School teachers' knowledge of tooth avulsion and dental first aid before and after receiving information about avulsed teeth and replantation.

Dent Traumatol. 2008 Feb;24(1):43-9

Authors: Al-Asfour A, Andersson L, Al-Jame Q

School teachers can play an important role in improving the prognosis of avulsed permanent teeth of school children after they are informed about the immediate and proper dental first aid steps to be taken at the time of an accident. The aims of this study were: (i) to assess the knowledge level of emergency measures for tooth avulsion in Kuwaiti intermediate school teachers and (ii) to determine if a short lecture about tooth avulsion and replantation could improve teachers' knowledge on this topic. Eighty-five teachers at two intermediate schools (children 10-14 years old) in Kuwait were interviewed using a questionnaire about their first-aid knowledge with particular focus on the following five categories: General knowledge of teeth and avulsion, replantation of primary and permanent teeth, how to clean an avulsed tooth before replantation, extra-oral time and storage methods and media for an avulsed tooth. For each category, a score ranging from 0-3 was possible. An informative 30-min lecture about tooth avulsion and replantation was presented to a group of 43 teachers. After the lecture, the knowledge level of the teachers was re-tested using the same method. Descriptive statistics was used to describe and analyze the data. Improvement in teacher knowledge to an adequate (score of 2) or complete (score of 3) level was observed after the lecture in all five categories. The general knowledge of tooth avulsion and replantation improved from 39% to 97% and knowledge of avulsed permanent and primary teeth from 8% to 71%. Knowledge of how to clean an avulsed tooth improved from 5% to 93%. The knowledge level on the importance of extra-alveolar time before replantation increased from 1% to 74% and knowledge of a suitable storage medium for the avulsed tooth improved from 4% to 86%. Many avulsed permanent teeth in school children can be saved by replantation if school teachers learn what to do when a tooth is avulsed. A lecture followed by discussion proved to be an effective and efficient method of intervention to enhance the knowledge level of teachers so that proper dental first-aid procedures can be achieved.

PMID: 18173664 [PubMed - in process]

Expression of proliferating cell nuclear antigen in pulp cells of extracted immature teeth preserved in two different storage media.

Dent Traumatol. 2008 Feb;24(1):38-42

Authors: Tekin U, Filippi A, Pohl Y, Kirschner H

A specially composed medium for storing avulsed teeth has been developed. In experimental and clinical studies it could be shown that PDL cells could be kept viable during storage in the medium for up to 53 h. In the present study the medium was tested on pulp cells. A total of 40 immature unerupted third molars with open apices were removed surgically and the teeth were stored in a special cell culture medium (SCCM) or in Hank's balanced salt solution (HBSS) at room temperature for 6, 12, 18 or 24 h. Five teeth were assigned to each group. A total of seven consecutive pulp cross-sections per tooth were examined, resulting in a total of 280 specimens. Viable cells were marked using proliferating cell nuclear antigen (PCNA). The pulp was divided in three regions: apical region (0-0.5 mm), middle region (>0.5-1.5 mm) and coronal region (>1.5 mm). The labelling index (LI) was calculated for the whole cut (regions 1, 2 and 3) and for each region separately. The statistical evaluation was made using the One-way anova and Mann-Whitney Test. Pulp cells of all teeth expressed PCNA. About 110 of 140 specimens in the SCCM and 101 of 140 specimens in the HBSS group showed PCNA-positive cells. The highest LI was observed within the apical region and decreased with increased distance from the medium. No marked cells were observed at a distance of more than 1.5 mm. The LI for both media showed a significant increase with storage intervals (P < 0.05). The pulp cells of teeth stored in SCCM showed a LI nearly twice as high compared to pulp cells of teeth stored in HBSS for the apical and middle region (time interval 6, 18 and 24 h: P < 0.05). The LI for the apical region was found to be 8.43% for the SCCM and 4.50% for the HBSS after 24 h. For the middle region the LI was found to be 2.02% for the SCCM and 0.81% for the HBSS after 24 h. Within the parameters of this study, it appears that the SCCM is able to maintain pulp cell viability better than HBSS. The use of special cell culture media in case of tooth avulsion may be beneficial.

PMID: 18173663 [PubMed - in process]

Dental trauma: restorative procedures using composite resin and mouthguards for prevention.

