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PubMed2005

Dental trauma incidence and mouthguard use in elite athletes in Turkey.

Contact sports may lead to dental trauma, which often can be reduced with appropriate preventive measures. While numerous studies exist on this topic for several countries throughout the world, there is a lack of comprehensive descriptive studies in Turkey. The purpose of this study was to investigate the incidence and type of dental injuries associated with three different sports among Turkish elite athletes, who do not contact (volleyball), contact directly (taekwondo) or indirectly (handball) with competition rivals. Additionally, awareness and use of mouthguards were also compared. Thus, during the 2003 and 2004 Turkish National Championships in three sports, 50 taekwondo, 62 handball and 50 volleyball male athletes were interviewed by questionnaire. Results showed that taekwondo and handball athletes experienced significantly more dental trauma than volleyball athletes (P < 0.05). Twelve of the taekwondo (24%), 16 of the handball (26%) and four of the volleyball athletes (8%) experienced at least one type of dental injury. Awareness of mouthguards as a preventive measure against dental trauma was significantly higher among taekwondo and handball athletes (P < 0.05), although a very small percentage in either of these sports actually wore a mouthguard (10 and 0%, respectively). Trauma incidence between direct contact with rival competitors and indirect contact with rival competitors was not significantly different. The incidence of dental trauma in contact sports shows that the awareness and use of mouthguards must be intensified. Mouthguard use should be made compulsory, especially in those sports with high risk for dental trauma.

Adult↗
PubMed1990

Treatment of traumatic dental injuries. Shift in strategy.

A more conservative approach to the treatment of traumatic dental injuries has been made possible by knowledge concerning the pathogenesis of external root resorption, increased knowledge about wound healing processes in the pulp and periodontium, as well as by advances in restorative dentistry (reattachment of crown fragments with a dentin bonding system, the use of adhesive bridges, and advances in autotransplantation and implantation). However, a rethinking by the public, clinicians, and third-party payers is necessary for these procedures to gain wider acceptance. The present article describes the state of the art of treating dental trauma in the hope that these advances can become an accepted part of the dental trauma armamentarium and not merely scientific curiosities.

Cost-Benefit Analysis↗
PubMed1992

Root resorption following traumatic dental injuries.

Permanent teeth are usually not attacked by osteoclasts despite their situation in a site where active bone resorption constantly takes place as a result of local and systemic osteoclast activating factors. This fact points to antiresorption factors residing in both the periodontal ligament (PDL) and the pulp. Concerning the PDL homeostasis factor (i.e. permanency of a separation between the alveolar socket and the root surface and protection of the root surface against osteoclastic activity), recent studies have shown that this factor, at least with respect to trauma and wound healing, is linked to, and probably resides in, the cementoblast layer and/or the cells next to this layer. If there is loss of this tissue integrity, root resorption may occur; especially if non-PDL derived cells gain access to the site. With respect to the pulp, no systematic research has been performed regarding the homeostasis of this structure (i.e. permanency of the pulpal organ with its specific anatomy and functional stability). In evaluating the events where resorption does occur, it appears that the loss of tissue components within the pulp (including odontoblasts) implies a risk of root canal resorption if nonpulpally derived cells gain access to the site. Root resorption following traumatic dental injuries, whether located along the root surface or within the root canal appears to be a sequel to wound healing events, where a significant amount of the PDL or pulp has been lost due to the effect of acute trauma. The goal of these processes is removal of injured tissue from zones of trauma, space creation for neovascularization or control of infection. Irrespective of the goal, these processes have a potential for root resorption. The type of tissue repair, i.e. repair originating from the dental pulp, the PDL or bone or a combination, seems to be of importance in determining the risk of root resorption during the healing process.

Dental Pulp↗
PubMed2005

Dental emergencies presenting to a university-based paediatric dentistry clinic in the West Indies.

OBJECTIVES: The aims of the present study were to investigate the type and prevalence of dental emergencies presenting at a teaching hospital paediatric emergency clinic in Trinidad, and to describe the socio-demographic factors related to the use of the service. DESIGN AND METHODS: The authors used a prospective study of consecutive dental patients presenting to a paediatric emergency clinic. Data recorded included type of presenting emergency and socio-demographic variables. RESULTS: Data were available for 309 participants; 47% were male and 53% female. The average age of the participants was 8.66 years (SD = 3.75 years; range = 1-16 years). Seventy-three per cent of the participants' parents were involved in manual work or unemployed, and 21% were in nonmanual/professional employment; the occupation was not known in 6% of cases. Caries-related problems accounted for 74% of emergencies. Dental trauma mostly affected the upper permanent incisor teeth, with concussion, subluxation and intrusion being the most common injuries. CONCLUSION: Dental emergencies presenting to this university-based clinic were predominantly related to caries and trauma. The service was more frequently utilized by children in the mixed dentition stage, children from lower socioeconomic groups and those living in the local area. The frequency of caries-related problems indicates the need for more community-based preventive strategies, including encouraging greater attendance for routine dental care and dental health education. Strategies for oral health promotion should also be developed to prevent dental trauma.

