Dental Injuries Research Articles

Specialists' management of permanent dentition traumatic dental injuries in 7-16-year-olds: A qualitative study.

Specialist paediatric dentists are integral to dental trauma care pathways. General dentists rely on specialist input, more so in complex cases. Little is known about specialists' role in these pathways or the perceived barriers they face. The aim is to explore specialists' role in managing traumatic dental injuries in the permanent dentition in children. Face-to-face (remote video) online semi-structured interviews were undertaken. All UK specialists were invited by email. Purposeful sampling aimed to investigate representation from the devolved nations, presence/absence of working within a managed-clinical network and level of care provision. Interviews were audio-recorded and transcribed verbatim. Transcripts were thematically analysed. Data saturation was reached after nine interviews. Three main themes established were: inconsistent access to care; the need to formalise traumatic dental injuries care pathways; educationally upskilling general dentists. Geographical variation in provision of specialist and out-of-hours/emergency department care meant patients risked not receiving care by the most appropriate individual. Formalizing care pathways by clearly defining the role of each stakeholder (specialist, dentist, medical professionals and parents) and developing a method to assess complexity was perceived to be essential to improving treatment outcomes. Upskilling general dentists in trauma management appeared essential. A potential lack of engagement was raised, with a suggestion that trauma management education should become core continuing-professional development. Specialist input should be available in the management of traumatic dental injuries. Current access to specialist care is inequitable across the UK. Formalizing care pathways and upskilling general dentists could ease inconsistencies.

Angiotensin II Type 2 Receptor Inhibits M1 Polarization and Apoptosis of Alveolar Macrophage and Protects Against Mechanical Ventilation-Induced Lung Injury.

Angiotensin II (Ang II) is associated with macrophage polarization and apoptosis, but the role of the angiotensin type 2 receptor (AT2R) in these processes remains controversial. However, the effect of AT2Rs on alveolar macrophages and mechanical ventilation-induced lung injury has not been determined.Mechanical ventilation-induced lung injury in Sprague‒Dawley (SD) rats and LPS-stimulated rat alveolar macrophages (NR8383) were used to determine the effects of AT2Rs, selective AT2R agonists and selective AT1Rs or AT2R antagonists. Macrophage polarization, apoptosis, and related signaling pathways were assessed via western blotting, QPCR and flow cytometry.AT2R expression was decreased in LPS-stimulated rat alveolar macrophages (NR8383). Administration of the AT2R agonist CGP-42112 was associated with an increase in AT2R expression and M2 polarization, but no effect was observed upon administration of the AT2R antagonist PD123319 or the AT1R antagonist valsartan. In mechanical ventilation-induced lung injury in Sprague‒Dawley (SD) rats, the administration of the AT2R agonist C21 was associated with attenuation of the pathological damage score, lung wet/dry weight, cell count and protein content in BALF. C21 can significantly reduce proinflammatory factor TNF-α, IL-1β levels, increase anti-inflammatory factor IL-4, IL-10 levels in BALF, compared with the model group (p < 0.01). Similarly, compared with those at the same time points, the M1/M2 ratios in alveolar macrophages and apoptosis in peritoneal macrophages at 4h, 6h and 8h in the mechanical ventilation models were lower after C21 administration.These findings indicated that the expression of AT2Rs in alveolar macrophages mediates M1 macrophage polarization and apoptosis and that AT2Rs play a protective role in mediating mechanical ventilation-induced lung injury.

Early infiltrating NKT lymphocytes attenuate bone regeneration through secretion of CXCL2.

Trauma rapidly mobilizes the immune response of surrounding tissues and activates regeneration program. Manipulating immune response to promote tissue regeneration shows a broad application prospect. However, the understanding of bone healing dynamics at cellular level remains limited. Here, we characterize the landscape of immune cells after alveolar bone injury and reveal a pivotal role of infiltrating natural killer T (NKT) cells. We observe a rapid increase in NKT cells after injury, which inhibit osteogenic differentiation of mesenchymal stem cells (MSCs) and impair alveolar bone healing. Cxcl2 is up-regulated in NKT cells after injury. Systemic administration of CXCL2-neutralizing antibody or genetic deletion of Cxcl2 improves the bone healing process. In addition, we fabricate a gelatin-based porous hydrogel to deliver NK1.1 depletion antibody, which successfully promotes alveolar bone healing. In summary, our study highlights the importance of NKT cells in the early stage of bone healing and provides a potential therapeutic strategy for accelerating bone regeneration.

