Impact Of Traumatic Dental Injuries Research Articles

Assessing the Prevalence of Traumatic Dental Injuries and its Impact on Self-esteem among Schoolchildren in a Village in Gurugram

Background: Pitiful smile and oral health have always been bounded up to poor social relationships and permanent impairment that causes harm to the ability to learn and grow which may lead toward decreased self-esteem. Aim: This study was conducted to assess the prevalence of traumatic dental injuries (TDIs) and its impact on self-esteem among schoolchildren in a village of Gurugram. Materials and Methods: This cross-sectional epidemiological study was conducted among 10–17-year-old schoolchildren to assess the prevalence and impact of TDIs. Convenience sampling was used and 240 schoolchildren constituted the sample size. TDIs were recorded using Ellis classification, and self-esteem was recorded using Rosenberg’s Self-Esteem Scale. For statistical analysis, Chi-square test and t-test were used. The odds ratio was utilized to assess and compare the self-esteem according to high and low esteem among individuals with or without dental trauma. Results: Results of the present study showed that out of total 240 children, 54.2% were males and 45.8% were females. The overall prevalence of trauma was found to be 28.3%. Ellis class I was the most common type of injury in schoolchildren (70%). The most frequently traumatized teeth were maxillary incisors, among which maxillary central incisor was the most affected (60.4%). The difference between low and high self-esteem among individuals with or without dental trauma low esteem, high esteem was not statistically significant (P > 0.05). Conclusion: By improving oral health in schools may contribute considerably to the self-esteem of individuals in positive direction and help them in becoming a socially competent adult.

Impact of traumatic dental injury treatment on the Oral Health-Related Quality of Life of children, adolescents, and their family: Systematic review and meta-analysis.

Measures of oral health-related quality of life (OHRQoL) are useful in clinical trials to evaluate treatment outcomes. To detect the treatment impact of traumatic dental injuries (TDI) on OHRQoL is extremely relevant. The aim of this study was to assess whether there is scientific evidence of the impact of TDI treatment on OHRQoL of children, adolescents, and their families. A systematic review and meta-analysis were conducted selecting articles from PubMed, Web of Science, Scopus, Cochrane Library, and Virtual Health Library until May 22nd, 2020. The gray literature, clinical trial registers, and a manual search were performed. Two independent reviewers selected the studies, extracted the data, and assessed the ROBINS-I risk of bias. A meta-analysis was performed using RevMan 5.4 program. The certainty of the evidence was evaluated using the GRADE system. In the electronic search, 413 abstracts and one registered study were found. After removing the duplicates and eligibility application, six studies were included. Individually, the studies presented low to moderate risk of bias and they found that TDI treatment reduces the negative impact on OHRQoL. In the meta-analysis, TDI treatment improved OHRQoL for 8- to 10-year-old children (p=.03; CI 5.19 [0.62, 9.75]) (detected by CPQ 8-10 questionnaire). In the perception of parents, the children, and adolescents who had suffered TDI also had their OHRQoL improved (p=.04; CI 14.77 [0.95, 28.60]) (detected by PPQ and P-CPQ questionnaire) but both evaluations had very low certainty of evidence. Treatment of traumatic dental injuries reduces the impact on the OHRQoL of children and adolescents. However, more studies are necessary to detect the TDI treatment influence on OHRQoL of preschoolers and in the family as well to estimate the effects due to outcomes that had a very low certainty of evidence (#CRD42018091210).

Primary Care Dentists' management of permanent dentition traumatic dental injuries in 7- to 16-year-olds: A sequential mixed-methods study.

