.7%). Very few children attended for dental check-up (3.9%). Five hundred ninety (73.8%) children suffered from dental caries, while 275 (34.4%) children manifested gingivitis. The average number of teeth decay was 3.71 (SD+/-3.76). Only 51 (6.4%) children attended with traumatic injuries to the dentition. Treatment performed at the first visit mainly consisted of dental extractions (21.8%), oral prophylaxis and dental health education (20.5%) and restorative treatment (20.0%). CONCLUSIONS: The presenting complaint for most patients was pain. However, there was an almost equal demand for orthodontic treatment. Dental caries was the most prevalent dental disease. Oral prophylaxis and dental health education (DHE) constituted a significant component of treatment offered at first visit.

Child↗
PubMed2006

Radiation-related damage to dentition.

Because of typical tissue reactions to ionising radiation, radiotherapy in the head and neck region usually results in complex oral complications affecting the salivary glands, oral mucosa, bone, masticatory musculature, and dentition. When the oral cavity and salivary glands are exposed to high doses of radiation, clinical consequences including hyposalivation, mucositis, taste loss, trismus, and osteoradionecrosis should be regarded as the most common side-effects. Mucositis and taste loss are reversible consequences, usually subsiding early post-irradiation, whereas hyposalivation is commonly irreversible. Additionally, the risk of rampant tooth decay with its sudden onset and osteonecrosis is a lifelong threat. Thus, early, active participation of the dental profession in the development of preventive and therapeutic strategies, and in the education and rehabilitation of patients is paramount in consideration of quality-of-life issues during and after radiotherapy. This Review focuses on the multifactorial causes of so-called radiation caries and presents possible treatment strategies to avoid loss of dentition.

Dental Caries↗
PubMed2006

Orofacial injury in a Brazilian professional basketball player: case report.

The frequency of dental trauma has increased among children and athletes of all ages who play contact sports. This kind of trauma may result in irreversible damage to the patient. The aim of this report is to present a case of an orofacial trauma involving a professional basketball player who was elbowed by another player. The athlete reported loss of sensitivity in three teeth and computerized tomography showed fractures in three points of the malar bone. After the incident and dental follow-up, the player was made aware of the need to wear a mouthguard.

Adult↗
PubMed2005

Traumatic injuries of the permanent incisors in children in southern Turkey: a retrospective study.

The aim of this study is to investigate the incidence, etiologic factors and results of dental trauma and the effects of age and gender on the trauma in permanent incisors. Over a 3-year period, 514 permanent incisor teeth in 317 patients with trauma history, who applied to Suleyman Demirel University School of Dentistry, Department of Pedodontics from the southern cities of Turkey, were evaluated. Standardized trauma forms were filled for each patient. In all age groups, the most frequent cause of trauma was found to be unspecified falls (47.6%). Maxillary teeth (88.5%) and central incisors (87.5%) were the most affected teeth from dental trauma. Ellis class II crown fracture was the most frequently seen type of injury (43.8%). The percent of the patients who applied to a dental clinic in the first 3 days after the trauma occurred (22.8%) was less than the percent of the patients who applied after 3 months and more time period (45.1%). It reveals that it is important to inform the public about dental trauma and the importance of time in these cases.

Accidental Falls↗
PubMed2002

Transoral 2.0-mm miniplate fixation of mandibular fractures plus 2 weeks' maxillomandibular fixation: a prospective study.

PURPOSE: We conducted a study to assess the efficacy of intraoral treatment of mandibular fractures using a 2.0-mm miniplate and 2 weeks of maxillomandibular fixation (MMF). PATIENTS AND METHODS: Forty-four mandible fractures in 31 patients with a mean of 15 days of MMF were included in this study. A 2.0-mm miniplate was adapted along Champy's lines of ideal osteosynthesis and secured with four 8.0-mm monocortical screws. All patients were followed for at least 8 weeks after surgery. The incidences of bone or soft tissue infections, wound dehiscence, nonunion, malunion, malocclusion, plate fractures, and iatrogenic neurosensory deficits were prospectively evaluated. RESULTS: Primary bone healing was achieved in 100% of cases. No soft or hard tissue infection, malocclusion, malunion, nonunion, dental injuries, plate fracture, or iatrogenic nerve injuries were observed. Two (4.52%) minor complications-intraoral wound dehiscences-were noted. CONCLUSIONS: The use of a single 2.0-mm miniplate adapted along Champy's line of ideal osteosynthesis and stabilized with 4 monocortical screws plus 2 weeks of MMF was a viable treatment modality for mandibular fractures.

Adolescent↗
PubMed1997

Validity of two methods for assessing oral health status of populations.

OBJECTIVE: This investigation assessed two methods for estimating epidemiologic indicators of oral health status among children: (1) a visual-only screening, performed independently by a dental hygienist and a registered nurse; and (2) a parent- or guardian-completed questionnaire. The indicators included dichotomous variables measuring dental caries and treatment needs, presence of sealants, injuries to the anterior teeth, and dental fluorosis. METHODS: Following training and calibration, data were collected over an eight-day period in April 1994 among 632 elementary schoolchildren (aged 5 to 12 years) in Monticello, Georgia. Both screening and questionnaire findings were compared pairwise with results from visual-tactile examinations done by a dentist. Validity, represented by sensitivity, specificity, and predictive values, was assessed for screening results from the dental hygienist, the nurse, and the parent-completed questionnaire. RESULTS: Validity was high for screening for caries and treatment needs (> 90% for sensitivity, specificity, and predictive values in a sample having 30% to 40% prevalence). Less valid data--mainly an effect of false negatives--were obtained for fluorosis, injuries, and presence of sealants. No significant difference in validity was observed between the nurse and the dental hygienist. One-third of respondents to the questionnaire did not know if their children needed fillings (a proxy for untreated decay) or had received sealants; only knowledge of restorations was comparable to results from screening. Intraexaminer reliability for the two screeners ranged from 85 to 100 for percent agreement and 0.70 to 0.93 for kappa scores. CONCLUSIONS: Screening by dental hygienists or nurses can provide valid data for surveillance of dental caries and treatment needs. Training for visual assessment of fluorosis and injuries must be improved to diminish the proportion of false negatives. A parent-completed questionnaire is less effective than visual screening for evaluating oral health status in children.