Evaluation of ChatGPT as a Multiple-Choice Question Generator in Dental Traumatology

Aim: This study aims to evaluate the ability of ChatGPT-4 to generate clinical case-based multiple-choice questions in dental traumatology. Material and Method: International Association of Dental Traumatology guidelines for the management of traumatic dental injuries were introduced to ChatGPT-4 as an information source and ChatGPT-4 was prompted to 20 generate questions in fractures and luxations, avulsion of permanent teeth, injuries in the primary dentition. Sixty questions in total were generated by ChatGPT and the questions were evaluated by 2 endodontists using a 3-point scale. The One-way analysis of variance and Post Hoc Tukey test were used to analyze the data and the significance was P

Clinical photography and documentation after traumatic dental injuries.

Clinical photographic documentation is recommended as part of the standardized clinical evaluation of traumatized patients according to the most current International Association of Dental Traumatology guidelines for the management of traumatic dental injuries (TDIs), published in 2020. The use of current technology such as mobile smartphones and the emergence of teledentistry for direct communication between dentists and with patients have increased the need to improve the knowledge and skills for contemporary clinical photographic documentation procedures at the dental office as well as at the accident site. The purpose of this review is to include findings from the available literature and discuss modern techniques, contemporary equipment, accessories and developments that can be used by both patients and dental professionals for proper clinical documentation after TDIs. Emphasis is given on the positioning and patient management based on the type and severity of the injury, and the selection of the appropriate technique. Moreover, the number and type of clinical photographs for each dental trauma scenario, the suggested timeline for optimal photographic documentation as well as legal considerations involved are also discussed.

Vinpocetine alleviated alveolar epithelial cells injury in experimental pulmonary fibrosis by targeting PPAR-γ/NLRP3/NF-κB and TGF-β1/Smad2/3 pathways

This study aimed to investigate the potential anti-fibrotic activity of vinpocetine in an experimental model of pulmonary fibrosis by bleomycin and in the MRC-5 cell line. Pulmonary fibrosis was induced in BALB/c mice by oropharyngeal aspiration of a single dose of bleomycin (5 mg/kg). The remaining induced animals received a daily dose of pirfenidone (as a standard anti-fibrotic drug) (300 mg/kg/PO) and vinpocetine (20 mg/kg/PO) on day 7 of the induction till the end of the experiment (day 21). The results of the experiment revealed that vinpocetine managed to alleviate the fibrotic endpoints by statistically improving (P ≤ 0.05) the weight index, histopathological score, reduced expression of fibrotic-related proteins in immune-stained lung sections, as well as fibrotic markers measured in serum samples. It also alleviated tissue levels of oxidative stress and inflammatory and pro-fibrotic mediators significantly elevated in bleomycin-only induced animals (P ≤ 0.05). Vinpocetine managed to express a remarkable attenuating effect in pulmonary fibrosis both in vivo and in vitro either directly by interfering with the classical TGF-β1/Smad2/3 signaling pathway or indirectly by upregulating the expression of Nrf2 enhancing the antioxidant system, activating PPAR-γ and downregulating the NLRP3/NF-κB pathway making it a candidate for further clinical investigation in cases of pulmonary fibrosis.

