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PubMed2006

Immunocytochemical evidence that most sensory neurons of the rat molar pulp express receptors for both glial cell line-derived neurotrophic factor and nerve growth factor.

Most pulpal afferent neurons have cytochemical features in common with the class of nociceptors that express neuropeptides and respond to NGF, while very few bind the plant lectin IB4, a widely used marker for the class of nociceptors that respond to the GDNF family of neurotrophic factors. The present study was undertaken to determine whether the GDNF receptor, GFRalpha-1, is expressed by pulpal afferents, and, further, to determine whether tooth injury evokes changes in expression of the GDNF and NGF receptors among pulpal afferents. The tracer, fluoro-gold (FG), was applied to shallow cavities in dentin of first and second maxillary molars. After 4 weeks, the molars of one side received a test injury consisting of a deeper cavity that exposed pulp horns. Animals were perfusion fixed 2 days later, and sections of the trigeminal ganglia were double immunostained with combinations of antibodies against GFRalpha-1, and TrkA. Under control conditions, GFRalpha-1 immunostaining was observed in 72% of neurons that projected to the molar pulp, TrkA in 78%, and immunostaining for both receptors was observed in 65% of pulpal afferents. Tooth injury evoked up-regulation of GFRalpha-1 expression (to 93%) and a slight down-regulation of TrkA expression (67%) among tooth afferents, while there was no discernable change in the proportion of pulpal afferents that expressed both TrkA and GFRalpha-1 (to 61%).

Animals↗
PubMed2005

[Analysis of the causes and emergency management of 154 traumatized permanent incisors in primary school children].

PURPOSE: This study was designed to investigate the related factors of permanent incisors trauma among primary school children, and evaluate the results of replantation of 56 avulsed teeth. METHODS: Data were collected by 122 questionnaire from teachers or parents of the primary school children with dental trauma, with regard to the related trauma causes, altitudes and emergency management of dental avulsion. 56 avulsed teeth were replanted immediately after appropriate manipulation. The results of replantation were evaluated 1 year later. RESULTS: Tumble (fall off) was the main cause for dental trauma. The maxillary central incisor was most vulnerable to injury, without differences between the right and the left side. Single tooth injury was predominant in all age groups. Children with an incisal overjet tended to have a greater chance of dental trauma. Crown fractures represented 89 (57.79%)of 154 traumatized teeth; root fractures represented 9 (5.84%); avulsed represented 56 (36.3%). Most teachers and parents had little knowledge of the correct procedures for replanting or transporting avulsed teeth. 53 of 56 replanted teeth (94.64%) were integrated successfully. CONCLUSION: The parents and school educators should be advised about prevention of injuries and actions to be taken in case of an accident. The functional and esthetical outcome of replantation in avulsed teeth is excellent.

Child↗
PubMed2003

Traumatic dental injuries in Brazilian preschool children.

The purpose of this study was to determine the prevalence and distribution of traumatic injuries to primary anterior teeth in children from zero to 6 years old, all attendees in 28 public nursery schools in Canoas (Brazil). A total of 1545 boys and girls participated in the study. The children were clinically examined for signs of trauma according to Andreasen's classification. Traumatic injuries were identified in 35.5% of children. The largest percentage of injuries was demonstrated by 3-4-year-old child, with no significant difference between boys and girls. The maxillary central incisor was the most vulnerable to injury, without differences between the right and the left side. Single tooth injury was predominant in all age groups. Crown fractures represented 83% of all traumatic injuries. Our findings emphasize the importance of encouraging parents to visit the dentist with their child at an early stage. Furthermore, parents and educators should be advised about prevention of traumatic injuries and actions to be taken in case of an accident.

Brazil↗
PubMed2003

Dental complaints in emergency departments: a national perspective.

STUDY OBJECTIVES: Using nationally representative data, we sought to describe the incidence of emergency department (ED) visits for dental-related complaints for children and adults in the United States. We hypothesized that dental-related ED visits were more likely than other ED visits to have Medicaid or no insurance as the payer. METHODS: We used data from the 1997 to 2000 National Hospital Ambulatory Medical Care Survey, a national probability sample survey of hospital ED visits that is conducted by the National Center for Health Statistics. From these data, all ED visits in which one of the reasons for the visit was toothache or tooth injury were compiled and used to determine national estimates of counts and rates of ED visits for dental-related complaints. Logistic regression analysis on the outcome variable, presentation to the ED with a dental complaint (versus other problem), was performed to determine the association with payer and other covariates. RESULTS: During the 4-year period from 1997 to 2000, there were an estimated 2.95 million ED visits in the United States for complaints of tooth pain or tooth injury, for an average of 738,000 visits annually. Population-based rates and proportion of all ED visits for dental complaints were highest in the 19- to 35-year-old group, accounting for 1.3% of all ED visits and 5.6 ED visits per 1,000 people in this age category. "Dental problem, not otherwise specified" was the most commonly assigned International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis. Multivariate logistic regression results indicated that the adjusted odds of presentation to the ED for a dental complaint compared with other problems were significantly elevated for visits in which Medicaid or self-pay was listed as the payer relative to those with private insurance. CONCLUSION: EDs are an important point of care for dental-related complaints, particularly for individuals who lack private insurance. ED providers should be equipped to triage, diagnose, provide basic treatment, and ensure appropriate follow-up care for dental problems, which may require enhancement of dental training for emergency medicine providers and improved dental care during and after ED visits.

