Dental Emergencies Research Articles

Impact of COVID-19 on hospital visits for non-traumatic dental conditions in Ontario, Canada

Background and rationaleAs general health care is publicly funded in Canada and oral health care is not, many people seek care from hospitals for their dental problems. This study assessed if the unprecedented times of Coronavirus disease (COVID-19) affected the hospital visits for dental emergencies, making disadvantaged populations further vulnerable for attendance of their dental problems.MethodsData from IntelliHealth Ontario for emergency department (ED) visits, day surgery visits, and hospitalizations associated with non-traumatic dental conditions (NTDCs) were retrieved for years 2016 to 2020 to assess trends before COVID-19 and changes, if any, for the year 2020. Trends by month, for the years 2019 and 2020, to make straight comparisons and understand the effects of lockdown in Ontario, was also analyzed.ResultsIn the year 2020, there was a reduction of 40% in day surgeries, 21% in ED visits and 8% in hospitalizations compared to 2019. Stratified by month, largest reductions were observed in April 2020: 96% in day surgeries; 50% in ED visits; and 38% reductions in hospitalizations when compared to the same month of 2019. In May 2020, day surgeries and ED visits though remained reduced, hospitalization rates increased by 31%.ConclusionHospital EDs are inefficient avenues for handling dental emergencies. Nevertheless, they do remain a care setting that is sought by many for dental problems, and if the need for hospitalization and day surgery is there, this care setting is an important avenue for dentally related medical care. Perhaps unsurprisingly, COVID-19 has lessened the opportunity and capacity for such care.Practical implicationsAdministrators and policy makers can utilize this information to strategize on augmenting community infrastructure for building more effective, and cost-efficient avenues of care for timely management of dental problems.

Penyuluhan dan Pelatihan Kegawatdaruratan Dental Serta Penanganannya Kepada Guru-guru SDI Assalam Joglo Jakarta Barat

Dental emergencies are potentially life-threatening conditions and immediate treatment is needed to stop ongoing bleeding, reduce pain and also uncontrolled bleeding, cellulitis or bacterial tissue infection causing swelling in the mouth or mouth area and trauma to the bones in the facial area . Delay in treatment of trauma to the teeth can lead to treatment failure. Delay in emergency dental treatment after trauma will increase the risk of complications, non-vital teeth and an unpredictable prognosis.Dental emergencies often occur at the elementary school level and the most common cases are loose or avulsed teeth due to falls and impacts. Teachers in schools not only have a central role as educators, but teachers also act as first aid agents in dealing with health problems in schools. In addition, teachers also play a role and assist health workers in collecting data and also as the first emergency referral before being handled by health workers.SDI Assalaam has a staff of 46 teachers and 250 students. Having students who are actively moving has a risk of accidents such as falling and so on which can cause injury, especially the oral cavity, while knowledge of dental emergencies and their management according to the Principal of SDI Assalaam has never been received by the teachers who teach at SDI Assalaam , so that if there is a dental emergency the teachers don't know what action to take.To overcome the lack of knowledge about dental emergencies and their management. So the teachers of SDI Assalam are given counseling and training about dental emergencies and their handling so that the importance of dental emergencies is socialized so that teachers at SDI Assalaam can increase their knowledge about dental emergencies and their management.Based on the evaluation results of community service activities. There was a significant increase in the level of knowledge of SDI Assalaam teachers regarding dental emergencies and their treatment.

Antibiotic prescribing for children referred to an emergency dental clinic during the COVID-19 lockdown

Introduction During the COVID-19 pandemic, antibiotics for dental infections have been prescribed more frequently owing to reduced access to face-to-face appointments. Updated guidance emphasised antimicrobial prescribing for children. This study assessed whether the correct dose of antibiotics had been prescribed for children who were triaged by telephone at a dental emergency clinic in a London teaching hospital during the COVID-19 lockdown. Methods Data were collected for a retrospective service evaluation from the case notes of children whose parents had contacted the triage telephone line between May and September 2020. A proforma was used to extract information including the type of antibiotics that had been prescribed, the prescriber and the dose. Results Of the 815 children who were triaged via the telephone emergency clinic, 229 (28%) had received antibiotics. Three-quarters (n = 175, 76%) had been prescribed amoxicillin. Half of these (n = 88, 50%) had been prescribed a lower than recommended dose of amoxicillin; all incorrect dosages were prescribed by dentists in primary care. Patients aged 5–11 years were most affected by this (65%). Conclusions Incorrect antibiotic dose prescribing is a likely contributor to antimicrobial resistance as these patients often required further antimicrobial treatment. Our service evaluation highlights the importance of prescribing in line with the latest guidelines and literature.