MiR-21-5p modulates LPS-induced acute injury in alveolar epithelial cells by targeting SLC16A10

Sepsis is a systemic inflammatory response syndrome resulting from the invasion of the human body by bacteria and other pathogenic microorganisms. One of its most prevalent complications is acute lung injury, which places a significant medical burden on numerous countries and regions due to its high morbidity and mortality rates. MicroRNA (miRNA) plays a critical role in the body's inflammatory response and immune regulation. Recent studies have focused on miR-21-5p in the context of acute lung injury, but its role appears to vary in different models of this condition. In the LPS-induced acute injury model of A549 cells, there is differential expression, but the specific mechanism remains unclear. Therefore, our aim is to investigate the changes in the expression of miR-21-5p and SLC16A10 in a type II alveolar epithelial cell injury model induced by LPS and explore the therapeutic effects of their targeted regulation. A549 cells were directly stimulated with 10 µg/ml of LPS to construct a model of LPS-induced cell injury. Cells were collected at different time points and the expression of interleukin 1 beta (IL-1β), tumor necrosis factor-α (TNF-α) and miR-21-5p were measured by RT-qPCR and western blot. Then miR-21-5p mimic transfection was used to up-regulate the expression of miR-21-5p in A549 cells and the expression of IL-1β and TNF-α in each group of cells was measured by RT-qPCR and western blot. The miRDB, TargetScan, miRWalk, Starbase, Tarbase and miR Tarbase databases were used to predict the miR-21-5p target genes and simultaneously, the DisGeNet database was used to search the sepsis-related gene groups. The intersection of the two groups was taken as the core gene. Luciferase reporter assay further verified SLC16A10 as the core gene with miR-21-5p. The expression of miR-21-5p and SLC16A10 were regulated by transfection or inhibitors in A549 cells with or without LPS stimulation. And then the expression of IL-1β and TNF-α in A549 cells was tested by RT-qPCR and western blot in different groups, clarifying the role of miR-21-5p-SLC16A10 axis in LPS-induced inflammatory injury in A549 cells. (1) IL-1β and TNF-α mRNA and protein expression significantly increased at 6, 12, and 24 h after LPS stimulation as well as the miR-21-5p expression compared with the control group (P < 0.05). (2) After overexpression of miR-21-5p in A549 cells, the expression of IL-1β and TNF-α was significantly reduced after LPS stimulation, suggesting that miR-21-5p has a protection against LPS-induced injury. (3) The core gene set, comprising 51 target genes of miR-21-5p intersecting with the 1448 sepsis-related genes, was identified. This set includes SLC16A10, TNPO1, STAT3, PIK3R1, and FASLG. Following a literature review, SLC16A10 was selected as the ultimate target gene. Dual luciferase assay results confirmed that SLC16A10 is indeed a target gene of miR-21-5p. (4) Knocking down SLC16A10 expression by siRNA significantly reduced the expression of IL-1β and TNF-α in A549 cells after LPS treatment (P < 0.05). (5) miR-21-5p inhibitor increased the expression levels of IL-1β and TNF-α in A549 cells after LPS stimulation (P < 0.05). In comparison to cells solely transfected with miR-21-5p inhibitor, co-transfection of miR-21-5p inhibitor and si-SLC6A10 significantly reduced the expression of IL-1β and TNF-α (P < 0.05). MiR-21-5p plays a protective role in LPS-induced acute inflammatory injury of A549 cells. By targeting SLC16A10, it effectively mitigates the inflammatory response in A549 cells induced by LPS. Furthermore, SLC16A10 holds promise as a potential target for the treatment of acute lung injury.

Public health policies in dental traumatology: A call for action!

Traumatic dental injuries (TDI) are a prevalent public health concern, requiring preventive measures as well as timely and appropriate interventions to prevent adverse outcomes and optimize patients' prognosis. Although dental trauma injuries require prompt clinical intervention, some challenges persist in effectively managing these injuries. In dental traumatology, the implementation of public health policies assumes critical importance, these policies play an important role in addressing preventive measures and mitigating the repercussions of TDI. This review aims to emphasize the importance of developing comprehensive public health policies in dental traumatology, recognizing the strategic importance of this approach and its benefits. By proactively addressing issues associated with dental injuries, these policies have extensive implications for individual quality of life and public health in general. Furthermore, this review will present a suggested structured framework for the development of public health policies, encompassing key domains including prevention, intervention, and education in dental traumatology. The creation and implementation of these policies will address dental trauma through prevention programs, research, and development, and will provide a significant step toward enhancing the well-being of the population and dental trauma victims' prognosis promoting a more resilient healthcare system.

