BACKGROUND/AIM:Wrestling is a high-intensity contact sport in which head, neck, and oral injuries occur frequently. However, comprehensive investigations specifically focusing on dental trauma among wrestlers remain limited. The aim of this study was to assess the prevalence of dental trauma and history of head and neck injuries among wrestlers who participated in the 2022 National Sports Festival in Japan. MATERIAL AND METHODS:All 659 athletes who entered the wrestling competition at the 77th National Sports Festival (Tochigi, 2022) were invited to complete an anonymous questionnaire regarding their history of dental trauma, as well as head and neck injuries. A total of 500 valid responses were obtained (response rate: 76%). Data were analyzed using the Steel-Dwass and Mann-Whitney U tests, with the significance level set at p < 0.05. RESULTS:Of the respondents, 89% reported a history of injuries. The most common oral injuries included lip lacerations (86%), tongue lacerations (67%), tooth fractures (30%), and tooth dislocations (11%). Head and neck injuries involved neck injuries (31%) and concussions (25%). No significant differences were observed between wrestling styles in terms of injury prevalence. Adult wrestlers showed a significantly higher prevalence of dental injuries, neck injuries, and concussions than under 18 wrestlers. In addition, a history of injuries was significantly associated with wrestling experience, with longer competitive careers corresponding to a higher prevalence of injuries. CONCLUSIONS:This survey demonstrated that dental trauma and head and neck injuries are highly prevalent among wrestlers, particularly in adult athletes and those with longer competitive experience. Such injuries may negatively affect quality of life and athletic performance. These findings underscore the importance of early mouthguard use and injury prevention education to reduce the risk of trauma in wrestlers.
Scuba diving exposes teeth, dental restorations and prosthetic devices to substantial hyperbaric mechanical stress. Dental barotrauma (pressure-induced structural injury) and barodontalgia (pressure-induced dental pain) are oral complications that remain underdiagnosed in routine dental practice, despite their capacity to cause acute pain, restoration failure and in-water emergencies. Gas entrapped within defective restorations, incompletely obturated root canals or poorly adapted prostheses responds to pressure change according to Boyle's law, generating forces that can fracture tooth structure or displace restorations, while barodontalgia reflects the activation of pressure-sensitive nociceptors within inflamed pulpal or periapical tissue. This comprehensive review, reported with attention to the SANRA quality criteria, synthesises current evidence on the pathophysiology, clinical manifestations, risk factors, epidemiology and preventive and restorative management of these conditions. Reported barodontalgia prevalence ranges from roughly 10%-19% in civilian and recreational diver surveys to markedly higher rates of dental or orofacial pain in some military naval cohorts. Epidemiological data are sparse, particularly from low- and middle-income countries, and no international dental professional body has issued clinical practice guidelines for divers. Evidence-based management centres on pre-dive dental assessment, durable restorative seals and structured post-procedure diving-restriction protocols. In patients who actively dive, particularly those presenting with unexplained pressure-associated dental pain or recurrent restorative complications, dental practitioners should consider diving exposure as part of the clinical history and apply targeted preventive and restorative measures. Prospective studies and, in due course, consensus guidance would help reduce the burden of diving-related dental complications.
BACKGROUND/AIM:Learning traumatic dental injury management is challenging for dental students. Although clinical guidelines provide structured recommendations, it remains difficult to translate theoretical knowledge into clinical decision-making for complex trauma cases. Various types of simulation are increasingly used in dental education and may represent a valuable approach for improving training in dental traumatology. The aim of this systematic review was to evaluate the use of simulation-based education in dental traumatology among dental students, focusing on knowledge acquisition, clinical performance, and self-confidence. MATERIALS AND METHODS:Following PRISMA guidelines, a systematic search was conducted in the MEDLINE/PubMed and Scopus databases in January 2026, with prior registration on PROSPERO (CRD420261296263). Inclusion criteria targeted studies involving dental students and evaluating simulation-based training in dental traumatology, in English, reporting on knowledge, performance, or self-confidence. The risk of bias was evaluated using the Risk of Bias in Non-randomized Studies of Interventions and the Risk of Bias in Randomized Trials tools. RESULTS:Out of 880 records initially identified, six studies met the inclusion criteria. All six studies investigated procedural simulation through hands-on training using physical models. Simulation-based training was consistently associated with improvements in knowledge, clinical performance, and self-confidence in managing traumatic dental injuries. However, all studies operated at Kirkpatrick levels 1-2, and three presented a high risk of bias. CONCLUSIONS:Simulation-based training in the management of traumatic dental injuries shows preliminary potential educational benefits, particularly in terms of students' self-confidence and perceived competence. However, all included studies assessed outcomes only at the first two levels of the Kirkpatrick model, with no assessment of clinical behavior change or patient outcomes. Greater diversity in simulation modalities and improved standardization of simulation protocols are needed. Simulation scenarios should be better aligned with established frameworks used in healthcare simulation-based education. Moreover, future studies evaluating simulation in dental education would benefit from more rigorous methodological designs and standardized outcome measures.
