Acessibilidade / Reportar erro

The impact of the COVID-19 pandemic on dental trauma attendance: a systematic review and meta-analysis

Abstract

This systematic review and meta-analysis aimed to analyze the impact of the COVID-19 pandemic on dental trauma patient attendance. The study was registered in the PROSPERO system, using the CRD42021288398 protocol. Searching was performed in PubMed, Scopus, Web of Science, Embase, Lilacs, and OpenGrey databases, using the following keywords: “Tooth injuries,” “Dental trauma,” “Traumatic Dental injury,” and “COVID-19". We included observational studies evaluating dental trauma in the context of the COVID-19 pandemic. Quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Checklist for Cross-Sectional Studies. Meta-analysis was performed in RevMan 5.4 software with Odds Ratios as a pooled measure of effect, with a 95% confidence interval, and using random-effects modeling. After applying the eligibility criteria, 32 studies were included for qualitative analysis, in which 10 were used to assess the frequency of dental trauma diagnoses in dental emergencies. Despite the decrease of visits during COVID-19, the analysis revealed no difference between the pandemic and pre-pandemic periods. Regarding the type of dental trauma, two of the studies revealed no differences for the periods before and during the pandemic. This study revealed that the COVID-19 pandemic has not impacted the frequency or type of dental trauma compared to previous periods.

COVID-19; Tooth injuries; Tooth avulsion; Tooth fractures; Systematic review; Meta-analysis

Introduction

The COVID-19 pandemic has affected the world’s population, causing significant impacts to health care. Due to the aerosol transmission of the disease, health professionals, especially dentists, are more vulnerable and exposed to the risk of contamination. Given this scenario, there have been readjustments in health care, with greater investment in personal protective equipment (PPE) and biosafety measures to minimize the risk of cross-contamination between professionals and patients in the dental office environment.11 - Pereira LJ, Pereira CV, Murata RM, Pardi V, Pereira-Dourado SM. Biological and social aspects of Coronavirus Disease 2019 (COVID-19) related to oral health. Braz Oral Res. 2020;34:e041. doi: 10.1590/1807-3107bor-2020.vol34.0041

2 - Warnakulasuriya S. Protecting dental manpower from COVID-19 infection. Oral Dis. 2021;27 Suppl 3:651-4. doi: 10.1111/odi.13410
-33 - Ayub K, Alani A. Acute endodontic and dental trauma provision during the COVID-19 crisis. Br Dent J. 2020;229(3):169-75. doi: 10.1038/s41415-020-1920-0

Moreover, to prevent the contamination, restrictive measures also had to be imposed, such as distancing and social isolation, occasionally suspending elective dental care for a period and assisting only urgent cases.44 - Alharbi A, Alharbi S, Alqaidi S. Guidelines for dental care provision during the COVID-19 pandemic. Saudi Dent J. 2020;32(4):181-6. doi: 10.1016/j.sdentj.2020.04.001 The main types of emergency in dental care are endodontic, surgical, traumatic, and infectious disease.55 - Madi M, Kumar M, Varchas P, Vineetha R, Pentapati KC. Changing trends in the outpatient dental visits during the COVID–19 pandemic in a tertiary care hospital. Saudi J Biol Sci. 2021;28(8):4437-41. doi: 10.1016/j.sjbs.2021.04.038,66 - Samuel SR, Mathew MG, Suresh SG, Varma SR, Elsubeihi ES, Arshad F, et al. Pediatric dental emergency management and parental treatment preferences during COVID-19 pandemic as compared to 2019. Saudi J Biol Sci. 2021;28(4):2591-7. doi: 10.1016/j.sjbs.2021.02.002

Traumatic dental injuries are a public health problem worldwide that affect a considerable proportion of the population, especially children and young adults. Such injuries vary according to tooth structure involvement, from simple enamel fractures to avulsion. Depending on the severity, a trauma may require urgent professional care, possibly resulting in an irreparable dental damage. Many causes, such as falls, car accidents, sports, occupational accidents, or interpersonal violence can affect the dental arch and involve both teeth and their supporting tissues, causing functional, esthetic, and even psychological injury.77 - Levin L, Day PF, Hicks L, O’Connell A, Fouad AF, Bourguignon C, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: general introduction. Dent Traumatol. 2020;36(4):309-13. doi: 10.1111/edt.12574