Traumatic dental injuries among children attending the public after-hours emergency dental clinic in Bergen, Norway.

To investigate traumatic dental injuries (TDIs) among children who for 1 year attended a Norwegian public after-hours emergency public dental (EPD) clinic. The study included 7-18-year-olds (n = 312) who presented at the EPD clinic, underwent a clinical dental examination, and consented to the disclosure of clinical information. Recording of TDIs was restricted to anterior permanent teeth. Potential TDI predictors were also analysed. Almost half (n = 148) of the children were assessed with TDIs in permanent teeth, showing a mean age of 11.0 (standard deviation [SD]: 3.5) years. Males constituted 54.7%. The children experienced TDIs often outside school hours (43.9%), and the majority (58.1%) were caused by falls/accidents. Sixty of them experienced only one TDI. The most common location was the maxillary central incisors. Assessment of TDIs according to severity, could only be done in 131 individuals, involving 253 TDIs. Of these, 81.8% were mild. The odds of visiting the emergency clinic for a TDI were higher (odds ratio [OR] = 2.64, confidence interval [CI]: 1.61-4.31) among children with previous TDIs and lower (OR = 0.28, CI: 0.12-0.68) among those with poor dental attendance. Traumatic dental injuries were a common reason for seeking emergency care. Milder injuries dominated and involved mostly one maxillary central incisor. Previous episodes of TDIs and attendance patterns seemed to be associated with seeking care for TDIs.

Noncombat injury and illness prevalence and working score percentage quantify the impact on duty availability in US Army Special Operations military working dogs.

This cross-sectional study determined the 2-year period prevalence and quantified the impact on working status of noncombat injury and illness by a working score percentage (WSP) based on the number of duty days lost (DDL). 126 dogs from 9 US Army Special Operations kennels. Dog injury and illness events between May 1, 2021, and April 30, 2023, were recorded to determine period prevalence and calculate a WSP metric to quantify loss of duty status. 93 health events occurred in 62 of 126 (49.2%) dogs over a 24-month period resulting in 4,130 DDL. The period prevalence was 25 of 126 (19.8%) for dental injuries, 20 of 126 (15.9%) for musculoskeletal injuries, and 13 of 126 (10.3%) for gastrointestinal illnesses. Musculoskeletal conditions resulted in the highest total DDL at 1,472 (35.6%) in 20 dogs, followed by neurologic conditions at 950 (23%) in 4 dogs and heat injuries at 521 (12.6%) in 7 dogs. The total population 24-month mean WSP was 88.1% (95% CI, 86.6 to 89.5). The mean WSP for 43 dogs with acute events was 96.0% (95% CI, 95.0 to 97.0), and the mean WSP for 14 dogs with chronic events was 55.2% (95% CI, 47.8 to 62.5). Quantifying the impact of noncombat illness and injury on the working status of military working dogs is the first step to identify risk factors, develop preventive strategies, resource veterinary care requirements, and improve these canine athletes' health and welfare. The metrics developed in this study can be used to evaluate the population health of working, herding, and sport dogs.

E-scooter-related dental injuries: a two-year retrospective review.

Introduction In June 2020, the United Kingdom (UK) published guidance on electric scooter (e-scooter) use to ease transport congestion and reduce pollution. This study aims to examine dental injuries sustained during the two years following initiation of the trial.Methods The research was conducted at a UK, Level 1, supra-regional major trauma centre. All eligible patient records were analysed to identify e-scooter-related dental injuries to the following regions: teeth, periodontium, alveolus, palate, tongue, floor of mouth, frenum, buccal mucosa and lips. To assess significant associations between recorded variables, a Pearson's chi-square test was utilised.Results Of the 32 patients who experienced a total of 71 dental injuries, 46.5% (n = 33) affected teeth, predominantly upper central incisors (n = 17). 'Lacerations' (n = 14) and 'lip' (n = 11) were the most common type and site of soft tissue injuries, respectively. Unprovoked falls by riders accounted for 53.1% (n = 17) of the injuries. There was an overall increase in e-scooter-related dental injuries throughout the two-year period.Conclusion E-scooters have introduced an additional source of dental trauma. It is imperative health care professionals can also identify signs of head and non-dental injuries when managing such patients. Further studies are warranted allowing for better informed and optimised dental public health interventions.

