Risk Of Traumatic Dental Injuries Research Articles

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.

Mechanisms of dental injuries in basketball, United States, 2003-2022.

Oral injuries such as oral soft tissue lacerations and contusions can occur in basketball by mechanisms such as running into other players or falling. Given a high enough impact force, dental injuries such as tooth fractures and avulsions can occur. Previous research has studied the different types of oral injuries as well as the mechanisms that cause them. Yet, the mechanisms resulting in dental injuries have remained unexplored. The aims of this study were to investigate the distribution of different oral injuries within each injury mechanism and evaluate which mechanisms were most likely to lead to a dental injury. This is a retrospective cohort study using the National Electronic Injury Surveillance System (NEISS). Subjects who experienced oral injuries from basketball between January 1, 2003 and December 31, 2022 were included in this study. The independent variable was the injury mechanism. The dependent variable was the dental injury outcome (yes/no). Multivariate logistic regression was used to measure the association between the injury mechanism and the dental injury outcome. A p < .05 was considered statistically significant. This study included 4419 subjects who experienced oral injuries (national estimate, 138,980). Approximately 14.7% of oral injuries were dental injuries. Subjects experiencing collisions with objects such as walls or the basketball hoop (odds ratio (OR), 4.39; p < .001), falls (OR, 3.35; p < .001), or contact with the basketball (OR, 1.77; p = .006) had significantly higher odds of sustaining a dental injury relative to those experiencing contact with another player. Basketball players experiencing contact to the mouth have high odds of sustaining a dental injury. An understanding of injury mechanisms is important for medical teams to manage these injuries and for coaches to educate athletes on safe and proper playing styles. Furthermore, healthcare providers and basketball staff should encourage athletes to wear mouthguards to reduce the risk of traumatic dental injuries.

Risk factors associated with traumatic dental injuries in individuals with special healthcare needs-A systematic review and meta-analysis.

Individuals with special healthcare needs (SHCN) are more likely to sustain traumatic dental injuries (TDIs) due to distinct risk factors. The aim of this review was to assess various risk factors associated with TDIs in individuals with SHCN. The protocol was designed according to the recommendations of the Cochrane-handbook, Joanna Briggs Institute, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in PROSPERO (CRD42022357422). A comprehensive search was performed in PubMed, LILACS, Web of Science, EMBASE and Scopus using a pre-defined strategy without any limitation of language and year of publication. It was last updated on 25 April 2023. Studies addressing the TDIs in individuals with SHCN were included. Data extraction and analyses were performed, risk of bias (ROB) assessment was done using the Joanna Briggs Institute's critical appraisal tool, and a meta-analysis was performed using random-effects model. A total of 21 studies were included in the review. They were categorized according to the target disease/condition: cerebral palsy (n = 5), ADHD and autism spectrum disorders (n = 5), visually impaired (n = 4), and multiple disorders (n = 7). The studies showed variability in the design and methods; however, 17 out of 21 studies showed moderate to low ROB. Increased overjet and lip incompetence were the main risk factors reported in the studies. The commonest injuries were observed to be enamel and enamel and dentine fractures. The overall pooled prevalence of TDI in individuals with special healthcare needs was 23.16% with 20.98% in males and 27.06% in females. Overjet >3 mm and inadequate lip coverage were found to be associated with a higher risk of TDI in all the categories of individuals with special healthcare needs except ADHD and ASD. Falls at home in cerebral palsy, falls while walking and self-harm in ADHD and ASD, falls at home and collision in visual impairment, and unspecified falls in multiple disorders could be identified as the most common cause of TDI.

Lip incompetence and traumatic dental injuries: a systematic review and meta-analysis.

Background/aim Traumatic dental injury is an impact injury to the teeth and/or other hard and soft tissues severity of which can lead to pain, as well as aesthetic, psychological, behavioural and functional problems among children. Lip incompetence directly exposes teeth increasing the risk of traumatic dental injuries. This review aimed to assess the existing evidence regarding association of lip incompetence and dental trauma.Methods The review protocol was registered with PROSPERO with Protocol number: CRD42020163069. Electronic searches of grey literature and three databases were performed. Cross sectional studies conducted between the years 2009-2019 on children aged 0-15 years were selected. Studies were evaluated with the help of NIH quality assessment scale. Data on research question, study population, inclusion and exclusion criteria, sample size justification, exposure and outcome clearly defined and adjustment for confounding variables were assessed. All analyses were performed using Review Manager 5.4.Results The study identified 10,223 articles, 33 were included. Among these 20 identified articles reported 'Good' quality with 13 studies reporting 'Fair' quality post assessment. Subject with lip incompetence were at 2.44 (1.59-3.75) times the risk of developing traumatic injuries during primary dentition. This risk increases to 3.26 (2.21;4.53) times in mixed and permanent dentition. At 12 years of age the OR for dental trauma is 3.77 (2.06;6.91) in subjects with incompetent lips.Conclusions The results confirm the association between lip incompetence and dental trauma.