The Impact of the COVID-19 Pandemic on Pediatric Dentistry: Insights from an Italian Cross-Sectional Survey.

The COVID-19 pandemic has had a significant impact on pediatric dentistry and also dental education. This study aimed to assess the observed changes in children's oral health by pediatric dentists and also served as an educational tool for dentistry students during the pandemic. Postgraduate students in pediatric dentistry prepared a survey addressed to Italian pediatric dentists. Over 5476 dentists were invited to participate, and collaboration among the students took place through virtual meetings and electronic platforms. The online questionnaire was composed of 29 questions focusing on the management of pediatric patients during and after the lockdown period. A descriptive statistic was used for data analysis, and chi-square tests were performed (p < 0.05). A total of 1752 pediatric dentists participated in the survey. During the lockdown, 68.3% of dentists exclusively handled dental emergencies. In the subsequent semester, a significant decrease in the number of pediatric treatments was reported. Pediatric dentists also noted a decline in children's oral hygiene practices, a deterioration in dietary habits, and an increase in anxiety during dental procedures. This survey shed light on the diverse effects of the pandemic on children's oral health and also provided valuable educational insights.

Addressing problem of nocturnal dental pain and emergency treatment for patients

Addressing problem of nocturnal dental pain and emergency treatment for patients

Association of Medicaid expansion with dental emergency department visits overall and by states’ Medicaid dental benefits provision

BackgroundEvidence on the association of Medicaid expansion with dental emergency department (ED) utilization is limited, while even less is known on policy-related changes in dental ED visits by Medicaid programs’ dental benefits generosity. The objective of this study was to estimate the association of Medicaid expansion with changes in dental ED visits overall and by states’ benefits generosity.MethodsWe used the Healthcare Cost and Utilization Project’s Fast Stats Database from 2010 to 2015 for non-elderly adults (19 to 64 years of age) across 23 States, 11 of which expanded Medicaid in January 2014 while 12 did not. Difference-in-differences regression models were used to estimate changes in dental-related ED visits overall and further stratified by states’ dental benefit coverage in Medicaid between expansion and non-expansion States.ResultsAfter 2014, dental ED visits declined by 10.9 [95% confidence intervals (CI): -18.5 to -3.4] visits per 100,000 population quarterly in states that expanded Medicaid compared to non-expansion states. However, the overall decline was concentrated in Medicaid expansion states with dental benefits. In particular, among expansion states, dental ED visits per 100,000 population declined by 11.4 visits (95% CI: -17.9 to -4.9) quarterly in states with dental benefits in Medicaid compared to states with emergency-only or no dental benefits. Significant differences between non-expansion states by Medicaid’s dental benefits generosity were not observed [6.3 visits (95% CI: -22.3 to 34.9)].ConclusionsOur findings suggest the need to strengthen public health insurance programs with more generous dental benefits to curtail costly dental ED visits.

Managing Endodontic Emergencies Amid the COVID-19 Pandemic

The impact of Covid 19 on dentistry has been profound with dental clinicians, who are at high risk of exposure to the virus. Initially at the inception of the pandemic, during the periods of lockdown, the elective dental treatment was halted and advice, analgesia and antimicrobials were preferred to manage the dental emergencies. Some patients could not be successfully managed with this approach and required face-to-face consultation. Therefore, dental emergency assessment via telephonic triage, Covid 19 screening and strict adherence to standard operating protocols for the patient, operatory and dentist were ensured while providing dental treatment based on minimum intervention and restraining from aerosol generating procedures. Now three years from the commencement of the pandemic, calls have been made for gradual return to regular clinical practice with extra precautions. Due to the emergence of new variants and ongoing easing and reimplementation of restrictions, it remains imperative to mitigate the risk of disease transmission during the dental treatment. Thus, this article provides an insight into the clinical protocols for the management of endodontic emergencies in the Covid 19 era, making the dentist better prepared to provide dental care in the patient’s best interest during such pandemic disease outbreaks now and in future. Keywords: Coronavirus disease 19 outbreak, endodontic emergency, dental care..