Attention deficit hyperactivity disorder and dental traumatic injuries: a systemic review and meta-analysis.

The objective of this study was to assess whether individuals with attention deficit hyperactivity disorder (ADHD) exhibit a higher prevalence of traumatic dental injuries (TDIs) compared to those without ADHD through a systematic review and meta-analysis of the existing literature. A search strategy using the Medical Subject Heading (MeSH) vocabulary was employed for a comprehensive search across various databases, including PubMed, Scopus, Web of Science, Cochrane Library, and Embase. The Joanna Briggs Institute Summary was utilized for data collection. Additionally, quality assessment, meta-analysis, and bias control were conducted to ensure the reliability of the included studies. A meta-analysis was performed to consolidate the findings of the individual studies. The prevalence of TDIs among individuals with ADHD ranged from 9.6% to 68.2%, while in the healthy control group, it ranged from 0.8% to 44.7%. The meta-analysis findings revealed that individuals with ADHD had 1.98 times higher odds (OR = 1.98, ranging from 1.51 to 2.59 with 95% CI) of experiencing TDIs compared to individuals without ADHD. The findings of this study suggest a significant association between ADHD and an increased risk of TDIs. Individuals with ADHD were found to be nearly twice as likely to experience TDIs compared to those without ADHD. Efforts should not only be directed towards improving the oral health of this vulnerable group of individuals, but also healthcare practitioners need to be provided with opportunities to create awareness and implement preventive measures to mitigate the risk of TDIs among individuals with ADHD.

Management of Dental Trauma of Senior-Year Medical Students Attending Medical School in Tokat

Aim: Since trauma often requires immediate intervention, the initial care of patients is typically provided by emergency room physicians. Emergency departments prioritize the treatment of conditions that threaten the patient's overall health, which can lead to overlooking the treatment of traumatic dental injuries. Early intervention in dental and surrounding tissue injuries is crucial for prognosis. Therefore, it is important to assess the knowledge and awareness of dental trauma among medical doctors, who are often the first responders in trauma cases. The aim of this study is to evaluate the knowledge and approaches of senior-year medical students regarding dental traumas in Tokat city, Türkiye. Materials and Methods: For this cross-sectional study, a validated questionnaire consisting of 10 questions previously used in similar studies was used. Students completed the questionnaire online using the Google® Forms program. The data obtained in this study were analyzed using the SPSS v23 (Chicago, IL, USA) software package program. Frequency and percentage values were obtained. Results: While 7.1% of the students stated that they would reimplant the avulsed tooth, 71.4% stated that they would refer the patient to the dentist. While 42.8% of the students preferred sterile saline solution for handling the avulsed tooth, 20.2% preferred wet gauze. While 85.7% of the students found the level of knowledge about oral and dental injuries insufficient, 71.4% stated that they would like to participate in an educational program on this subject. Conclusions: It has been observed that senior medical school students have insufficient knowledge about intervening in injuries to teeth and surrounding tissues. Curriculum regulation and training programs are required to improve students' knowledge and awareness about injuries to teeth and surrounding tissues. Students should also be informed that they can access the free IADT ToothSOS Mobile App on the International Association for Dental Trauma (IADT) website (http://www.iadt-dental-trauma.org), which can guide them on emergency response to dental trauma when they encounter dental trauma.

