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Background. Traumatic dental injuries represent nearly 5% of children and adolescents’ injuries leading to serious medical and psychological issues. This current study aims to evaluate the prevalence of dental trauma and its potential association with different predisposing factors among 12-and 15-year-old schoolchildren in Lebanon. Materials and Methods. 7902 schoolchildren, 3806 male and 4096 female aged 12 years (n = 3985) and 15 years (n = 3917), were recruited by a stratified multistaged randomized cluster sampling method from public and private schools and were clinically examined in a national cross-sectional study. WHO criteria were used to assess anterior permanent teeth; the nature of trauma, the tooth involved, the size of the incisal overjet, and the type of the lip coverage were furthermore assessed. Data regarding age, sex, and causes of TDI were recorded through a structured questionnaire. Results. The prevalence of dental trauma to anterior teeth was 10.9%. Maxillary central incisors (83.7%) were commonly affected. The most common type of injury was enamel fracture (68.3%), falls being the main reason (52.5%). Increased overjet (OR = 2.32, p = 0.034), deficient lip coverage (OR = 5.73, p = 0.019), and gender (OR = 5.36, p ≤ 0.001) were significant predisposing factors for dental trauma. Conclusion. This research highlighted many predisposing factors for dental trauma that affect commonly the anterior teeth. Based on these results, the implementation of strategic preventive measurements targeting especially the identified risk groups remains crucial.

Background Video laryngoscopes are widely used for tracheal intubation, particularly in challenging airway scenarios. The McGrath MAC, AIRWAY SCOPE ® , and AceScope ® are popular video laryngoscopes with different design features. This study aimed to compare the effectiveness and usability of these three devices in novice healthcare providers during simulated tracheal intubation scenarios employing a manikin. Methods Sixty novice healthcare providers, including nurses and pharmacists, were enrolled in this randomized crossover study. Participants performed tracheal intubation using the McGrath MAC, AIRWAY SCOPE, and AceScope in both normal airway and cervical spine immobilization models. Primary outcomes were intubation success rate and time to intubation. Secondary outcomes included user preferences, device ease of use, and the incidence of dental injuries. Results The AIRWAY SCOPE demonstrated the shortest intubation time in both normal airway and cervical spine immobilization models (14.90 ± 1.76 s and 23.80 ± 2.43 s, respectively), followed by the McGrath MAC and AceScope. All devices exhibited high success rates, and there were no significant differences in perceived difficulty among the three video laryngoscopes. The incidence of dental injuries was generally comparable among the devices. However, in the cervical spine immobilization model, the AceScope demonstrated a significantly higher rate of dental injuries compared to the McGrath MAC ( p  < 0.05), highlighting a potential concern for clinical practice. Conclusions The AIRWAY SCOPE was the most efficient video laryngoscope in terms of intubation time, followed by the McGrath MAC and AceScope. However, all devices showed high success rates and no significant differences in perceived difficulty. Further research is needed to validate these findings in clinical settings and investigate the impact of device-specific features on intubation outcomes and dental injury incidence. Trial registration Registration number: jRCT1030240598 ( https://jrct.niph.go.jp/re/reports/detail/91422 ) The registration date of the clinical trial is January 8, 2025.UMIN000050394.

The efficacy of devices for difficult intubation in paediatric patients, especially with a Cormack-Lehane grade 4 view, has yet to be established. We compared intubating parameters among three devices (the Airtraq®, McGrath®, and Macintosh laryngoscopes). This study is a randomised cross-over trial. Participants were 20 anaesthetists. Each device was tested three times using a paediatric manikin with a Cormack-Lehane grade 4 view. The order to use each device was randomised by a computer-generated random sequence. The primary endpoint was the rate of successful intubation. Secondary endpoints included the time taken to intubate, percentage of glottic opening score, and severity of potential dental trauma. The successful intubation rates of the Airtraq®, McGrath®, and Macintosh laryngoscopes were 100%, 72%, and 45%, respectively. The risk ratio of the success rates of Airtraq® compared with McGrath® and Macintosh laryngoscopes were 1.40 (95% CI; 1.19-1.64, P < 0.001) and 2.22 (95% CI; 1.68-2.94, P < 0.001), respectively. The modified Cormack-Lehane grade and percentage of the glottic opening score were better for the Airtraq® than for the other devices. The dental trauma score was lower for the Airtraq® than for the other devices. There were no significant differences in the intubation time among the groups. The Airtraq® had higher success rate, had better visibility, and was associated with less dental trauma than the other devices in a difficult paediatric intubation model with a Cormack-Lehane grade 4 view.