BACKGROUND/AIMS:Traumatic dental injuries (TDIs) frequently present with acute symptoms, yet many adverse outcomes manifest months or years later as medium- and long-term consequences. These sequelae, such as pulp necrosis with infection of root canal system, periapical radiolucency, and external inflammatory resorption, pose significant diagnostic and therapeutic challenges. Evidence describing such healing complications as the first presenting complaint remains limited. The aim of this study was to describe the pattern of such complications in children and adolescents reporting to a tertiary care hospital and to evaluate associated patient- and injury-related factors. METHODS:A hospital-based cross-sectional study was conducted on patients aged 6-18 years presenting with a history of TDI to permanent teeth and exhibiting clinical and/or radiographic signs of medium- and long-term complications. Standardized assessment protocols were followed, including NA0D classification for injury type, Miller's criteria for mobility, thermal and electric pulp testing for pulp sensibility, and radiographic evaluation using RVG and CBCT when indicated. Medium- and long-term consequences were categorized using established criteria. Statistical analysis included Student's t-test and ordered logistic regression. RESULTS:A total of 185 participants (218 teeth) were evaluated. Maxillary central incisors were most frequently affected (39.9%). The predominant injuries were enamel-dentin fractures (43.1%) and complicated crown fractures (41.3%). The most common medium- and long-term consequences were periapical radiolucency (90.3%), pulp necrosis with infection of root canal system (77.1%), and external inflammatory resorption (67.4%). Delay in reporting showed significant associations with discoloration, tenderness on percussion, and external inflammatory resorption (p < 0.01). Type of injury was significantly associated with multiple complications. Root maturity and age showed limited association. CONCLUSION:Medium- and long-term complications of TDIs predominantly involved pulp necrosis with infection of root canal system, apical pathology, and external inflammatory resorption. Longer delays in seeking care significantly increased the likelihood of adverse outcomes. The findings highlight the need for improved awareness, early emergency management, and future research focusing on combined injury patterns to better predict long-term prognosis.
BACKGROUND/AIMS:The growing use of generative artificial intelligence, especially chatbots, has motivated researchers to test the accuracy of health advice provided. Though there are studies comparing chatbot health advice for traumatic dental injuries (TDI), variable results have been reported. Hence, this systematic review aimed to assess contemporary chatbots for their ability to accurately and reliably provide responses to different types of questions related to emergency care of TDI. METHODS:The protocol was developed using the Cochrane Handbook and the Chatbot-Assessment-Reporting-Tool (CHART) statement and registered in the Open Science Framework. A literature search, based on the research question, was conducted in PubMed, EMBASE, Scopus, and Web of Science on September 19th, 2025, without any limitations. Screening of titles and abstracts and later full text, and data extraction were performed. These steps were followed by qualitative synthesis and meta-analysis. The quality of studies was assessed using their compliance with CHART. RESULTS:The review included 10 articles published in 2024 and 2025. Seven contemporary chatbots were evaluated with different themes and types of questions. Eight of the studies showed good compliance with CHART (≥ 75%). The overall pooled accuracy was 65% (95% CI 52%-78%, I2 = 88%) in ChatGPT-3.5, 79% (95% CI 61%-93%, I2 = 88.8%) in ChatGPT-4.0, and 70% (95% CI 60%-79%, I2 = 86.4%) in Gemini. CONCLUSION:Overall accuracy of chatbot-generated advice was moderate, with substantial variation depending on the type of questions assessed. The meta-analysis demonstrated a suggestive trend of higher accuracy for ChatGPT-4.0, followed by Gemini, Copilot P, and ChatGPT-3.5. However, these findings should not be interpreted as evidence of clinical reliability, as even limited inaccuracies in emergency dental trauma advice may contribute to delayed or inappropriate management and adverse outcomes.
