Dental Traumatology research and education—Foundations for a better tomorrow

Abstract

An avulsed permanent tooth is a serious traumatic dental injury (TDI), which should be dealt with immediately.^{1, 2} The prognosis is very much dependent on decisions at the place of the accident and the time immediately after the avulsion has taken place.² The preferred treatment for an avulsed permanent tooth is replanting the avulsed tooth back into its socket, which should be carried out as soon as possible to have the best outcome.^{2, 3} If the tooth cannot be replanted immediately, it must be stored.^{3, 4} According to the guidelines of the International Association of Dental Traumatology (IADT), saline, saliva, and milk are considered physiological media that preserve the periodontal ligament before replantation.⁵ In this Issue, Gul et al. performed a long-term clinical assessment of the risks of ankylosis-related resorption in different storage conditions.⁶ Avulsed teeth were divided into three groups: immediately replanted teeth, teeth stored in physiologic media, and the control group dry stored teeth. The storage media used in the physiological storage group in this study were saliva and saline. The storage conditions are of great importance and impact the prognosis of the avulsed teeth.

Basketball is a contact sport with risks of oral injuries, defined as injuries to the teeth, periodontium, and surrounding soft tissues such as the lips and tongue.^{7, 8} Common basketball-related oral injuries include soft tissue lacerations and contusions.⁸ Given a high-enough impact force, traumatic dental injuries such as tooth fractures and avulsions can occur.^{7, 8} In this Issue, Liang et al. investigated the distribution of different oral injuries within each injury mechanism and evaluated which mechanisms were most likely to lead to a dental injury.⁹ Understanding the mechanisms of dental injuries in basketball and other sports is imperative for medical teams to acutely manage and treat these injuries. Furthermore, information regarding the mechanisms leading to severe dental injuries will help basketball staff educate athletes on prevention and safer playing techniques.

TDIs occur frequently and at any age, although the peak incidence is during childhood.^{10, 11} It is known that the quality of immediate emergency treatment positively influences the outcome of any TDI.^{11, 12} It is reasonable to expect that a dental practitioner would have the knowledge and skills to manage a dental emergency with the same confidence as a medical emergency as a result of basic education during their professional training.^{12, 13} In this Issue, O'Connell and Olegário investigated teaching practices in Dental Traumatology around the world in Undergraduate education.¹⁴ A total of 203 responses from 164 institutions from 69 different countries were obtained. This paper highlights that dental trauma education varies internationally and is delivered in a fragmented fashion in most dental schools.

TDIs represent a significant public health concern, and their prevalence among children is remarkably high.¹⁰ The school environment represents a frequent setting for these incidents.^{8, 15} Teachers play a crucial role, in as much as optimal long-term prognosis depends on prompt implementation of appropriate immediate actions, along with swift access to treatment, and diligent post-trauma follow-up.^{11, 15} In this Issue, de Medeiros et al. created and validated an educational comic book for lay individuals, designed to guide immediate actions in dental trauma cases and assess its effects toward enhancing reader knowledge.¹⁶ The lack of appropriate knowledge needed to manage dental trauma situations undermines the quality of life of individuals who have experienced trauma, diminishes the potential for effective treatment, and lowers the chances for successful outcomes.¹⁷ Evaluating the readability of educational material is important in averting the learning constraints stemming from limited educational backgrounds.

TDIs are a public health problem given their prevalence with physical, psychological, and social consequences on those affected.¹⁸ A questionnaire is a commonly used data collection method, and its validation is a crucial part of the research, as it is important to verify the psychometric properties of the designed questionnaire.^{19, 20} In this Issue, Magno et al. aimed to develop and validate a questionnaire (TDI-Q) to assess the knowledge of laypeople about TDIs, including participants from five regions of Brazil.²¹ Identifying the level of laypeople's knowledge of TDIs is essential to the planning of prevention strategies, through the correct and focused dissemination of knowledge. Using validated tools is necessary to avoid any error or inability of the researcher when collecting the data, as well as to avoid confusing and incomplete information.

Tooth avulsion requires instant dental treatment, and immediate replantation for a positive prognosis.²² As immediate replantation is not always a feasible option, delayed replantation is, at times, the more realistic and practical treatment choice.³ The predominant reaction to any type of dental injury is an acute inflammation and stimulating the termination of inflammatory response will lead to healing.^{23, 24} In this Issue, Herr et al. evaluated the effect of Frondoside A application in the alveolar socket on inflammatory responses after delayed replantation in rat teeth.²⁵ Root surface treatment materials could be beneficial for encouraging anti-inflammatory responses following tooth avulsion and further research in this area is warranted.

