Vanessa Polina Pereira Costa

Long-term clinical and radiographic follow up of subluxated and intruded maxillary primary anterior teeth.

AIMS This study aimed to determine the kinds of sequelae resulting from intrusive luxation and subluxative injuries in primary anterior teeth as well as the timing of such sequelae. MATERIALS AND METHODS In this longitudinal retrospective study, data were collected from dental records and radiographs of patients with traumatic dental injury (TDI) treated at the Centre for the Study and Treatment of Dental Trauma in Primary Dentition (Pelotas, RS, Brazil). Fifty-two children, with seventy intruded teeth, and 76 children, with 99 subluxated teeth, met the inclusion criteria. Sequelae, such as crown discoloration, fistula, pulp canal obliteration (PCO), inflammatory root resorption (IRR), and internal root resorption, were investigated. The data on the sequelae were distributed into eight follow-up periods: 0-30 days, 31-90 days, 91-180 days, 181-365 days, 1-2 years, 2-3 years, 3-4 years, and >4 years. RESULTS The sample comprised 99 subluxation cases and 70 intruded teeth. Crown discoloration was the most prevalent sequelae. Among the subluxated teeth, <50% of IRR, fistula, crown discoloration, and PCO occurred within 180 days after TDI; however, the sequelae were also diagnosed after longer periods. Majority of sequelae of intrusion were diagnosed within the 181-365 days and 1-2 years periods but were also observed after more than 4 years of follow up. CONCLUSIONS For both intrusion and subluxation, trauma sequelae were diagnosed even after the 3-4 years of follow-up.

Maternal perception of the occurrence of traumatic dental injuries in children: a cohort study of south Brazil.

BACKGROUND Adolescent mothers may have an inaccurate perception and awareness of dental trauma occurrence in children, which may influence whether or not they seek treatment. OBJECTIVE This study evaluated maternal perception of traumatic dental injury (TDI) occurrence and related factors in children, 24-36 months of age, of adolescent mothers from a cohort in the city of Pelotas/RS, Brazil. METHODS Clinical data from 508 children were collected through physical examination; demographic variables (including socio-economic status) and maternal perception of trauma occurrence were collected through interviews with the childrens mothers. Statistical analysis was performed using STATA 12.0. RESULTS The prevalence of dental trauma was 12.6% (64). A total of 291 (57.9%) mothers reported that their child had hit his or her teeth/mouth at least once. Only 69 (24.8%) mothers who perceived a TDI sought care. The maternal perception of dental trauma experienced by children showed no relationship with diagnosis on clinical examination. Enamel fracture was the most prevalent type of trauma (71.6%), and the maxillary central incisors were the teeth most affected. CONCLUSIONS Owing to lack of awareness about TDI, the adolescent mothers in this study sample did not seek treatment for their children. Awareness campaigns for parents and caregivers about the possible consequences of TDI and the importance of follow up after dental trauma are required.

Perinatal health and malocclusions in preschool children: Findings from a cohort of adolescent mothers in Southern Brazil