BACKGROUND/AIM:This study developed a deep learning-based convolutional neural network (CNN) model for detecting external root resorption (ERR) in periapical radiographs and cone-beam computed tomography (CBCT) scans, particularly in the presence of image-degrading artifacts. MATERIAL AND METHODS:A total of 480 bovine incisors were allocated into four experimental conditions (n = 120) according to the presence and absence of root canal treatment and ERR. Resorption defects were made 5 mm from the root apex using a round diamond bur. All specimens were imaged using periapical radiography and CBCT under standardized acquisition protocols. CBCT images were processed using a post-processing CBCT software, with and without the Blooming Artifact Reduction (BAR 1) algorithm, and with a volumetric rendering reconstruction tool. A pre-trained AlexNet CNN was adapted using transfer learning for four-class image classification. The CNN performance was evaluated using standard classification metrics, including overall accuracy, precision, recall, and F1-score. RESULTS:CNN performance varied across imaging modalities. Periapical radiography yielded perfect classification (100% accuracy). High accuracy was also observed for CBCT without BAR 1 (95.83%) and CBCT with BAR 1 (97.92%). CBCT with three-dimensional reconstruction showed reduced performance (73.96%), particularly in endodontically treated teeth without root resorption. CONCLUSIONS:Deep learning-based CNN model demonstrated high diagnostic performance for detecting ERR, strongly influenced by image acquisition and processing protocols.
BACKGROUND:Successful management of an avulsed tooth depends on preserving periodontal ligament viability during the extraoral period. Although Hank's Balanced Salt Solution (HBSS) is recommended for storage of avulsed teeth, it lacks bioactive components that actively support tissue repair. This study evaluated whether supplementation with L-ascorbic acid (L-AA) could enhance biological responses associated with periodontal healing. MATERIAL AND METHODS:Complementary in vitro and ex vivo models were used. Cultured human periodontal ligament cells were exposed to HBSS, HBSS supplemented with L-AA, or Dulbecco's Modified Eagle Medium containing fetal bovine serum. Wound closure, inflammatory cytokine expression, matrix metalloproteinase expression, and collagen type I alpha 1 chain gene and protein expression were evaluated. In the ex vivo model, 18 freshly extracted premolars were stored in the respective media for 24 h at 4°C before assessment of periodontal ligament tissue viability and gene expression. Statistical significance was set at p < 0.05. RESULTS:The optimized concentration of L-AA was 175 μg/mL. Supplementation of HBSS with L-AA resulted in significantly greater wound closure than HBSS alone. In both in vitro and ex vivo models, L-AA supplementation significantly reduced the expression of pro-inflammatory cytokines and matrix metalloproteinases while enhancing the expression of collagen type I alpha 1 chain. Although periodontal ligament tissue viability was numerically higher following supplementation, differences were not statistically significant. CONCLUSIONS:Supplementation of HBSS with L-AA favorably modulated inflammatory and extracellular matrix-related responses in cultured and ex vivo periodontal ligament tissues. Although no significant improvement in tissue viability was observed, the findings suggest potential biological benefits relevant to periodontal repair. Further studies are required to validate these findings in animal replantation models and determine their clinical relevance.
