Traumatic Dental Injuries Research Articles

Enhancing, Targeting, and Improving Dental Trauma Education: Engaging Generations Y and Z.

Dental trauma is highly prevalent, involving 25% of school-age children and about 12.5% of the general population of the world. Due to the young age of the patients that are usually involved in dental trauma, there are tooth-related complicating factors, such as open apices, thin dentinal walls, and unfavorable crown-to-root ratio, as well as patient-related factors, such as anxiety and cooperation, and other challenges related to the complex diagnosis and treatment. Therefore, it is not surprising that the global status of knowledge for the prevention and emergency management of traumatic dental injuries among dental professionals was often reported as insufficient. Aiming to improve dental trauma education, one should consider that the contemporary educational settings have transitioned to a digital learning ecosystem and that the current students belong to a unique generational cohort. Therefore, this paper examines the challenges educators encounter in contemporary dental school classrooms and the defining characteristics of current generation Y and Z dental student cohorts. Finally, it outlines strategies to optimize dental trauma learning, considering the unique generational characteristics of the current dental students.

An evaluation of the knowledge, attitudes and treatment approaches of general dental practitioners in Ireland in the management of traumatic dental injuries.

Traumatic Dental Injuries (TDIs) are a common oral health problem worldwide. Prompt and accurate diagnosis and treatment maximises the chances of favourable outcomes. This study aimed to evaluate the knowledge and attitudes of Irish Dentists regarding the management of TDIs based on different trauma scenarios. Following ethical approval, a cross-sectional, 22-item self-administered questionnaire was distributed electronically to members of the Irish Dental Association between January and March 2024. A total of 245 complete responses were obtained, representing a 17% response rate. The results demonstrated a correlation between self-reported knowledge and number of correct answers. Overall 80% of respondents chose the correct storage medium for avulsed teeth. The majority of dentists aged > 46 years were unaware of the updated IADT guidelines. A large proportion of dentists showed inadequate knowledge with regard to the management of intruded permanent teeth (65%) and the endodontic management of an immature avulsed permanent tooth (50%). Management of intruded teeth and knowledge of root fractures was not as good as other injury types. The majority of respondents (85%) correctly answered that a tooth with negative sensibility tests following subluxation does not require endodontic treatment immediately. The survey had an acceptable response rate and demonstrated overall good knowledge in the management of TDIs. However, there was still confusion over management of certain scenarios which could have negative repercussions for patients entering an unnecessary restorative cycle. There is a need to improve practitioner confidence and experience in the management of certain TDIs and improve awareness of the IADT guideline as a resource, especially in dentists with more years of experience.

Long-Term Evaluation of Direct Composite Resin Restoration for Traumatic Anterior Crown Fractures in Children and Adolescents

Direct composite resin restorations are often the first choice in children and adolescents with anterior crown fractures. This study aimed to assess the long-term outcomes of direct composite resin restoration in children and adolescents with traumatic dental injuries. Patients with anterior crown fractures treated with direct composite resin restoration at the Department of Dentistry of Wonju Severance Hospital between March 2011 and February 2022 were included. A total of 86 teeth from 59 patients were evaluated. The survival rate according to the sex, age, history of pulp treatment, and ratio of the resin restoration to the clinical crown were statistically calculated using chi-square test, Fisher’s exact, and Kaplan-Meier methods. Factors associated with failure were evaluated using Cox regression analysis. Survival rates during the follow-up period were significantly different according to the patient’s age at the time of trauma (<i>p</i> = 0.036). The survival rate was not significantly different between the sexes (<i>p</i> = 0.632). The survival rate was not influenced by pulp treatment before resin restoration (<i>p</i> = 0.617). Based on the Kaplan-Meier method, the mean retention time of teeth with and without pulp treatment was 99.35 ± 9.98 and 79.68 ± 9.07 months, respectively. Additionally, there was no significant difference between both survival curves (<i>p</i> = 0.215). Furthermore, the survival rate was not significantly different according to the ratio of the resin restoration to the clinical crown (<i>p</i> = 0.334). Similar to the results from Fisher’s exact test, there was no significant difference in survival rates between Group I (ratio of the resin restoration to the clinical crown < 0.5) and Group II (ratio of the resin restoration to the clinical crown ≥ 0.5) (<i>p</i> = 0.228). This study demonstrates the clinical efficacy of direct composite resin restorations for anterior crown fractures in children and adolescents, with favorable survival rates observed over 10 years of follow-up suggesting it as a conservative and effective primary treatment option across various clinical conditions.