Primary care dentists play a pivotal role in the management of traumatic dental injuries in children, despite little evidence on the barriers they face in providing care. The aim of this study was to explore and contextualize the knowledge and attitudes of general dental practitioners regarding their management of permanent dentition traumatic dental injuries in children aged 7-16years old. A two-phase sequential mixed-methods study included a questionnaire that was disseminated to all 619 primary care dentists, identified via a triangulated sampling strategy, based across the north-east of England (Phase I). Statistical analyses were performed using Mann-Whitney U- and Kruskal-Wallis tests, Spearman's correlation and chi-square test. Multivariate factor analysis, with principal components extraction, was used to test between multiple ordinal variables. Respondents were invited to a face-to-face or telephone semi-structured interview (Phase II). Interviews were transcribed verbatim and analysed using inductive thematic analysis. Primary care dentists were less confident in managing complex dental trauma. Inadequate financial remuneration was the main reason for not providing care, often prompting a referral to the local dental hospital. This was more apparent for those who qualified before 2000. More recently qualified dentists felt the long-term costs, related to traumatic dental injuries, were insufficiently remunerated. Most still provided emergency management, irrespective of remuneration, as long as they had the requisite knowledge and skills. Four major themes arose: impact of traumatic dental injuries on patients, parents and primary care dentists; barriers to providing treatment; educational opportunities for primary care dentists; and interactions between primary and secondary care services. There is high confidence in managing simple traumatic dental injuries but less for complex injuries. A lack of sufficient financial remuneration associated with the long-term management of dental trauma was the main barrier for dentists to manage these cases.

Social and Psychological Impact of Traumatic Dental Injuries in Children and Adolescents: A Review of Literature

Facial esthetics play an important role in self-identification, selfimage, self-presentation, and interpersonal confidence...

Impact of Traumatic Dental Injuries on Oral Health-Related Quality of Life of Preschool Children and Their Families Attending a Dental Trauma Care Program

Background: Traumatic dental injury (TDI) constitutes a public health problem. Objective: The objective of this study was to detect the impact of TDI on oral health-related quality of life (OHRQoL) of preschool children in a dental trauma care program and to evaluate the psychometric properties of the OHRQoL instrument in this population. Methods: A cross-sectional study including a nonprobabilistic sample of 2- to 6-year-old children from a 5-year collection period was performed. We used Andreasen’s classification to evaluate TDI and the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS) to assess OHRQoL. Based on the Kolmogorov-Smirnov test, Student’s t test was applied to compare the means of impact in the cases of complicated and uncomplicated TDI considering a p value <0.05. Results: The final sample was composed of 146 children (mean age 4.31 ± 1.68 years). The search for treatment was 90% mediated and 56.7% TDI was in support of tissue. The ECOHIS had satisfactory properties (Cronbach’s α = 0.83 and test-retest/intraclass correlation coefficient = 0.79). The ECOHIS mean was 6.79 ± 8.64 for the total scale, 4.29 ± 6.46 for the child subscale, and 2.50 ± 3.06 for the family subscale. Complicated TDI had a greater impact on OHRQoL in total score (p = 0.036), child subscale (p = 0.038), symptoms domain (p = 0.049), and function domain (p = 0.030). Conclusions: The OHRQoL instrument was satisfactory. It was detected that complicated TDI impacts negatively on the OHRQoL of children and their families.

Understanding patients' and dentists' perspectives in dental trauma management: A mixed-methods study.

Patients suffering dental trauma are unprepared for the disability challenge and necessary rehabilitation, while a traumatic event places an expanded demand on the dentist who is focused on treating disease. The aim of this study was to examine the impact of traumatic dental injuries (TDI) on patients and to compare patients' and dentists' perceptions of the event. TDI patients (aged≥21years) attending a tertiary dental hospital from 2011 to 2013, and their dentists were recruited with informed consent. An exploratory sequential mixed-methods design was adopted. The Oral Health Impact Profile (OHIP-14) quantitatively identified patients with "very often," "fairly often" or "occasionally" in at least one of the OHIP-14 questions (Phase 1) to participate in the qualitative phase of the study through focus group discussions (FGD) (Phase 2). FGD for dentists was conducted separately. Quantitative analysis showed 28%-55% of TDI patients had "occasional" to "very often" discomfort during eating, increased self-consciousness and embarrassment. Qualitative analysis showed patients were concerned with aesthetic disability, treatment cost and potential tooth loss but overcame their negative outlook and accepted prescribed protective measures. Dentists appreciated patients' concerns about aesthetics and functional disruptions but were less attuned to patients' sense of guilt and fear of judgement. TDI exert functional, psychological and social impacts on patients. Patients' and dentists' perspectives were useful for understanding the need for continuity of care, and the findings could contribute to effective TDI management.

