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Mitogenic effect of L-dopa on human periodontal ligament fibroblast cells.

In cases of tooth avulsion, immediate replantation is the treatment of choice. In the event of any problem, the tooth should be stored in a medium that supports the periodontal ligament cell viability. Theoretically, mitotic promoting agents may be of use to preserve cell viability. It has previously been reported that levodopa (L-dopa) accelerates healing by increasing the growth hormone level. In this study, the direct effect of L-dopa was investigated on human periodontal ligament fibroblast (HPLF) cells. Cell culture methods were used to assess the potential mitogenic effect of L-dopa. Results show that in low concentrations of L-dopa (1 microgram/microl in this study), the number of HPLF cells were remarkably higher than the control group, and the number of viable cells were not affected by increasing the L-dopa concentration in the range of the study. These results suggest that L-dopa can also have a direct local effect on the growth of HPLF cells. These results may be of use clinically to increase the viability of HPLF cells in cases of an avulsed tooth preserved in storing medium.

Cells, Cultured↗

Parental awareness of the emergency management of avulsed teeth in children.

Although public awareness campaigns on avulsed teeth have been mounted in the past, no study has investigated the knowledge parents possess of the protocol for the management of this dental emergency. The purpose of this investigation was to evaluate, by means of a questionnaire, the parental awareness of the emergency management of avulsed teeth in children. Over 2000 parents were surveyed during a four-week period at 20 suburban vacation swimming centres. The results indicated that almost two-thirds of respondents would attempt replantation of an avulsed tooth but further questioning showed they did not know the correct procedures. Thirty-three per cent of respondents were unaware of any after-hours emergency dental services. Ninety-two per cent felt they should seek professional help urgently following an avulsion injury, but their knowledge of transport media for the tooth was poor. Only 5 per cent knew that milk was the medium of choice for both washing and transporting an avulsed tooth. Ninety per cent of parents surveyed had never received advice on what to do in the event of an accident where a permanent tooth was avulsed. This study revealed the need for educational campaigns aimed at parents to increase their knowledge of the emergency procedures required when the tooth is avulsed.

Adult↗

Lay and professional knowledge of methods for emergency management of avulsed teeth.

Proper treatment during the first 30 minutes offers the best prognosis for traumatically avulsed teeth. This study sought to determine both lay people's and dental professionals' knowledge of and attitude to emergency procedures. A 12-question survey was administered to 5 groups: (a) parents of learner swimmers and (b) coaches of college sports teams (lay); (c) State Dental Nurses, (d) dentists and (e) dental nurse/receptionists (professional). Respondents totalled 184 (a 32, b 86, c 24, d 18, e 24) i.e. 118 lay and 66 professional. Data revealed that group b had the greatest personal experience of avulsed teeth and groups c and e the least. Public hospital accident and emergency services (A & E) were perceived by all groups as most available. 18% of lay groups could not cite an emergency service. Lay people thought first of A & E for management whereas profession groups preferred the victim's own dentist. Most professional people would replant avulsed permanent teeth and about 1/3 would replant deciduous teeth: 1/2 lay people would replant permanent teeth and 1/8 deciduous teeth. Where treatment was not straightforward lay people would seek advice before acting. Half of the lay groups would transport an avulsed tooth dry. All the professionals had had advice on management of avulsed teeth but only 1/4 of the lay groups. This study highlighted the need for educational campaigns aimed at members of the lay public likely to be involved in the emergency management of traumatically avulsed teeth.

Attitude of Health Personnel↗

Knowledge of physicians in hospital emergency rooms in Israel on their role in cases of avulsion of permanent incisors.

OBJECTIVE: The purpose of this study was to assess the knowledge of physicians in hospital emergency room care on their possible role in cases of traumatic loss of permanent incisors. METHODS: A questionnaire was sent to directors of emergency room facilities in hospitals in Israel regarding the medical team at the emergency room in the hospital, availability of an in-house dental service and existence of a protocol for management of avulsed teeth. Another questionnaire, completed by physicians in the emergency room, contained demographic questions and questions regarding their knowledge of management of avulsed permanent teeth. RESULTS: The findings of the study showed that only 4% (12 of 335 physicians) would provide an appropriate initial treatment that, if followed by treatment by a dentist as recommended, could save the avulsed tooth. No correlation was found between knowledge of appropriate treatment of avulsed teeth and type of specialty, years of experience, previous exposure to information on trauma to the teeth and gender. The only significant association was found between physicians' knowledge and having a dentist spouse. Most of the physicians had never attended any formal seminar or lecture or received printed instructions on the management of avulsed teeth. CONCLUSIONS: Medical students and physicians in hospitals' emergency rooms should be made aware of their possible role in cases of avulsion of permanent teeth, in order to minimize late complications associated with such injuries. One possible way to achieve this goal is through education during and after training and introduction of a formal protocol for treatment of avulsed permanent teeth and other dental injuries.