Adolescent↗
PubMed1998

Type of treatment and estimation of time spent on dental trauma--a longitudinal and retrospective study.

The consequences of traumatic tooth injuries (dental trauma) are time-consuming and costly treatment and follow-ups, of which our knowledge is scarce. Consequently the aim of the present study was to measure the total time of treatment of uncomplicated and complicated traumas to primary and permanent teeth. The study was performed in three steps based on a randomly selected sample of Danish children and adolescents living in the municipality of Copenhagen, Denmark: (I) A descriptive analysis of traumas affecting 106 children and adolescents all born in 1970 and randomly chosen among the total number of patients treated. Treatments took place between 1972 and 1988. (II) A study of the time and frequency of different types of emergency and planned treatment estimated by 14 dentists employed by the municipal dental service. (III) Calculation of the total treatment time on the basis of the results from (I) and (II). The most common traumas were luxations of primary teeth and fractures of permanent teeth. The most frequent treatments dealt with were uncomplicated crown fractures and luxations followed by other different diagnoses of complicated traumas. The treatment time for primary teeth for uncomplicated traumas were used mostly for information, while the time for complicated traumas was used for follow-ups. The treatment time for traumas to permanent teeth was dominated by follow-ups, irrespective of the complication status. Only 3% of uncomplicated traumas of permanent teeth resulted in endodontic treatment, compared to 67% with complicated traumas. Uncomplicated traumas to primary teeth required a total of 2.5 visits and 0.8 hrs treatment time, while 4.3 visits and 1.6 hrs per individual were used for complicated traumas. For permanent teeth with uncomplicated traumas 9.2 visits and 3.2 hrs were required, and for complicated traumas 16.4 visits and 8.5 hrs per individual. The respective treatment times for complicated traumas for primary and permanent teeth were 2.0 and 2.7 times higher, compared to the corresponding uncomplicated traumas. There were no gender differences in type of injury and number of visits for injuries to primary and permanent teeth.

Adolescent↗
PubMed2006

Management of the perforations due to miniplate application.

Microdimensioned osteosynthesis using miniplates has been common practice in maxillofacial surgery. However, tooth injury during the application of the miniplates have been reported in few papers. In this case, a 32-yr-old female patient, whose two teeth were necrosed because of the perforation during screw insertion was presented. The reason of the perforations during the rigid internal fixation was the lack of radiographic assessment because of the pregnancy. Maxillary right first premolar and maxillary left canine were perforated and necrosed because of the screw insertion. The necrosed teeth were detected 1 yr after the rigid internal fixation. The root canals of nonvital teeth were filed using step-down approach. Cold lateral condensation of gutta-percha was used to fill the canals. Six-month recall visits were scheduled and there was no problem after 2-yr follow-up period.

Adult↗
PubMed1998

Oral health status of special athletes in the San Francisco Bay Area.

A standardized oral health screening protocol was developed for assessing the oral health status of athletes participating in annual Special Olympics events at sites across the country. This paper reports on results at the San Francisco Bay Area Special Olympics event, where 385 athletes participated in the oral health screening. Trained dental screeners determined the presence or absence of edentulism, untreated decay, filled teeth, missing teeth, tooth injury, fluorosis, and gingival signs, as well as treatment urgency. The frequency of mouth cleaning, having a mouth guard, use of tobacco, and presence or absence of pain were self-reported. Overall, child athletes 9-20 years of age had more untreated decay and substantially more missing permanent teeth than 9-20-year-old children represented in the 1986-87 National Institute of Dental Research Survey of U.S. School Children. Prevalence of missing teeth among adult athletes compared favorably with data from the Third National Health and Nutrition Examination Survey and the Behavioral Risk Factor Surveillance System Survey. Approximately one-third of child and adult athletes were determined to need dental care. Continued use of a standardized screening protocol could allow state-specific data to be available on the oral health status of this population; trends could be tracked; and needs could be identified, with strategies developed to meet those needs.