Impact of traumatic dental injuries on quality of life in preschoolers and schoolchildren: A systematic review and meta-analysis

Impact of traumatic dental injuries on quality of life in preschoolers and schoolchildren: A systematic review and meta-analysis

Relationship between overweight/obesity in the first year of age and traumatic dental injuries in early childhood: Findings from a birth cohort study.

The impact of traumatic dental injuries (TDI) in the primary dentition on oral health-related quality of life indicates the need for the planning of prevention strategies. The aim of this study was to assess whether anthropometric characteristics in early life are associated with TDI by preschool age. A birth cohort was recruited from the public healthcare system in the city of Porto Alegre, Brazil. Socio-demographic variables, type of birth, head circumference, weight, and length were collected at birth (WHO standards). Head circumference, body mass index for age, and height for age were collected at 12months. TDI (Andreasen criteria) at three years of age (n=458) were recorded by two examiners who had undergone training and calibration exercises. Multivariable analysis was carried out with Poisson regression with robust variance. A total of 31.0% of the children (142/458) exhibited TDI at three years of age. In the final model, the risk of TDI was 47% higher among children with a smaller head circumference upon birth and nearly 60% higher among those who were overweight/obese at 12months of age (RR: 1.58; 95% CI: 1.15-2.17). The risk of TDI was also significantly higher among boys (RR 1.50; 95% CI: 1.13-2.00), but the outcome was not significantly associated with socioeconomic variables or other anthropometric variables. Overweight/obesity in early life is a risk factor for TDI in preschool children.

Perception of parents and self-reports of children regarding the impact of traumatic dental injury on quality of life.

Traumatic dental injuries occur frequently among young children. The aim of this study was to evaluate the impact of traumatic dental injuries on oral health-related quality of life (OHRQoL) in preschool children using the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5). This study involved 769 five-year-old children enrolled at public and private preschools. Two examiners underwent a training process which involved the determination of interexaminer and intra-examiner agreement (Kappa statistic) for all clinical conditions (K>0.82). Descriptive statistics were performed, followed by Poisson regression analysis (α=5%). The prevalence of the impact of oral problems on OHRQoL was 32.9% and 42.2% according to the parents/caregivers and children, respectively. Based on the children's self-reports, the occurrence of two or more injured teeth (PR=1.30; 95% CI: 1.04-1.64), toothache (PR=1.68; 95% CI: 1.35-2.09), and a low level of parent's schooling (PR=1.54; 95% CI: 1.24-1.91) exerted impacts on OHRQoL. For the reports of parents/caregivers, the occurrence of non-complicated TDI (PR=0.66; 95% CI: 0.44-0.98), toothache (PR=8.03; 95% CI: 5.92-10.88), and a low level of parent's schooling (PR=1.60; 95% CI: 1.17-2.17) remained associated with the final model. The impact of oral problems on the OHRQoL of the preschool children was high. A greater number of injured teeth, the presence of toothache, and socioeconomic factors were associated with poorer OHRQoL, based on the reports of both the parents/caregivers and the children. The occurrence of non-complicated TDI was a protective factor for OHRQoL.

Impact of traumatic dental injuries on quality of life in preschoolers and schoolchildren: A systematic review and meta-analysis.

