DENTAL TRAUMA. Public Health Aspects. IADT EDUCATION COMMITTEE / Ulf Glendor DDS, PhD

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1 DENTAL TRAUMA Public Health Aspects IADT EDUCATION COMMITTEE / Ulf Glendor DDS, PhD

2 Dental trauma takes longer to treat and is more expensive than many other bodily injuries treated on an outpatient basis (1,2).

3 Dental Trauma Affects Quality of Life An untreated dental trauma affects an individual 20 times more, compared to those who have never suffered a dental trauma (3-6). The dominating problem was chewing, eating food and school activities (3-6).

4 Prevalence of Traumatic Dental Injuries

5 The prevalence of dental trauma is still high world wide Statistics from many countries show that about:! One third of preschool children! One fourth of school children! One third of adults have suffered a dental trauma at least once during their life time (7).

6 A comparison of oral and non-oral accidental injuries in all ages during one year (8) Incidence per About 90% of all dental traumas occur before the age of 20 (8). Age Age

7 Proportion of accidental injuries in the age interval 0-30 years during one year (8) Per cent Oral 5 %.

8 Incidence of Traumatic Dental Injuries

9 Incidence of dental trauma by age and gender (9) Incidence / Incidence: 13 / / year Boys Girls < Years

10 Repeated Traumatic Dental Injuries

11 During a 12-year period (age interval 6-18 years) (10) :! 49% of school children with a dental trauma suffered more than one dental trauma event.! In average these patients suffered 2.9 episodes during the 12-year period.! There was no significant difference in gender or severity regarding number of dental trauma events.! 45% of those patients who suffered more than one trauma event injured the same tooth again.

12 Number of dental trauma events and age (10) Mean age at first dental trauma episode to permanent teeth related to number of episodes per patient during a 12-year period ( ) Number of trauma episodes per patient Number of patients Age at first episode (3.6) 8.6 (1.9) 8.9 (2.5) 8.0 (1.6) 8.6 (2.1) 1 Standard deviations within parentheses. The risk of receiving more dental trauma events increased significantly (8.4 times) if the first event occurred at 9 years of age instead of at 12 years of age.

13 Accident Sites Predisposing Factors and Etiology

14 Predisposing factors of dental traumas (11)! Overjet with protrusion! Inadequate lip coverage / closure

15 Causes of dental traumas (11)! Falls! Collisions! Being struck by an object! Material deprivation! Emotionally stressful states (non-nuclear family, paternal abuse)! Mobbing! ADHD! Epilepsy! Cerebral palsy! Learning difficulties! Hearing or visual impairment

16 Continued! Child and elderly physical abuse! Assaults! Torture! Inappropriate use of teeth! Oral piercing! Extreme sports! Iatrogenic injuries

17 Sports is an important cause of dental trauma (8) Place of injury related to age and gender (in percent) years Male Female All Traffic Around home School Sports stadium Other years Male Female All Traffic Around home Work Sports stadium School Spare time/pleasure Other

18 When Do Most Traumatic Injuries Happen?

Time of day of oral injuries in the age interval 0-30 years during one year (8) 40 35 30 2 out of 3 individuals in the age interval 16-30

19 Time of day of oral injuries in the age interval 0-30 years during one year (8) out of 3 individuals in the age interval years were injured between hours. Per cent years 7-15 years years Other

20 Day of week of oral and non-oral injures in the age interval during one year (8) out of 3 individuals in the age interval years with oral injuries were injured at week ends. Per cent Oral Non-Oral 5 0 Mon Tues Wed Thur Fri Sat Sun

21 A comparison of resources spent between dental trauma and other bodily injuries

22 A comparison between dental trauma and other bodily injuries concerning average number of visits per individual (1,12) Dental trauma Glendor et al A 2-year prospective study of patients 6-19 years of age (12). Other bodily injuries Lindqvist & Brodin 1996 A 1-year retrospective study including all ages (1). Uncomplicated dental injuries * Permanent teeth Complicated dental injuries ** Other bodily injuries treated at outpatient care * Uncomplicated=the pulpal tissue is not exposed and the tooth is not dislocated. ** Complicated=exposure of the pulpal tissue and/or dislocation of the tooth. 1.5