Introduction: Pregnancy in adolescence has long‐term consequences that can negatively influence oral conditions. In this study, we aimed to assess malocclusion in deciduous dentition and its association with prolonged breastfeeding, pacifier use, and perinatal health indicators pertaining to the periods immediately before and after birth. Methods: This cross‐sectional study was nested in a cohort of adolescent mothers who became pregnant from 13 to 19 years of age (mean age, 17.3 ± 1.6 years). A total of 509 mother‐child dyads were included. Information on perinatal indicators, including Apgar score (0‐10), which is a standardized assessment of the condition of the infant at birth (heart rate, breath rate, muscle tone, reflex irritability, and skin color), head circumference, birth weight, and need for intensive care unit admission were collected after delivery through interviews with the mothers. By the time the children were 24 to 36 months of age, malocclusion was assessed, and information on the use of pacifiers and breastfeeding was collected. Multivariate Poisson regression was used to assess the effect of independent variables on the outcome (malocclusion). Results: The prevalence of malocclusion was 62.33%, and open bite was the most frequent one (47.45%). After adjustments, children with no need for intensive care unit admission had a lower risk of malocclusion (prevalence ratio [PR] = 0.75; 95% CI, 0.56‐0.99), whereas those with an Apgar score less than 7 had a higher risk (PR = 1.32; 95% CI, 1.06‐1.64). Children who had used a pacifier (PR = 1.82; 95% CI, 1.02‐3.24) or were still using it (PR = 3.88; 95% CI, 2.65‐5.68) had a higher chance of malocclusion compared with children who never used a pacifier. Children breastfeeding for 24 months or longer were less likely to have malocclusion (PR = 0.46; 95% CI, 0.34‐0.73). Conclusions: Poor perinatal health and pacifier use may be risk factors for malocclusion development in deciduous teeth. Long duration of breastfeeding is associated with better occlusal conditions in children of adolescent mothers. Further studies are needed with other age groups. HighlightsPoor perinatal health may pose risk factors for malocclusion in deciduous teeth.Admission to the ICU and low Apgar score were associated with malocclusion in children.Long duration of breastfeeding promotes better occlusal conditions in deciduous dentition.Pacifier use is associated with malocclusion in children of adolescent mothers.

Clinical and radiographic sequelae to primary teeth affected by dental trauma: a 9-year retrospective study

This retrospective study aimed at determining the predicted risks of clinical and radiographic complications in primary teeth following traumatic dental injuries, according to injury type, severity and childs age. Data were collected from records of children treated at a Dental Trauma Center in Brazil for nine years. Records of 576 children were included; clinical sequelae were assessed in 774 teeth, and radiographic sequelae, in 566 teeth. A total of 408 teeth (52.7%) had clinical sequelae and 185 teeth (32.7%), radiographic sequelae. The type of injury with the highest number of clinical sequelae was the crown-root fracture (86.4%). Clinical sequelae increased with injury severity (p < 0.001), whereas radiographic sequelae did not (0.236). The predicted risk of color change was 29.0% (95%CI 19-41) for teeth with enamel fracture, and 26.0% (95%CI 14-40) for teeth with enamel dentin fracture as well as enamel dentin pulp fracture. Risk of periapical radiolucency was higher for teeth with enameldentinpulp fracture (61.1% 95%CI 35-82) and those with subluxation (15.8% 95%CI 10-22). Risk of premature loss was 27.3% (95%CI 13-45) for teeth with extrusive luxation, and 10.2% (95%CI 5-17) for those with intrusive luxation. The assessment of predicted risks of sequelae showed that teeth with hard tissue trauma tended to present color change, periapical radiolucency and premature loss, whereas teeth with supporting tissue trauma showed color change, abnormal position, premature loss and periapical radiolucency as the most common sequelae. Knowledge about the predicted risks of complications may help clinicians establish appropriate treatment plans.

Crown-Root Fractures in Primary Teeth: A Case Series Study of 28 Cases

Crown-root fractures in primary teeth are rare, with a wide variation of patterns that make diagnosis and treatment difficult. The aim of this study was to present a case series of crown-root fractures in primary teeth of children who attended a reference center. The study followed 28 cases of crown-root fractures in 26 children, representing 4% of the total number of attendees over 11 years of reference service at the Universidade Federal de Pelotas, Pelotas, Brazil. In most cases, the maxillary central incisors (85.7%) were involved. In the crown, 57.1% of the cases had a simple line of fracture, and 42.9% had multiple lines. Simple lines predominated in the root (89.3%). In cases with simple fracture lines in the crown, 37.6% underwent a total extraction, 31.2% required a partial extraction and 31.2% underwent pulpectomy. In most teeth with multiple lines of fractures in the crown, total extraction was performed (91.7%) All cases were followed-up until the eruption of the permanent successor tooth, and all patients had favorable outcomes.