Adolescent↗
PubMed2004

Distant consequences of traumatic injuries to deciduous teeth--a case report.

The ever increasing number of injuries to deciduous teeth in children constitutes a serious problem in paedodontics. Among many factors that facilitate tooth injuries are malocclusions, and most specifically protrusions of upper incisors of Class II/1 according to Angle. This is a case report of a 6-year-old girl with irregularities of upper permanent incisors due to traumatic injuries to deciduous teeth. In view of the ongoing child development processes, medical check-ups following injuries to deciduous teeth should be undertaken once every two or three months. Since such injuries have an impact on the development of the masticatory organ, children should undergo medical inspection and observation immediately upon the completion of relevant post-trauma treatment.

Child↗
PubMed1994

Dental trauma in children and adolescents in Valparaiso, Chile.

This study analyzed traumatic injuries in the primary and permanent dentition in children treated from 1990 to 1992 at the Children's Dental Traumatology Service in Valparaiso, Chile. A total of 227 records from patients 2 to 21 years old was studied with regard to the cause of injury, location of injury, time elapsed before treatment, history of previous trauma, type of injury, number of injured teeth, and how patients seek treatment. A total of 73 patients had injuries to the primary dentition (pD) and 154 to the permanent dentition (PD) with a total of 357 injured teeth (115 primary, 242 permanent). Ten to 12-year-old children had the highest number of injuries (33%). Falling was the most common cause of injury in both groups (82% pD, 58% PD), followed by striking against objects (13% pD, 19% PD) and bicycle accidents (9% PD). Most injuries in children with primary dentition (68%) occurred at home, while children with permanent dentition had most accidents at school (38%). Most children (61%) sought treatment after 24 h (52% pD, 65% PD), 61 children had suffered previous trauma (36% pD, 23% PD). The most common injuries in primary teeth were luxation (26%), intrusion (21%) and subluxation (18%). Uncomplicated crown fracture (34%), followed by complicated crown fracture (21%), were the main injuries in permanent teeth. There was no difference in the number of teeth involved for either dentition. A single tooth injury was found in 54%. Two teeth were involved in 35%, and three or more teeth in 11%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Management of trauma to primary and developing teeth.

Traumatic dental injuries to the young child can present both diagnostic and therapeutic challenges. Luxation injuries to the primary dentition are the most common injuries. Yet, they are the most controversial with regard to definitive treatment, prognosis, and sequelae. Damage to the developing teeth subsequent to primary tooth injury is often unavoidable and has permanent effects on the dentition. Diagnostic criteria, treatment options, and outcomes are presented in this article; however, treatment decisions are often based on patient behavior.

Child↗
PubMedDate not supplied

[Possibilities of preventing traumatic dental injuries--a prospective study].

INTRODUCTION: The aim of this study was to investigate the most important etiological factors related to traumatic dental injuries, type of required treatment, period from injury to initial treatment and frequency of recall appointments. MATERIAL AND METHODS: The sample consisted of 283 children with dental injuries managed at the Department of Dentistry of the Faculty of Medicine in Novi Sad, during the last 7 years. Retrospective data relied on trauma protocols of this department, whereas collected data referred to etiological factors, type of initial treatment, period from injury to initial treatment, recall appointments and complications of traumatic dental injuries. These results were compared with other similar national and international studies, in order to promote implementation of preventive strategies that would reduce the increasing frequency of dental trauma. RESULTS: Fall accidents were the most common cause of dental trauma. Injuries were most frequent in autumn, in the street, and in the afternoon hours. Single tooth injury was predominant, while the injured mostly denied previous injuries. Almost half of the injured patients did not seek professional help in the first 24 hours after the injury. 40% of treated patients missed their recall appointment. CONCLUSION: Knowledge of the etiology is important for planning preventive measures, but because of the complexity of etiological factors, it is difficult to prevent traumatic dental injuries. It is also important to underline the importance of immediate initial treatment of traumatized patients, and significance of their regular professional supervision. Generally speaking, almost all treatment procedures in management of traumatic dental injuries include preventive component.

Adolescent↗
PubMed1998

Traumatic dental injuries in Brazilian pre-school children.