Referral patterns to the Paediatric Dental Emergency Clinic at The University of the West Indies, School of Dentistry, Trinidad and Tobago

Referral patterns to the Paediatric Dental Emergency Clinic at The University of the West Indies, School of Dentistry, Trinidad and Tobago

Dentists' Perspective on the Impact of COVID-19 on the Utilization of Emergency Dental Services in Kuwait: A Cross-Sectional Study.

This cross-sectional study intends to evaluate dentists' perceptions of COVID-19's effects on the use of emergency dental care both during and after Kuwait's lockdown periods. A convenience sample of dentists employed by the Ministry of Health's various emergency dental clinics and School Oral Health Programs (SOHP) throughout Kuwait's six governorates were invited to take part in this study. To determine the impact of various demographic and occupational characteristics on the mean perception score of the dentist, a multi-variable model was developed. The study was conducted between June-September 2021, and a total of 268 dentists (61% males and 39% females) participated in this study. When compared to pre-lockdown periods, the overall number of patients seen by dentists had significantly decreased after the lockdown period. After lockdown, there were significantly more cases of acute pulpitis with apical periodontitis, abscesses, and pericoronitis than there were before lockdown (p < 0.05). After the lockdown, a significantly higher percentage of dentists (p < 0.05) reported using fewer droplets-generating procedures to manage patients with dental emergencies. After correcting for the other variables in the model, female dentists (β = 0.146; 95% CI = 0.071 to 1.451) and non-Kuwaiti dentist (β = 0.012; 95% CI = 0.234 to 1.854) had a significantly (p < 0.05) more positive perception of the utilization of dental services than others after adjusting for the other variables in the model. The majority of dentists perceive that the COVID-19 pandemic has had a negative impact on Kuwait's use of emergency dental services.

Dental Emergency Management: An Emergency Medicine Workshop Curriculum

Dental Emergency Management: An Emergency Medicine Workshop Curriculum

Treatment Management of Patients Placed under Mandatory Quarantine and Requiring Emergency Dental Treatment, in the Context of COVID-19 Prevention

Treatment Management of Patients Placed under Mandatory Quarantine and Requiring Emergency Dental Treatment, in the Context of COVID-19 Prevention

An interprofessional education initiative: Introducing a local anesthesia dental course for nurse practitioner and physician assistant students.

To assess the impact of local anesthesia (LA) course for physician assistant (PA) and adult gerontology-acute care nurse practitioner (NP) program students on knowledge, attitudes, confidence, and intention to incorporate skills in clinical practice. The course was conducted by dental faculty for forty-eight PA and seven NP students and consisted of two lecture hours on anatomy of the oral cavity, anesthesia and pain management, 2 hours of preclinic lab where participants practiced injection technique on mannikins, and a clinical practicum conducted by dental school faculty and residents where students observed dental treatment including administration of LA, and discussed symptom triage by NPs and PAs for patients with dental problems including orofacial pain, initial management including LA, and patient referral to dentists. An online survey was administered to all students before and after the course to assess changes in knowledge, attitudes, confidence, and intention to incorporate LA administration skills into clinical practice and elicit students' perception of program quality. Pre- to post-changes were analyzed by two-tailed t-tests and analysis of variance (ANOVA) with significance at 0.05. The response rate for pre- and post-course assessment was 96.4% and 87.3% respectively. Students' overall scale score for self-assessment of dental knowledge increased significantly from pre- (2.34) to post-assessment (4.19). An increase was seen in students' attitudes regarding management of dental emergencies (t=2.181; p<0.05). Furthermore, overall confidence of students related to managing patients with dental problems increased significantly (2.00 to 3.85) after taking the course. The LA course was well received by PA and NP students and resulted in increased knowledge and confidence in recognizing common oral health conditions, understanding dental pain management including administration of LA, and making referrals to dentists to optimize patient care.