МЕТОДИКА МЕДИЦИНСКОГО СОПРОВОЖДЕНИЯ ПАЦИЕНТОВ ПОСЛЕ ПРОВЕДЕНИЯ ДЕНТАЛЬНОЙ РЕПЛАНТАЦИИ

Modern dentistry is aimed at using minimally invasive interventions to preserve dentition. This fact determines the need for wider use of various types of tooth-preserving operations. In modern conditions, tooth-preserving operations are increasingly being carried out with a predictable successful outcome. Treatment of dental trauma involves complex endodontic or surgical treatment protocols. An important aspect in the rehabilitation of dental injuries is the development of clear diagnostic tactics both at the initial appointment and at all stages of treatment. We observed 127 patients from 2012 to 2022 with diagnoses: complete, incomplete tooth dislocation, uncomplicated or complicated by fractures of the coronal part of the teeth, men and women aged 18 to 40 years. The first group consisted of 66 people with traumatic dislocations of teeth, who sought medical help within 24 hours after the injury, who underwent tooth replantation surgery, endodontic treatment, a complex treatment developed aimed at stopping an acute inflammatory reaction of a post-traumatic nature, and carrying out the necessary splinting measures. The second group consisted of 61 people with traumatic dislocations of teeth who sought medical help after 24 hours or later. Patients in each group were divided into subgroups; in the control subgroups, traditional treatment and rehabilitation after dental replantation were carried out; in the main subgroups, the technique we developed using M-Chip nanomatrices and LED radiation was used. All patients underwent macrohistochemical examination and measurement of dentogingival attachment using a periodontal probe. The results of a macrohistochemical study 7 days after replantation showed that in groups 1b and 2b, whose patients received complex treatment according to the developed method, the area of inflammation of the mucogingival complex was smaller than in patients in groups 1a and 2a, who were treated according to the traditional method. Results of probing of the dentogingival attachment found that in groups 1b and 2b, whose patients received complex treatment using the developed method, the dentogingival attachment corresponds to normal indicators of a healthy periodontal complex than in patients in groups 1a and 2a, who were treated using the traditional method. The inclusion in the complex of rehabilitation measures after dental replantation surgery of drugs that have antiseptic, reparative, hemostatic and immunoadjuvant effects, using LED radiation, increases the effectiveness of these measures by 2-3 times.

Knowledge of undergraduate and postgraduate dental students about managing traumatic dental injuries based on the 2020 International Association of Dental Traumatology guidelines: A online survey of 10 dental schools from 10 countries.

The knowledge of dental students about managing traumatic dental injuries (TDIs) may not be uniform, depending on global location and dental education. The aim of this study was to evaluate the level of knowledge of undergraduate and postgraduate students specializing in endodontics and pediatric dentistry at 10 dental schools in 10 countries about the 2020 International Association of Dental Traumatology (IADT) guidelines regarding the management of TDIs. A previously published questionnaire was used in the current survey. It was an online survey with 12 questions regarding the management of TDIs and some additional questions regarding sociodemographic and professional profiles of the participants were added. The survey was distributed to final-year undergraduate students and postgraduate students in pediatric dentistry and endodontics from 10 dental schools. Simple frequency distributions and descriptive statistics were predominantly used to describe the data. Differences in the median percentage scores among the student categories were assessed using the Kruskal-Wallis test followed by Dwass-Steel-Critchlow-Fligner pairwise comparisons. A total of 347 undergraduates, 126 postgraduates in endodontics, and 72 postgraduates in pediatric dentistry from 10 dental schools participated in this survey. The postgraduates had a significantly higher percentage score for correct responses compared with the undergraduates. No significant difference was observed between the endodontic and pediatric dentistry postgraduates. The knowledge possessed by undergraduate and postgraduate students concerning the IADT-recommended management of TDIs varied across the globe and some aspects were found to be deficient. This study emphasizes the critical importance of reassessing the teaching and learning activities pertaining to the management of TDIs.

Pediatric patients with facial fractures: a retrospective study.