Child↗
PubMed2004

Socio-demographic characteristics and clinical features among patients attending a private paediatric dental clinic in Nairobi, Kenya.

OBJECTIVES: To evaluate the socio-demographic characteristics, chief complaints and clinical presentation of children attending a private dental clinic in Nairobi, Kenya. DESIGN: A retrospective survey of dental clinic records. SETTING: A private dental clinic in Nairobi, Kenya. SUBJECTS: All patients aged 0-18 years who were first-time attenders at the dental clinic during a three year period. RESULTS: The records of 800 patients were examined, comprising 395 males and 405 female children. The average age was 7.2 years (95%CI, 6.9-7.4). Referral to the clinic for treatment was mostly by self (81.4%). Most patients (57.9%) were self-sponsored for their dental treatment. Majority of the patients attending (86.8%) did not clinically have any underlying medical conditions. The major complaints for most patients were dental decay (27.4%) and dental pain (21.6%). Very few children (7.6%) attended for dental check-up. Five hundred and forty nine (68.6%) of the children suffered from dental decay while 294 (36.8%) suffered from gingivitis. The average number of teeth decayed was 4.02, SD +/- 2.4 (95% CI 3.8-4.2). Most carious lesions occurred in the younger children. There was a significant increase in the occurrence of decay over the three year period of the study. Significantly higher levels of gingivitis was observed in the prepubertal and pubertal age group. Attendance for traumatic injuries was relatively low with only 46 (5.8%) children reporting traumatic injuries to their dentitions. Most traumatic injuries involved the anterior teeth as a result of falls. Treatment given at the first visit was mainly restorative (28.6%) followed by dental extractions (25.4%). CONCLUSION: The average are of patients attending the clinic was 7.2 years. Interdisciplinary referral was low since most patients were self-referred and self sponsored for treatment. Dental caries was prevalent, necessitating a high demand for restorative treatment. Although gingivitis was less prevalent, it was significant among children in the prepubertal years.

Adolescent↗
PubMed1984

Custom mouth protectors: a review of their applications.

The greatest use of mouth protectors is the reduction of injuries in sports-related activities. However, mouth protectors are used with increasing frequency in other areas of therapeutic and preventive dentistry and medicine. Although the full scope of the use of custom mouth protectors has not yet been realized, this article reviewed the most common current uses. Health professionals should familiarize themselves with this treatment modality because the simplicity and cost of the custom mouth protector makes its use applicable to a wide range of patients for the potential preservation of oral structures.

Fluorides, Topical↗
PubMed1999

Self-inflicted injury in a case of Hallervorden-Spatz disease.

Hallervorden-Spatz disease (HSD) is a rare neurodegenerative disorder characterized by abnormally high deposits of iron in the brain. This report describes a child with HSD who presented with self-inflicted ulceration of the lip and tongue, which was initiated during periods of intense oro-facial spasms. Other findings included dental caries and trauma to the primary incisors. Comprehensive dental care was carried out under general anaesthesia. The self-mutilation of the oro-facial mucosa was eliminated by placement of upper and lower soft resin bite guards.

Child↗
PubMed2006

Physician and emergency medical technicians' knowledge and experience regarding dental trauma.

The purpose of the present study was to evaluate the knowledge of physicians and emergency medical technicians (EMT) regarding primary treatment for dental trauma and to assess the experience they have in treating dental injuries. The study population consisted of 70 military physicians and EMT during their military service. A questionnaire was distributed relating to demographic data, such as age, gender, position, and type of military service, as well as the following issues: past experience in treating or witnessing dental trauma, former education regarding diagnosis and treatment of dental trauma, assessment of knowledge regarding dental trauma, etc. Of all participants, only 4 (5.9%), all physicians, received education regarding dental trauma. Nevertheless, 42 (61.8%) reported they witnessed such an injury during their military service. Dental injuries were first seen by the EMT in 41.2% of the cases, by the physician in 25%, and by a dentist in only 7.3%. Overall, 58 (85.3%) of the physicians and EMT stated that it was important to educate the primary health care providers regarding diagnosis and treatment of dental trauma. Special emphasis should be given to providing primary caregivers with the relevant education to improve their knowledge and ability of dealing with diagnosis and treatment of dental trauma.

Clinical Competence↗
PubMedDate not supplied

A life course approach to assessing causes of dental caries experience: the relationship between biological, behavioural, socio-economic and psychological conditions and caries in adolescents.

The objective of this study was to further elucidate the relationship between relevant biological, behavioural, socio-economic and psychological conditions, experienced in very early life and along the life course, and dental caries experience using the life course approach. A two-phase study was carried out in Brazil. In the first phase, 652 13-year-olds were clinically examined and interviewed. In the second phase, 330 families were randomly selected for interview to collect information on the teenagers' early years of life. Clinical assessment included dental caries, periodontal and traumatic dental injury status. The data analysis involved multiple logistic regression analysis. Adolescents born in a non-brick house, those with a low birth weight and those who were the second or later child in the family were statistically significantly more likely to have a high DMF-T. In conclusion, the results of this study show that there is an association between socio-economic and biological factors in very early life and levels of caries in adolescents.

Adolescent↗