Adult↗

Pre-replantation storage of avulsed teeth: fact and fiction.

Recent laboratory and clinical studies have proven that there is a rapid decrease in the regenerative potential of normal periodontal ligament the longer an avulsed tooth is out of the socket. These findings make some guidelines for the management of avulsed teeth inaccurate. This paper will review the effects of pre-replantation storage on periodontal ligament healing. In addition, current management recommendations are reviewed and suggestions for change presented.

Animals↗

Lay knowledge of physical education teachers about the emergency management of dental trauma in Hong Kong.

The purpose of this study was to investigate the knowledge of a group of physical education (PE) teachers about the emergency management of dental trauma in Hong Kong. A postal questionnaire was sent to PE teachers in 100 randomly selected secondary schools in Hong Kong. A total of 166 teachers from 65 schools responded. Results show that a majority of the respondents have received formal teaching training (98.8%). While all but one teacher had received formal first aid training, only eight of them recalled that they had received advice on the management of dental trauma. Concerning the management of tooth fracture, 118 respondents (71.1%) gave an appropriate answer. In contrast, only 29 teachers (17.5%) were able to indicate the appropriate management for an avulsed tooth. Over 60% (102) of the respondents indicated it was "very urgent" to seek professional assistance if a permanent tooth has been avulsed, but they had little knowledge of the correct procedures for replanting or transporting avulsed teeth. Only 15 respondents (9%) pointed out that milk was the medium of choice for transporting avulsed teeth. Finally, over 90% (157) of respondents indicated that they had never received advice on the emergency procedures for the management of dental avulsion. The present study showed that the level of lay knowledge of management of dental injuries in a selection of PE teachers in Hong Kong is inadequate and educational campaigns are necessary to improve their emergency management of dental injuries.

Adult↗

[New treatment protocols for avulsed teeth].

Traumatized teeth present a clinical challenge with regard to their diagnosis, treatment plan and prognosis. The injuries to the permanent dentition include crown and root fractures, subluxations, luxations and tooth avulsion. Common complications are pulp necrosis, periapical pathosis and root resorption. This article will describe new clinical modalities for the treatment of avulsed teeth and discuss the rational for their use.

Demeclocycline↗

Paediatric dentistry avulsion: case reports.

Children may present at a dental surgery for management of oro-facial injuries. Most general dental practitioners are able to handle straightforward cases but referral may be required for complex injuries. Successful healing following tooth avulsion depends on the amount of damage to teeth and supporting structures, emergency treatment, and follow-up treatment. All of these play a role in the long-term prognosis of avulsed teeth.

Child↗

[Tooth extraction in irradiated areas].

Tooth avulsion after head and neck radiotherapy has always been and is still a risk gesture when the avulsion is situated on the irradiation sites. The post-operating effects can become complicated with a delay in healing which can eventually induce an osteoradionecrosis. Dental treatment before the begining of radiotherapy aiming at the elimination of any suspicious tooth, and the generalisation of fluorotherapy aiming at limiting the decayed degeneration, did not make the avulsion indication disappear. At present tooth avulsion is still possible in case of tooth infection or broken tooth.

Collagen Type II↗

A quantitative analysis of Propolis: a promising new storage media following avulsion.

Both length of extra-alveolar time and type of storage media are significant factors that can affect the long-term prognosis of replanted teeth. Numerous studies have examined various media in an attempt to determine the ideal material for storage of the avulsed tooth. The purpose of this study was to use a Collagenase-Dispase assay to investigate the potential of a new storage media, Propolis, in maintaining viable periodontal ligament (PDL) cells on simulated avulsed teeth. Seventy freshly extracted human teeth were divided into five experimental groups and two control groups. The positive and negative controls corresponded to 0-min and an 8-h dry time, respectively. The experimental teeth were stored dry for 30 min and then immersed in one of the five media (Hank's balanced salt solution (HBSS), milk, saline, Propolis 50%, and Propolis 100% for 45 min). The teeth were then treated with dispase grade II and collagenase for 30 min. The number of viable PDL cells were counted with a hemocytometer and analyzed. Statistical analysis demonstrated that both Propolis groups kept significantly more PDL cells viable compared to either milk, saline, or HBSS. Within the parameters of this study, it appears that Propolis may be a better alternative to HBSS, milk, or saline in terms of maintaining PDL cell viability after avulsion and storage.

Analysis of Variance↗

Knowledge and attitude of 2,000 parents (urban and rural - 1,000 each) with regard to avulsed permanent incisors and their emergency management, in and around Davangere.