Pediatric Dental Emergencies during the COVID-19 Pandemic in Romania: A Retrospective Study.

Pediatric dental emergencies can occur as a result of untreated dental caries, or can be caused by trauma or periodontal issues. The lockdown imposed during the COVID-19 pandemic reduced the number of centers authorized to deliver dental services in Romania, with only a small number of dentists delivering dental emergency treatments. The aim of this study was to investigate the demographic characteristics of children and adolescent patients who were treated in the dental emergency department of Oradea, Romania and to compare the patients who were treated in the dental emergency department in the pre-lockdown (2019), lockdown (2020) and post-lockdown year (2021). All patients who were treated in the dental emergency department were included in the study except for adults and medical files that did not contain all relevant information. Several variables were investigated (age, gender, living environment, location of affected teeth, type of emergency). In 2019, 257 children and adolescents were treated, in 2020, 198, and in 2021, 136. Most patients were aged 7-12 years in all investigated years (2019-47.9%; 2020-50.5%; 2021-43.4%), and the most affected teeth were located in the lower posterior arch (2019-53.3%; 2020-53%; 2021-48.5%). The most frequent emergencies were pulpitis (2019-40.5%; 2020-43.9%) and acute apical periodontitis (2021-42.6%). It was observed that in 2019, patients aged between 0 and 6 years were more frequently associated with trauma (p < 0.001), and in 2019 and 2020, patients aged between 7 and 12 years were more frequently associated with periodontal emergencies (p < 0.001). In 2020, patients from rural areas were more frequently associated with pulpitis (p = 0.025), and in 2021, patients from rural areas were more frequently associated with pulpitis or acute apical periodontitis, and patients from urban areas were associated more frequently with periodontal emergencies (p = 0.042). Pediatric patients with ages between 7 and 12 years old, who lived in an urban environment were most affected. Teeth located in the lower and upper posterior dental arches were most affected, and pulpitis or acute apical periodontitis were the most common pathologies.

Dental and Maxillofacial Emergency Algorithms in Swiss Emergency Departments.

This study aimed to evaluate the availability and use of dental and maxillofacial emergency algorithms in Swiss hospitals. A survey was performed among physicians at Swiss emergency departments (ED) and participants of the "36th Annual Meeting of the Society for Oral and Cranio-Maxillofacial Surgery". Eighty-nine EDs in Switzerland were questioned about the availability and use of electronic algorithms in their hospitals. Eighty-one (91%) participated in the study. In 75 (93%) of the EDs, electronic algorithms are used, mainly "medStandards". Six have no available algorithms. Fifty-two (64%) use algorithms daily. Eight (10%) Swiss EDs have maxillofacial and dental algorithms, and 73 (90%) have no access to or do not know about them. For dental algorithms, 28 (38%) of the respondents would like to have access, and 16 (22%) do not desire access. For maxillofacial algorithms, 23 (32%) want to have access and 21 (29%) do not want it. Most (74%) of the participating maxillofacial surgeons did not know about the existence of ED algorithms regarding their specialty. Our study shows that the existence of specific algorithms is often not known. Furthermore, there is a demand for dental and maxillofacial algorithms in Swiss EDs.

Major relationships of tooth extraction in patients with cardiovascular diseases: a concise systematic review

Introduction: Cardiovascular diseases (CVD) are the leading cause of death worldwide. The number of tooth extraction patients with cardiovascular disease in our country is increasing year by year. Blood pressure control, determination of cardiac function, recognition of arrhythmias, glycemic control, and use of antiplatelet agents or oral anticoagulants need to be investigated. Objective: It was to carry out a concise systematic review of the main relationships of tooth extraction in patients with cardiovascular diseases, to emphasize the main risk predictors. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from February to March 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using articles from 2009 to 2022. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed accordingly, according to the Cochrane instrument. Results and Conclusion: A total of 124 articles were found, 38 articles were evaluated and 24 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 26 studies with a high risk of bias and 40 studies that did not meet GRADE. It was concluded that the cardiovascular response of elderly outpatients with systemic diseases during tooth extraction is quite significant. Age, sex, systemic diseases, and some tooth extractions may be risk factors closely associated with cardiovascular response. It is necessary for the dental treatment of these patients with heart disease a good knowledge of the subject and requires medical and dental coordination. Dental surgeons need to be prepared to identify possible medical and dental emergencies and take steps to prevent or treat them effectively and quickly.