Background Applying excessive force during endotracheal intubation (ETI) is associated with several complications, including dental trauma and hemodynamic alterations. A gum-elastic bougie (GEB), a type of tracheal tube introducer, is a useful airway adjunct for patients with poor laryngoscopic views. However, how the use of a GEB affects the force applied during laryngoscopy is unclear. We compared the force applied on the oral structures during ETI performed by novices using the GEB versus an endotracheal tube + stylet. Methods This prospective crossover study was conducted from April 2017 to March 2019 in a public medical university in Japan. In total, 209 medical students (4th and 5th grade, mean age of 23.7 ± 2.0 years) without clinical ETI experience were recruited. The participants used either a Macintosh direct laryngoscope (DL) or C-MAC video laryngoscope (VL) in combination with a GEB or stylet to perform ETI on a high-fidelity airway management simulator. The order of the first ETI method was randomized to minimize the learning curve effect. The outcomes of interest were the maximum forces applied on the maxillary incisors and tongue during laryngoscopy. The implanted sensors in the simulator quantified these forces automatically. Results The maximum force applied on the maxillary incisors was significantly lower when using a GEB than when using an endotracheal tube + stylet both with the Macintosh DL (39.0 ± 23.3 vs. 47.4 ± 32.6 N, P  < 0.001) and C-MAC VL (38.9 ± 18.6 vs. 42.0 ± 22.1 N, P < 0.001). Similarly, the force applied on the tongue was significantly lower when using a GEB than when using an endotracheal tube + stylet both with the Macintosh DL (31.9 ± 20.8 vs. 37.8 ± 22.2 N, P < 0.001) and C-MAC VL (35.2 ± 17.5 vs. 38.4 ± 17.5 N, P < 0.001). Conclusions Compared with the use of an endotracheal tube + stylet, the use of a GEB was associated with lower maximum forces on the oral structures during both direct and indirect laryngoscopy performed by novices. Our results suggest the expanded role of a GEB beyond an airway adjunct for difficult airways.

The second paper in this two-part review series aims to outline the long-term complications of dental trauma in the adult patient in relation to discoloured, displaced or missing teeth. A brief overview of the cause of discolouration is outlined, followed by assessment and management options. These can include bleaching, veneers, or crown restorations to mask the discolouration. Displacement of teeth from the socket can occur due to luxation injuries. Management can include simple digital manipulation, surgical repositioning, or orthodontic extrusion based on the severity of extrusion and the time from injury. Teeth can be lost early or in the long-term following dental trauma and associated hard and soft tissues deficiencies may also ensue. Replacement options can include a removable partial prosthesis, resin-retained bridge or dental implants. Often, hard and soft tissue augmentation procedures may be required to address any defects and rebuild lost anatomical contours. A thorough assessment followed by the development of a sound management plan which takes patients' general and local factors into account can ensure a predictable and successful treatment outcome. This would end in an aesthetically pleasing and a functionally stable result for the patient. Key points This paper provides an overview of discoloured, displaced and missing teeth following dental trauma and their management options. This paper discusses hard and soft tissue deficiencies following dental trauma and their management options. Clinical photos have been provided to illustrate the discussions throughout this paper with the aim to enable readers to visualise the management approaches and apply it to their daily practice.

A 17-year-old boy presented to the ED with pain and swelling in his jaw 2 hours after an e-cigarette exploded during use. He had extensive lacerations in his mouth, multiple disrupted lower incisors, and bony incongruity of his left mandible.

Introduction This survey reports the incidence of traumatic dental injuries in an adult population attending an adult dental trauma clinic in a London teaching hospital. Materials and methods Retrospective data were collected from patients attending an adult dental trauma clinic between 2012 and 2018. Results In total, 1,769 patients attended, with more men seen (1,030; 58.2%) compared to women (739; 41.8%) and this was statistically significant (p <0.05). The most common aetiological factor was an accidental fall (728; 41.15%), followed by assaults (413; 23.35%), bicycle accidents (253; 14.3%), sports injuries (132; 7.46%) and road traffic accidents (84; 4.75%). Lateral luxation (833) was the most common traumatic injury and this was followed by avulsions (362; 17%). Enamel-dentine fractures were the most common type of fracture injury (1,273; 64%). Discussion This retrospective survey attempts to report on the incidence of traumatic dental injuries in a London-based cohort of patients attending a specialised dental trauma clinic. In line with other reports, there were more men than women affected, which is probably attributed to behavioural activities. Conclusion(s) Accidental falls are the most common cause of a traumatic dental injury, lateral luxation was the most common type of displacement injury and enamel-dentine fractures were the most common type of fracture injury. Key points Reports incidence of dental trauma in adults in the UK. Outlines the aetiology of dental trauma. Describes the differences between men and women in sustaining dental trauma. Lists the types and incidence of fracture injuries presenting to an adult dental trauma service.