Maxillofacial trauma is one of the leading causes of morbidity and mortality.²⁶ The epidemiology of maxillofacial trauma varies due to socioeconomic, demographic, and environmental factors.²⁷ In this Issue, Gugliotta et al. analyzed the epidemiology of maxillofacial trauma over more than two decades to evaluate whether there have been significant changes in the causes of fractures in pediatric, adult, and elderly populations in a tertiary care hospital in Italy.²⁸ It is essential to collect long-term epidemiological data on maxillofacial injuries to enable national governments not only to assess the evolving patterns of trauma etiology and associated costs but also to develop preventive measures for the causes that most commonly lead to facial fractures.

TDIs are generally encountered in the early period of life and constitute 5% of all injuries.²⁹ Dental trauma occurs in 25% of school-age children and 33% of young adults, mostly before the age of 19 years.^29-31 Early intervention and correct treatment approaches are essential for a traumatized tooth to have a good prognosis.³² The IADT introduced the ToothSOS application in 2018 to disseminate information on first aid in the event of any dental trauma.³³ This free App aims to ensure public information for individuals and dental professionals regarding TDIs and is reported to be a preferable alternative to other documents and tools for being an easily accessible and apparent tool.³² In this Issue, Sari et al. assessed the knowledge level of pediatricians regarding TDIs and their awareness of the ToothSOS mobile application.³⁴ ToothSOS can be recommended as an educational tool for both professionals and individuals.

Different types of dental and orofacial injuries are encountered during sports practice.³⁵ Mouthguards are used to prevent dental trauma and orofacial injuries in sports.⁸ Different materials have been tested to fabricate mouthguards, but the one that presented more adequate mechanical properties was ethylene-vinyl acetate.³⁶ In this Issue, Costa et al. evaluated the influence of ethylene-vinyl acetate aging by thermocycling on elastic modulus, stress, strain, and shock absorption ability of different ethylene-vinyl acetate brands used for mouthguards.³⁷ Thirty specimens of four different brands were randomly divided into two groups: without thermocycling and with thermocycling. The effectiveness of mouthguards was tested by performing a uniaxial tensile test and non-linear dynamic impact analysis. The thermocycling process is a well-established research method for aging protocols and is very useful in dental material science.

Assaults, falls, and motor vehicle accidents are the leading causes of maxillofacial injuries.^{38, 39} The specific type of facial fracture can be influenced by various factors including vehicle type, road conditions, and safety equipment.^{40, 41} In this Issue, Yari et al. assessed the incidence and pattern of maxillofacial fractures and related demographic data in the victims of rollover crashes.⁴² Given the high morbidity associated with these injuries, understanding their distribution and patterns is important for prevention efforts. Such data aids in the development of innovative strategies to reduce the incidence of maxillofacial trauma and provide appropriate care by assessing the at-risk population and identifying contributing factors to trauma.

Tooth autotransplantation is a successful alternative to dental implants for tooth replacement due to dental caries or trauma, with success rates of over 95% in children and adolescents, and 80% in adults.^43-46 3D-printed replicas reduce trauma, extraoral exposure, and potentially preserve cell viability, and can help minimize damage to the donor's tooth during extraction and reduce the number of fitting attempts required, thus preserving the integrity of the periodontal ligament.⁴⁷ In this Issue, Lejnieks et al. presented a protocol that combines cone-beam computed tomography (CBCT), software, and 3D printing to design 3D replicas for tooth autotransplantation.⁴⁸ Integrating CBCT, software, and 3D printing into autotransplantation is a promising approach to reduce the extra-oral time of the donor tooth and potentially increase the success rates.

The IADT published the updated version of its guidelines in 2020.²⁹ The guidelines were prepared by the guideline committee of the IADT which comprised of global experts from several specialties.^{18, 29} Citation analysis is a method of gauging the frequency and pattern of citation of a particular document.⁴⁹ In this Issue, Ravi et al. assessed the impact, global scientific reach, and utilization of the IADT guidelines through altimetric and citation analysis.⁵⁰ The number of citations an article receives reflects the dissemination and impact of the work in the scientific community.