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AIMS/OBJECTIVES: Dental trauma is a highly prevalent dental emergency. Children and adolescents without inadequate lip coverage, increased overjet, and anterior open bite are associated with the occurrence of traumatic dental injuries. Observational studies do not allow the inference of causality, one of the reasons being: the potential confounding factors. Therefore, this review aimed to critically appraise the confounding factors considered in epidemiological studies that associate dentofacial features with the occurrence of dental trauma in Brazilian children and adolescents. METHODS: Studies included in the qualitative synthesis of a recently published comprehensive systematic review and meta-analysis on the topic were screened. Studies that only mentioned the performance of bivariate analyzes or that did not mention the performance of multivariate analyzes were excluded. Evaluation of control statements for possible confounders and bias consideration was performed for each selected study. Confounding factors in these studies were also identified and categorized according to their domains. RESULTS: Fifty-five observational studies were screened, of which 11 were excluded due to the mention of only bivariate analyzes or the lack of multivariate analyses. The remaining 44 studies were critically appraised. Of these, 9 studies specifically mentioned the term confounding, and 12 studies mentioned the term bias. However, only 14 studies mentioned limitations on confounding factors in their findings. Among the 99 different variables identified, the most used were type of trauma, followed by sex and age. CONCLUSION: Most studies did not acknowledge the control for possible confounding factors and rarely stressed the need for caution in interpreting their results. Cross-sectional studies do not allow inferring a cause-and-effect relationship between dentofacial features and dental trauma.

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The orthodontic treatment of patients with chief complaint of temporomandibular disorders (TMD) presents doubtful prognosis, due to the poor correlation between malocclusions and TMDs. The present case report describes the treatment of an adult patient with Angle Class II Division 2 subdivision left malocclusion associated with anterior deep overbite and TMD. This case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO), as part of the requirements to obtain the title of BBO Diplomate.

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ABSTRACT The orthodontic treatment of patients with chief complaint of temporomandibular disorders (TMD) presents doubtful prognosis, due to the poor correlation between malocclusions and TMDs. The present case report describes the treatment of an adult patient with Angle Class II Division 2 subdivision left malocclusion associated with anterior deep overbite and TMD. This case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO), as part of the requirements to obtain the title of BBO Diplomate.

RESUMO O tratamento ortodôntico de pacientes com queixa principal de disfunção nas articulações temporomandibulares (DTM) apresenta prognóstico duvidoso, devido à baixa correlação entre as más oclusões e as DTMs. O presente relato de caso descreve o tratamento de um paciente adulto com má oclusão de Classe II, divisão 2, subdivisão esquerda, de Angle e sobremordida profunda, associadas à DTM. Esse caso foi apresentado à Diretoria do Board Brasileiro de Ortodontia e Ortopedia Facial (BBO), como parte dos requisitos para a obtenção do título de Diplomado pelo BBO.

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PURPOSE: To assess the prevalence of traumatic dental injuries to permanent anterior teeth in 9- to 14-year-old schoolchildren attending public schools in Anápolis, Brazil, and to investigate the association between the occurrence of these injuries and the size of incisal overjet and type of lip coverage. MATERIALS AND METHODS: A cross-sectional survey and a two-stage cluster sampling technique were used. The sample size included 765 9- to 14-year-old schoolchildren. Data were collected through clinical examinations and interviews carried out by a trained, calibrated dentist. Oral examinations dealt with the type of traumatic dental injury (TDI), the treatment received, the size of incisal overjet and the type of lip coverage. The teeth examined were maxillary and mandibular incisors. RESULTS: A 16.5% prevalence of dental trauma was found. Boys experienced double the number of girls' injuries. The maxillary central incisors were the teeth most affected, totaling 84.8%. The most frequent type of injury found was enamel fracture (66%), followed by enamel-dentin fracture (27%) and enamel cracks (5%). Only 26% of traumatised teeth were restored. Children with an overjet size > 3 mm were 1.78 times (CI= 1.18 - 2.69) more likely to have a dental injury than children with an overjet size <= 3 mm. Children with inadequate lip coverage were 2.18 times (CI= 1.27 - 3.76) more likely to experience dental trauma than children whose lip coverage was adequate. CONCLUSION: This study shows that the prevalence of traumatic dental injuries among schoolchildren in Anápolis, Brazil is similar to that of other regions in Brazil. The teeth most affected by dental trauma are the maxillary central incisors. Boys run a 2.03-times higher risk of crown fracture than girls, and children with an overjet size > 3 mm are 1.78 times more likely to have dental injuries. In addition, children with inadequate lip coverage are 2.18 times more likely to present traumatic dental injuries than children with adequate lip coverage.

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This purpose of this article was to report the clinical case of a patient with Eagle's syndrome. She was referred to the orthodontic clinic by her general clinician, with the complaint of temporomandibular dysfunction. The orthodontic records showed a styloid process elongation accompanied by calcification and fracture on the right side. Eagle's syndrome was diagnosed, and the patient was referred to a buccomaxillofacial surgeon for surgical correction.