Benefits and Risks of Orthodontic Treatment: A Systematic Review

Background: Malocclusion is one of the main problems of oral and dental health, ranked third after caries and periodontal diseases. In Asian population, the percentage of class II and III Angle malocclusion is 21.42% and 5.76% respectively. Thus, orthodontic treatment is still needed by the people. However, not every patient knows the potential risks that orthodontic treatment, and whether the treatment will bring them benefits they want to achieve. Purpose: this study aimed to describe benefits and risks of orthodontic treatment on the patient and operator through scooping review. Review(s): The search of literatures show that orthodontic treatment increases patient’s oral health related quality of life, reducing the risk of traumatic dental injuries in children with large overjet, and reducing the incident of muscle tenderness, and myofascial pain. However, orthodontic treatment poses the risk of damage to the teeth, oral and mucosal pain, speech problems, allergic reactions, and orthodontics relapse. Conclusion: Orthodontic treatment can provide benefits to patients’ oral health related quality of life, as well as reducing the incidence of temporomandibular disorder and traumatic dental injuries in children with large overjet. But these benefits must outweigh the risks that can occur in the patient such as teeth damage, oral and mucosal pain, speech problems, allergic reactions, and the probability of relapse must also be minimized.

Emergency management of dental injury; preparedness among school teachers in Bhubaneswar, India.

School is the place, identified with a noticeable risk of Traumatic Dental Injuries (TDI) in children which have functional, esthetic and psychological effects. To assess the preparedness of concerning traumatic dental injuries and their management among school teachers and also to empower the clinician to frame a set of instructions for school teachers to handle the emergencies effectively at the site of the incident. A cross-sectional study was conducted among 330 school teachers enrolled in government and private schools of 24 randomly selected schools in Bhubaneswar city. A self-administered questionnaire was distributed to collect information on participants demographic characteristics, knowledge, attitude and practice about emergency management of Traumatic Dental Injury. Chi-square test with level of significance set at 5% was used for statistical analysis. Statistically significant (p<0.05) correct responses were provided by 66.7% males and 35.6% females and 100% younger age teachers. Larger population perceived that their level of knowledge was not satisfactory as they responded for inadequate and don't know options which was significant in relation to gender and age (p<0.05) but not with respect to the type of school (p>0.05). All the respondents expressed the need for a training program. This study highlights the instantaneous need for tailor made dental health educational and preventive programs for school teachers in order to effectively manage the Traumatic Dental Injuries.

Prevalence and factors associated with traumatic dental injuries among schoolchildren in war-torn Libya.

No previous epidemiological study has investigated the prevalence and associated factors of traumatic dental injuries (TDIs) among Libyan children. Such information is required for the planning and evaluation of health services. The aim of this study was to assess the prevalence of TDIs and associated factors among 12-year-old schoolchildren in Benghazi, Libya. Data for this study were collected as part of a comprehensive, cross-sectional survey investigating oral health status and treatment needs of 12-year-old schoolchildren in Benghazi, Libya, between December 2016 and May 2017. Sociodemographic information was collected through a dental health questionnaire. The children were assessed for oral health status, including TDIs according to modified World Health Organization (WHO) classification criteria, in their classroom by trained and calibrated examiners. Anthropometric measures, lip competence and overjet were all assessed and reported. History of TDIs was sought among those affected. Logistic regression models were applied for TDIs as an outcome variable. The statistical significance for all tests was ≤0.05. Data from 1134 participants were included in this study. TDIs were observed in 10.3% of the sample. Most of these TDIs were enamel fractures only (55.6%) and enamel and dentine fractures (35.9%). "Falling" was the most common cause of TDIs, accounting for 51% of cases. While increased overjet appeared to be associated with higher risk of TDIs (OR: 1.92; 95% CI: 1.29-2.86), being female (OR: 0.34; 95% CI: 0.22-0.53) and overweight (OR: 0.33; 95% CI: 0.13-0.83) were also associated with lower risk of having TDIs. This survey showed that a considerable proportion (10.3%) of 12-year-old Libyan children had TDIs, with relatively high unmet treatment needs. More efforts are required to develop effective prevention programmes and to enhance the provision of dental treatment of TDIs for Libyan children.