Traumatic dental injuries (TDIs) in childhood and adolescence are a potential public health problem given their prevalence and consequences. The aim of this study was to assess the impact of TDIs on the oral health-related quality of life (OHRQoL) of preschoolers and schoolchildren, by synthesizing the available evidence. A systematic search was conducted in MEDLINE, EMBASE, Cochrane, ScieLo and Lilacs databases since January 1966 until March 2016. The included studies compared OHRQoL between groups with and without TDIs, using validated instruments. The selection process and data extraction were carried out by two researchers independently. A third reviewer resolved discrepancies. Methodological quality was assessed with the Effective Public Health Practice Project's Quality Assessment Tool. Meta-analyses were performed using random effect models, separately for preschoolers and schoolchildren. Of 213 identified articles, 26 studies (involving a total of 4582 patients and 13 601 controls between the ages of 1 and 15 years) met the inclusion criteria. Most of the studies had been published in the last 5 years, and their methodological quality was judged to be moderate. The TDIs group had a significantly higher chance of reporting any impact on OHRQoL than controls for both preschoolers (OR = 1.44; 95% confidence interval [CI]: 1.28-1.63; I2 = 0%) and schoolchildren (OR = 1.31; 95% CI: 1.04-1.66; I2 = 70%). In preschoolers, the OR for OHRQoL impact for complicated vs uncomplicated TDIs was 1.53 (95% CI: 1.04-2.26; I2 = 0%). The social domain was the most affected one in schoolchildren (standard mean difference = 0.34; 95% CI: 0.13, 0.55; I2 = 68%). Traumatic dental injuries have a negative impact on OHRQoL of both preschoolers and schoolchildren. Outcome standardization to measure OHRQoL impact, such as mean score differences and cut-off points, is needed. Prospective cohort studies are recommended to confirm these findings and to understand how TDIs' impact changes with time.

Impact of traumatic dental injuries on oral health-related quality of life of preschool children: A systematic review and meta-analysis.

BackgroundObservational studies have suggested that traumatic dental injuries (TDI) can lead to pain, loss of function and esthetic problems, with physical, emotional and social consequences for children and their families. However, population-based studies that investigate the impact of TDI on oral health-related quality of life (OHRQoL) among preschool children are scarce and offer conflicting results. The aim of the systematic review and meta-analysis was to evaluate the impact of TDI on OHRQoL among preschool children (PROSPERO-CRD42015032513).MethodsAn electronic search of six databases was performed in PubMed (MEDLINE), ISI Web of Science, Scopus, Science Direct, EMBASE and Google Scholar, with no language or publication date restrictions. The eligibility criteria were TDI as the exposure variable, OHRQoL as the outcome and a population of children up to six years of age. RevMan software was used for data analysis. Results are expressed as odds ratios with 95% confidence intervals for the total score of the Early Childhood Oral Health Impact Scale (ECOHIS) as well as the scores of the Child Impact Section (CIS) and Family Impact Section (FIS). The random effect model was chosen and heterogeneity was evaluated using the I2 test.Results2,013 articles were initially retrieved; 1,993 articles were excluded based on title and abstracts; 10 articles excluded after full-text analysis. Ten studies comprising a population of 7,461 preschool children were included in the systematic review and nine studies were included in the meta-analysis. TDI caused a negative impact on OHRQoL based on the overall ECOHIS (OR: 1.24; 95% CI: 1.08–1.43) and CIS (OR: 1.23; 95% CI: 1.07–1.41), but not the FIS (OR: 1.09; 95% CI: 0.90–1.32).ConclusionsTDI negatively impacted on OHRQoL of preschool children. The present findings indicate the need for TDI prevention and treatment programs in early childhood.

Impact of Dental Trauma on Quality of Life Among 11-14 Years Schoolchildren.

Background:Traumatic injuries are common dental problems in pediatric dentistry that may influence the children's quality of life.Aim:the aim of this study is to assess the impact of traumatic dental injuries (TDI) and oral health-related quality of life (OHRQoL) among Egyptian schoolchildren aged 11–14 years.Materials and Methods:A cross-sectional study was carried out involving a sample of 11700 schoolchildren from public and private schools of Mansoura city, Egypt. OHRQoL was assessed using Child Perceptions Questionnaire. Clinical examination included the presence and type of TDI, malocclusion status, and dental caries in anterior teeth (decayed, missing, and filled teeth).Results:The prevalence of TDI was 13.6%. Untreated TDI was more likely to have a negative impact on the children's daily living regarding pain, functional, emotional, and social aspect than treated injuries and control children. Pearson's correlation test indicated significant association between trauma and malocclusion and dental caries.Conclusion:Untreated dental injury has a negative impact on quality of life regarding social, functional, and emotional aspects. However, treated injured teeth appear to improve social and emotional aspects of the OHRQoL of school children, whereas functional limitations may continue because of the pulpal and periodontal effects of the injury.