BACKGROUND/AIM:Emergency physicians are among the first healthcare professionals to manage traumatic dental injuries, yet knowledge deficiencies may compromise early care. This study evaluated emergency physicians' knowledge of traumatic dental injury management, ToothSOS awareness, and factors independently associated with overall knowledge. MATERIALS AND METHODS:This questionnaire-based cross-sectional study was conducted among emergency physicians in Turkey between April 2 and May 19, 2026. The survey assessed demographic and professional characteristics, traumatic dental injury knowledge, ToothSOS awareness, and willingness to use the application. Item-level associations were analyzed using chi-squared or Fisher's exact tests. An overall knowledge score, ranging from 0 to 8, was analyzed using univariable comparisons and multivariable linear regression. Factors associated with willingness to use ToothSOS were evaluated using multivariable logistic regression. RESULTS:A total of 208 emergency physicians were included. Correct-response rates ranged from 47.1% for the first intervention for an avulsed permanent tooth to 91.8% for identifying the most commonly affected teeth. ToothSOS awareness was 1.0%, although 79.6% of unaware participants stated they would consider using the application. The mean overall knowledge score was 5.23 ± 1.48. Previous dental trauma training and clinical exposure to traumatic dental injury cases were associated with higher scores in univariable analyses; only clinical exposure remained an independent predictor after adjustment. No factor independently predicted willingness to use ToothSOS. CONCLUSIONS:Emergency physicians demonstrated moderate overall traumatic dental injury knowledge, with deficiencies in avulsion management and referral decisions. Previous clinical exposure to such cases was the only independent predictor of higher knowledge scores, supporting structured training rather than reliance on incidental experience. Low ToothSOS awareness, despite high willingness to use it, supports integrating dental trauma education and digital decision-support tools into emergency medicine training and clinical protocols.
BACKGROUND/AIM:Although screw fixation of condylar head fractures is increasingly favored, optimal orientation strategies remain poorly defined, with limited evidence guiding intraoperative decision-making. This study compared the biomechanical behavior of four screw orientations in the fixation of type B condylar fractures. MATERIALS AND METHODS:A 3D maxillofacial model was reconstructed from CT and MRI data, incorporating a virtual type B fracture. Twelve simulations tested four distinct screw orientations across three functional occlusal biting scenarios. The stress distributions were analyzed in the screws, bone fragments, articular disc, articular surface, articular tubercle, and mandibular bone. The displacement was also recorded. RESULTS:While the first orientation (two screws parallel to each other and at 90° to the fracture line) showed the lowest screw stress (anterior: 91.8 MPa; fractured side: 113.7 MPa), the fourth performed best under non-fractured side biting (175.3 MPa). In contrast, the third orientation led to the highest stress on the screws (357.0 MPa). The first and fourth orientations minimized peak stress on the fractured-side condylar surface, whereas the second and third exhibited higher stress concentrations. Interfragmentary displacement remained < 0.06 mm across all orientations, with the first demonstrating superior micromotion control and the lowest bone stress (38.2 MPa). CONCLUSIONS:The first orientation is biomechanically optimal, minimizing hardware stress while maintaining construct stability. The fourth orientation is a viable alternative when surgical access or anatomical constraints exist. Conversely, the third orientation should be avoided due to excessive stress concentrations that predispose the construct to fatigue failure or bone resorption.
BACKGROUND/AIM:Tooth avulsion accounts for 0.5% to 16% of dentoalveolar traumas, and prognosis depends on immediate management. The International Association of Dental Traumatology developed an educational poster to guide laypeople in responding to such injuries. This study evaluated children's perceptions of the "Save a Tooth" poster and the knowledge acquired from it. MATERIALS AND METHODS:Children aged 8 to 10 years were recruited. The poster's illustrations, children's comprehension, and readability were assessed using instrument 1, while knowledge acquired about emergency management of avulsion was assessed using instrument 2. Both instruments were administered after the poster presentation. Responses to instrument 1 were analyzed by categories, and responses to instrument 2 were classified as correct or incorrect. RESULTS:A total of 58 children from third to fifth grade participated. Most children reported that the poster was easy to understand, used accessible language, presented a new topic, required only one reading, had an adequate length, and would be understandable to peers of the same age. However, participants did not identify with the characters depicted, and fourth-grade students suggested that the poster could include more illustrations. The reported frequency of dental trauma among acquaintances ranged from 36.8% to 65%. All participants expressed interest in reading similar materials. Regarding knowledge acquisition, 65% of third graders, 63.16% of fourth graders, and 66.67% of fifth graders answered the sequence of emergency procedures incorrectly. CONCLUSIONS:Although the "Save a Tooth" poster was perceived as engaging and accessible, children demonstrated limited identification with the characters and a low level of knowledge retention regarding the correct sequence of emergency management for tooth avulsion.