J Contemp Dent Pract. 2007;8(6):89-95

Authors: Santos Filho PC, Quagliatto PS, Simamoto PC, Soares CJ

AIM: The aim of this article is to describe a step-by-step protocol for emergency care of a patient with a dentoalveolar injury in the anterior region of the mouth as well as the fabrication of a mouthguard to prevent future trauma. BACKGROUND: Dental trauma is one of the most serious oral health problems in active children and adolescents. Care of traumatized patients requires immediate initial emergency treatment followed by integrated procedures to restore damaged oral structures along with a subsequent trauma prevention strategy. Dentoalveolar injuries in the anterior region of the mouth are often characterized by tooth avulsion and coronal fracture. They are managed using procedures such as dental splinting, endodontic therapy with its unique characteristics, and restorative techniques to re-establish function and esthetics as well as protective mouthguards. REPORT: A 16-year-old male presented with avulsion of his maxillary central incisors as a result of a direct, unintentional impact with an opponent during a basketball game. The teeth had been stored in physiological serum immediately following the injury and the patient received immediate care. On clinical examination, the right central incisor was fractured at the incisal third of the crown but no bone fractures were found. The teeth were reimplanted and splinted. The fractured right central incisor was restored following endodontic treatment and a mouthguard was fabricated for the patient. SUMMARY: The dentist must be knowledgeable about the most efficient and suitable treatment for each traumatic scenario in order to provide appropriate care for dental injuries. Coordinated multi-disciplinary action is fundamental in the successful treatment of these injuries. The dental mouthguard is an effective device for protecting the teeth and supportive structures during physical activities and must be part of the protective equipment used by athletes. It is the responsibility of the dental professional to make parents, trainers, and athletic associations aware of the risks associated with physical activities without orofacial protection; this should encourage the proper use of all protective devices to prevent dentoalveolar injuries that compromise oral functions, esthetics, and increase the cost of healthcare.

PMID: 17846676 [PubMed - indexed for MEDLINE]

Knowledge and attitude of 2,000 parents (urban and rural - 1,000 each) with regard to avulsed permanent incisors and their emergency management, in and around Davangere.

J Indian Soc Pedod Prev Dent. 2006 Sep;24(3):116-21

Authors: Shashikiran ND, Reddy VV, Nagaveni NB

It is well recognized today that for long-term success, the management of traumatized teeth optimally should be carried out as soon as possible. Since, majority of traumatic injuries occur at home, the ultimate prognosis of an avulsed tooth may depend on knowledge of the treatment procedure, possessed by his or her parents. The purpose of this study was therefore to evaluate the parental knowledge and attitude regarding the emergency management of avulsed teeth in children (in Davangere--both urban and rural, 1,000 each).

PMID: 17065777 [PubMed - indexed for MEDLINE]

[Assessment of traumatic tooth injuries in the emergency room]

Tidsskr Nor Laegeforen. 2006 Apr 27;126(9):1212-3

Authors: Risheim H

Many patients with facial injuries are first seen by doctors in the emergency room. Injuries affecting teeth and alveolar process are common in children; approximately half of all children have sustained such an injury before adulthood. Dentoalveolar trauma does not pose a significant morbid risk for the trauma patient. However, failure to recognise or obtain appropriate consultation can result in premature tooth or alveolar bone loss, resulting in problematic prosthetic rehabilitation. Emergency room doctors should know the initial treatment guidelines for traumatic dental injuries to provide optimal treatment before the patient can seen by a dentist. An avulsed tooth should be replanted immediately, or kept moist until it can be replanted. Prognosis is related to storage media and the length of the extra-alveolar period. Teeth replanted within 5 minutes have the best prognosis. If the primary consultation is by phone the patient, or the parent, should be informed to replant the avulsed tooth. If this is not feasible the tooth should be stored in milk, saliva (oral cavity) or physiologic saline until replanted. Primary teeth are not replanted.

PMID: 16670743 [PubMed - indexed for MEDLINE]

An application of a splint purposeful resin-bonded fixed partial denture after orthodontic treatment: a case report.

J Contemp Dent Pract. 2006 Feb 15;7(1):141-9

Authors: Bayda&#x15F; B, Denizoglu S

An adult male patient who had lost his maxillary left central incisor seven years ago in a traffic accident presented with a chief complaint about his unaesthetic appearance associated with the loss of his maxillary left central incisor space, a Class III molar occlusion, and an anterior open bite malocclusion due to tongue-thrust swallowing. Fixed orthodontic treatment was rendered following fan-type expansion of the maxilla. A Maryland bridge as a minimally invasive dentistry approach was used as a retention appliance and the patient's aesthetic appearance was restored.

PMID: 16491157 [PubMed - indexed for MEDLINE]

Clinical pearl In-treatment replacement of missing incisors.

J Orthod. 2005 Sep;32(3):182-4

Authors: Hodge TM

Four methods of in-treatment replacement of missing incisors are described.

PMID: 16170059 [PubMed - indexed for MEDLINE]

Immediate loading of two single tooth implants in the maxilla: preliminary results after one year.