Enamel fracture in the primary dentition has no impact on children's quality of life: implications for clinicians and researchers.

The aim of this study was to quantify the impact of traumatic dental injuries (TDI) on oral-health-related quality of life (OHRQoL) of preschool children, when enamel fractures were either included or excluded within the category of TDI. An oral health survey was undertaken of preschool children, age 1-5years attending public nurseries in Canoas, Brazil. Children were examined for TDI, dental caries, and malocclusion. Parents were interviewed on their perception of their child's OHRQoL (Early Childhood Oral Health Impact Scale-ECOHIS) and their sociodemographic background. Multivariable Poisson regression models with robust variance were fitted to assess the impacts of TDI (including and excluding enamel fractures) on OHRQoL. A full dataset was collected from 76% of the eligible population. The prevalence of TDI was 13.4% (171/1275). The prevalence of any impact (ECOHIS≥1) was significantly higher in children with crown discoloration (29.7%), enamel/dentin fracture (29.2%), and avulsion (73.3%), compared to children with enamel fracture (16.2%) or without a TDI (15.8%) (P<0.001). Enamel fractures were the most prevalent TDI (40%) but halved the proportion of children with a reported impact from their TDI. The mean increase in OHRQoL impact for those children with a TDI was 1.59 (95%CI 1.20-2.10) when enamel fracture was included, and 1.86 (95%CI 1.39-2.50) when it was excluded. Enamel fractures have no significant impact on young children's quality of life. Including enamel fractures within the diagnosis of TDI increases the prevalence of TDI while reducing the OHRQoL impact of TDI for the primary dentition.

Impact of dental trauma on oral health-related quality of life among 12 years Lucknow school children: A cross-sectional survey

Introduction: Dental trauma has become an important attribute of dental public health inducing feelings of embarrassment to smile, laugh, and show teeth affecting social relationships. Available literature regarding the impact of dental trauma on the quality of life of children in Lucknow is scarce. Aims: To assess the impact of traumatic dental injuries (TDI) on oral health-related quality of life (OHRQoL) among 12-year-old school going children of Lucknow. Materials and Methods: A cross-sectional survey was conducted among 12-year-old Lucknow school children. A total of 492 school children were selected through multistage cluster random sampling. The participants completed the child perceptions questionnaire (CPQ 11-14) - impact short form: 16 followed by an assessment of TDI. Unpaired t-test was used to determine the association of TDI with CPQ 11-14 because it involved two separate groups; one with dental trauma and other without dental trauma. Results: The prevalence of TDI was 10.8%. Maxillary central incisors (8.73%) were the frequently traumatized teeth. Enamel fracture (7.11%) was the most common type of TDI. OHRQoL had statistically significant association with TDI. Conclusions: TDI has a negative impact on OHRQoL of children affecting their personal relationships and school performance.

Impact of traumatic dental injuries and malocclusions on quality of life of preschool children: a population‐based study

Few studies assessed the impact of traumatic dental injuries (TDI) and malocclusions on the oral health-related quality of life (OHRQoL) in preschool children. To assess the impact of the presence of TDI and malocclusions, as well as its severity and types, respectively, on the OHRQoL of preschool children. The study was conducted in 1215 children aged 1-4years old who attended the National Day of Children Vaccination in Diadema, Brazil. Parents answered the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS) and socio-demographic conditions. Calibrated dental examiners performed the oral examinations for TDI and malocclusions. Poisson regression models adjusted by dental caries associated the clinical and socio-demographic conditions with the outcome. The multivariate adjusted models showed associations between some individual domains of the B-ECOHIS and clinical and socio-demographic conditions (P<0.05). The severity of TDI showed a negative impact on the symptoms domain and self-image/social interaction domain (P<0.05). Children with complicated TDI were more likely to experience a negative impact on total B-ECOHIS scores (PR=2.10; P=0.048). The presence of complicated TDI and dental caries were associated with worse OHRQoL of Brazilian preschool children, whereas malocclusions do not.

