Eliane Gerson Feldens

Understanding school teacher's knowledge regarding dental trauma: a basis for future interventions.

BACKGROUNDnTraumatic dental injuries frequently occur at school environment. However, teachers are not prepared to provide the adequate emergency management.nnnAIMnThe objectives of this study were to identify the factors associated with teachers knowledge about dental trauma and to describe school managers perception of possible strategies to change the scenario.nnnSUBJECTS AND METHODSnOur sample comprised 405 teachers from 17 public schools in Canoas, state of Rio Grande do Sul, Brazil, whose data were collected regarding demographic variables, training and professional experience information. The outcome was completely inadequate knowledge regarding trauma measured based on the answers to a structured questionnaire about dental fractures and tooth avulsion. The sample also included 14 school managers who answered a semi-structured questionnaire about the causes of teachers inadequate knowledge and possible strategies to change the scenario.nnnRESULTSnThe multivariate analysis demonstrated that the probability of completely inadequate knowledge was higher among male teachers, with less professional experience, who had not achieved a graduate degree, who had not witnessed at least one dental trauma case at school and who had not been trained in first-aid. School managers identified the following causes of inadequate knowledge: the fact that the topic is not approached during the teachers training and continual education and lack of experience involving dental trauma at school. In addition, they suggested that lectures and courses including written and visual communication should be offered, as well as training workshops.nnnCONCLUSIONSnStrategies to improve the teachers knowledge about dental trauma must take into consideration the results of the present study and optimize the inclusion of this topic in the teachers curricular training and pedagogical education in a continuous manner.

Dental anomalies and associated factors in 2- to 5-year-old Brazilian children

BACKGROUNDnDental anomalies in primary teeth may lead to functional and aesthetic disorders, and their recognition contributes to early diagnosis and long-term treatment planning.nnnOBJECTIVEnThis study investigated the prevalence of dental anomalies in primary dentition and associated factors in Brazilian preschoolers.nnnMETHODSnThe study population of this cross-sectional study comprised 1260 2- to 5-year-old children from public nurseries in Canoas, southern Brazil. Dental anomalies were recorded by five trained examiners according to Kreiborg criteria; classification included double teeth, hypodontia, supernumerary, and microdontia.nnnRESULTSnDental anomalies as a group were found in 2.5% of children, although no significant difference occurred between genders and races. All the anomalies were observed in the anterior region, with no significant differences between the arches. However, supernumerary teeth were significantly more frequent among the non-white racial group (Fisher; P = 0.025) and double teeth on the lower arch (McNemar; P = 0.020). Individual anomaly frequencies were: double teeth, 1.3%; hypodontia, 0.6%; supernumerary, 0.3%; and microdontia, 0.3%.nnnCONCLUSIONSnThe frequency of primary dentition anomalies as a group was greater than that reported in other populations; the findings of this study provide a clear vision of the distribution of this oral condition and may well contribute to early detection and treatment planning.

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

AIMnTo investigate risk factors for the occurrence of traumatic dental injuries (TDI) at 4xa0years of age.nnnDESIGNnProspective cohort study.nnnMETHODSnA birth cohort (nxa0=xa0500) was recruited from the public healthcare system in São Leopoldo, Brazil. Demographic, socioeconomic, anthropometric, and behavioral variables were collected at 6xa0months, 1xa0year, and 4xa0years of age. Clinical examinations at 4xa0years 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 4xa0years of age.nnnRESULTSnA total of 23.7% of the children (80/337) exhibited TDI at 4xa0years of age. The risk of TDI was 35% lower among children who had been breastfeed for ≥6xa0months 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 12xa0months of age. Higher household income in the first year of life and greater height at 4xa0years of age were significantly associated with the outcome.nnnCONCLUSIONSnThe identification of behavioral, socioeconomic, and anthropometric risk factors for TDI in early childhood can contribute to the elaboration of prevention strategies.