J Contemp Dent Pract. 2005 Aug 15;6(3):148-57

Authors: Nuzzolese E

This clinical report describes the traumatic avulsion of the left maxillary central and lateral incisors with minimal tissue trauma, followed by placement of provisional restorations of two root-form implants in a 14-year old female patient. Ten days following the avulsion, implant therapy was performed with Summers osteotomes and flapless technique using a root-form 3i osseotite NT. Angulated abutments and acrylic provisional crowns were placed. No occlusal contact was detected. An impression was made 30 days after implant insertion and ceramic restorations were placed 3 months later. No significant soft tissue contraction was observed during the provisional period. The patient exhibited no clinical or radiologic complications for 8 months after loading. In carefully selected under-aged patients implant therapy and immediate loading in the anterior maxilla for traumatic tooth avulsion may prove to be valuable to avoid soft tissue contraction, alveolar bone resorption, and positive esthetic/psychological response.

PMID: 16127484 [PubMed - indexed for MEDLINE]

Multiple dentoalveolar traumatic lesions: report of a case and proposition of dental polytrauma as a new term.

J Contemp Dent Pract. 2004 Nov 15;5(4):139-47

Authors: Martins WD, Westphalen FH, Westphalen VP, Souza PH

Traumatic injuries to permanent teeth are common, and dramatic episodes can occur during childhood. The aim of this paper is to present a report of severe trauma to the orofacial complex of an 8-year old girl that resulted in multiple injuries. The use of the term "dental polytrauma" (concomitant different dental traumatic injuries) is advocated in this case presentation.

PMID: 15558099 [PubMed - indexed for MEDLINE]

Assessing revascularization of avulsed permanent maxillary incisors by laser Doppler flowmetry.

J Am Dent Assoc. 2003 Dec;134(12):1597-603

Authors: Strobl H, Gojer G, Norer B, Emshoff R

BACKGROUND: Laser Doppler flowmetry, or LDF, is a noninvasive method used to assess pulpal blood flow, or PBF. Dental avulsion is associated with loss of pulpal sensitivity. The authors conducted this study to assess whether LDF could be used to detect revascularization of replanted teeth. METHODS: The authors used LDF to assess the PBF values of avulsed permanent maxillary incisors treated using replantation and splinting in 17 subjects. They took measurements at four sessions: on the day of splint removal and at 12 weeks, 24 weeks and 36 weeks after splint removal. Five vital control teeth and five nonvital control teeth were used to assess the background signal. At 36 weeks, the authors determined clinically and radiographically whether revascularization had occurred. RESULTS: LDF readings correctly predicted the pulp status in 88.2 percent of the readings. Of the readings for vital teeth, 100 percent were correct, and of the readings for nonvital teeth, 80 percent were correct. Univariate analysis of variance demonstrated that in revascularized teeth, the PBF value increased significantly from splint removal to week 12 after splint removal and from week 24 to week 36 after splint removal. In the teeth that failed to revascularize, the PBF value dropped significantly from week 24 to week 36 after splint removal. CONCLUSIONS: The results of this study suggest that LDF accurately diagnoses revascularization of avulsed maxillary incisors after replantation and splinting. CLINICAL IMPLICATIONS: LDF may become useful in detecting revascularization much earlier than standard sensitivity tests.

PMID: 14719756 [PubMed - indexed for MEDLINE]

Ridge augmentation with a folded acellular dermal matrix allograft: a case report.

J Contemp Dent Pract. 2001 Aug 15;2(3):31-40

Authors: Fowler EB, Breault LG

Deformities of the dentoalveolar ridge are usually the result of developmental defects, periodontal disease, trauma, or surgical insult. Various techniques are available to correct ridge defects. In this case presentation, ridge augmentation was achieved utilizing an acellular dermal matrix allograft in lieu of an autograft. This report demonstrated an acceptable esthetic result with a significant improvement in the bucco-lingual dimension of the dental ridge. Color match was judged to be excellent. Furthermore, there was no post-surgical loss in papillae height. This case report illustrates an innovative soft tissue surgical technique for clinicians attempting to correct dentoalveolar ridge defects.

PMID: 12167925 [PubMed - indexed for MEDLINE]

Good occlusal practice in children's dentistry.

Br Dent J. 2001 Dec 22;191(12):655-9

Authors: Davies SJ, Gray RJ, Mackie IC

The difference between paediatric dentistry and most other branches of dentistry is that in the child the occlusion is changing. Consequently 'Good Occlusal Practice' in children is a matter of making the right clinical decisions for the future occlusion. The clinician needs to be able to predict the influence that different treatment options will have on the occlusion when the child's development is complete.

PMID: 11792110 [PubMed - indexed for MEDLINE]

A three-part bilateral swinglock design denture revisited.

Br Dent J. 2001 May 26;190(10):538-40

Authors: Barclay CW, Russell MD, Murphy P

This case was first reported by one of the authors in 1987, subsequent to the patient being treated using a combination of a hinge and split pin sectional denture. The same patient attended for review some 14 years later for assessment of this denture at which stage a replacement was made.