Dental trauma in children in Budapest. A retrospective study.

Traumatic dental injuries (TDIs) are among the most serious dental public health problems in childhood. This study aimed to determine the prevalence of anterior tooth TDIs in 7- to 18-year-old children who presented for treatment over a period between January 2007 and December 2016, and to survey the effect of an increased health awareness and educational campaign about the risk of TDIs and the importance of prevention methods in decreasing their prevalence compared with data published in the years 1985-1999. The current study was carried out on 454 children who presented for treatment at the Department of Paediatric Dentistry and Orthodontics in Budapest, Hungary. The prevalence of TDIs was 1%. Males experienced more dental injuries than females. The incidence of dental trauma peaked at 9 years of age. The most observed injury was luxation. Most accidents occurred during playtime at home. TDIs occurred most frequently in the spring. The increased health awareness, a wide educational campaign about the risk of TDIs and the importance of prevention methods have essentially contributed to the decrease in the prevalence of TDIs, with an increase of luxation injuries and a decrease of teeth fractures.

Risk factors for traumatic dental injuries in the Brazilian population: A critical review.

Strategies for the prevention of traumatic dental injuries (TDI) should consider the risk factors involved for each population studied. The aim of this study was to perform a critical review regarding the risk factors for TDI in the Brazilian population. A systematic literature search was performed in the MEDLINE, Scopus, Web of Science, Lilacs, and BBO databases using MeSH terms, synonyms, and keywords, with no language or date restrictions. In the first step, all relevant studies identified, regardless of the type of statistical analysis performed, were grouped according to their geographic location. In a second step, the studies using Andreasen's criteria to classify the injuries and multivariate analysis to identify the risk factors for TDI in Brazilian subjects were included for data extraction. The search strategy initially identified 3373 articles. However, only 108 articles assessed TDI with predisposing factors and were included in the first step. From those, 28 were deemed eligible for inclusion in the second step. No consensus related to the relationship between gender and TDI in the primary dentition was achieved. Nonetheless, males were found to be more prone to trauma in the permanent dentition. Overjet, inadequate lip sealing and anterior open bite increased the risk for TDI, both in primary and permanent dentitions. Social environment was related to trauma only in primary dentition. For permanent dentition, dental caries, obesity, binge drinking, and drug use were identified as considerable risk factors for TDI. The risk factors for TDI in the Brazilian population are similar to those found worldwide. However, some differences can be observed, such as gender and socioeconomic indicators as predisposing factors.

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.

Increased risk of dental trauma in patients with allergic rhinitis: A nationwide population-based cohort study.

Allergic rhinitis (AR) is associated with various developmental issues that affecting dentition. We aimed to determine whether AR is associated with an increased risk of traumatic dental injuries (TDIs) in Taiwanese individuals. We used the Taiwan National Health Insurance Research Database (NHIRD) to conduct a nested case-control study. We compared an AR cohort with a matched cohort of patients without AR. New TDI cases were determined during our study period. To compare TDI risk between our study cohorts, we used Cox proportional regression analysis, and hazard ratios (HR) with 95% confidence intervals (CI) were calculated to quantify the association between AR exposure and TDI risk. In total, 76749 patients with AR (31715 male; 45034 female) were identified. In the AR and the non-AR cohorts, 312 patients in total had TDI. Patients with AR had a significantly higher risk of TDI than those without AR (aHR = 1.92; 95% CI = 1.459–2.525; P < 0.001). The risk of TDI was markedly higher in the AR cohort, except in the 3–12-year-old group, and with a CCI ≥ 1. AR patients had a future risk of TDI, indicating a potentially linked disease pathophysiology. The association between AR and TDI is greater among general patients. Clinicians and caregivers should be aware of potential TDI co-morbidity in patients with AR.