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BACKGROUND: The aim of the present study was to investigate the prevalence of dental trauma, etiological factors, predisposing factors, and associations with socioeconomic status and the risk of alcohol and illicit drug use among adolescents in the city of Belo Horizonte, Brazil. METHODS: A cross-sectional study was carried out that included clinical examinations and self-administered questionnaires. The sample population was composed of 891 adolescents from public and private schools. The Social Vulnerability Index (SVI) was used for socioeconomic classification. Information on alcohol and illicit drug use was obtained using two questionnaires: the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). RESULTS: The prevalence of traumatic dental injury (TDI) was 24.7%. Falls (17.7%) was the most frequently cited etiological factor in dental injury. Among the participants with TDI, 32.8% were students in the private school system (P = 0.006). A total of 56.8% of individuals with accentuated overjet had some type of TDI (P = 0.000). There was a high prevalence of adolescents who consumed alcoholic beverages (50.3%) and used illicit substances (15.2%). However, no statistically significant associations were found between these variables and the presence of TDI. The results of the analysis demonstrate that individuals in a private school system [prevalence ratio (PR) = 1.11; 95% confidence interval (CI): 1.03-1.20] and those with accentuated overjet (>3 mm) (PR = 1.17; 95% CI: 1.10-1.25) had a 1.11- and 1.17-fold greater chance of belonging to the group of individuals diagnosed with some type of TDI. CONCLUSIONS: The prevalence of dental trauma in the study population was high. The same was true regarding alcohol and illicit drug use among the adolescents examined, although no statistically significant associations were found between these variables and a history of TDI. Private school system and accentuated overjet were significantly associated with dental trauma.

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OBJECTIVE: To determine the prevalence of traumatic dental injuries (TDI) in children younger than 7 years and the effect of predisposing clinical factors on their occurrence. MATERIAL AND METHODS: Dental records of 2725 children younger than 7 years seen in a private pediatric dental clinic in Goiânia, Brazil, from February 1993 to December 2008 were analyzed. A group of 150 children without traumatic injuries and with similar characteristics to those of the trauma group were used to study predisposing clinical factors as follows: lip coverage (adequate/inadequate), overbite (normal/negative/deep), and overjet (less or greater than 3 mm). Frequency distribution and a chi-square test were used for data analysis. The level of significance was set at 5%. RESULTS: Clinical and radiographic data of 412 injured deciduous teeth were found in 383 records. TDI prevalence was 11.9%, with no significant difference between sexes. The maxillary central incisors were the teeth most frequently affected (83.3%), and the most frequent type of injury was subluxation (35.1%). TDI was most prevalent in the 13-to-36-month age group (47.7%). Home (43.5%) was the main place of occurrence, followed by school (10.1%); falls (50.3%) were the most common cause, followed by collisions with objects (18.2%). The first examination or treatment occurred in the first 24 h in 46.5% of the cases. The analysis of the association of predisposing clinical factors with TDI revealed no differences in lip coverage; however, overjet >3 mm and deep and negative overbite were significantly associated with TDI. CONCLUSION: TDI in primary dentition should receive careful attention, particularly when it affects children younger than 3 years and in the presence of overjet, overbite, or both.

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An interdisciplinary approach is often the best option for achieving a predictable outcome for an adult patient with complex clinical problems. This case report demonstrates the combined periodontal/orthodontic treatment for a 49-year-old woman presenting with a Class II Division 1 malocclusion with moderate maxillary anterior crowding, a 9-mm overjet, and moderate to severe bone loss as the main characteristics of the periodontal disease. The orthodontic treatment included 2 maxillary first premolar extractions through forced extrusion. Active orthodontic treatment was completed in 30 months. The treatment outcomes, including the periodontal condition, were stable 17 months after active orthodontic treatment. The advantages of this interdisciplinary approach are discussed. Periodontally compromised orthodontic patients can be satisfactorily treated, achieving most of the conventional orthodontic goals, if a combined orthodontic/periodontic approach is used.

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OBJECTIVES: This study investigated the prevalence of traumatic dental injury (TDI) and associated factors in the permanent incisors of Brazilian schoolchildren. METHODS: A cross-sectional survey was carried out with 1,612 male and female children aged 11 to 14 attending public and private elementary schools in Belo Horizonte, Brazil. A multistage sampling technique was adopted to select the children. Oral examinations were performed by calibrated examiners for the diagnosis of TDI (criteria proposed by Andreasen) and dental caries [Decayed, Missing and Filled Teeth Index (DMFT)]. The Social Vulnerability Index was used for socioeconomic classification. Data analysis involved descriptive statistics and the Poisson regression model. RESULTS: The prevalence of TDI was 17.1%. Falls (43.6%) were the most common cause of TDI, mainly at home (41.8%). Boys were more affected than girls. There was no statistically significant association between TDI and socioeconomic status. The adjusted results revealed that TDI was significantly associated with DMFT [1.11, 95% confidence interval (CI): 1.06 to 1.16] and overjet (1.15, 95% CI: 1.00 to 1.31). CONCLUSIONS: TDI was associated with dental caries and overjet and was not influenced by socioeconomic status.

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