Replantation of young permanent teeth: Techniques and Management of traumatic pulp exposure

Introduction: Dental traumatology is one of the most challenging pediatric treatment aspects. Avulsion of young permanent teeth is a rare and serious traumatic dental injury that needs immediate and complex management. Tooth avulsion is a severe dental trauma defined by complete displacement of the tooth out of its alveolar socket. The primary approach to managing such cases is tooth replantation. The management of replanting the tooth according by the guideline such as the extra oral time which should be very short, the time of pulp removal after replantation, and the appropriate storage medium. Case History: A 9-year-old male presented with history of fall from the slide he played and injuries sustained to the maxillary region. He was referred to the IGD RSKGM-P Airlangga Surabaya and complained that his upper tooth was loose from its socket around 2 hours of trauma. The tooth was soaked in normal saline. Discussion: The optimal treatment option following an avulsion injury is to replant the avulsed tooth immediately. The duration of the extraoral period and the storage conditions of the tooth significantly influence the prognosis. The prognosis for avulsion injuries is highly dependent on timely intervention, appropriate treatment planning and techniques, and effective emergency management. Post-replantation, regular monitoring is essential to assess for ankylosis, resorption, mobility, and vitality of the tooth. Conclusion: Successful replantation of young permanent teeth with traumatic pulp exposure relies on timely intervention, proper technique, and careful postoperative management.

Preclinical Dentistry Students' Knowledge And Attitude Towards Traumatic Dental Injuries (TDI) In Children At Syiah Kuala University

Preclinical Dentistry Students' Knowledge And Attitude Towards Traumatic Dental Injuries (TDI) In Children At Syiah Kuala University

Radiographic characteristics and chronological patterns of transient apical breakdown (TAB) in luxated permanent teeth: A retrospective observational study.

To describe radiographic features, clinical signs and symptoms, and chronological patterns of post-traumatic transient apical breakdown (TAB) in luxated permanent teeth. Records from 56 patients treated at the Dental Trauma Clinic of the School of Dentistry of the Federal University of Minas Gerais from 1993 to 2024 were accessed to collect demographic, clinical, and imaging features of 89 teeth that presented with radiographic signs of TAB after traumatic dental injury (TDI). Kaplan-Meier curves were built to illustrate the time elapsed between trauma until TAB onset and resolution for the whole sample and for each one of the TAB patterns. A Cox regression was used to explore the effect of clinical covariates in both events. Patients' mean age at the time of trauma was 17.7 ± 6.6years (range 9.1 to 39.7years), with most being male (59.6%). All included teeth were mature at the time of trauma (Moorrees stage 6). Upper central incisors (66.3%) were predominant and mostly suffered extrusions (40.4%) or lateral luxations (32.6%). TAB was observed as an expansion of the periodontal ligament associated with a "V-shaped" widening of the apical foramen together with apical root resorption in 45 teeth (50.6%). Expansion of the periodontal ligament associated with "V-shaped widening of the apical foramen only was observed in 32 teeth (36%), and 12 teeth (13.5%) showed expansion of the periodontal ligament associated with apical root resorption only. The overall median time for TAB onset was 3.2months (range, 26days to 8months), being significantly lower for pattern 2 (1.8months) when compared to TAB pattern 1 and 3 (3.4, and 3.9months) respectively (Logrank test p values < 0.001 for both comparisons). The overall median time for TAB regression was 9.1months (range, 4.8 to 34.8months) after trauma. Again, TAB pattern 2 presented lower periods when compared to TAB pattern 1 and 3 (Logrank test p values < 0.001 and 0.013, respectively). Color changes were not frequent neither at the time of TAB onset nor at the time of TAB resolution. However, while most teeth (53.3%) did not respond to pulp sensibility tests at the time of TAB onset, this proportion decreased to 17.6% by the time of TAB resolution. TAB was mainly diagnosed within four months after luxation of mature teeth, most of them being resolved within the 1-year of follow-up. The most frequent TAB pattern was an expansion of the PDL associated with a "V-shaped" widening of the apical foramen together with external apical root resorption. These findings represent an important contribution for treatment decision-making during the follow-up of luxated permanent teeth.