8 - Vieira WA, Pecorari VG, Figueiredo-de-Almeida R, Carvas N Junior, Vargas-Neto J, Santos EC, et al. Prevalence of dental trauma in Brazilian children and adolescents: a systematic review and meta-analysis. Cad Saude Publica. 2021;37(12):e00015920. doi: 10.1590/0102-311X00015920

9 - Yang YT, Zhang W, Xie L, Li ZB, Li Z. Characteristic changes of traumatic dental injuries in a teaching hospital of Wuhan under transmission control measures during the COVID-19 epidemic. Dent Traumatol. 2020;36(6):584-9. doi: 10.1111/edt.12589

10 - Woolley J, Djemal S. Traumatic dental injuries during the COVID-19 pandemic. Prim Dent J. 2021;10(1):28-32.doi: 10.1177/2050168420980994
-1111 - Bourguignon C, Cohenca N, Lauridsen E, Flores MT, O’Connell AC, Day PF, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations. Dent Traumatol. 2020;36(4):314-30. doi: 10.1111/edt.12578

Each treatment is performed in accordance with the need of the case. Thus, the variability of traumatic injuries determines the diversity of treatments, which can be categorized as endodontic (pulpotomy, pulpectomy), restorative, periodontal (splinting of teeth), surgical (extractions), or as pharmacological interventions.66 - Samuel SR, Mathew MG, Suresh SG, Varma SR, Elsubeihi ES, Arshad F, et al. Pediatric dental emergency management and parental treatment preferences during COVID-19 pandemic as compared to 2019. Saudi J Biol Sci. 2021;28(4):2591-7. doi: 10.1016/j.sjbs.2021.02.002,1212 - Walter E, von Bronk L, Hickel R, Huth KC. Impact of COVID-19 on dental care during a national lockdown: a retrospective observational study. Int J Environ Res Public Health. 2021;18(15):7963. doi: 10.3390/ijerph18157963,1313 - Patel N, Viswanathan A, Lee J, Barrow S, Cant A, Sanghvi R, et al. Paediatric dental A&E service during the COVID-19 pandemic in the Greater London area. Eur Arch Paediatr Dent. 2021;22(3):507-13. doi: 10.1007/s40368-020-00589-9
https://doi.org/10.1007/s40368-020-00589...

The COVID-19 pandemic has spread worldwide, bringing many challenges to Dentistry, especially in terms of the population’s access to dental care after the restrictive measures. Due to the need for urgent dental treatment in some cases of dental trauma, it is essential to understand how the pandemic impacted the demand for care of patients who suffered dental trauma and were treated in urgent dental services. In this context, this study aimed to assess the impact of the current pandemic on dental trauma health care by carrying out a systematic review of the literature with a meta-analysis.

Methodology

This systematic review and meta-analysis was carried out in accordance with the PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines,1414 - Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. J Clin Epidemiol. 2021;134:178-89. doi: 10.1016/j.jclinepi.2021.03.001 and the study was registered in the PROSPERO system, using the CRD42021288398 protocol.

The following research question guided the study development: “What is the impact on demand for care of patients who suffered dental trauma and were attended in urgent dental services?” From the PECOS strategy: Population – P: Dental trauma patients; Exposition – E: COVID-19 pandemic period; Comparison – C: Pre-pandemic period; Outcome – O: the impact of the COVID-19 pandemic on dental trauma attendance; Study design – S: Observational study.

Search strategy

In July 2022, searches were performed in the PubMed/Medline, Scopus, Web of Science, Embase, and Lilacs databases, without an year of publication or language limitations. Searches were also carried out in the Open Grey referring to gray literature. The elaboration of the search strategy (Supplementary material) was performed using Medical Subject Headings (MeSH) and their respective terms, combined with Boolean operators (AND, OR): “Tooth injuries,” “Dental trauma,” “Dental-alveolar trauma,” “Traumatic dental injury,” “Tooth fracture,” “Tooth avulsion,” “Tooth luxation,” “Tooth concussion,” “Tooth intrusion,” “Tooth extrusion,” “COVID-19,” “COVID-19 pandemic”. Manual searching in the manuscripts was performed to verify the included studies’ references.