Impact of traumatic dental injuries among adolescents on family's quality of life: a population‐based study

To evaluate the impact of traumatic dental injury (TDI) among Brazilian adolescents on their families' quality of life (QoL). A cross-sectional study was carried out with a population-based sample of 1122 schoolchildren aged 11-14 years selected using a multistage sampling procedure. Parents/caregivers answered the Brazilian version of the 14-item Family Impact Scale (B-FIS) to assess the impact on family's QoL. The main independent variable was TDI, which was diagnosed using the Andreasen classification. Malocclusion, dental caries, gender and socio-economic classification were the other independent variables. Poisson regression analyses were carried out (P<0.05). The prevalence of TDI was 14.8%. The multivariate model demonstrated that families of adolescents diagnosed with fracture involving the dentine or dentine/pulp were more likely to report a negative impact on the overall B-FIS score [rate ratio (RR)=1.44; 95% confidence interval (CI): 1.10-1.88] as well on the Parental/Family Activity (RR=1.45; 95% CI: 1.09-1.94), Parental Emotions (RR=1.45; 95% CI: 1.03-2.04) and Family Conflict (RR=1.46; 95% CI: 1.01-2.11) subscales in comparison with those who had no signs of TDI. Families of adolescents with more severe TDI were more likely to report a negative impact on QoL, affecting family activities and emotions, which can result in family conflicts.

Oral health‐related quality of life and traumatic dental injuries in Brazilian adolescents

To evaluate the impact of traumatic dental injuries (TDI) on oral health-related quality of life (OHRQoL) among Brazilian adolescents. A population-based case-control study was carried out, which was nested to a cross-sectional study with a sample of 1215 adolescents aged 11-14 years from Belo Horizonte, Brazil. OHRQoL was measured using the Brazilian version of the Child Perceptions Questionnaire (CPQ11-14 )--Impact Short Form (ISF:16). Two-step cluster analysis was performed to define cases and controls based on CPQ11-14--ISF:16 scores. This method considers the pattern of responses for each item separately and how important each item is to the formation of clusters. The case group included those adolescents who presented higher negative impact on OHRQoL (n=405), while the control group included those with lower negative impact (n=810). Two controls for each case were individually matched from the same school and gender. The main independent variable was TDI, diagnosed by the Andreasen's classification. Untreated dental caries, malocclusion, and age were confounding variables. Conditional logistic regression analysis was performed with the significance level set at 5%. A multiple conditional logistic regression model demonstrates that adolescents diagnosed with fracture involving dentin and/or pulp had a 2.40-fold greater chance of presenting high negative impact on QHRQoL [95% CI=1.26-4.58; P=0.008] than those without evidence of fractures. Enamel fracture only [P=0.065] and restored fractures [P=0.072] were not statistically associated with OHRQoL. Adolescents with more severe untreated TDI, such as fractures involving dentin and/or pulp, were more likely to self-report a higher negative impact on their OHRQoL than those without TDI.

