Risk factors for traumatic dental injuries in the primary dentition: concepts, interpretation, and evidence

Abstract

The purpose of this comprehensive review is to explore the main concepts related to quantification and interpretation of risk factors and investigate characteristics associated with traumatic dental injuries (TDI) in the primary dentition. Initially, the main concepts related to causality and risk factors were summarized, including how to measure, express, and compare risk as well as interpret statistical significance. Based on a structured search through PubMed, original research articles regarding TDI and associated factors in the primary dentition were then reviewed by two examiners. Studies with a sample size of at least 300 children aged between 0 and 6 years were summarized according to journal, country, study design, and type of statistical analysis. Variables associated with TDI in primary teeth were identified from studies with multivariable analysis. Measures of effect size and P values were presented. Thirty-two studies were retrieved: most were cross-sectional in design and only 17 (53.1%) performed multivariable analysis. Most investigations did not find an association between gender and socioeconomic variables with TDI. Increased overjet was the only factor consistently identified as an associated factor. Behavioral characteristics have been recently investigated and suggested as potential risk factors for TDI in the primary dentition. In conclusion, increased overjet is undoubtedly associated with TDI in the primary dentition. As behavioral factors may be targeted by preventive strategies, their role on TDI occurrence should be clarified in future cohort studies. Clinicians should understand the terms and measures described in studies on risk factors to properly apply knowledge and benefit patients.

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

“…However, this association is only consistent for older age groups, in which behavioral differences between genders are more evident. Although a statistically significant difference was found in the present study, it may not be clinically relevant, as it may not be large enough to warrant greater care or orientations given to the parents of male preschoolers …”

“…Although a statistically significant difference was found in the present study, it may not be clinically relevant, as it may not be large enough to warrant greater care or orientations given to the parents of male preschoolers. 4 This study has limitations that should be considered. The considerable proportion of dropouts during the follow up may have influenced the results in an unknown manner.…”

“…1,2 Such interventions should be based on the identification of risk factors for this outcome. To date, only accentuated overjet has been consistently recognized as a risk factor for TDI among preschool children, 3,4 which at least partially explains the absence of TDI prevention protocols at the individual and collective levels.…”

Eden Baysal Dental Trauma Index: Face and content validation

“…Studies reporting the epidemiologic data on TDI are limited to the information obtained from cross‐sectional and prospective studies and the methodology on how the information is gathered is not clear . For example, the prevalence of TDI in the primary dentition ranges between 6.2% and 47% in the literature . Shekhar et al reported a prevalence of 6.2% in India .…”

“…1,5,7 For example, the prevalence of TDI in the primary dentition ranges between 6.2% and 47% in the literature. 12 Shekhar et al reported a prevalence of 6.2% in India. 13 A study on 1-to 3-year-old children on previous TDI experience during a vaccination campaign was reported as 41.6%, 14 whereas it was even higher as 60.5% when radiographic evaluation was included.…”