Dental Traumatology最新文献

Objective: Traumatic dental injury (TDI) is the world's fifth most common injury affecting children and adolescents. This study aimed to predict TDI based on ear problems and other factors among Australian children aged 4 years or over.

Methods: We used two longitudinal studies: the Longitudinal Study of Indigenous Children (LSIC) and the Longitudinal Study of Australian Children (LSAC). The outcome was the prevalence of TDI in children aged 14 years. We assessed 50 features, including demographic characteristics, health conditions (such as ear diseases) and health-related behaviours of the children, their parents, and other family members in children aged 4-6 years. The performance of machine learning algorithms was evaluated using the area under the receiver operating characteristic curve (AUC) with its 95% confidence interval, along with sensitivity (recall), specificity, precision (positive predictive value), F1 score (the harmonic mean of sensitivity and precision) and accuracy (the proportion of correct predictions). These metrics were evaluated for the full sample and separately for Indigenous and non-Indigenous subgroups, using both the full sample and stratified models. A sensitivity analysis was performed to compare model performance across the groups.

Results: This study included 1746 Indigenous and 8357 non-Indigenous children and their parents and family members. The prevalence of TDI among Australian children at age 14 was approximately 13%. The full sample model applied to the full sample and the non-Indigenous subpopulation demonstrated high predictive performance, with AUCs of 0.85 (95% CI: 0.82-0.88) and 0.86 (95% CI: 0.82-0.89), respectively. In contrast, the model applied to the Indigenous subpopulation demonstrated lower performance, with AUC values ranging from 0.76 (95% CI: 0.68-0.83) in the full sample model to 0.80 (95% CI: 0.70-0.83) in the stratified model.

Conclusions: Our findings indicated that early childhood ear problems were strong predictors of traumatic dental injuries in Australian children.

Aim: This study aims to assess the impact of visual case scenarios on parental awareness and urgency perception regarding enamel-dentin fractures in children.

Methods: This descriptive study included parents of children aged 4-14 who were receiving active dental care. Data were collected via a structured questionnaire, which consisted of two sections: demographic characteristics and general knowledge questions, and visual case-based scenarios to evaluate trauma perception. Statistical analysis was conducted using descriptive methods and chi-square testing. Internal consistency was assessed using Cronbach's alpha.

Results: A total of 317 participants participated in the study; 65.9% of the participants were mothers and 56.8% had female children. A history of dental trauma was reported by 11.7% of parents. Regarding information sources, 50% relied on dentists or healthcare professionals, and 30.1% used the Internet. After a traumatic event, 42% preferred consulting a pediatric dentist, while 25.2% would visit a general dentist. 62.1% of participants could distinguish between primary and permanent teeth, but only 45.1% believed that the tooth type (primary or permanent) influenced treatment decisions. Regarding trauma concerns, 62.8% prioritized treatment for anterior teeth due to the risk of future complications. 96.8% acknowledged that the time elapsed since the trauma could affect treatment outcomes, and 72.2% considered fracture size important in treatment decisions. Furthermore, 87.1% did not view posterior tooth fractures as concerning as anterior ones.

Conclusion: This study highlights significant gaps in parental knowledge about pediatric dental trauma, stressing the need for improved education on trauma severity, timely intervention, and the impact of fracture size and tooth type on treatment.

Objectives: The purpose of this study was to evaluate the impact of a case-based hands-on training session on dental students' self-perceived competence in managing traumatic dental injuries (TDI) using an innovative 3D-printed model.

Methods: Fifth-year undergraduate students were invited to voluntarily participate in a hands-on training on dental traumatology. Participants worked through a case-based multi-injury trauma using a specially designed 3D-printed model, allowing them to practice examination, diagnosis, and treatment procedures in a realistic clinical scenario. A questionnaire evaluating self-perceived competence in various TDI management domains was conducted immediately before, directly after, and 12 months after the training. Pre- and post-training scores were analyzed statistically.

Results: A total of 42 students participated in the training over two consecutive years. Thirty students participated in the evaluation 12 months after the training. Participants demonstrated a statistically significant increase in self-perceived competence for most assessed areas directly after the training, which kept true even after 12 months. The only exception was "worries about complications during clinical management," which showed no significant change.

Conclusion: Simulation-based hands-on training substantially enhanced dental students' self-perceived competence in managing TDI.