Adolescent↗
PubMed1997

Childhood obesity: a risk factor for traumatic injuries to anterior teeth.

The relationship between obesity and traumatic dental injuries was evaluated in a study population of 938 6- to 11-year-old schoolchildren from Rome, Italy, and it was suggested by the lifestyle and the physical activity of obese children, which, according to many authors, is different from the lifestyle of other children. The subjects were examined at school: presence and type of dental injury, overjet, incisor protrusion, upper lip incompetence and presence of obesity were recorded. Trauma predisposition was evaluated with a questionnaire investigating the behaviour which may predispose to impacts. Six out of eight questions in this questionnaire concerned the children's lifestyle and the trauma predisposition score was therefore also considered an estimate of lifestyle and physical activity. The dental injury prevalence of the study population was 21.3% and obesity prevalence was 11.4%. Of the obese children 30.8% had dental injuries vs. only 20.0% of non-obese subjects (P = 0.007). Obese children had only enamel and enamel-dentine fractures and the main reported trauma cause was indoor play; conversely, lean children also had other types of injuries and the most frequently reported cause was outdoor play. The main predisposing factors significantly affecting the probability of dental injury, evaluated with multiple logistic regression, were upper lip uncoverage (OR: 1.23; P = 0.02), overjet larger than 3 mm (OR: 1.68; P = 0.001) and obesity (OR: 1.45; P = 0.01). Surprisingly, trauma predisposition was a protective factor (OR: 0.50; P = 0.00001). The results of this study were explained by the significant inverse correlation between obesity and trauma-predisposing behaviour, thus suggesting that subjects frequently playing sports and lively games were not only less obese but also more skillful and, for this reason, less prone to trauma when they fell or sustained impacts.

Accident Proneness↗
PubMedDate not supplied

Implants in management of gunshot injuries of teeth, facial bones and jaws.

The use of implants in management of gunshot injuries of teeth, face and jaws presents novelty that is manifested in primary surgical treatment, reduction and fixation of bone fragments and teeth, replacement of lost parts of bone tissues as well as preparation for definitive prosthetic management. At the Clinic for Maxillofacial Surgery of the MMA 173 implants of different types and purposes have been placed in the period 1991-1997, in rehabilitation of the patients injured during the civil war. Although this number of placed implants is significant, the conclusive estimate about benefit of using implants may be obtained only after a longer period of time. Early results are satisfactory.

Adolescent↗
PubMed1995

A history of oral protection for the ECT patient: past, present, and future.

Dental injuries and oral soft tissue trauma are recognized risks of electroconvulsive therapy (ECT), which continue to cause concern for patients and providers. The sudden forceful closure of the jaws that precipitates trauma is not avoidable since the pterygoid, masseter, and temporalis muscles are stimulated during treatment. Therefore, the use of a biteguard and oral protection techniques is recommended. No one biteguard has been found to be effective in protecting against all of the oral conditions that exist in the adult ECT patient population. A review of the objectives of ECT oral protection and biteguard design is detailed. The characteristics of patented, commonly used, and home-made ECT oral devices are considered, and recommended techniques for oral protection are detailed.

Adult↗
PubMed2001

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

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.

Adolescent↗
PubMed2005

Relationship between traumatic dental injuries and attention-deficit/hyperactivity disorder in children and adolescents: proposal of an explanatory model.

The objective of the present study was to determine the association between attention-deficit/hyperactivity disorder (ADHD) and traumatic dental injuries in a child psychiatric clinical population in Istanbul. A total of 475 consecutive children aged 8-17 years were enrolled in the study. Children and their parents were interviewed about the presence of traumatic dental injury and if a positive response was obtained further questions were inquired regarding the time and cause of the injury, and whether treatment had been sought. Child psychiatric diagnosis was based on Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria. Of the 475 children, 32 reported a traumatic dental injury (6.7%) with statistically significant association with ADHD (chi(2) = 26.90, d.f. = 1, P = 0.0001; odds ratio = 17.41, 95% CI: 4.11-73.55). On the Conners Teacher Report Questionnaire, children with dental trauma group differed significantly from the non-ADHD group but not from the ADHD group (F = 17.02, d.f. = 2, P = 0.0001). Among children with ADHD and dental fracture, the most common subtype was combined ADHD (90%). This is the first study describing a significant association between dental fractures and ADHD which contributes to an explanatory model on dental traumas among children. According to us, awareness of this association is essential at child psychiatry and pediatric dentistry settings and we recommend preventive efforts to be directed at the treatment of ADHD.