ABSTRACT Background/Aim Traumatic dental injuries (TDIs) are a common occurrence in children. They vary in their severity, management can be complex, and various settings may be accessed by families for management. The care pathway to manage TDIs in children varies across the UK, with little understanding of these pathways and the impact they have on children following a TDI. Aim To explore families' experience and their management pathway following a TDI to a permanent tooth in the Northwest, England. Participants and Methods Semi‐structured interviews with a family dyad took place. A sample of seven dyads each consisting of a parent and child (7–15 years old) who accessed either a dental hospital, or a children's emergency department for management of a TDI was achieved through purposive sampling. The interviews were held either face‐to‐face or using a video call platform. Reflective thematic analysis and coding of transcripts led to identification of themes. Results Four key themes with subthemes were identified: family frustration, psychological impact, information and advice, and the perceived lack of a clear pathway. There was a recurrent barrier with families feeling there was a lack of signposting for acute TDI management resulting in accessing multiple services before receiving dental management. Families highlighted a lack of knowledge amongst services, including dental professionals, on the management and pathway to treat TDIs in children. Conclusions This is the first study in the UK to explore children and their families' experience of TDI acute management. There is a need for clear regional pathways whereby families can be signposted by sports clubs, schools, medical and dental professionals to receive the appropriate care for a TDI involving children. Further education with various professionals and services in the UK is required to enable better signposting and knowledge on TDI management.
ABSTRACT Introduction Domestic abuse is a significant public health issue associated with physical harm and long‐term health consequences. Injuries involving the head, face, and oral region are among the most frequent physical manifestations, making oral and maxillofacial trauma a potentially critical indicator of abuse in clinical settings. This study aimed to examine the occurrence, demographic characteristics, and injury patterns of head and neck trauma associated with domestic abuse using provincial hospital‐based data from Saskatchewan, Canada. Methods A retrospective population‐based analysis was conducted using the Health Research Data Platform–Saskatchewan. Records from the National Ambulatory Care Reporting System (NACRS) and the Discharge Abstract Database (DAD) were reviewed for the period of 2017–2024. ICD‐10‐CA and CCI codes were used to identify head and neck injuries and cases in which the injuries were documented as related to domestic abuse. Descriptive statistics were used for data analysis. Results Among 490,180 hospital visits for head and neck injuries, 510 were identified as domestic abuse‐related, corresponding to 0.10% of all visits. Most cases involved women (83.1%), with the highest proportion occurring among adults aged 21–40 years. Physical abuse was the most frequently documented type, followed by sexual abuse, and intimate partners were the most common perpetrators. Superficial head injuries were the leading presentation (37%), followed by other head injuries (34%) and intracranial injuries (12%). About one‐third of cases required imaging, indicating a substantial burden of clinically significant trauma. Conclusions Domestic abuse‐related head and neck injuries in Saskatchewan disproportionately affect young adult women and are most often linked to intimate partner violence. These findings support the need for improved screening, stronger interdisciplinary training, and better integration of domestic abuse recognition into healthcare and dental practice.
BACKGROUND/AIM:Traumatic dental injury (TDI) in the primary dentition represents a significant global public health problem. This study aimed to analyse the worldwide trends and perspectives on TDI between 2016 and 2026 through bibliomsetric analysis. MATERIALS AND METHODS:A systematic search of the Web of Science Core Collection was conducted using predefined search terms related to TDI and primary dentition. Two independent investigators screened the retrieved records according to predefined inclusion and exclusion criteria. The included articles were analyzed according to the following aspects: (a) countries; (b) journals; (c) authors and co-authorship patterns; (d) citation counts; (e) study designs and level of evidence; and (f) research topics. Bibliometric techniques, including thematic mapping and keyword co-occurrence analysis, were also performed. Bibliometric analyses were performed using VOSviewer 1.6.20 and the Bibliometrix package in RStudio R4.5.3 to map collaboration networks, visualise keyword co-occurrence patterns, and identify thematic structures within the literature. RESULTS:A total of 132 articles indexed in the Web of Science Core Collection were included. Brazil was the most productive country with 43 articles. Australia ranked first in total citation impact with 967 citations. The journal Dental Traumatology accounted for 45.45% of all included articles. Epidemiology and aetiology was the dominant research theme (30.62%), followed by sequelae & prognosis (27.5%), and clinical treatment & materials (16.88%). Thematic mapping identified artificial intelligence and digital clinical decision support tools as developing research areas. Research on knowledge and attitudes showed a declining trajectory. Cross-sectional and retrospective designs predominated. Level 3 evidence accounted for the majority of the dataset. CONCLUSIONS:High-quality, well-designed studies are notably absent from the literature on traumatic dental injuries in primary dentition. Publications addressing prevention, clinical and social dimensions, and quality-of-life outcomes remain disproportionately scarce relative to their significance. Digitalisation of evidence-based guidelines may support wider dissemination among clinicians.