Eligibility criteria

Observational studies that evaluated dental trauma during and before the COVID-19 pandemic were selected. Of these studies, those that also presented data from the pre-pandemic period were used as controls for comparative analysis. Case reports, case series, letters to the editor, comments, editorials, and literature reviews were excluded. Furthermore, studies that mentioned craniofacial, maxillofacial, or dentoalveolar trauma, yet without specifying the damage to dental structures, were not considered. Clinical trials were not considered due to ethical limitations regarding exposure parameters.

Study selection

The study selection process was performed using the Rayyan software (https://www.rayyan.ai/). Files from each database were imported and duplicates removed. The initial step was selecting the studies by title and abstract, followed by reading the full-text of each potentially eligible article. Articles that did not meet the selection criteria were excluded with justification. Study selection was performed by two independent reviewers (ACG and LRMB) and disagreements were resolved by a third reviewer (DSC).

Data extraction

Data extraction from the included studies employed a standardized collection form with the following information: author, year, country, period, sample characteristics, dental trauma, tooth affected, cause of trauma, and treatment. The data extraction was performed by three reviewers (DSC, IAFM, and LEDS) and revised by a fourth reviewer (FLCDA).

Quality assessment

Quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Checklist for Cross-Sectional Studies1515 - The Joanna Briggs Institute. The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews: checklist for analytical cross sectional studies [Internet]. Adelaide: The Joanna Briggs Institute; 2017 [cited 2022 Dec 6]. Available from: https://jbi.global/sites/default/files/2019-05/JBI_Critical_Appraisal-Checklist_for_Analytical_Cross_Sectional_Studies2017_0.pdf
https://jbi.global/sites/default/files/2...
by two independent examiners (DSC and IAFM). The responses to the items in the checklist were “yes,” “unclear,” “no,” or “not applicable.” The questions evaluated and their respective answers were assessed using the RevMan 5.4 software (Review Manager 5.4, The Cochrane Collaboration).1616 - Polmann H, Réus JC, Massignan C, Serra-Negra JM, Dick BD, Flores-Mir C, et al. Association between sleep bruxism and stress symptoms in adults: a systematic review and meta-analysis. J Oral Rehabil. 2021;48(5):621-31. doi: 10.1111/joor.13142

Meta-analysis

Meta-analysis was performed on the studies and presented comparative results in the pre-COVID-19 and COVID-19 periods for the frequencies of dental trauma diagnosed from the total number of dental emergencies. Subgroup analysis was also performed to assess the types of dental trauma in these same periods. The analyses and their respective forest plots were performed using the RevMan 5.4 software (Review Manager 5.4, The Cochrane Collaboration) considering odds ratios (ORs) as a pooled measure of effect, with a confidence interval of 95%, and using a random-effects model.

To quantify statistical heterogeneity, the I2 test was used, classifying heterogeneity as low (I2 close to 25%), moderate (I2 close to 50%), high (I2 close to 75%), or without statistical heterogeneity (I2=0%).

Results

Figure 1 shows the flowchart of the study selection process following the PRISMA guidelines. Initially, 643 articles were identified in the databases, 337 duplicates were removed, and 306 studies were maintained for the title and abstract reading. After excluding 246 articles, 57 full-texts were read to verify the eligibility criteria, and 25 were excluded with justification (Supplementary material). No further studies were included, which may be a result from database searches originated in references. Thus, 32 studies were included in qualitative analysis, and 12 articles were included in quantitative analysis.