The purpose of this investigation was to estimate the prevalence of traumatic dental injuries in a sample of Brazilian pre-school children with limited access to dental care. The sample included 1,853 one-to-five-year-old children attending public nursery schools in the Federal District of Brazil. Dental injuries were clinically assessed as follows: 1) uncomplicated crown fracture, 2) complicated fracture, 3) crown discoloration, 4) intrusive luxation, 5) extrusive luxation, 6) exarticulation or extraction after trauma and 7) subluxation. The results showed that 10% (< 2 years), 12% (3-4 years) and 20% (5 years) of the children had suffered at least one type of injury clinically identified at the time of the examination. Boys and girls were similarly affected. Dental injuries were almost entirely restricted to the maxillary central incisors (88%). Single tooth injury was predominant in all age groups. In the youngest group the most common types of injuries were crown fracture (69%) and crown discoloration (18%). However, from the age of three, crown discoloration showed percentages ranging from 41% to 47%. Prematurely lost tooth accounted for 11% of the injuries in 5-year-old children. The observed increase of dental injuries with age indicates accumulated treatment needs due to the children's limited access to dental care.

Brazil↗
PubMed1993

Etiological and predisposing factors related to traumatic injuries to permanent teeth.

Etiological and predisposing factors related to traumatic injuries to permanent teeth were studied in an epidemiological material comprising 1610 children with 286 registered traumatic dental injuries. The results showed that (1) postnormal occlusion, (2) an overjet exceeding 4 mm, (3) short upper lip, (4) incompetent lips, and (5) mouth breathing were all factors which significantly increased susceptibility to traumatic dental injury. The average overjet in children with injuries limited to enamel fracture was 4.3 mm. In cases exhibiting more severe injuries (dentine fracture, pulp lesion, root fracture, exarticulation) the mean overjet was significantly greater, 5.0 mm. The most common causes for injury were 'falls and blows' which were recorded as etiological factors in 69.9% of the boys and in 86.7% of the girls. Dental injuries sustained during participation in sports were twice as common in boys (18.2%) as in girls (8.2%). The frequency of tooth injuries caused by traffic accidents was comparatively low, 9.7% in boys and 5.5% in girls.

Adolescent↗
PubMed1992

Reactions of sensory nerves to dental restorative procedures.

The reactions of sensory nerves to restorative procedures can be classified as immediate, early and late. For each of these, the neural response depends upon the severity of pulpal injury and the stages of inflammation and healing. Immediate responses in the first few minutes include destruction of nerve fibers in the injured dentin and pulp, hypersensitivity of surviving fibers, release of neuropeptides into the pulp and neurogenic inflammation. Early responses occur during the first few days after cavity preparation, with nerve fibers sprouting in the surviving pulp and gaining increased axonal transport and neuropeptide contents. Sensory fibers containing calcitonin gene related peptide (CGRP) greatly outnumber those with substance P (SP); but both types grow toward the surviving odontoblasts and associated pulp tissue surrounding the lesion. Later during subsequent weeks the nerve fibers accompany granulation tissue as it replaces acute inflammation; and nerve sprouting subsides when inflammation is reduced and when reparative dentin covers the injury site. An important response to tooth injury that may regulate nerve sprouting reactions is the increased production of nerve growth factor (NGF) by pulpal fibroblasts near the lesion. The timing of the nerve sprouting reactions suggests that they may contribute to tooth hypersensitivity after restorative procedures.

Animals↗
PubMed1995

Clinical management of injuries to the maxilla, mandible, and alveolus.

Facial bone and especially mandibular fractures are injuries in which first aid and management of late complications require dental professionals, and consequently all dentists should be familiar with the modern principles of their treatment. Tooth involvement is common in mandibular and maxillary fractures and can require more treatment than does the jaw fracture. Nonsurgical treatment of bone fractures involves immobilization, which for the facial bones is achieved with maxillomandibular fixation (MMF) using dental fixed arch bars. Hence, associated tooth injuries are difficult or impossible to treat during immobilization, so that some treatment is necessary beforehand (for example, coverage of exposed dental areas, temporary filling of crown fractures, repositioning of luxated teeth, and endodontic treatment if the pulpal vascular supply is lost in the accident). Operative treatment of mandibular and/or maxillary fractures nevertheless involves some disadvantages and risks of complications. Teeth on the line of a mandibular fracture should not be extracted as a first-aid measure unless they impair repositioning of the jaw fragments. MMF can be avoided by means of direct internal fixation, which in principle allows treatment of associated dental injuries.

Alveolar Process↗
PubMed1994

Unusual pattern of pulp canal obliteration following luxation injury.

Pulp canal obliteration can occur as a result of tooth injury. A case report is presented in which a 6-yr-old patient developed partial pulp canal obliteration of a maxillary central incisor 9 months after luxation injury. The mineralization created unusual canal morphology which presented some difficulty in endodontic treatment of the tooth.

Child↗