Avaliação clínica e radiográfica de dentes decíduos intruídos por traumatismo alvéolo-dentário

A luxacao intrusiva e causada por um impacto no sentido axial, no qual o dente e deslocado para dentro do osso alveolar, afetando comumente a denticao decidua e podendo gerar sequelas. O seu tratamento e definido por sinais clinicos e radiograficos. Objetivo: acompanhar dentes deciduos intruidos e observar a ocorrencia de sequelas. Metodo: Avaliaram-se prontuarios de pacientes com historia de traumatismo alveolodentario na denticao decidua e selecionaram-se os prontuarios de pacientes que sofreram intrusao com, no minimo, dois anos de acompanhamento, verificando-se: graus de intrusao e de reerupcao; presenca de mobilidade dentaria; coloracao e posicao do dente apos reerupcao; presenca de fistula; condicao do canal pulpar e da regiao periapical; presenca de reabsorcao radicular; e tratamento executado. Resultados: Dentre os 435 pacientes atendidos, foram encontrados 83 casos de intrusao e 29 desses foram incluidos na amostra, totalizando 39 dentes deciduos traumatizados. Assim, as intrusoes representaram 19,1% dos traumatismos observados. Embora o sexo feminino fosse o mais acometido (55,2%), nao existiu correlacao entre sexo e prevalencia de dentes deciduos traumatizados. Em relacao aos dentes atingidos, o mais acometido foi o 61 (34,4%), seguido pelo 51 (31,0%). Ainda, em 31,0% dos casos, os dois incisivos centrais superiores foram acometidos. O estudo aponta, ainda, que queda da propria altura foi a etiologia prevalente, com 58,6% dos casos. Do total de dentes, 27 tiveram reerupcao total, tres reerupcao de 2/3 da coroa e nove esfoliaram ou foram extraidos. Observando-se as sequelas, discoloracao dentaria foi a mais frequente, sendo encontrada em 23 dentes (79,3%). Quanto ao tratamento, dos 39 dentes, 28 foram apenas acompanhados (71,8%), nove necessitaram de endodontia (23,1%) e dois de extracao (5,1%). Conclusao: o monitoramento da reerupcao espontânea dos dentes intruidos e a observacao cuidadosa do aparecimento de sequelas sao as melhores alternativas, pois algumas complicacoes podem aparecer varios meses apos o traumatismo. As sequelas e o grau de intrusao apresentam grande relacao, visto que quanto maior o grau de intrusao, maior sera a gravidade das sequelas e mais importante torna-se o acompanhamento por um profissional.(AU) Intrusive luxation is caused by an impact in the axial direction by which the tooth is displaced into the alveolar bone. It usually affects the primary dentition and can generate sequalae. Its treatment is defined by clinical and radiographic signs. Objective: to follow intrusive primary teeth and observe sequela occurrence. Methods: Dental records of patients with a history of alveolodental trauma were evaluated and records from patients that had suffered intrusion with at least a two-year follow-up period were selected. Intrusion and reeruption degrees, dental mobility occurrence, coloration and tooth position after reeruption, fistula occurrence, pulp canal and periapical region condition, root resorption occurrence and treatment performed were checked. Results: Out of 435 treated patients, 83 intrusion cases were found, 29 of which were included in the sample, totaling 39 traumatized primary teeth. Thus, intrusion represented 19.1% of the analyzed traumas. Although females were more affected (55.2%) than males, a correlation between sex and traumatized primary teeth was not found. With reference to affected teeth, the most affected was tooth 61 (34.4%), followed by tooth 51 (31.0%). Also, in 31.0% of the cases, the two central upper incisives were affected. The study showed that fall from height was the prevailing etiology, encompassing 58.6 % of the cases. Out of the total, 27 teeth showed total reeruption, 3 presented a 2/3 reeruption of the crown, and 9 either exfoliated or were extracted. Upon observing sequelae, dental discoloration was most frequent, having been encountered in 23 teeth (79.3%). As to treatment, 28 out of 39 teeth were only followed up (71.8%), 9 needed endodontic treatment (23.1%) and 2 extraction (5.1%). Conclusion: the monitoring of the spontaneous reeruption of intruded teeth and the careful observation to determine sequela occurrence are the best choices, once complications might arise several months after trauma. Sequelae and inclusion degree are closely related, inasmuch as the higher the intrusion degree, the greater the sequela severity; thus, professional follow-up is indispensable.(AU)