Figure 1
Flow diagram of literature searches in accordance with PRISMA 2020

Figure 2 shows the information extracted from the selected studies. The studies were carried out in 13 countries (Qatar, Saudi Arabia, England, United Kingdom, Italy, Switzerland, Israel, India, China, Germany, Russia, United States, and Romania). Among the included articles, the United Kingdom and England (n=11) and China (n=6) presented most of the studies. Regarding the study periods, 20 studies1212 - Walter E, von Bronk L, Hickel R, Huth KC. Impact of COVID-19 on dental care during a national lockdown: a retrospective observational study. Int J Environ Res Public Health. 2021;18(15):7963. doi: 10.3390/ijerph18157963,1313 - Patel N, Viswanathan A, Lee J, Barrow S, Cant A, Sanghvi R, et al. Paediatric dental A&E service during the COVID-19 pandemic in the Greater London area. Eur Arch Paediatr Dent. 2021;22(3):507-13. doi: 10.1007/s40368-020-00589-9
https://doi.org/10.1007/s40368-020-00589...
,1717 - Ali SA, Al-Qahtani AM, Al Banai SR, Albaker FJ, Almarri AE, Al-Haithami K, et al. Role of newly introduced teledentistry service in the management of dental emergencies during COVID-19 pandemic in Qatar: a cross-sectional analysis. Telemed e-Health. 202224;28(11):1623-32. doi: 10.1089/tmj.2021.0584

18 - Alzahrani SB, Alrusayes AA, Alfraih YK, Aldossary MS. Characteristics of paediatric dental emergencies during the COVID-19 pandemic in Riyadh City, Saudi Arabia. Eur J Paediatr Dent. 2021;22(2):95-7. doi: 10.23804/ejpd.2021.22.02.2
https://doi.org/10.23804/ejpd.2021.22.02...

19 - Amin S, Zaheer K, De Souza M. Dental public health in action: utilising a telephone triage system to run an urgent dental care hub during the COVID-19 pandemic. Community Dent Health. 2021;38(3):161-4. doi:10.1922/CDH_00023Amin04
https://doi.org/10.1922/CDH_00023Amin04...

20 - Ball M, Akintola D, Harrington Z, Djemal S. Emergency dental care triage during the COVID-19 pandemic. Br Dent J. Forthcoming 2021. doi: 10.1038/s41415-021-3379-z
-2121 - Blackhall KK, Singh RP. Dental emergencies presenting to maxillofacial units during the COVID-19 pandemic: a five-centre UK hospital study. Br Dent J. Forthcoming 2021. doi: 10.1038/s41415-020-2499-1,2323 - Carter E, Currie CC, Asuni A, Goldsmith R, Toon G, Horridge C, et al. The first six weeks: setting up a UK urgent dental care centre during the COVID-19 pandemic. Br Dent J. 2020;228(11):842-8. doi: 10.1038/s41415-020-1708-2,2525 - Eggmann F, Haschemi AA, Doukoudis D, Filippi A, Verna C, Walter C, et al. Impact of the COVID-19 pandemic on urgent dental care delivery in a Swiss university center for dental medicine. Clin Oral Investig. 2021;25(10):5711-21. doi: 10.1007/s00784-021-03872-1

26 - Elalouf A, Moran R, Yaron B, Oman M. Pediatric dental emergency visits and treatment during lockdown in the COVID-19 pandemic: a retrospective study. Int J Environ Res Public Health. 2022;19(7):3774. doi: 10.3390/ijerph19073774
-2727 - Goswami M, Gogia M, Bhardwaj S. From lockdown to slow release: pediatric dental services during covid-19 pandemic - emergency preparedness and impact on future. Int J Clin Pediatr Dent. 2021;14(3):398-402. doi: 10.5005/jp-journals-10005-1962,2929 - Hahn B, Hollenberger L, Schlagenhauf U, Böhm H, Haubitz IR, Soliman S, et al. The utilization of dental emergency services during COVID-19 pandemic in a German university center: Do we lose vulnerable patients? Quintessence Int. 2021;52(9):828-36. doi: 10.3290/j.qi.b1702163
https://doi.org/10.3290/j.qi.b1702163...