Clarifying the effect of behavioral and clinical factors on traumatic dental injuries in childhood: a hierarchical approach

AIMnTo explore associations between traumatic dental injuries (TDI) in Brazilian preschool children and clinical, behavioral, and socio-demographic factors using a hierarchical approach.nnnMATERIAL AND METHODSnA cross-sectional study was conducted involving 1316 children aged 0-5xa0years at public preschools in the city of Canoas (southern Brazil). Demographic (sex and age), socioeconomic (mothers schooling, income and family structure) and behavioral (use of pacifier, breastfeeding duration and bottle use at 12xa0months) factors were collected through a questionnaire. TDI (Andreasen criteria) and malocclusion (overjet and anterior open bite) were recorded by trained and calibrated examiners. Poisson regression was employed to determine factors associated with TDI using a hierarchical approach.nnnRESULTSnThe prevalence of TDI was 13.3%. In the final model, the probability of TDI was 50% higher in children who used a pacifier (PR: 1.50; 95% CI: 1.08-2.10), 77% higher in children with overjet between 3 and 5xa0mm (PR: 1.77; 95% CI: 1.22-2.57) and nearly threefold higher in children with overjet > 5xa0mm (PR: 2.73; 95% CI: 1.77-4.20) compared with children with overjet ≤ 2xa0mm. Additional analysis demonstrated that overjet represented the pathway by which pacifier use was associated with TDI.nnnCONCLUSIONnPacifier use is strongly associated with the occurrence of TDI in the primary dentition, and accentuated overjet represents a pathway to this association. These findings suggest the need for prevention strategies that address early counseling on pacifier use to reduce the occurrence of TDI.

Exploring the profile of articles on traumatic dental injuries in pediatric dental journals

AIMnTo explore the profile of articles on traumatic dental injuries (TDI) published in leading pediatric dental journals between 2000 and 2010 via bibliometric analysis.nnnMETHODSnA search was conducted on the PubMed database to find the six pediatric dental journals with the highest numbers of articles on TDI published between January 2000 and December 2010. All titles and abstracts of full-length articles were reviewed by two examiners. Studies focusing on TDI were independently categorized according to the following aspects: (i) year of publication; (ii) country where the study was carried out; (iii) study design; (iv) topic addressed; (v) type of TDI; and (vi) type of dentition. Data were analyzed in terms of frequency distribution.nnnRESULTSnOf a total of 3720 articles published in the six selected journals, only 119 (3.2%) focused on TDI, with no significant variations across the journals or years. The countries with the greatest number of publications on TDI were India (19.3%), followed by the USA (15.1%), Brazil (13.4%), and Italy (11.8%). Case report and case series were the dominant study design (53%). Most studies addressed treatment of TDI (63%) and described injuries to permanent teeth (68%), especially avulsion and crown fractures.nnnCONCLUSIONSnThere is an urgent need for expanding the number and quality of research on TDI in pediatric dental journals, especially with better quality study designs. Cohort studies and investigations focusing on the assessment of health services and technologies are important targets for future research.

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

AIMnThe 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.nnnMATERIAL AND METHODSnAn oral health survey was undertaken of preschool children, age 1-5xa0years attending public nurseries in Canoas, Brazil. Children were examined for TDI, dental caries, and malocclusion. Parents were interviewed on their perception of their childs 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.nnnRESULTSnA full dataset was collected from 76% of the eligible population. The prevalence of TDI was 13.4% (171/1275). The prevalence of any impact (ECOHISxa0≥xa01) 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%) (Pxa0<xa00.001). 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.nnnCONCLUSIONnEnamel fractures have no significant impact on young childrens 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.

Práticas Alimentares Cariogênicas e Fatores Associados em Crianças do Sul do Brasil

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

BACKGROUND/AIMnThe 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.nnnMATERIALS AND METHODSnA 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 12xa0months. TDI (Andreasen criteria) at three years of age (nxa0=xa0458) were recorded by two examiners who had undergone training and calibration exercises. Multivariable analysis was carried out with Poisson regression with robust variance.nnnRESULTSnA 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 12xa0months 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.nnnCONCLUSIONnOverweight/obesity in early life is a risk factor for TDI in preschool children.