This study aimed to determine the incidence of traumatic dental injuries (TDIs) during oral tracheal intubation by traditional laryngoscopy in general anesthesia (GA) in pediatric patients aged 4–13 and the correlated risk factors in Damascus, Syria. The study included children at the Department of General Surgery, Damascus University. Each child was examined before, during, and after 12–24 h of entering the operation room. The examination aimed to obtain demographic data and information regarding anesthesia procedures and the oral cavity. This study demonstrated that the incidence of TDIs during oral tracheal intubation was 16.00%. Most of those injuries are intra-oral, which were related to soft tissue. Maxillary incisors were the most affected teeth. Concussion and tongue injury were the common types of hard and soft tissue injury, respectively. There is a relation between TDIs and the occlusal stage, the difficulty of intubation, the number of intubation attempts, the Mallampati score, inter-incisor distance, and the distance between the mental and thyroid cartilage ( p  < 0.05). TDIs during oral tracheal intubation in GA are injuries with many risk factors and can’t be avoided even with skilled anesthetists. Careful Preoperative clinical examination of the oral cavity by anesthesiologists can reduce the incidence of TDIs.

Objective. To evaluate the prevalence, risk factors, aetiology, and management of traumatic dental injuries (TDIs) among children aged 1–18 years attending the Department of Pediatric Dentistry, Damascus University, Syria, during 2023–2024, and to illustrate representative clinical cases with documented outcomes. Methods. This retrospective cross-sectional study reviewed 2716 patient records (2023–2024) and identified 301 children with TDIs. Demographic, clinical, and behavioural variables were extracted and analysed using χ2, t tests, ANOVA, and binary logistic regression (IBM SPSS v26). Results. The overall TDI prevalence was 11.08%. Males were over twice as likely as females to experience TDIs (OR = 2.30; 95% CI = 1.76–3.01; p < 0.001). Older age acted as a protective factor (OR = 0.56; 95% CI = 0.43–0.74; p < 0.001). Falls were the most common cause (63.7%), and injuries most often occurred at home (48.9%). The maxillary central incisors were most frequently affected (68.5% of cases). Children with special healthcare needs had significantly more traumatised teeth (mean = 2.61 ± 1.13) than healthy children (1.66 ± 0.92; p < 0.001). Nearly half of the patients (45.3%) presented > one month after injury, and asymptomatic apical periodontitis and reversible pulpitis were the most frequent diagnoses. Representative case presentations demonstrated multidisciplinary management using restorative, endodontic, and orthodontic approaches with favourable follow-up outcomes. Conclusions. TDIs affected about one in nine children in this Syrian cohort. Male gender, younger age, and previous trauma were key risk factors. The predominance of delayed presentation underscores the need for community education, early referral systems, and targeted preventive programs within school and home environments.

Dental calculus (DC) is the most widespread oral problem in domestic dogs. Chewing items are used to remove DC from the tooth surface; they also favor oral health and animal welfare. Raw beef bone mastication also shortly reduces DC in adult dogs. However, it can cause oral lesions and hence is not popular. This study evaluated the impact of bone mastication on the dental roots, enamel, and gingiva of dogs. Twelve adult Beagle dogs were randomly divided into 2 treatment groups in a completely randomized block design: cortical bone (CB) or spongy bone (SB). Intraoral radiographs were obtained on days 0 and 14, and calculus assessment was performed using images captured on days 0, 3, 6, 9, 12, and 14; an integration program was used to measure the proportion between the area covered by calculus and the total area of teeth. DC was completely removed from the first and second premolars and molars from both the arcades in less than 3 days of supplementation, indicating that these teeth were frequently used for chewing (P < 0.10). Bones were highly effective for DC removal and gingival inflammation reduction. Despite the hardness of bones, no lesions or teeth root and enamel fracture, or esophageal or intestinal obstructions—complications related to bone ingestion—were noted. However, SB showed some gingival lesions (n = 4) and bone remnants between teeth (n = 2). Gingival lesions were caused by the daily and continuous supply of new pieces of bone for 13 days. Specific pieces of bone should be used for oral home care programs because they shortly remove almost 90% of DC, allowing longer intervals between periodontal cleaning procedures. Long-term studies are required to evaluate the use of bones and evaluate their impact on teeth and periodontium after prolonged supplementation.