Epidemiology of maxillofacial injuries vary depending on geographic location, culture and socioeconomic condition. This study assessed etiology and pattern of facial fractures in children reported at Burdwan Dental College and Hospital, Burdwan, West Bengal, India. Clinical files of 206 children with facial fractures were evaluated retrospectively. Diagnosis of fractures were confirmed by radiographic examination. Study period was from July 2018 to June 2022. Data collected were age and sex of the patient, site of fracture, and etiology of trauma. Descriptive statistics were used for statistical analysis with a P-value less than 0.05. There were 127 (61.7%) males and 79 (38.3%) females with a male to female ratio of 1.6:1. Within the study sample, the majority of facial fractures (n= 146, 70.9%) belonged to 6-to-9-year age group. Overall, falls (44.2%) and motor vehicles accidents (31.5%) were the two leading causes of trauma. Mandible fracture was the most common, accounting for 72.8% of cases. 74 patients (35.9%) with facial fracture had dental injuries. Male predominance in facial fracture is seen. With age, frequency of facial fractures tends to increase. Falls are the main cause of facial fracture and mandible is the most common anatomic location.

Effects of Two Different Methods of Teeth Grinding on Dental Injuries, Skin Lesions, Growth and Behaviour of Suckling Piglets Compared to a Non-Treated Control Group.

Teeth grinding in suckling piglets is performed on many farms to protect the piglets' littermates and the sow's udder from injuries caused by the piglets' canines and third incisors. In this study, the effects of two teeth-grinding methods on the piglets' dental health and welfare were investigated. The piglets of a litter were evenly assigned to a treatment: one-third of littermates were ground with a roller grinding head (RG), one-third with a teacup grinding head (TCG), and one-third were not ground at all (CG). A random sample of 100 animals each from the RG and TCG treatment was examined for tooth injuries, i.e., dental pulp openings. Additionally, behavioural analysis was performed (n = 650 piglets), and skin lesions, growth and mortality were determined (n = 1565 piglets). TCG piglets had a lower risk (p < 0.001) of pulp opening than RG piglets (0.08 ± 0.31 vs. 2.67 ± 1.67 opened pulps per piglet). Mortality, growth, skin lesions and behaviour of piglets were not influenced by treatment (p > 0.05). This study showed that both teeth-grinding methods led to pulp openings. If teeth grinding cannot be avoided on a farm, using the teacup grinding head is recommended concerning animal health and welfare.

A systematic search, heuristic evaluation and analysis of dental trauma mobile applications.

Despite the exponential growth of mobile device applications in promoting awareness on traumatic dental injuries (TDIs), the overall validity of existing applications in content, engagement, usability, functionality, esthetics, and user perception remains largely uncertain. The primary aim was to systematically search and assess the quality, functionality, perceived impact and usability of available applications related to TDIs using the User Version of the Mobile Application Rating Scale (uMARS) and the Coventry, Aberdeen, and London-Revised (CA-LO-RE) scale. A heuristic evaluation was additionally performed. The secondary aim was to categorize existing mobile applications according to their target users, including general population, dentists, dental students, medical healthcare professionals, and researchers. A systematic search for dental trauma applications (free and paid) was conducted using the AppStore and Google Play store. Two reviewers independently performed data extraction and quality assessment for all the included applications using uMARS and CA-LO-RE. A user experience architect conducted a heuristic evaluation. Only 6 of the 3061 initially screened applications were eligible for qualitative and quantitative assessments. These applications' average star uMARS rating was 12.5 (standard deviation [SD] 2.6). The mean and SD for the uMARS objective items were as follows: A-engagement (mean 12.1 [SD 3.3]), B-functionality (mean 15.5 [SD 1.4]), C-esthetics (mean 9.5 [SD 2.5]), and D-information (mean 13 [SD 4.5]). The severity rating for the heuristic evaluation criteria was low to moderate for all the included applications, excluding tooth emergencies with a high severity score. Despite moderate quality, functionality, user perception, behavioural impact and usability scores, the inclusion of advanced features to "engagement" and "usability" in existing trauma based apps will enhance their purpose. A design-thinking approach coupled with interactive features is recommended for future mobile applications on TDIs.

Frequency and Patterns of Traumatic Dental Injuries Reported at Islamabad Dental Hospital: A Retrospective Study.