Incidence of traumatic dental injuries associated with orotracheal intubation in general anesthesia in children during mixed dentition in Damascus, Syria: a prospective longitudinal study

ObjectivesEndotracheal tube intubation by laryngoscope during general anesthesia is a safe procedure with a few complications. However, it may cause some damage to the oral cavity structures, which leads to postoperative pain and discomfort. Traumatic dental injuries associated with endotracheal tube intubation are one of the most common complications. The study aimed to determine the incidence of traumatic dental injuries during oral-endotracheal tube intubation in general anesthesia among children receiving surgery at the Children’s Hospital in Damascus City during 2022–2023.MethodsIt was a prospective longitudinal study which investigated the incidence of traumatic dental injuries during oral-endotracheal tube intubation under general anesthesia in 110 children aged 6–12 years old at the University Children’s Hospital in Damascus City in 2022. After ensuring that the child met inclusion criteria and obtained written consent. Each child was examined before, during, and after 12–24 h of entering the operation room. Personal information (gender – age), information related to anesthesia procedures, and some oral cavity characters were collected.ResultsThe incidence of traumatic dental injuries during general anesthesia was 9.1%. Most of them intra-oral soft tissue injuries. The concussion is the most common injury related to teeth damage. In addition, the tongue was the most common-place. There is a correlation between the incidence of traumatic dental injuries and the difficulty of intubation, the number of intubation attempts, Mallampati score (p < 0.05).ConclusionThe anesthesiologist should evaluate the condition of each patient carefully. Document every detail in their record and inform the patient of the possibility of dental damage during the procedures especially in the case that has difficulty intubation.

Increased Risk of Dentoalveolar Trauma in Patients with Autism Spectrum Disorder: A Systematic Review with Meta-Analysis

The prevalence of traumatic dental injuries (TDI) in patients with autism spectrum disorders (ASD) remains unclear. Given these discrepancies, an updated review of the evidence on the risk of TDI in patients with ASD is essential. This systematic review and meta-analysis aimed to evaluate the prevalence of TDI in patients with ASD and compare it to that in neurotypical patients. This study protocol was registered on PROSPERO (CRD42024580127) and followed the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA guidelines. A comprehensive search of four databases—MEDLINE/PubMed, Web of Science, Scopus, and Embase—was conducted for articles published up to August 2024. Moreover, the gray literature (ProQuest) and reference lists were screened. The inclusion criteria required participants with ASD to assess TDI across deciduous, mixed, and permanent dentition regardless of age. No restrictions were applied on TDI type, language, or publication date. Additionally, case reports, reviews, letters, and studies addressing other oral disorders without specific TDI data were excluded. A single-arm meta-analysis evaluated the cumulative proportion and 95% confidence interval (CI) of TDI in patients with ASD. Moreover, a comparative meta-analysis was performed to assess the risk of TDI between ASD and neurotypical patients, calculating the odds ratio (OR) with a 95% CI, and a p &lt; 0.05 was deemed significant, using the R program. Quality assessment was performed using the National Heart, Lung, and Blood Institute tool, and the certainty of evidence was evaluated using GRADE. A total of 22 studies were included to determine the overall prevalence of TDI, of which 16 studies directly compared patients with ASD to neurotypical individuals. In total, 3817 participants were evaluated, including 2162 individuals with ASD and 1655 neurotypical patients. A single-arm meta-analysis estimated a TDI prevalence of 22% (Confidence Interval [CI]: 17–27%) among patients with ASD. A significant difference in the risk was observed between ASD and neurotypical patients (p = 0.003; Odds Ratio [OR]: 1.67; CI: 1.19–2.26). However, substantial heterogeneity was observed in this analysis. Although the majority of studies were rated as high quality, the certainty of the evidence was considered very low. Despite the limitations of this study, the findings suggest that patients with ASD are at a higher risk of developing TDI than the risk observed in neurotypical patients. Therefore, preventive educational initiatives are recommended to reduce the risk of TDI in this population.

Interdisciplinary Approach to Managing Complex Traumatic Dental Injuries in the Young Permanent Dentition.