BACKGROUND/AIMS:The prognosis of traumatic dental injuries (TDI) of permanent teeth depends on several factors related to the injury, patient characteristics, management, and follow-up protocols. When such injuries affect both hard dental tissues and the periodontium ("combination injuries"), the risk of adverse healing complications increases. However, a significant knowledge gap exists regarding the factors associated with their etiopathogenesis. Therefore, this systematic review aimed to evaluate the prognosis of traumatized permanent teeth affected by combination injuries. METHODS:An a priori protocol was registered in PROSPERO. A search strategy based on the research question was prepared, and the search was performed on PubMed, EMBASE, Web of Science, and Scopus on December 4, 2026. An additional grey literature search and reference search were also performed. Clinical studies reporting outcomes of permanent teeth with combination injuries and a follow-up greater than six months were included. Data extraction, risk of bias assessment, and meta-analysis were performed. The certainty of evidence was evaluated using GRADE. RESULTS:The electronic search of databases revealed 8190 records. Titles and abstracts of 4445 of them were evaluated, resulting in 177 studies for full-text screening. Finally, 10 of them could qualify for inclusion in the systematic review, and one more study was identified from reference searching. The incidence of pulp necrosis was high, with a pooled incidence of 42% (95% CI: 33%-52%, I2 = 87%) in teeth with crown fracture and luxation and 33% (95% CI: 26%-41%, I2 = 16.2%) in teeth with the combination of uncomplicated crown fracture and subluxation. Teeth with mature root development had a significantly higher risk of pulp necrosis (risk ratio = 1.70; 95% CI: 1.15-2.48). Other complications were less frequently reported. The overall certainty of evidence was very low. CONCLUSIONS:The pooled incidence of pulp necrosis among permanent teeth with combination injuries was 39%. Greater severity of luxation injury in any combination and mature status of the root showed a significantly higher risk of pulp necrosis and healing complications. The evidence base for the prognosis of combination injuries showed very low certainty, indicating the need for future studies addressing the limitations observed in the review.
OBJECTIVE:To evaluate the diagnostic accuracy of cone-beam computed tomography (CBCT) visualization techniques in detecting clinically relevant non-displaced dentoalveolar fractures and to assess their impact on observer efficiency during trauma evaluation. METHODS:Non-displaced alveolar fractures were experimentally induced in 15 fresh sheep heads under standardized conditions to simulate clinically relevant dentoalveolar trauma. CBCT imaging was performed using a standardized acquisition protocol, and four visualization techniques were generated using fixed display parameters. Fracture presence was confirmed by an independent oral and maxillofacial radiologist and served as the reference standard. Five blinded dentists evaluated datasets in two sessions separated by a 3-week washout interval. Diagnostic performance was assessed using ROC analysis with pairwise comparisons using the DeLong method. RESULTS:Multiplanar reconstruction demonstrated the highest diagnostic accuracy (AUC = 0.87), followed by volume rendering (0.75), surface rendering (0.73), and maximum intensity projection (0.70). Inter- and intra-observer agreements were substantial to almost perfect (κ = 0.78 and κ = 0.85, respectively). Multiplanar reconstruction required significantly shorter evaluation time and lower user interaction compared with volume rendering and surface rendering (p < 0.05). CONCLUSION:The selection of CBCT visualization techniques significantly influences diagnostic confidence and observer workflow efficiency in dentoalveolar trauma assessment. Multiplanar reconstruction provided the most favorable balance between diagnostic accuracy and efficiency, supporting its use in time-sensitive clinical trauma evaluation.