THE RELATIONSHIP OF MOTIVATION ON THE INTEREST OF THE COMMUNITY VISITING THE DENTIST DURING THE COVID-19 PANDEMIC IN SUNGAI MIAI VILLAGE

THE RELATIONSHIP OF MOTIVATION ON THE INTEREST OF THE COMMUNITY VISITING THE DENTIST DURING THE COVID-19 PANDEMIC IN SUNGAI MIAI VILLAGE

Research on the cone-beam CT of the fracture morphology and location of a single oblique complicated crown-root fracture of maxillary incisors

Objective: To study the morphological pattern of single oblique complex crown fracture and its relative location to periodontal hard tissues from a three-dimensional perspective by using cone-beam CT, which provides a more intuitive and comprehensive understanding for the pathological features and rules of single oblique complex crown fracture. Methods: Primary cone-beam CT images of 56 maxillary permanent anterior teeth with oblique complex crown root fractures were collected from the Department of Integrated Emergency Dental Care, Capital Medical University School of Stomatology during January 2015 to January 2019. Fracture pattern, fracture angle, fracture depth, fracture width, and the relative location of the fracture line to the crest of the adjacent alveolar ridge were retrospectively analyzed. Independent samples t-test was used to compare the differences in angle, depth and width of fractures between sexes and tooth locations, as well as the pre-and post-fracture crown-to-root ratios between different tooth locations. Then the affected teeth were divided into juvenile group (≤18 years), young group (19-34 years) and middle-aged and elderly group (≥35 years). One-way ANOVA was applied to compare the differences in angle, depth and width of fracture between age groups, and Fisher exact test to compare the differences in fracture pattern of the teeth and the relative position of the fracture line to the crest of the adjacent alveolar ridge. Results: There were 35 males and 21 females in 56 patients, aged (28.2±13.2) years. Among the 56 affected teeth, forty-six were maxillary central incisors and 10 were lateral incisors. According to the patients' age and growing stage, they could be divided into the juvenile group (19 cases), the young group (14 cases), and the middle-aged and elderly group (23 cases). Forty-six (82%) affected teeth had an S-shaped fracture pattern, and ten (18%) had a diagonal pattern, in which the fracture angle of the S-shaped fracture line (47.85°±10.02°) was significantly greater than that of the diagonal line (28.30°±8.07°) (P<0.001). The fracture nadir was flush with or below the top of the alveolar crest in 98% (55/56) of cases. The fracture depth was significantly greater in the juvenile group [(1.75±0.73) mm] than in the young group [(1.21±0.68) mm](P=0.042) and in the middle-aged and elderly group [(1.12±0.90) mm] (P=0.001). The width of fractures among 56 patients was (4.75±1.44) mm, which had no statistically significant differences between different age, sex and tooth location groups (P>0.05). There were no statistically significant differences in the crown-to-root ratios after fracture of maxillary central incisors (1.18±0.13) compared to maxillary lateral incisors (1.14±0.20) (t=1.90, P=0.373). Conclusions: The fracture patterns of single oblique complex crown fracture were mainly S-shaped and oblique alignment; the fracture nadir was mostly located within 2.0 mm below the palatal alveolar crest.

The financial and quality of life impact of urgent dental presentations: A cross-sectional study.