Traumatic dental injuries (TDIs) are a frequent challenge in pediatric dentistry, requiring a coordinated interdisciplinary approach for successful management. These injuries can affect various dental tissues and pose significant diagnostic and therapeutic challenges, particularly in young patients with developing dentition. This review aims to explore the complexities of managing TDIs in young permanent dentition, focusing on the role of orthodontics, endodontics, and other specialties in providing comprehensive care. We highlight the importance of interdisciplinary collaboration in achieving optimal functional and aesthetic outcomes, emphasizing the need for updated diagnostic tools and treatment protocols tailored to the growing child. Specific recommendations are provided for clinicians on integrating orthodontic and endodontic management in trauma cases, focusing on minimizing complications and ensuring long-term prognosis.

Contemporary Approach for Traumatic Dental Injuries in the Primary Dentition.

Management of traumatic dental injuries (TDI) is very complex, even under ideal circumstances. Children in the primary dentition have unique needs, and it is important that the diagnosis and treatment choices are offered to parents. The prevalence of TDI in the primary dentition is far greater than for any other age group. Education of parents and caregivers in prevention and emergency management of oral injuries is essential. When injuries occur, the dental professionals must also respond appropriately to establish correct diagnosis of the injuries and assist parents in making decisions for management while communicating realistic expectations for the future. Progress has been made in the diagnosis and management of dental injuries in the primary dentition based on the biological healing response of oral tissues following injury over time. Several factors influence critical decisions that must be made based on basic principles and guidelines to improve successful outcomes for the child. Managing co-operation must be balanced with the benefit of anticipated treatment need. The current evidence challenges previous dental interventions. The IADT guidelines updated the approach to management of TDI in children in the primary dentition. Encouraging a positive attitude to the dental setting early in the life course prepares the child to be a motivated dental attendee throughout their lifetime. This manuscript aimed to outline the critical issues and clinical choices for injuries to the primary dentition and to summarise recent guidance from the International Association of Dental Traumatology (IADT).

Position Statement and Recommendations for Custom-Made Sport Mouthguards.

Sports-related traumatic dental injuries (TDIs) are a significant global concern, particularly in contact sports, where the risk of orofacial injuries is high. Custom-made sports mouthguards (CSMs) are recognized as the most effective means of preventing these injuries, providing both protection and comfort without impairing athletic performance. Despite their proven benefits, there is no globally standardized approach to mouthguard design, fabrication, or usage, primarily due to varying regulations, awareness levels, and cultural attitudes toward sports safety across different countries. This document from the European Association for Sports Dentistry (EA4SD) outlines the latest guidelines for selecting, constructing, clinical use, and maintaining CSMs. It emphasizes the need for mouthguards fabricated from FDA-approved materials, designed to absorb and distribute impact forces effectively, and customized to ensure optimal fit and comfort. The EA4SD also highlights the importance of education for dental professionals and athletes on the benefits of CSMs, advocating for their mandatory use in high-risk sports to reduce the prevalence of TDIs and related complications.

Performance of Artificial Intelligence Chatbots in Responding to Patient Queries Related to Traumatic Dental Injuries: A Comparative Study.

Artificial intelligence (AI) chatbots have become increasingly prevalent in recent years as potential sources of online healthcare information for patients when making medical/dental decisions. This study assessed the readability, quality, and accuracy of responses provided by three AI chatbots to questions related to traumatic dental injuries (TDIs), either retrieved from popular question-answer sites or manually created based on the hypothetical case scenarios. A total of 59 traumatic injury queries were directed at ChatGPT 3.5, ChatGPT 4.0, and Google Gemini. Readability was evaluated using the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) scores. To assess response quality and accuracy, the DISCERN tool, Global Quality Score (GQS), and misinformation scores were used. The understandability and actionability of the responses were analyzed using the Patient Education Materials Assessment Tool for Printed Materials (PEMAT-P) tool. Statistical analysis included Kruskal-Wallis with Dunn's post hoc test for non-normal variables, and one-way ANOVA with Tukey's post hoc test for normal variables (p < 0.05). The mean FKGL and FRE scores for ChatGPT 3.5, ChatGPT 4.0, and Google Gemini were 11.2 and 49.25, 11.8 and 46.42, and 10.1 and 51.91, respectively, indicating that the responses were difficult to read and required a college-level reading ability. ChatGPT 3.5 had the lowest DISCERN and PEMAT-P understandability scores among the chatbots (p < 0.001). ChatGPT 4.0 and Google Gemini were rated higher for quality (GQS score of 5) compared to ChatGPT 3.5 (p < 0.001). In this study, ChatGPT 3.5, although widely used, provided some misleading and inaccurate responses to questions about TDIs. In contrast, ChatGPT 4.0 and Google Gemini generated more accurate and comprehensive answers, making them more reliable as auxiliary information sources. However, for complex issues like TDIs, no chatbot can replace a dentist for diagnosis, treatment, and follow-up care.