Background: Searching online for dental emergency treatment as a non-expert can lead to unreliable guidance. We tested the publicly available first multimodal large-language model, ChatGPT-4o, prospectively with real emergency-department avulsion cases to determine if it would deliver guideline-correct, time-critical directions within seconds.

Methods: Seventy-eight anonymized avulsion charts (42 permanent, 36 primary teeth; 39 dry, 39 moist; 40 immature roots) were rewritten as lay prompts. ChatGPT-4o created two single responses to each vignette, 14 days apart (156 responses). Three oral and maxillofacial surgeons (OMFS) scored diagnostic accuracy, immediate action, contraindication identification, and completeness. Three lay assessors scored clarity (0-15 composite rating). An additional time-critical safety flag required simultaneous accuracy in immediate action and contraindication advice. Statistical analysis was performed at a 95% confidence level.

Results: ChatGPT-4o demonstrated significant rates of accurate guidance. Inter-rater reproducibility was near perfect (ICC = 0.94; κ = 0.88-0.998). The median composite score was 13 (IQR 12-14); permanent dentition elevated the probability for perfect diagnostic, contraindication, and immediate-action scores (p ≤ 0.046), but extra-oral dry time lowered immediate-action (p = 0.003) and reduced completeness (p = 0.023). Root maturity had no effect. Clarity was rated at more than 93% in both sessions. The safety flag was present in 81% and 89% of cases (χ² = 6.73, p = 0.009), with one in eight potentially unsafe situations.

Conclusions: This first clinical validation of ChatGPT-4o demonstrates expert-level, reproducible triage for tooth avulsion and introduces the "time-critical safety" composite as a strict benchmark for emergency chatbots. There is still a need for guideline-linked retrieval before unsupervised deployment. Clinically, these findings show that while ChatGPT can offer quick and largely accurate advice, the remaining deficiencies highlight the risk of incomplete or unsafe guidance during emergencies.

Background: Dental erosion, the irreversible loss of enamel due to acid exposure, is increasingly observed among adolescents and athletes, primarily due to frequent consumption of acidic energy and sports drinks. These beverages, while marketed for performance enhancement, can lead to significant enamel demineralization, especially under reduced salivary flow during intense activity. This in vitro study evaluated the erosive potential of commercially available energy and sports drinks on human enamel and assessed the protective effects of three toothpaste formulations fluoride-based, herbal based and NovaMin-based.

Materials and methods: Forty extracted human premolars were randomly divided into four groups (n = 10): Group I (fluoridated toothpaste), Group II (Herbal toothpaste), Group III (NovaMin-based toothpaste), and Group IV (erosion control, no brushing). Baseline surface micro-hardness was measured using the Vickers hardness test. Following brushing simulation, specimens were exposed to Monster Energy and Gatorade for seven days. Post-treatment micro-hardness was assessed and data were analyzed statistically.

Results: All test groups showed significantly higher enamel micro-hardness compared to the control group. A significant increase in Mean Vickers Hardness Number was observed from baseline to post-treatment across all test groups. Pepsodent Germicheck (fluoridated toothpaste) showed the greatest protective effect, with mean post-treatment hardness values of 176.11 (Monster Energy) and 165.18 (Gatorade), with corresponding mean differences of 91.82 and 102.75 (p = 0.01).

Conclusion: Fluoride and NovaMin toothpastes significantly reduce enamel erosion from acidic drinks. Herbal dentifrices offered limited protection. Preventive strategies, including remineralizing toothpaste use and awareness of beverage acidity, are essential to combat dental erosion.

Background/aim: This study aimed to investigate the prevalence and characteristics of orofacial-dental trauma (OT) among 582 child athletes (aged 6-16) in Damascus, Syria.

Material and methods: Data were collected through structured interviews and a 13-item questionnaire administered between December 2023 and December 2024. The questionnaire included information about demographics, sports participation, injury history (including both soft and hard tissue injuries), mechanisms of injury, and use of protective gear. A pilot study confirmed the reliability of the questionnaire with a Cronbach's alpha of 0.829. A two-stage sampling method was employed, which involved randomly selecting clubs from a list provided by the General Sports Federation and then randomly sampling 20% of players from each club.