23 Treatment costs of dental trauma (US$) (13-15) Study Primary teeth Permanent teeth In- resp. out patient care In- and out patient care Non-oral: children or in all ages Uncompl. Compl. Uncompl. Compl. Glendor et al (13)* Borum & Andreasen 2001 (14)* Standard Pessimistic Wong & Kolokotsa 2004 (15) ** * During a period of 2 years. ** During a period of 11 years. Treatment costs of non-oral injuries (US$) (13) Sweden Netherlands USA Children All ages Out patient care All ages

24 Knowledge among lay people and professional care givers in how to act at the scene of a dental trauma is scarce

25 Many people lack knowledge (16)! Children and adolescents! Parents! Physical trainers and active sportsmen! School- and physical teachers! Acute medical staff at emergency centres! Medical students! Doctors! School nurses! Fire brigades, ambulance personnel! Lay people! Correct and sufficient information about dental trauma in First Aid Textbooks and manuals is lacking.

26 What has been done recently to increase knowledge among lay people and care givers? (17)! Short lessons including discussion about replantation of a totally luxated tooth.! Distribution of brochures and posters about Dental First-aid.! Telemedical.! Manuals in waiting rooms. Lessons and manuals must be repeated / updated regularly, which is costly and time-consuming.! Today lay people prefer to use the following methods to look for knowledge:! Internet! Dental personnel! Television

27 ! The following is known:! The main part of year olds are injured outside working hours (evenings and weekends) when many emergency dental clinics are closed.! Which means:! Those who are present at the scene of a dental accident are the first to take care of the injured person.! If acute clinics are closed they must take care of the dental trauma until they reach an opened dental clinic.

28 Does it pay off to act correctly already at the scene of a dental accident?

29 The prognosis of an avulsed permanent front tooth (18) The estimated risk (%) of losing a replanted permanent tooth with a fully root formation and a closed apex Time and type of storage medium before replanting Dry storage time before replanting: Dry storage no more than 4 minutes followed by a correct transport medium like MILK, SALIVA or SALINE. Estimated risk for a lost tooth after: 1 year 3 years 10 years 0-4 minutes 1.5% 5.5% 21.5% 5-60 minutes 1.1% 13.9% 44.3% 61+ minutes % 70.1% 2.1% 7.5% 26.4%

30 Looking for knowledge at Internet Many people of today use the Internet to look for knowledge. Tools to help the searcher to secure relevant information are still lacking in dentistry. A recently published paper compared information about mouth guards found at Internet and published in scientific papers at Pub Med, which are not easily reachable for lay people.

31 Surfing for mouth guards: assessing quality of online information (19) M & M. Internet search, two scoring systems. Results. Of 223 websites, 39 were designated valid and evaluated. The Public Institution Web site (Health Canada) presented 31 out of 34 scores. Conclusion. There is a high amount of information about mouth guards on the Internet but the quality varies. It should be the responsibility of health care professionals to suggest and provide reliable Internet URL addresses to patients. An appropriate search terminology and search strategy should be made available to persons who want to search beyond the recommended sites.

32 Internet (20,21)! It is easy to distribute GuideLines via Internet.! The dental institutions have to suggest and provide lay people and other care givers with suitable dental links.! Dental applications, e.g. in smartphones, could easily reach a person anywhere with information concerning a dental trauma already at the scene of an accident.! When the application is downloaded to the smartphone there is no need for Internet. Updates are free and are sent automatically to the app.! The app DENTAL TRAUMA is a Dental First Aid app which is endorsed by the International Association of Dental Traumatology (IADT). This app can be found on IADT homepage, on App Store and Google Play.

33 The app DENTAL TRAUMA Presented in 18 languages

34 The target groups of the DENTAL TRAUMA app! Parents! School personnel! Sports or physical trainers! Emergency personnel at hospitals or clinics! Ambulance/Fire brigades/police! Receptions in dental clinics! and probably more.