PMID: 11411888 [PubMed - indexed for MEDLINE]

ABC of oral health. Dental emergencies.

BMJ. 2000 Sep 2;321(7260):559-62

Authors: Roberts G, Scully C, Shotts R

PMID: 10968824 [PubMed - indexed for MEDLINE]

Tooth avulsions resulting from basketball net entanglement.

J Am Dent Assoc. 1997 Sep;128(9):1273-5

Authors: Kumamoto DP, Winters J, Novickas D, Mesa K

The authors conducted a survey of dentists reporting tooth avulsions from basketball net accidents. Although the number of people injured was small, the dental injuries were serious. In many cases, multiple teeth were avulsed as a result of the maxillary anterior teeth becoming entangled in the basketball net while the patients were attempting to slamdunk a basketball either on a lowered backboard or from a raised take-off area. The authors present recommendations for preventing tooth avulsions resulting from basketball net entanglement.

PMID: 9297949 [PubMed - indexed for MEDLINE]

Emergency treatment of avulsed teeth.

BMJ. 1990 Aug 18-25;301(6748):386-7

Authors: Roberts GJ

PMID: 2400861 [PubMed - indexed for MEDLINE]

Use of histoacryl tissue adhesive to manage an avulsed tooth.

BMJ. 1990 Jul 7;301(6742):20-1

Authors: McCabe MJ

PMID: 2383702 [PubMed - indexed for MEDLINE]

Emergency treatment of avulsed incisor teeth.

BMJ. 1990 Jul 7;301(6742):4

Authors: Scheer B

PMID: 2256990 [PubMed - indexed for MEDLINE]

Field endotracheal intubation by paramedical personnel. Success rates and complications.

Chest. 1984 Mar;85(3):341-5

Authors: Stewart RD, Paris PM, Winter PM, Pelton GH, Cannon GM

One-hundred thirty mobile intensive care unit paramedics were trained in the technique of direct laryngoscopic endotracheal intubation of cardiac arrest or deeply comatose patients. Three attempts at intubation were permitted. Of the 779 patients studied, 701 (90.0 percent) were successfully intubated: 57.9 percent on the first attempt, 26.1 percent and 5.5 percent on the second and third respectively. Reported and observed complications of the procedure numbered 74 (9.5 percent) of the 779 patients included in the study. There were three unrecognized esophageal intubations. The success rate rose to more than 94 percent toward the end of the study. It is concluded that endotracheal intubation of deeply comatose patients is a field procedure safely and skillfully performed by well-trained and monitored paramedical personnel, with success and complication rates at least comparable to other invasive airway techniques.

PMID: 6697789 [PubMed - indexed for MEDLINE]

Traumatized anterior teeth in Iraqi and Sudanese children--a comparative study.

J Dent Res. 1981 Mar;60(3):677-80

Authors: Baghdady VS, Ghose LJ, Enke H

This epidemiological study describes the prevalence of trauma to the anterior teeth of 6090 Iraqi and 3507 Sudanese primary school children. 7.7% of Iraqi and 5.1% of Sudanese presented incisal trauma. The male to female ratio was 1.3:1 in Iraqis and 2.6:1 in Sudanese. The frequency of trauma to Iraqi females below age nine yr was higher than the males, but the condition was reversed with age. In Sudanese children the frequency was higher in males in all age groups. In general, males suffered a higher rate of trauma in both countries, but the Iraqi children had a significantly higher rate of trauma than the Sudanese in both sexes.

PMID: 6937498 [PubMed - indexed for MEDLINE]

Effects of extra-oral exposure and multiple avulsions on revascularization of reimplanted teeth in dogs.

J Dent Res. 1980 Feb;59(2):140

Authors: Sheppard PR, Burich RL

PMID: 6927997 [PubMed - indexed for MEDLINE]

Genetic and epidemiologic studies of oral characteristics in Hawaii's schoolchildren: V. Sibling correlations in occlusion traits.

J Dent Res. 1975 Mar-Apr;54(2):324-9

Authors: Chung CS, Niswander JD

Sibling correlations with adjustment for age, sex, and other covariates showed the highest degree of similarity in incisor width, followed by malalignment, overjet, overbite, crowding, spacing, and crossbites. The smallest intrafamily correlations were observed in the variables in buccal segment relationship, especially in neutroclusion and idealized occlusion pattern.

PMID: 1054343 [PubMed - indexed for MEDLINE]

Restoration of teeth after facial injuries in road accidents.

Proc R Soc Med. 1972 Oct;65(10):920

Authors: Pickard HM

PMID: 4404408 [PubMed - indexed for MEDLINE]

Ash and fluoride content of normal, luxated, and transplanted rat molars.

J Dent Res. 1970 Sep-Oct;49(5):1177

Authors: Ronen E, Gedalia I, Weinreb M

PMID: 5272104 [PubMed - indexed for MEDLINE]