BACKGROUND:Maxillofacial injuries are commonly observed among women who have experienced domestic violence. The prevalence and characteristics of these injuries in Jordan remain underexplored. This study aimed to evaluate the frequency and patterns of maxillofacial injuries among females affected by domestic violence in Jordan. MATERIAL AND METHODS:A total of 2643 records of domestic violence-related maxillofacial injuries in females were retrieved from the Family Protection and Juvenile Department and the Accident and Emergency (A&E) departments of two major hospitals in Jordan. Descriptive statistics were computed, and associations were evaluated using Chi-square and Kruskal-Wallis tests. Significance was set at p ≤ 0.05. RESULTS:The mean age at the time of injury was 29.19 years (SD: 11.8). The spouse was responsible for violent acts in 20% of cases. In 89.9% of cases, injuries were caused by direct blows. Soft tissue injuries were observed in most cases (98.1%), followed by midfacial fractures (5.6%), dentoalveolar injuries (1.7%), upper face fractures (1.2%), and lower face fractures (0.9%). The vast majority did not require surgical intervention (98.9%). Concomitant injuries to other body regions were identified in 70.6% of cases, with the upper extremities the most frequently affected (50.4%). Trauma to the upper extremities showed a significant inverse association with midfacial fractures (p < 0.001). Recurrent trauma was documented in 7.6% of cases. Individuals with recurrent trauma were more likely to present with concomitant injuries to other body regions (84.2%) than first-time trauma victims (69.5%). CONCLUSION:Facial soft-tissue injuries were the most frequent. Midfacial fractures were the most common facial fracture type, though they were rare and less likely when an upper-limb injury occurred. Repeated trauma increases the likelihood of multiple fractures, emphasizing the need for early detection, reporting, and referral by healthcare professionals including oral & maxillofacial surgeons and dental health professionals.
BACKGROUND:Combination injuries or multiple traumatic dental injuries (TDI) affecting a single permanent tooth are clinically significant but remain underrecognized. Although the global prevalence of TDI is well documented, the epidemiology of combination injuries has not been clearly established. This systematic review and meta-analysis aimed to assess the prevalence and patterns of combination injuries in traumatized permanent teeth. METHODS:A review protocol was registered in PROSPERO (CRD1245967). Comprehensive searches of PubMed, EMBASE, Web of Science, and Scopus were conducted without language or date restrictions on December 4, 2025. Observational studies done in clinical settings involving patients older than 6 years with TDI in permanent teeth and reporting combination injuries were included. Two authors independently performed screening, data extraction, and risk of bias assessment using the Joanna Briggs Institute checklist. Random-effects meta-analyses were performed to estimate pooled prevalence and proportions of specific injury combinations. The certainty of evidence was evaluated using the GRADE framework. RESULTS:Thirty studies from 20 countries were included. Among 34,382 traumatized permanent teeth, 7161 presented with combination injuries. Reported prevalence ranged from 2.36% to 48.28%, with a pooled prevalence of 14% (95% CI: 11%-19%; I2 = 98.2%). Denmark demonstrated the highest pooled prevalence among countries represented by multiple studies. The most frequently reported combinations were enamel-dentin fracture with subluxation (25%) and enamel-dentin fracture with concussion (17%). Reporting terminology varied considerably, and many studies did not explicitly document combination injuries. While most studies had a low risk of bias, the overall certainty of evidence was very low. CONCLUSIONS:The pooled prevalence of combination injuries was 14%, with the highest country-specific prevalence reported in Denmark, and the most common pattern being enamel-dentin fracture combined with subluxation. Considerable variation in reporting terminology and the very low certainty of evidence highlight an urgent need for standardized nomenclature, calibrated diagnostic protocols, and well-designed studies to accurately capture the complexity of these injuries.