30 - Ilyas N, Agel M, Mitchell J, Sood S. COVID-19 pandemic: the first wave - an audit and guidance for paediatric dentistry. Br Dent J. 2020;228(12):927-31. doi: 10.1038/s41415-020-1702-8

31 - Ilyas N, Green A, Karia R, Sood S, Fan K. Demographics and management of paediatric dental-facial trauma in the ‘lockdown’ period: a UK perspective. Dent Traumatol. 2021;37(4):576-582. doi: 10.1111/edt.12667
-3232 - Kamalova MK, Fomenko I V, Dmitrienko DS, Matvienko N V, Arjenovskaya EN, Gevorkyan AG, et al. Reasons for 1-17-year-old children to visit a dentist during the COVID-19 pandemic. Eur J Mol Clin Med. 2020;7(7):546-58.,3434 - Langella J, Magnuson B, Finkelman MD, Amato R. Clinical response to COVID-19 and utilization of an emergency dental clinic in an academic institution. J Endod. 2021;47(4):566-71. doi: 10.1016/j.joen.2020.11.025,3636 - Pajpani M, Patel K, Bendkowski A, Stenhouse P. Rapid response: activity from a hospital based Urgent Dental Care Centre during the COVID-19 pandemic. Br J Oral Maxillofac Surg. 2020;58(9):e98-103. doi: 10.1016/j.bjoms.2020.07.004,3838 - Simpson S, Sumner O, Holliday R, Currie C, Hind V, Lush N, et al. Paediatric Dentistry and the coronavirus (COVID-19) response in the North East of England and North Cumbria. medRxiv [Preprint]. 2020 [cited 2022 Dec 6]. Available from: https://doi.org/10.1101/2020.06.02.20114967
https://doi.org/10.1101/2020.06.02.20114...
,4040 - Yang F, Yu L, Qin D, Hua F, Song G. Online consultation and emergency management in paediatric dentistry during the COVID-19 epidemic in Wuhan: a retrospective study. Int J Paediatr Dent. 2021;31(1):5-11. doi: 10.1111/ipd.12722,4242 - Yu J, Zhang T, Zhao D, Haapasalo M, Shen Y. Characteristics of endodontic emergencies during coronavirus disease 2019 outbreak in Wuhan. J Endod. 2020;46(6):730-5. doi: 10.1016/j.joen.2020.04.001performed evaluations involving just the pandemic period and 12 studies55 - Madi M, Kumar M, Varchas P, Vineetha R, Pentapati KC. Changing trends in the outpatient dental visits during the COVID–19 pandemic in a tertiary care hospital. Saudi J Biol Sci. 2021;28(8):4437-41. doi: 10.1016/j.sjbs.2021.04.038,66 - Samuel SR, Mathew MG, Suresh SG, Varma SR, Elsubeihi ES, Arshad F, et al. Pediatric dental emergency management and parental treatment preferences during COVID-19 pandemic as compared to 2019. Saudi J Biol Sci. 2021;28(4):2591-7. doi: 10.1016/j.sjbs.2021.02.002,99 - Yang YT, Zhang W, Xie L, Li ZB, Li Z. Characteristic changes of traumatic dental injuries in a teaching hospital of Wuhan under transmission control measures during the COVID-19 epidemic. Dent Traumatol. 2020;36(6):584-9. doi: 10.1111/edt.12589,1010 - Woolley J, Djemal S. Traumatic dental injuries during the COVID-19 pandemic. Prim Dent J. 2021;10(1):28-32.doi: 10.1177/2050168420980994,2222 - Cagetti MG, Balian A, Camoni N, Campus G. Influence of the COVID-19 pandemic on dental emergency admissions in an urgent dental care service in North Italy. Int J Environ Res Public Health. 