This study aimed to: (i) calculate personal financial costs associated with urgent dental attendance; and (ii) investigate the pain-related disability and quality of life impact of dental conditions which result in urgent dental attendance. Data were collected from those presenting with urgent dental conditions to an out-of-hours dental service, a dental emergency clinic (DEC) and five primary care general dental practices across North-East England. A pre-operative questionnaire explored the impact of urgent dental conditions on oral health-related quality of life (OHRQoL) using Oral Health Impact Profile-14 (OHIP-14) and a modified Graded Chronic Pain Scale (GCPS). OHIP-14 yields a maximum score of 56, with a higher score indicating a lower OHRQoL. Personal financial costs were summed to provide a total. These included travel, appointment fees, childcare costs, medication use and time away from work. Data were analysed using one-way anova and multivariable modelling. In total, 714 participants were recruited. The mean OHIP-14 score was 25.73; 95% CI [24.67, 26.79], GCPS CPI was 71.69; 95% CI [70.09, 73.28] and GCPS interference was 49.56; 95% CI [47.24, 51.87]. Symptomatic irreversible pulpitis was the most frequently managed dental emergency and was associated with the highest mean OHIP-14 score (31.67; 95% CI [30.20, 33.15]). The mean personal financial cost of urgent dental care (UDC) was £85.81; 95% CI [73.29, 98.33]. Differences in travel time (F[2, 691] = 10.24, p < .001), transport costs (F[2, 698] = 4.92, p = .004), and appointment time (F[2, 74] = 9.40, p < .001) were significant between patients attending an out-of-hours dental service, DEC and dental practices for emergency care, with a DEC being associated with the highest costs and dental practices the lowest. Diseases of the pulp and associated periapical disease were the most common reason for patients to present for UDC and were the most impactful in terms of OHRQoL and pain in the present sample. Personal financial costs are significant from urgent dental conditions, with centralized services increasing the burden to patients of attending appointments.

Impact of the COVID-19 lockdown on the oral health status of paediatric dental patients in Greece.

Limited evidence regarding the post-COVID-19 dental status of paediatric patients is available, with most studies assessing only children's oral health habits. To evaluate the effect of the COVID-19 lockdown on the oral health of paediatric dental patients in Greece. This was a retrospective cohort study that included a questionnaire on children's oral health behavior and a clinical examination assessing dental caries and dental treatment needs using the International Caries Detection and Assessment System criteria, dmft/DMFT, and Treatment Need Index. The Wilcoxon signed-rank test was used for a statistical comparison between questionnaire and clinical data before, during, and after the lockdown. A total of 102 children with a median age of 9 years were recruited from the current cohort of patients that had their last dental examination 6months prior to the lockdown. Results from the questionnaire showed decreased brushing frequency with increased eating frequency and sugar consumption during the lockdown period (p < .001). Moreover, 16.5% had to visit the dentist for urgent care during the lockdown, 13.6% experienced dental pain, and 51.5% did not experience any dental emergencies. Clinical examination, after the lockdown, recorded significantly increased mean dmft/DMFT scores by 0.63 units in the primary dentition (p=.01) and 0.52 units in the permanent teeth (p=.002). Significantly higher treatment needs, with more carious lesions requiring extensive treatment after the lockdown, were recorded (p < .001). The COVID-19 lockdown negatively affected children's oral health behavior: caries prevalence increased and more complex dental treatments were required.

Critical appraisal of confounding factors of observational studies on the association between dentofacial features and dental trauma in a Brazilian population

Dental trauma is a highly prevalent dental emergency. Children and adolescents without inadequate lip coverage, increased overjet, and anterior open bite are associated with the occurrence of traumatic dental injuries. Observational studies do not allow the inference of causality, one of the reasons being: the potential confounding factors. Therefore, this review aimed to critically appraise the confounding factors considered in epidemiological studies that associate dentofacial features with the occurrence of dental trauma in Brazilian children and adolescents. Studies included in the qualitative synthesis of a recently published comprehensive systematic review and meta-analysis on the topic were screened. Studies that only mentioned the performance of bivariate analyzes or that did not mention the performance of multivariate analyzes were excluded. Evaluation of control statements for possible confounders and bias consideration was performed for each selected study. Confounding factors in these studies were also identified and categorized according to their domains. Fifty-five observational studies were screened, of which 11 were excluded due to the mention of only bivariate analyzes or the lack of multivariate analyses. The remaining 44 studies were critically appraised. Of these, 9 studies specifically mentioned the term confounding, and 12 studies mentioned the term bias. However, only 14 studies mentioned limitations on confounding factors in their findings. Among the 99 different variables identified, the most used were type of trauma, followed by sex and age. Most studies did not acknowledge the control for possible confounding factors and rarely stressed the need for caution in interpreting their results. Cross-sectional studies do not allow inferring a cause-and-effect relationship between dentofacial features and dental trauma.