Psychosocial factors and traumatic dental injuries among adolescents

To examine the association of traumatic dental injuries (TDI) and psychosocial factors in adolescents and to identify psychological profiles associated with TDI. A cross-sectional study was conducted involving 531 students aged 13-16 years. Data were collected through oral examination and a structured interview with the adolescents, in conjunction with a questionnaire answered by their mothers. Associations between TDI and independent variables were analysed using a model-based approach, while an exploratory data analysis was applied to identify homogenous clusters of adolescents in relation to their sense of coherence (SoC), perception of parental support and their mothers' SoC. These clusters were examined further for associations with TDI and psychosocial variables. The prevalence of TDI was 15.8%. Adolescents with high TDI prevalence were males, nonfirstborns, or those frequently engaging in physical activity. In addition, both their own SoC and that of their mother were low and they reported low parental support. They were also prone to complaining about the behaviour of their peer group. The hierarchical cluster analysis (HCA) demonstrated three homogenous clusters. The cluster with the highest scores for all psychological variables included adolescents with low TDI prevalence, low paternal punishment, spacious home environment, high Family Affluence Scale (FAS) score, good school grades, few complaints about schoolmates and higher maternal education. Psychosocial factors appear to influence an adolescent's risk of TDI. High parental support, high own and maternal SoC and a higher socioeconomic status (SES) are typical of adolescents with low TDI experience.

Traumatic dental injuries in children with special health care needs.

Children with special healthcare needs (CSHCN) are at an increased risk for traumatic dental injuries (TDI) due to unique predisposing factors; moreover, their access to dental care is compromised. In Jordan, there is a need to study TDI among CSHCN to highlight their dental care needs. The aim of this study was to identify the prevalence, types, possible risk factors associated with TDI, and treatment-seeking behavior in CSHCN in Jordan. Children (n=959) were examined in schools/centers for CSHCN, and compared to a healthy age- and gender-matched control group. Data concerning demographics, types of trauma, risk factors associated with TDI, and treatment-seeking behavior were collected. Data were analyzed using SPSS for descriptive and bivariate analyzes. Significance level was set at P≤.05. Prevalence of TDI in the study group (age, 11.76±4.2years) and control group (age 11.70±4.2years) was (83 of 959, 8.7%) and (42 of 1010, 4.1%), respectively. TDI prevalence was highest in children with multiple disabilities (14.0%), followed by intellectual disabilities (13.1%), and cerebral palsy (12.2%). The most common type of TDI was an uncomplicated crown fracture (91.0%). Increased overjet and incompetent lips were significant risk factors associated with TDI. Reasons for not seeking treatment in the study vs control group included parental attitude and lack of dental awareness (68.1% vs 60%), difficulties getting an appointment and availability of dental clinics willing to see CSHCN (36.2% vs 0%), P≤.01, and financial reasons (31.9% vs 40%). Prevalence of TDI was higher in CSHCN, and associated with increased overjet and incompetent lips. Uncomplicated crown fracture was the most common injury. In both groups, the main reason for not seeking treatment was lack of dental awareness among parents/caregivers; however, difficulties in getting an appointment and availability of dental clinics willing to see children were more prominent in the CSHCN group.

Protecting Smiles: Tips for Dental Trauma Management

Drs Slayton and Dubik have disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.. In a recently published AAP Clinical Report, Dr. Keels and the Section on Oral Health explore the diagnosis, evaluation, management, and prevention of dental trauma in children.1 As children learn to walk and become involved in activities of daily living, they are at increased risk for traumatic dental injuries. Trauma to permanent teeth most commonly occurs as a result of falls, followed by automobile accidents, assaults, and sports.2 Since primary care providers are often the first to see children with traumatic injuries that …

Preterm birth does not increase the risk of traumatic dental injuries or unintentional injuries

To evaluate the prevalence of traumatic dental injuries (TDIs) and unintentional injuries (UIs) in Swedish children from 0 to 12 years of age, comparing those who were born preterm with matched full-term controls. The associations between TDI and UI and medical health problems or socio-demographic characteristics were also studied. This cross-sectional, case-control study used dental record reviews and interviews to obtain TDI data on 187 matched pairs aged from 0 to 6 (Sample I) and a structured questionnaire to study TDI and UI among 82 matched pairs aged from 0 to 12 (Sample II). Reports of TDI in the primary teeth and permanent teeth from 0 to 12 years of age were significantly more common in the control than preterm born children (p = 0.032). No significant differences were seen in the 0-6 age group. When it came to UI, there were no statistical significant differences between the preterm and control groups and no correlations between TDI and UI and medical health problems or socio-demographic characteristics. The study indicates that preterm children are no more exposed to TDI or UI than matched full-term controls. In fact, the control group parents reported significantly higher prevalence of TDI in the primary and permanent teeth.

