The association of inadequate lip coverage and malocclusion with dental trauma in Brazilian children and adolescents – A systematic review and meta‐analysis

Abstract

Background/Aim: Dental trauma (DT) occurs frequently in children and adolescents.Therefore, understanding the factors associated with its occurrence in these age groups is important to establish specific preventive measures. The aim of this study was to investigate the relationships of lip coverage, overjet, and open bite to dental trauma in Brazilian children and adolescents. Material and methods:The review protocol was registered in the PROSPERO database (CRD42020156290) and the bibliographic search was performed in nine electronic databases until July 2020. The studies included were observational, performed in Brazil, with healthy children and adolescents (0-19 years old), and without the restriction of date or language. Two reviewers assessed the individual risk of bias of the eligible studies with a standardized checklist. The meta-analyses were stratified by dentition stage and age range using fixed or random effects, odds ratio (OR) as the effect measure, and 95% confidence interval. The heterogeneity across studies was assessed with the I² test and the GRADE approach assessed the certainty of evidence. Results: The search presented 2493 initial results, from which 55 met the eligibility criteria and were included. Most studies (67%) presented a low risk of bias and were published between 2000 and 2019. Children and adolescents with inadequate lip coverage are 1.86-2.36 times more likely to suffer from DT, while those with increased overjet are 1.94-3.11 times more likely. Children with primary dentitions and anterior open bites are 1.76 (95% CI: 1.20-2.59) times more likely to suffer from DT. The certainty of evidence varied from very low to moderate. Conclusions: Inadequate lip coverage, increased overjet, and anterior open bite are associated with the occurrence of dental trauma in Brazilian children and adolescents.

Traumatic dental injuries in the primary lower incisors

“…In this study, the prevalence of severe TDI in the primary lower incisors was 1.7 times as high in children presenting with an anterior crossbite. Even though this result was not statistically significant, we believe that this is the first time that this type of occlusion presents an association with TDI occurrence, as previous studies have investigated TDI in upper teeth and reported only other malocclusions as factors associated with TDI, for example, increased overjet and anterior open bite 18 . The lack of significant association in our result may be related to the limited number of cases of anterior crossbite, which can be explained by the low occurrence of anterior crossbite in the primary dentition 19 or because the highest incidence of TDI occurred in very young children who presented with an incomplete dentition.…”

“…Even though this result was not statistically significant, we believe that this is the first time that this type of occlusion presents an association with TDI occurrence, as previous studies have investigated TDI in upper teeth and reported only other malocclusions as factors associated with TDI, for example, increased overjet and anterior open bite. 18 The lack of In the teeth that suffered hard and support tissue trauma, both types of trauma were considered separately. b From the 208 teeth included, 95 were not followed up until complete eruption of the permanent successor.…”

Dental trauma and oral health-related quality of life among 7th-grade students of public elementary schools

“…A critical review of risk factors for dental trauma in the permanent dentition of the Brazilian population showed inadequate lip coverage as a predisposing factor for traumatic injuries 11 . A recent Brazilian systematic review also found a positive association between lip coverage and dental trauma, in which children and adolescents with inadequate lip coverage were more likely to present dental trauma 12 . Almost all students (94.6%) in this study showed adequate lip coverage fully covering the anterior teeth.…”

“…A recent systematic review and meta-analysis showed a significant association between ≥5 mm overjet in permanent dentition and dental trauma 34 . A Brazilian systematic review also found a significant association between ≥3 mm and ≥5 mm overjet and dental trauma in permanent teeth, which is the main risk factor for traumatic dental injuries 12 . The present study dichotomized overjet by the median of 2.5 mm (Table 1), which could partially explain the absence of significant association with trauma.…”

“…The most frequent risk factors associated with traumatic injuries in the permanent dentition of the Brazilian population have been sex (male), severe overjet, inadequate lip coverage, and obesity 11 . Two recent Brazilian systematic reviews also showed a higher dental trauma prevalence in male children and adolescents 10 and that lip coverage and overjet were the main risk factors 12 . Furthermore, contact sports practice has also represented a significant variable associated with traumatic injuries in permanent dentition 13,14 .…”