Management of Complications in Dental Traumatology.

Management of traumatic dental injuries is often challenging due to the complexity in diagnosis, concomitant injuries, and the interdisciplinary treatment planning. As a result, the clinicians are often confused and not confident over important treatment decisions. The guidelines of International Association of Dental Traumatology have improved the standard of dental trauma care globally and provide a roadmap for predictable prognosis. However, there are unique situations that require additional investigations such as the Cone Beam Computed Tomography and customized treatment and follow up protocol. An essential requisite for prevention of adverse late complications of dental injuries is clear understanding of their etiopathogenesis and the changes that occur after an injury. Additionally, it is prudent to understand the basic physiology behind the healing that is expected after a treatment protocol. This review presents the science behind the development of late complications of dental injuries and their management protocols in a simplified and clinical manner. An attempt has been made to highlight the clinical paradigms and decisions that reduce the chances of failures in traumatized teeth.

A Cross-Sectional Survey of Anesthesiologists' Awareness Toward Traumatic Dental Injuries During General Anesthesia in Syrian Arab Republic.

Traumatic dental injuries with tracheal intubation during general anesthesia are considered one of the most common complications. It is also the primary reason for malpractice legal claims against anesthesiologists according to insurance companies. There is much information regarding the incidence, consequences, and risk factors of traumatic dental injuries during general anesthesia. This study aimed to assess the awareness (knowledge, practice, and attitude) of anesthetists regarding peri-anesthetic traumatic dental injuries and discuss measures to reduce the risk regarding peri-anesthetic traumatic dental injuries. Sixty seven anesthetists participated in this cross-sectional survey between January 2023 and July 2023, which was carried out in the Syrian Arab Republic. The questionnaire was generated using Google Forms and sent individually, as the researcher (MNA) was accompanied by all included anesthesiologists while filling out all the questionnaire paragraphs to answer any questions. The Fisher exact test and Pearson's Chi-squared test were used to analyze the results. The dental trauma caused by the anesthetists during their professional careers was 38.8%, and none of them were exposed to any legal claim. 77.6% of the anesthetists thought that avulsed permanent teeth could be replanted, 46.2% believed that the procedure must be done in < 30 min, and 84.6% thought they could not do it themselves and would send the patient to a dentist after the procedure. More than half of respondents (63.5%) indicated that the sterile saline solution was the best storage medium for avulsed teeth. Furthermore, 74.6% of anesthetists stated that emergency intubations are related to more traumatic dental injuries in comparison with elective intubation and about 62% were aware of the importance of mouthguard. However, nearly 57% complained about the shortage of knowledge related to the oral cavity and its special structure. Syrian anesthetists have limited awareness (knowledge, practice, and attitude) of traumatic dental injury classification, prevention, and management. More information and training are still needed about factors used within clinical dentistry.

Analysis of the Prevalence of Traumatic Dental Injuries in the Primary Dentition: Findings From a Cohort Study Involving 4-Year-Old Children From South Brazil.

To identify factors associated with the prevalence of traumatic dental injuries (TDI) in children at 4 years of age. Participants from the 2015 Pelotas (Brazil) birth cohort were included. Demographic, socioeconomic, behavioral, and environmental data were collected through interviews and physical examinations during cohort follow-up. Dental examination at 4 years of age revealed the presence of TDI. A theoretical model was constructed using a directed acyclic graph (DAG). A descriptive analysis was performed, followed by Poisson regression models relating TDI to each outcome. Data from 3650 4-year-old children were analyzed; the prevalence of dental trauma was 20.2% (95% confidence interval [CI] 18.9%-21.5%). The prevalence of TDI was lower among girls compared with boys, suggesting a protective effect of female sex (relative risk [RR] 0.80 [95% CI: 0.79-0.91]). Increased height for age (RR 1.55 [95% CI: 1.14-2.09]), increased overjet (RR 1.45 [95% CI: 1.2-1.74]), and anterior open bite (RR 1.26 [95% CI: 1.01-1.56]) demonstrated an association with TDI after testing regression models based on DAGs. Male sex, increased height, and increased overjet and open bite were factors predisposing to TDI at 4 years of age. Understanding these factors can contribute to the implementation of targeted prevention strategies for reducing TDI and their potential long-term consequences.