Socioeconomic, behavioral, and anthropometric risk factors for traumatic dental injuries in childhood: a cohort study

To investigate risk factors for the occurrence of traumatic dental injuries (TDI) at 4years of age. Prospective cohort study. A birth cohort (n=500) was recruited from the public healthcare system in São Leopoldo, Brazil. Demographic, socioeconomic, anthropometric, and behavioral variables were collected at 6months, 1year, and 4years of age. Clinical examinations at 4years of age were carried out by a single examiner using the Andreasen classification. Poisson regression was used to determine risk factors for the occurrence of TDI at 4years of age. A total of 23.7% of the children (80/337) exhibited TDI at 4years of age. The risk of TDI was 35% lower among children who had been breastfeed for ≥6months relative risk (RR 0.65; 95% CI 0.43-0.97) and more than twofold higher among those who were bottle fed ≥ three times a day (RR 2.37; 95% CI 1.10-5.11) at 12months of age. Higher household income in the first year of life and greater height at 4years of age were significantly associated with the outcome. The identification of behavioral, socioeconomic, and anthropometric risk factors for TDI in early childhood can contribute to the elaboration of prevention strategies.

Aetiology and risk factors related to traumatic dental injuries – a review of the literature

During the past 30 years, the number of aetiologies of traumatic dental injuries (TDIs) has increased dramatically in the literature and now includes a broad spectrum of variables, including oral and environmental factors and human behaviour. The aim of this study is to present an international review of well-known as well as less well-known unintentional and intentional causes of TDIs. Moreover, some models that are useful in investigating contact sport injuries are presented. The databases of Medline, Cochrane, Social Citation Index, Science Citation Index and CINAHL from 1995 to the present were used. Oral factors (increased overjet with protrusion), environmental determinants (material deprivation) and human behaviour (risk-taking children, children being bullied, emotionally stressful conditions, obesity and attention-deficit hyperactivity disorder) were found to increase the risk for TDIs. Other factors increasing the risk for TDIs are presence of illness, learning difficulties, physical limitations and inappropriate use of teeth. A new cause of TDIs that is of particular interest is oral piercing. In traffic facial injury was similar in unrestrained occupants (no seat belts) and occupants restrained only with an air bag. Amateur athletes have been found to suffer from TDIs more often than professional athletes. Falls and collisions mask intentional TDIs, such as physical abuse, assaults and torture. Violence has increased in severity during the past few decades and its role has been underestimated when looking at intentional vs unintentional TDIs. There are useful models to prevent TDIs from occurring in sports. WHO Healthy Cities and WHO Health Promoting Schools Programmes offer a broad solution for dental trauma as a public health problem. The number of known causes of TDIs has grown to alarming levels, probably because of increased interest of the causes and the underlying complexity of a TDI. Accepted oral, environmental and human aetiological factors must therefore be included in the registration of TDIs.

Abstracts

Objectives: To assess the prevalence of traumatic dental injuries (TDI) in Taiwan, and to analyse the relationships between the occurrence of traumatic dental injuries and school type, age, gender, socio-economic status, family structure, overjet and lip morphology. Methods: A random sample of 6284 15–18-year-old academic and vocational senior high school students in southern Taiwan was selected. Each completed a questionnaire and was examined with standard clinical procedures. Results: Participation rate was 99.97%. The prevalence of TDI in Taiwan was 19.94% (95% C.I. 18.96%, 20.95%). Male adolescents (OR = 1.809, 95% C.I. 1.589, 2.058) attending private (OR = 1.158, 95% C.I. 1.004, 1.336) and/or vocational schools (OR = 1.200, 95% C.I. 1.030, 1.398), with an overjet greater than 5 mm (OR = 1.697, 95% C.I. 1.450, 1.985), inadequate lip morphology (OR = 1.350, 95% C.I. 1.189, 1.533), living with at least one nonbirth parent (OR = 1.274, 95% C.I. 1.013, 1.601), and/or having the middle educated chief guardian (OR = 1.210, 95% C.I. 1.039, 1.411), were found to be at greater risk of TDI. Conclusions: The prevalence of TDI in Taiwan was similar to that found in other countries. Correlates of TDI were gender, lip morphology, overjet, chief guardian's level of education, family structure and school type. Further investigation into the aetiology of TDI is indicated.