Adolescent↗
PubMed2005

Are mouthguards necessary for basketball?

This literature review evaluates the significance of dental injuries and their relationship to a specific sport--basketball. Many studies have been published on individual sports or groups of sports, but most pertain to specific age groups or levels of competition. Research suggests that many sports that do not require mouthguards should encourage male and female participants to use orofacial protectors. Athletes, coaches, athletic directors, athletic trainers, parents, and members of the dental community should be aware of how individuals who participate in sporting activities are at risk for dental trauma. Any sport where the potential for dental trauma can exist, such as basketball, soccer, or wrestling, should consider utilizing mouthguards to protect the competitors. The establishment of mouthguard programs for athletes of all ages and genders who participate in basketball may help to reduce the incidence of dental trauma.

Basketball↗
PubMed1996

Dental injuries during general anaesthesia.

Although most anaesthetic textbooks cite dental injury as a complication of endotracheal intubation few studies have examined the extent and nature of the problem. Such damage however, formed the basis for one-third of all confirmed or potential anaesthetic claims notified to the Medical Protection Society between 1977 and 1986. This article seeks to explore the extent of the problem, outline predisposing factors, summarise current prophylactic measures and make recommendations to reduce the overall incidence. Increased awareness of the problem, by both anaesthetists and dental surgeons, coupled with appropriate prophylactic measures may result in a reduced incidence of dental injury arising from general anaesthesia. Given the high incidence of dental damage we recommend that all patients undergoing a surgical operation under endotracheal intubation should have a pre-operative dental check wherever possible. Clearly, the first dental examination would be conducted by an anaesthetist familiar with the predisposing factors. Where he/she considers there to be a higher than average risk of dental damage occurring during intubation a more specialised examination should be conducted by a dental surgeon. It may, where appropriate, be possible for remedial dental treatment to be carried out and customised mouth guards to be constructed prior to the operation. Obviously such recommendations have certain financial implications and would have to be subject to controlled cost-benefit analysis before their widespread application.

Anesthesia, General↗
PubMed2001

Can maxillary incisor trauma be predicted from cephalometric measurements?

Dental injury is a traumatic event related to many factors, including dentofacial morphology. In a previous study in which we used a logistic regression model, 5 cephalometric variables were defined as being the best predictors of traumatic injury. The purposes of this study were to test the predictive value of the logistic regression analysis results for the occurrence of dental injury in a new patient sample and to compare these results with the outcome based on a visual evaluation of cephalograms. The study population consisted of 2 groups of orthodontic patients: patients with injured incisors (n = 64) and patients with non-injured incisors (n = 90). Cephalometric skeletal, dental, and soft tissue measurements were made. In addition, 6 professional judges visually evaluated all cephalograms. Classification tables were constructed for the results of the logistic regression model and for the assignment of patients according to the visual evaluation of the cephalograms. The percentage of correctly classified patients at the.7 probability level was 62%. Surprisingly, the professional panel rendered an equal predictive value. The relatively inferior performance of both the mathematical model and the "eyeballing" may demonstrate that dentofacial morphology is only partially responsible for susceptibility to trauma.

Cephalometry↗
PubMed2003

Traumatised permanent teeth in 11-16-year-old Saudi Arabian children with a sensory impairment attending special schools.

- The aim of this study was to determine the prevalence of traumatised permanent teeth among sensory (visual (VI) and hearing (HI)) impaired children attending special schools in Riyadh, Saudi Arabia. All the dental injuries involved incisor teeth, and trauma was noted in 33 (6.7%) children attending government schools (control group) compared to 7 (9%) VI children and 24 (11.4%) HI children. Differences in the dental trauma only reached statistical significance between the HI and control group (P < 0.05). Gender differences were only apparent in the HI group, with males having higher levels of traumatised teeth. In addition, HI children aged 11-12 years were more prone to trauma than children in the control group of the same age (P < 0.05). In conclusion, sensory impaired children do have a tendency for more dental trauma. However, this was only statistically significant for HI children. Whereas a gender difference was most noticeable for the HI group, with males having higher levels of trauma, this was noticeable by its absence among VI children.

Adolescent↗
PubMed2005

A study into dentists' knowledge of the treatment of traumatic injuries to young permanent incisors.