BACKGROUND/AIMS:Adhesive procedures performed after dental trauma are often carried out in emergency settings with compromised isolation due to bleeding, limited access, and patient cooperation. This study evaluated how variation in intraoral relative humidity influences dentin bond strength of three resin cements under simulated intraoral temperature. METHODS:A methyl methacrylate-based self-curing resin cement (Super-Bond EX), a primer-assisted dual-cure resin cement (Panavia V5), and a self-adhesive dual-cure resin cement (SA Luting Multi) were tested at 50%, 65%, 80%, and 95% relative humidity at 32°C. Mid-coronal bovine dentin was prepared and resin composite rods were bonded in a humidity-controlled environmental chamber according to the manufacturers' instructions, following an ISO/TS 16506:2017 Annex A of the ISO standard-based shear bond strength framework. For the primer-assisted cement, the primer was applied outside the chamber under ambient conditions to standardize solvent evaporation, and specimens were then transferred into the chamber for cementation. Shear bond strength was measured after 24 h water storage at 37°C, and failures were classified as interfacial or cohesive. RESULTS:The methyl methacrylate-based cement showed stable bond strength across all humidity conditions with no significant differences among groups. The primer-assisted cement demonstrated significantly higher bond strength at 50% relative humidity than at 65%, 80%, and 95% (p < 0.05) and showed predominantly interfacial failures at and above 65% relative humidity. The self-adhesive cement showed the lowest bond strength overall, with mainly interfacial failures and only minor changes across humidity levels. CONCLUSIONS:Under simulated intraoral conditions, dentin bonding performance depended mainly on cement type. The methyl methacrylate-based cement maintained stable bond strength even at high humidity, whereas the primer-assisted cement was more susceptible at and above approximately 65% relative humidity. The self-adhesive cement showed consistently low bond strength irrespective of humidity.
AIM:Tooth avulsion is among the traumatic dental injuries that require immediate intervention during childhood, and children are often with teachers or parents at the time of such incidents. This situation highlights the need to evaluate the first aid knowledge levels of these individuals regarding the emergency management of avulsion. The aim of this study was to examine the level of first aid knowledge regarding tooth avulsion among teachers working in special education and rehabilitation centers. METHODOLOGY:This is a cross-sectional study. An online questionnaire regarding the emergency management of tooth avulsion was administered to 305 volunteer teachers working in special education and rehabilitation centers (72.8% female; 27.2% male). Ethical approval was obtained prior to the study. Data were analyzed using the independent samples t-test, Chi-square (χ2) test, and one-way analysis of variance (ANOVA). RESULTS:A total of 4.3% of the participants reported that they would reinsert the avulsed permanent tooth into the socket. The most frequently preferred transport method was clean cotton/tissue/gauze (69.2%), while 13.1% indicated that milk was an appropriate storage medium. Knowledge scores of participants who had previously encountered a case of tooth avulsion were statistically significantly higher than those without such experience (p < 0.05). No significant differences were observed in knowledge scores according to field of graduation, and sex, duration of professional experience, and level of education were not found to have a significant effect on knowledge level (p > 0.05). CONCLUSIONS:Knowledge levels regarding the emergency management of tooth avulsion among teachers working in special education and rehabilitation centers were found to be insufficient. Accordingly, planning and implementation of structured and comprehensive educational programs targeting this group are necessary.
BACKGROUND/AIM:To assess knowledge of initial management of traumatic dental injuries among senior medical students and to compare knowledge at cohort level before and after implementation of structured teaching on traumatic dental injury management within an emergency medicine module. MATERIAL AND METHODS:This single-center study was conducted at a German medical faculty. An anonymous structured questionnaire covering common first-aid scenarios for traumatic dental injuries, including avulsion, luxation, and fracture management, was administered to two independent cohorts of senior medical students before and after implementation of a dental trauma lecture. The questionnaire comprised 16 multiple-choice items regarding knowledge of traumatic dental injury management. Total knowledge scores and item-level results were compared between cohorts using unpaired statistical analyses. RESULTS:A total of 117 students participated in the pre-implementation cohort and 92 in the post-implementation cohort. Mean knowledge scores were higher in the post-implementation cohort (10.0 vs. 6.6 points, p < 0.0001). The proportion of students classified with low knowledge decreased, whereas moderate and high knowledge categories increased at cohort level after structured teaching. Higher proportions of correct responses were observed in avulsion-related items, including replantation and appropriate timing of intervention. However, no significant differences were found in management of luxated primary teeth and recommended timing of dental referral after initial management. CONCLUSIONS:Knowledge of traumatic dental injury management among senior medical students was predominantly low before lecture implementation and was higher at cohort level after structured teaching within an emergency medicine module. Given the anonymous unpaired design, these findings should be interpreted as cohort-level differences rather than direct within-subject learning effects. Clinically relevant gaps persisted in dentition-specific management and dental referral timing. These findings support structured integration of guideline-based dental trauma management into medical curricula while highlighting the need for future studies assessing practical skills and clinical performance.