Background: Traumatic dental injuries (TDIs) are increasingly becoming a public health concern, with a significant number of cases presenting to emergency departments worldwide. They affect a diverse age range, particularly children and adolescents, and are influenced by various etiological factors such as falls, sports injuries, and road traffic accidents. Previous studies have indicated a gender predisposition, with males more frequently affected, and a pattern of injury that varies by region. Objective: This study aimed to investigate the frequency and patterns of TDIs treated at the Department of Operative Dentistry, Islamabad Dental Hospital, and to analyze the management strategies employed. Methods: A retrospective cross-sectional analysis was conducted, examining patient records from 2015 to 2022. Approval was obtained from the institutional review board, aligning with the Declaration of Helsinki. Data from complete TDIs forms were extracted, detailing the type of injury, timing, and treatment administered. Statistical analysis was performed using SPSS v.23, with chi-square tests applied to examine the association between the type of trauma and demographic variables. Results: A total of 88 teeth with TDIs were recorded. The most common injuries were complicated crown fractures (28.4%) and root fractures (17.0%), with splinting (31.8%) and root canal treatments (29.5%) being the most frequent management procedures. Male patients were predominantly affected. Notably, adult cases surpassed those of children and adolescents, contrary to global trends. Conclusion: TDIs constitute a significant portion of dental emergency cases, with specific patterns and treatments that vary by demographics. Immediate and appropriate management, guided by current guidelines, is essential. Efforts should focus on increasing awareness and providing adequate training to healthcare providers for timely and effective treatment of TDIs.

Anesthesia-Related Closed Claims in Free-Standing Ambulatory Surgery Centers.

As higher acuity procedures continue to move from hospital-based operating rooms (HORs) to free-standing ambulatory surgery centers (ASCs), concerns for patient safety remain high. We conducted a contemporary, descriptive analysis of anesthesia-related liability closed claims to understand risks to patient safety in the free-standing ASC setting, compared to HORs. Free-standing ASC and HOR closed claims between 2015 and 2022 from The Doctors Company that involved an anesthesia provider responsible for the claim were included. We compared the coded data of 212 free-standing ASC claims with 268 HOR claims in terms of severity of injury, major injuries, allegations, comorbidities, contributing factors, and financial value of the claim. Free-standing ASC claims accounted for almost half of all anesthesia-related cases (44%, 212 of 480). Claims with high severity of injury were less frequent in free-standing ASCs (22%) compared to HORs (34%; P = .004). The most common types of injuries in both free-standing ASCs and HORs were dental injury (17% vs 17%) and nerve damage (14% vs 11%). No difference in frequency was noted for types of injuries between claims from free-standing ASCs versus HORs--except that burns appeared more frequently in free-standing ASC claims than in HORs (6% vs 2%; P = .015). Claims with alleged improper management of anesthesia occurred less frequently among free-standing ASC claims than HOR claims (17% vs 29%; P = .01), as well as positioning-related injury (3% vs 8%; P = .025). No difference was seen in frequency of claims regarding alleged improper performance of anesthesia procedures between free-standing ASCs and HORs (25% vs 19%; P = .072). Technical performance of procedures (ie, intubation and nerve block) was the most common contributing factor among free-standing ASC (74%) and HOR (74%) claims. Free-standing ASC claims also had a higher frequency of communication issues between provider and patient/family versus HOR claims (20% vs 10%; P = .004). Most claims were not associated with major comorbidities; however, cardiovascular disease was less prevalent in free-standing ASC claims versus HOR claims (3% vs 11%; P = .002). The mean ± standard deviation total of expenses and payments was lower among free-standing ASC claims ($167,000 ± $295,000) than HOR claims ($332,000 ± $775,000; P = .002). This analysis of medical malpractice claims may indicate higher-than-expected patient and procedural complexity in free-standing ASCs, presenting patient safety concerns and opportunities for improvement. Ambulatory anesthesia practices should consider improving safety culture and communication with families while ensuring that providers have up-to-date training and resources to safely perform routine anesthesia procedures.