OBJECTIVE: The aims of this study were to evaluate dentists' knowledge of the emergency treatment of traumatic injuries to young permanent incisors, and to investigate barriers to treatment. DESIGN: A closed-ended questionnaire was sent to 1023 general dental practitioners (GDPs) and community dental officers (CDOs) in West/North Yorkshire and Humberside, UK. METHODS: The questionnaire comprised 17 questions. Six questions asked for general information about the participants (i.e. profession, age, gender, year of graduation, training or education on dental trauma, and willingness to provide emergency care), 10 were relevant to the emergency treatment of crown fractures, root fractures, luxation and avulsion injuries, and the last question queried any perceived barriers to treatment. Results. Seven hundred and twenty-four questionnaires were returned, a response rate of 71%, and these indicated that dentists' knowledge of the emergency treatment of dentoalveolar trauma in children was inadequate. The CDOs were significantly more knowledgeable than the GDPs, as were younger and more recently graduated dentists compared with older ones. The GDPs regarded the difficulty of treating children and the inadequate fees of the UK National Health Service as important barriers to treatment. Dentists who attended continuing dental education courses on dental traumatology had a more thorough knowledge than those who did not. CONCLUSION: Overall, the dentists' knowledge of the emergency treatment of dentoalveolar trauma in children was inadequate. Greater emphasis on undergraduate and postgraduate education in this area is indicated.

Adult↗
PubMed2006

The role for 'reminders' in dental traumatology: 4. The use of a computer database for recording dento-alveolar trauma in comparison to unstructured and structured paper-based methods.

The aims of this study were to investigate the effectiveness of a computer database (CD) developed for this study, a plain paper unstructured history (USH) and structured histories (SH) for the recording of important prognostic factors for simulated dento-alveolar trauma. Twelve vocational trainees, seven postgraduates in paediatric dentistry and 24 general dental practioners were randomly assigned to using USH, SH or CD. Each dentist visited a series of simulated trauma cases (with models, photos, radiographs and actors) and was asked to record important prognostic factors for each injury and make a diagnosis. There were a total of 243 dentist contacts with the trauma stations. The average percentage of important prognostic factors recorded per station was: USH 53%, SH 75.3% and CD 58.6%. SH was significantly better than the other two methods (P < 0.001, anova). Interestingly, those general dental practitioners (GDPs) who qualified prior to 1990 were significantly poorer at recording important prognostic information using CD. This effect was not obvious when using USH and SH. It was also seen that USH and SH were significantly better at helping clinicians reach a correct diagnosis as compared with CD (P < 0.001, chi-squared). A paper-based SH was the most effective method for collecting essential prognostic information for simulated trauma cases used in this study. At present, the introduction of our CD for recording of trauma is not justified without significant modification.

Chi-Square Distribution↗
PubMed2002

[Injuries of permanent incisors: epidemiology and management in a public health clinic in Dakar].

This prospective study done in a dental care center in a near suburb of Dakar during a period between January 1999 and December 2000, bas shown that permanent incisors traumatism's frequency is about 10.30% (61 teeth) which come within common values of the literature; and a sex ratio of 2.25. These traumatisms concern central maxillary incisors (75.41%) on patients less than 20 years old; falls, violence and road accidents are the major etiology. The consulting time limit is quite disadvantaged to preserve pulp vitality and dental re-implant in case of recent traumatisms. 53.33% of old dental traumatisms are observed to patients between 20 and 40 years old. And overall 80.76% of endodontic treatments realised in this case were not finished. The control of pain and anxiety would ease the emergency treatment. The information's of patients about significance of the consulting time limit, their motivation on differed dental treatments and/or endodontic treatments, as well the post traumatic watch would improve the management and the prognostic by setting of a referenced dental care units.

Accidental Falls↗
PubMed2005

Level of information concerning dental injuries and their prevention in Swiss basketball--a survey among players and coaches.

Basketball carries a medium risk of dental injuries. Swiss data are not available in this respect. Using a standardized questionnaire 302 basketball players from 29 Swiss teams and their 29 coaches were interviewed. The questions focused on the frequency of dental accidents, their prevention and subsequent procedure. The participating 302 players came from three divisions: semi-professional players of National League A and B (102), amateurs of Regional League 2 and 3 (100) and young people of up to the age of 18 (100). The data were evaluated in relation to division, sex and team function. Of the 331 interviewed persons 102 had already seen a dental trauma in basketball and 55 had already had a dental trauma. Only four of the interviewed persons wore mouthguards. The awareness of the procedure following a dental trauma was unsatisfactory. The results of the survey show that significantly more information and education is required in Swiss basketball not only through sports associations but also through coaches and dentists.

Adolescent↗
PubMed2004

Prevalence of traumatic injuries to the permanent incisors in candidates for orthodontic treatment.

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.

Adolescent↗