Prevalence of Traumatic Dental Injuries and Associated Risk Factors Among Preschool Children in Goa: A Cross-Sectional Study.

Primary teeth trauma has received very little attention compared to permanent teeth due to their eventual exfoliation. Enamel discolorations, hypoplasias, and enamel-surface abnormalities have been reported in the permanent dentition following primary tooth trauma. Traumatic dental injuries (TDI) also have an impact on the quality of life of an individual. The study aims to determine the prevalence of TDI and its association with various risk factors in preschool children in the state of Goa. The primary objective is to determine the prevalence of TDI in primary anterior teeth in preschool children in the state of Goa. The secondary objective is to determine the association of various risk factors with TDI in preschool children in the state of Goa. A cross-sectional survey was conducted among preschool children aged three to five years across the state of Goa. A total of 971 children were included in the study. Parents or guardians of participants who reported trauma answered an interview addressing the history of the injury. The anterior dental trauma and associated factors such as age, gender, time of injury, month of injury, place of injury, occlusal relationship, lip competence, oral habits, and ordinal position of the child were assessed and analyzed. Out of the 971 children examined, TDI was reported in 157 (16.1%) children. Of these, 83 of 157 (52.8%) children had experienced TDI at home. Three-year-old children had the highest TDI prevalence of any age group, with 32 of 145 (22.0%) experiencing TDI. The most commonly affected tooth (100 of 233, 10.3%) was the primary maxillary right central incisor. Of the 233 traumatized teeth, 100 (42.9%) had code 2 injuries (enamel fractures only), which were the most frequently reported injuries. Mesio-incisal angle fracture was detected in 84 (34.3%) teeth affected with TDI. With respect to the number of teeth traumatized, 99 of 157 (63.0%) of children had a single tooth traumatized. Among all children who had sustained TDI, 103 (65.6%) were firstborns, 50 (31.8%) were secondborns, and four (2.5%) were thirdborn children. Only eight children received treatment, of which seven received medications and only one child received dental treatment. Parents being unaware of TDI was the main reason for not seeking treatment. This study highlights the critical need for educating parents and teachers about TDI prevention and the importance of prompt dental care. The findings offer valuable insights for formulating state- and national-level policies and preventive strategies for managing TDI.

Knowledge and awareness of emergency department residents and physicians regarding the management of dentofacial traumatic injuries: a cross-sectional study

BackgroundMajority of patients with Dento-Facial Traumatic Injuries (DFTI) seek initial care at an Emergency Department (ED). The timely management of DFTI is of utmost importance in determining long-term prognosis of the tooth and the patient’s overall quality of life. Thus, knowledge and awareness of ED residents & physicians regarding the management of DFTI is crucial for better patient outcomes. Numerous studies have investigated the knowledge of ED specialists regarding initial management of dental trauma, however, scientific evidence in this domain is scarce in our region.ObjectiveThe aim of this study was to evaluate the knowledge and awareness of ED residents and physicians regarding diagnosis and management of DFTI using a web-based survey on REDCap.MethodsAn observational cross-sectional study was conducted among the ED residents and physicians of private and public hospitals in Karachi, Pakistan. Data was collected through a web-based questionnaire, sent via email to the participants. The survey comprised of questions assessing their knowledge regarding the diagnosis and management of various dental and maxillofacial injuries. Responses from the participants were graded as low, moderate or high knowledge levels according to a pre-determined criteria. Pearson’s chi-square test was applied to determine the association between knowledge scores.ResultsThe total response rate was 47.6%. Out of 116 participants, 49 (42%) responses were received from physicians and 67 (58%) from residents. The overall knowledge level of participants was low (46.6%) and there was no significant difference in the knowledge level between residents and physicians (p = 0.157). Participants who had received formal training in dental trauma (p = 0.038) and those with more years of clinical experience (p = 0.004) had higher knowledge scores, that were statistically significant.ConclusionsThe knowledge and awareness of ED residents and physicians in dental trauma management was generally low. Specialized training courses are required to provide timely and adequate management of traumatic dental injuries in order to improve patient-related outcomes.