35 Conclusion! The prevalence of dental trauma is still on a high level worldwide.! A dental trauma affect quality of life.! Dental traumas are costly and time consuming to treat.! Dental trauma events often occur outside office time, which may result in a worsened prognosis.! The knowledge about how to act at the scene of a dental accident is of major importance, especially concerning avulsed permanent teeth.! The IADT GUIDELINES and the DENTAL TRAUMA First Aid app are of great help to inform about how to professionally treat a dental trauma, and what to do at the scene of accident and later at home.

36 Thank you for listening

37 References 1. Lindqvist KS, Brodin H. One-year economic consequences of accidents in a Swedish municipality. Accid Anal Prev 1996;28: Glendor U, Halling A, Bodin L, Andersson L, Nygren Å, Karlsson G, Koucheki B. Direct and indirect time spent on care of dental trauma: a 2-year prospective study of children and adolescents. Endod Dent Traumatol 2000;16: Cortes MI, Marcenes W, Sheiham A. Impact of traumatic injuries to the permanent teeth on the oral health-related quality of life in year-old children. Community Dent Oral Epidemiol 2002;30: Giannetti L, Murri A, Vecci F, Gatto R. Dental avulsion: therapeutic protocols and oral health-related quality of life. Eur J Paediatric Dent 2007;8(2): Porritt J, Rodd HD, Baker SR. Quality of life impacts following childhood dento-alveolar trauma. Dent Traumatol 2011;27: Viegas CM, Paiva SM, Carvalho AC, Scarpelli AC, Ferreira FM, Pordeus IA. Influence of traumatic dental injury on quality of life in Brazilian preschool children and their families. Dent Traumatol 2014 Oct;30(5): Glendor U. Epidemiology of traumatic dental injuries a 12-year review of the literature. Dent Traumatol 2008;24: Eilert-Petersson E, Andersson L, Sörensen S. Traumatic oral vs. non-oral injuries. An epidemiologic study during one year in a Swedish county. Swed Dent J 1997;21: Glendor U, Halling A, Andersson L, Eilert-Peterson E. Incidence of traumatic tooth injuries in children and adolescents in the county of Västmanland, Sweden. Swed Dent J 1996;20: Glendor U, Koucheki B, Halling A. Risk evaluation and type of treatment of multiple dental trauma episodes to permanent teeth. Endod Dent Traumatol 2000;16: Glendor U. Aetiology and risk factors related to traumatic dental injuries a review of the literature. Dent Traumatol 2009;25: Glendor U, Halling A, Bodin L, Andersson L, Nygren Å, Karlsson G, Koucheki B. Direct and indirect time spent on care of dental trauma: a 2-year prospective study of children and adolescents. Endod Dent Traumatol 2000;16: Glendor U, Jonsson D, Halling A, Lindqvist K. Direct and indirect costs of dental trauma in Sweden: a 2-year prospective study of children and adolescents. Community Dent Oral Epidemiol 2001;29: Borum MK, Andreasen JO. Therapeutic and economic implications of traumatic dental injuries in Denmark: an estimate based on 7549 patients treated at a major trauma centre. Int J Paediatr Dent Jul;11(4): Wong FSL, Kolokotsa K. The cost of treating children and adolescents with injuries to their permanent incisors at a dental hospital in the United Kingdom. Dent Traumatol 2004;20: Glendor U. Has the education of professional caregivers and lay people in dental trauma care failed? Dent Traumatol 2009;25: Al-Sane M, Bourisly N, Almulla T, Andersson L. Laypeoples preffered sources of health information on the emergency management of tooth avulsion. Dent Traumatol Dec;27(6): Magunacelaya MB, Glendor U. Surfing for mouth guards: assessing quality of online information. Dent Traumatol 2011;27:

Knowledge of first aid measures of avulsion and replantation of teeth in Nigerian school children.

ISPUB.COM The Internet Journal of Dental Science Volume 7 Number 1 Knowledge of first aid measures of avulsion and replantation of teeth in Nigerian school children. C Adekoya Sofowora, E Oziegbe, V Ugboko,