Results: The overall prevalence of OT was found to be 45.5%. Age and type of sport significantly affected injury patterns; although males exhibited a slightly higher prevalence, this difference was not statistically significant. The highest injury rate (52.5%) was seen among athletes with 1-5 years of experience. The 12-16 age group was more likely to experience extra-oral soft tissue injuries (39%), followed by dental injuries (23.5%). Falls were identified as the most frequent mechanism of injury, with the highest injury rates (53.2%) occurring during training sessions. Overall, the use of protective gear was low (27.3%), and while injured athletes were less likely to use such gear, this difference was not statistically significant.

Conclusions: This study highlights the significant burden of OT among young athletes in Damascus and emphasizes the urgent need for improved prevention strategies, particularly promoting the use of protective gear.

Aim: Tooth fracture is one of the most common complications of dental trauma, which needs to be addressed on an emergency basis. The pressing demand for reliable information has prompted both professionals and laypersons to turn to video-sharing platforms like YouTube and Vimeo for guidance regarding the management of tooth fractures among local users. These platforms have emerged as significant sources for advice on dental emergencies; however, the trustworthiness and precision of the information provided have not been thoroughly examined. This research sought to evaluate the quality, accuracy, and reliability of videos on YouTube and Vimeo that address the management of tooth fractures.

Materials and methods: A search was conducted on YouTube and Vimeo between November 11, 2024, and February 27, 2025, using terms related to the management of tooth or dental fractures, and 92 videos were included for analysis. Demographic information for the videos, including platform, length, category, upload date, number of likes, and comments, was documented. The assessment of video content quality, reliability, and accuracy was conducted utilizing the Global Quality Scale (GQS), benchmarks from the Journal of the American Medical Association (JAMA), and the Video Information and Quality Index (VIQI).

Results: In total, 92 videos were examined. The average scores were JAMA: 3 ± 1, modified DISCERN: 53 ± 11, GQS: 3 ± 1, and VIQI: 5 ± 1. Statistically significant differences were observed across video types in key parameters such as the DISCERN score (YouTube: p = 0.002; Vimeo: p < 0.001), JAMA benchmark (YouTube: p = 0.045; Vimeo: p = 0.002), GQS, VIQI, and overall video evaluation (p < 0.001), emphasizing that video format, video posted, target audience, and platform influence educational impact. With the highest mean views (983,441) and significantly elevated DISCERN (63 ± 9) and JAMA scores (3 ± 1), actual procedure videos exemplify strong informational reliability and public trust.

Conclusion: The research indicates that, although the majority of the videos on managing tooth fractures are produced by dental professionals, their overall quality is subpar. This highlights the potential dangers of relying on misleading or insufficient information in these important circumstances.

Aim: To critically evaluate existing systematic reviews to assess the current status of vital pulp therapy (VPT) for managing traumatic pulpal exposures in permanent teeth.

Methods: A comprehensive literature search of multiple electronic databases was conducted for systematic reviews published until November 30, 2024, without language restrictions. Eligible reviews assessed the clinical effectiveness of VPT compared to alternative treatments or no intervention. Reviews that included case reports, laboratory studies, animal studies, and narrative reviews were excluded. The methodological quality was assessed using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR)-2 tool, while the overlap among primary studies was quantified using the covered area and corrected covered area metrics.

Results: Four systematic reviews and meta-analyses, incorporating 32 primary studies, met the inclusion criteria. The overlap among primary studies was 18.75%, indicating a high degree of overlap. AMSTAR-2 revealed that all included reviews had a critically low level of confidence due to limitations in search strategies, inconsistency in risk of bias assessment, and lack of reporting of primary study funding sources. Despite these limitations, VPT demonstrated promising outcomes, with partial pulpotomy achieving higher success rates than direct pulp capping and emerging as the preferred approach for immature and mature permanent teeth with complicated crown fractures. However, conflicting evidence prevented definitive conclusions regarding the superiority of pulpotomy over pulp capping with calcium hydroxide Ca(OH)₂ or mineral trioxide aggregate (MTA). Additionally, no significant differences were observed between bioceramic materials and Ca(OH)₂ in pulpotomy cases.

Conclusion: Partial pulpotomy appears to be a promising treatment for traumatic pulp exposures in permanent teeth; however, the current evidence base, characterized by critically low AMSTAR-2 ratings, remains insufficient to support definitive clinical recommendations. Given the conflicting and low-quality evidence on the preferred material and the high overlap of primary studies among the included reviews, well-designed randomized controlled trials with long-term follow-up are essential for definitive clinical recommendations.

Trial registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42025650026.