Traumatic dental injuries and oral health-related quality of life in children and adolescents with special health care needs in Eastern India: A case-control study.

This matched case-control study aimed to investigate the prevalence of traumatic dental injuries (TDI) and its impact on oral health-related quality of life (OHRQoL) in hearing and/or visually impaired children attending government special schools in Eastern India. A two-step cluster analysis was performed to define cases and controls based on the Parental-Caregivers Perceptions Questionnaire (PCP-Q) scores from the 228 parent/guardian responses. The cases included children with a higher negative impact on OHRQoL (89 subjects), whereas the controls were those with a lower negative impact on OHRQoL (139 subjects). Groups were matched for age and gender and researchers were blinded to case/control status. Binary logistic regression was performed. The prevalence of TDI among the study subjects was 24.12%. Compared to subjects in the control group (16.5%), a significantly higher proportion of cases (36%) reported a history of TDI. Children with TDI had considerably higher OHRQoL scores across all P-CPQ sub-scales. Falls were the most common cause of TDI, primarily at home or school and none received treatment. TDI significantly impacts OHRQoL in these children. Lack of treatment highlights the need for caregiver awareness and improved dental access for children with special needs. Further research with larger samples and specialized OHRQoL tools is recommended.

Stress Distribution in Traumatized Teeth Splinted With Fiber Localizing on Incisal/Cervical Positions: A Three-Dimensional Finite Element Analysis.

The fiber splint represents an advanced treatment for traumatized dental injuries. The complete understanding of the localization of a splint on traumatized teeth remains elusive. The aim of this study was to assess the impact of the incisal/cervical positions of the fiber splint on the stress distribution of traumatized dental roots in various occlusal relationships. Three-dimensional finite element models were generated based on a cone beam computer tomogram of a patient. The incisal and cervical splints were simulated by strips that were bonded close to the incisal/cervical labial surface of traumatic teeth. Force was loaded on the incisal ridge, incisal and cervical positions on the palatal surface of each tooth to simulate the conditions of traumatized teeth during mastication. The equivalent stress (von Mises) on the traumatic teeth and abutment teeth was calculated by Ansys software (version 2021, R1). The incisal splint effectively transferred the stress from the traumatized tooth roots to the abutment teeth when force was loaded on the incisal ridge and incisal and cervical positions on the palatal surface. Nevertheless, the reduction effect was notably diminished when the cervical splint was used. Notably, in cases of cervical splints, with a loading force on the incisal ridge, there is an increase in stress on the roots of traumatized teeth, which poses a disadvantage in the management of traumatic dental injuries. The incisal splint demonstrated a more effective transfer of stress from the roots of the traumatic teeth to the abutment teeth than the cervical splint and the raw.

Non-Surgical Endodontic Management of Large Periapical Lesions After Traumatic Dental Injuries.

Traumatic dental injuries of permanent teeth result in multiple immediate and long-term consequences depending upon the severity of trauma, age of the patient, the status of root maturity, and the emergency care provided. The healing responses may get disturbed due to severe damage, loss of vascularity of the supporting structures, and infections. As a result, the prohealing mediators and pathways are overpowered by the destructive stimuli often manifested by an increased osteoclastic activity. Among the various late complications, the apical periodontitis or the periapical lesions are most worrisome for the patients and create clinical dilemma for the dentists. In the past, many such lesions were classified as cysts and subjected to surgical management. However, better understanding of lesion pathophysiology, three-dimensional imaging, and molecular pathways have established their inflammatory nature. The advancements in materials such as calcium silicates, and regenerative techniques have propelled the research related to non-surgical endodontic management as its clinical acceptability. The treatment largely follows the recommendations of regenerative medicine and is based on four principles: (a) establishing the drainage or an endodontic access to the area, (b) removal of most of the triggering agents such as necrosed pulp, toxins, and inflammatory mediators, (c) disinfection of the area, controlling inflammation and reversal of the acidic pH, and (d) maintenance of this infection/inflammation-free state for a long time through adequate sealing. This review aims to highlight the rationale of the approach, case selection, pathophysiology of the causation and healing, clinical protocols, and the limitations of non-surgical endodontic management of large periapical lesions secondary to traumatic dental injuries.