It is well recognized today that for long-term success, the management of traumatized teeth optimally should be carried out as soon as possible. Since, majority of traumatic injuries occur at home, the ultimate prognosis of an avulsed tooth may depend on knowledge of the treatment procedure, possessed by his or her parents. The purpose of this study was therefore to evaluate the parental knowledge and attitude regarding the emergency management of avulsed teeth in children (in Davangere--both urban and rural, 1,000 each).

Child↗

Orthodontic and prosthodontic treatment in dental avulsion cases.

A clinical case of traumatic dental avulsion with endodontics, replantation and bracket fixation is presented. Subsequent follow-up led to extraction of the replanted teeth. The edentulous space was restored with a Maryland bridge. The factors which contribute to a successful tooth replantation as well as choosing the right time to begin orthodontic treatment in the case of tooth avulsion and replantation are described.

Child↗

Avulsed permanent incisors: knowledge and attitudes of primary school teachers with regard to emergency management.

OBJECTIVES: This study was designed to examine the knowledge and attitudes of primary school teachers with regard to the emergency management of avulsed permanent incisors. DESIGN: Data were collected by self-administered questionnaire. SETTING: The study was conducted in primary schools lying within a 2-mile radius of the University Dental Hospital, Cardiff. Sample and methods. A total of 388 teachers in 31 participating schools were asked to complete a questionnaire, which was subsequently collected by two of the authors (CS and AT). RESULTS: Two hundred and seventy-four teachers returned completed questionnaires, a response rate of 70.6%. One hundred and eighty-one respondents (60.1%) had received no advice about the emergency management of dental avulsion. Of the 133 teachers (48.5%) who possessed a first aid certificate, 39 (29.3%) had been given relevant advice as part of this training. Less than one-third of respondents (85 (31%)) cited an optimum extra-oral time of 30 min or less, with only 43 (15.7%) considering that this should be 10 min or less. However, 125 (45.6%) knew milk to be the best transport medium. Two hundred and four teachers (74.5%) stated that they would not be prepared to replant an avulsed tooth themselves, 133 (80%) basing this decision on lack of expertise and training. Two hundred and sixty-two teachers (95.6%) expressed a desire for further information. CONCLUSIONS: The majority of respondents possessed, at best, rudimentary knowledge of the emergency management of dental avulsion. Teachers, and other individuals who supervise children in schools, should receive simple instruction in dental first aid.

Animals↗

Management of avulsions.

The treatment of the avulsed tooth provides a significant challenge to the dental practitioner. It is obvious that this particular dental injury poses a significant number of questions for both the researcher and the clinician. There will be most likely a continued interest to find the ideal treatment for this injury. As much as the dental literature has provided an improvement to the treatment of patients with avulsed teeth, however, there remains a significant number of clinically relevant questions that must be addressed before patients who sustain avulsion injuries can receive an acceptable long-term prognosis.

Humans↗

Avulsion of primary teeth and sequelae on the permanent successors.

The purpose of the present study was to determine the frequency of avulsion of primary teeth and the location of the avulsed tooth in a representative population of Danish children. Also, the frequency and the type of developmental disturbances in the permanent successors were assessed and related to age at the time of injury. The material included dental records of 4238 children from three clinics in Municipal Dental Health Services near Copenhagen, Denmark. The children were born between 1 January 1983 and 31 December 2000. Thirty-five children (0.8%) were identified as having avulsed in all 44 primary teeth most frequently the maxillary incisors (89%). Thirty-three fully erupted permanent successors were included in the study, the prevalence of developmental disturbances was 30% (10 teeth). The results showed the risk of developmental disturbances in the permanent successors to be more frequent the younger the age at the time of injury (P = 0.04). Discolouration affected all 10 permanent teeth, but also hypoplasia and horizontal enamel hypoplasia were found.

Age Factors↗

Effect of bisphosphonates and gallium on dentin resorption in vitro.

Replacement resorption may follow the replantation of an avulsed tooth. Currently there is no effective treatment for replacement resorption. The purpose of this study was to investigate the effect of bisphosphonates and gallium nitrate, which have been shown to reduce bone resorption, on cells which resorb dentin. Osteoclast-like cells were obtained by culturing cells from prenatal chick tibeas. These cells were seeded onto slices of human dentin which had been soaked in either saline (control), or solutions of 10(-5) M 1-hydroxyethylidene-1, 1-bisphosphonic acid (EHBP), 10(-6) M dichloromethylene bisphosphonic acid (Cl2MBP), or 10(-6) M gallium nitrate. Resorption was measured by counting the number of resorptive lacunae produced by the cells. Results indicated that the experimental groups did not differ significantly from each other, but each exhibited significantly reduced resorption compared with saline controls (p < 0.01). These results suggested that the experimental treatment reduced dentinal resorption by the osteoclast-like cells, and that these agents might be useful to prevent or at least postpone replacement resorption in avulsed teeth.

Animals↗