Impact of traumatic dental injuries on the quality of life of schoolchildren

Knowledge of the impact of traumatic dental injuries (TDI) on children's quality of life is sparse. To determine the association between TDI and oral health-related quality of life (OHRQoL) among schoolchildren aged 11-14 years. A cross-sectional study was carried out involving a representative sample of 409 schoolchildren from 13 municipalities in the Midwest Region of the Brazilian Southern State of Santa Catarina. Clinical examination included the presence and type of TDI and the treatment provided (or needed) according to criteria used in the UK Children's Dental Health Survey. Dental caries in anterior teeth and malocclusion status were also collected according to WHO criteria. OHRQoL was assessed using the short form of the Child Perceptions Questionnaire (CPQ11-14), and the outcome was the prevalence of one or more adverse impacts on quality of life occurring often/very often. The prevalence of TDI was 16.6% (95% CI 13.0-20.2). The prevalence of one or more adverse impacts occurring often/very often was 46.6% (95% CI 41.7-51.5). Logistic regression modeling for the outcome indicated an independent and significant association between the prevalence of one or more adverse impacts occurring often/very often and the presence of TDI even after adjustment for gender, presence of dental caries in anterior teeth and malocclusion. A prevalence ratio of 1.79 (95% CI 1.16-2.76) of one or more adverse impacts occurring often/very often in schoolchildren with TDI was found, compared to those without TDI. Traumatic dental injuries appear to affect schoolchildren's OHRQoL.

Impact of traumatic dental injuries and malocclusions on quality of life of young children

BackgroundThe presence of traumatic dental injuries and malocclusions can have a negative impact on quality of life of young children and their parents, affecting their oral health and well-being. The aim of this study was to assess the impact of traumatic dental injuries and anterior malocclusion traits on the Oral Health-Related Quality of Life (OHRQoL) of children between 2 and 5 years-old.MethodsParents of 260 children answered the six domains of the Early Childhood Oral Health Impact Scale (ECOHIS) on their perception of the OHRQoL (outcome). Two calibrated dentists assessed the types of traumatic dental injuries (Kappa = 0.9) and the presence of anterior malocclusion traits (Kappa = 1.0). OHRQoL was measured using the ECOHIS. Poisson regression was used to associate the type of traumatic dental injury and the presence of anterior malocclusion traits to the outcome.ResultsThe presence of anterior malocclusion traits did not show a negative impact on the overall OHRQoL mean or in each domain. Only complicated traumatic dental injuries showed a negative impact on the symptoms (p = 0.005), psychological (p = 0.029), self image/social interaction (p = 0.004) and family function (p = 0.018) domains and on the overall OHRQoL mean score (p = 0.002). The presence of complicated traumatic dental injuries showed an increased negative impact on the children's quality of life (RR = 1.89; 95% CI = 1.36, 2.63; p < 0.001).ConclusionsComplicated traumatic dental injuries have a negative impact on the OHRQoL of preschool children and their parents, but anterior malocclusion traits do not.

Three Criteria for Ecological Fallacy

In a large cohort study published in Environmental Health Perspectives, Brenner et al. (2011) confirmed previous results on I-131 exposure and thyroid cancer among a Ukranian population. According to the authors, one motivation to study this association was based on evidence from ecological studies (Jacob et al. 1999) with two methodological limitations: use of grouped doses and poor control of confounding. With these new findings, evidence from ecological, case–control, and cohort studies are consistent; thus, an interesting question is whether there was an ecological fallacy. Although ecological studies are important to epidemiology (especially in environmental and social epidemiology), public health practitioners seem afraid of ecological studies. It is a common practice to assume the presence of ecological fallacy (Robinson 1950) and low-level validity when analyzing an ecological study. Most epidemiologists prefer an exclusive individualistic approach, although the importance of a multilevel causal approach is widely recognized (Diez-Roux 2002). In this sense, some authors suggest that it is as important to recognize the presence of ecological fallacy as to recognize psychologistic or individualistic fallacy (Subramanian et al. 2009) (Figure 1). Figure 1 Levels of analysys in epidemiologic studies and potential fallacies during casual inference. Thus, it is necessary to have clear guidelines on when there is or not an ecological fallacy. In this sense, I propose three criteria for the identification of ecological fallacy; all three of these should be present to confirm its existence: Results must be obtained with ecological (population) data. Data must be inferred to individuals. One use of ecological studies is to explore individual-level association when individual data are not available. When the focus of the study was contextual or based on population effects and there is no inference to individuals, ecological fallacy is not possible. When only the first two criteria are present—which is insufficient to affirm ecological fallacy—it is appropriate to acknowledge that there is a possible relationship and that further study is required. Results obtained with individual data are contradictory. Only when empirical data are available is it possible to confirm that an ecological fallacy is present.