2021;18(4):1812. doi: 10.3390/ijerph18041812,2424 - Davies A, Howells R, Lee SMG, Sweet CJ, Dominguez-Gonzalez S. Implementation of photographic triage in a paediatric dental, orthodontic, and maxillofacial department during COVID-19. Int J Paediatr Dent. 2021;31(4):547-53. doi: 10.1111/ipd.12773,2828 - Guo H, Zhou Y, Liu X, Tan J. The impact of the COVID-19 epidemic on the utilization of emergency dental services. J Dent Sci. 2020;15(4):564-7. doi: 10.1016/j.jds.2020.02.002,3333 - Kumar U, Gupta A, Goyal A, Gauba K. Impact of COVID-19 pandemic on characteristics of dental emergencies and treatment services at tertiary care centre. Saudi Dent J. 2021;33(8):1018-1023. doi: 10.1016/j.sdentj.2021.06.004,3535 - Lentge F, Jehn P, Zeller AN, Spalthoff S, Rahlf B, Korn P. Changes in emergency patient presentation to a maxillofacial surgery department during the COVID-19 pandemic. J Oral Maxillofac Surg. 2021;79(10):2123.e1-2123.e6. doi: 10.1016/j.joms.2021.05.026,3737 - Petrescu NB, Aghiorghiesei O, Mesaros AS, Lucaciu OP, Dinu CM, Campian RS, et al. Impact of COVID-19 on dental emergency services in Cluj-Napoca metropolitan area: a cross-sectional study. Int J Environ Res Public Health. 2020;1722;17(21):7716. doi: 10.3390/ijerph17217716,3939 - Wu K, Li C, Yang Z, Yang S, Yang W, Hua C. Changes in the characteristics of dental emergencies under the influence of SARS-CoV-2 pandemic: a retrospective study. BMC Oral Health. 2021;21(1):174. doi: 10.1186/s12903-021-01499-y,4141 - Yang J, Yang G, Jin R, Song G, Yuan G. Changes in paediatric dental clinic after reopening during COVID-19 pandemic in Wuhan: a retrospective study. BMJ Open. 2022;12(1):e048430. doi: 10.1136/bmjopen-2020-048430performed comparative analyses involving also previous (pre-pandemic) periods. Sample characteristics varied according to age group, with 12 studies66 - Samuel SR, Mathew MG, Suresh SG, Varma SR, Elsubeihi ES, Arshad F, et al. Pediatric dental emergency management and parental treatment preferences during COVID-19 pandemic as compared to 2019. Saudi J Biol Sci. 2021;28(4):2591-7. doi: 10.1016/j.sjbs.2021.02.002,1313 - Patel N, Viswanathan A, Lee J, Barrow S, Cant A, Sanghvi R, et al. Paediatric dental A&E service during the COVID-19 pandemic in the Greater London area. Eur Arch Paediatr Dent. 2021;22(3):507-13. doi: 10.1007/s40368-020-00589-9
https://doi.org/10.1007/s40368-020-00589...
,1818 - Alzahrani SB, Alrusayes AA, Alfraih YK, Aldossary MS. Characteristics of paediatric dental emergencies during the COVID-19 pandemic in Riyadh City, Saudi Arabia. Eur J Paediatr Dent. 2021;22(2):95-7. doi: 10.23804/ejpd.2021.22.02.2
https://doi.org/10.23804/ejpd.2021.22.02...
,2424 - Davies A, Howells R, Lee SMG, Sweet CJ, Dominguez-Gonzalez S. Implementation of photographic triage in a paediatric dental, orthodontic, and maxillofacial department during COVID-19. Int J Paediatr Dent. 2021;31(4):547-53. doi: 10.1111/ipd.12773,2626 - Elalouf A, Moran R, Yaron B, Oman M. Pediatric dental emergency visits and treatment during lockdown in the COVID-19 pandemic: a retrospective study. Int J Environ Res Public Health. 2022;19(7):3774. doi: 10.3390/ijerph19073774,2727 - Goswami M, Gogia M, Bhardwaj S. From lockdown to slow release: pediatric dental services during covid-19 pandemic - emergency preparedness and impact on future. Int J Clin Pediatr Dent. 2021;14(3):398-402. doi: 10.5005/jp-journals-10005-1962,3030 - Ilyas N, Agel M, Mitchell J, Sood S. COVID-19 pandemic: the first wave - an audit and guidance for paediatric dentistry. Br Dent J. 2020;228(12):927-31. doi: 10.1038/s41415-020-1702-8

31 - Ilyas N, Green A, Karia R, Sood S, Fan K. Demographics and management of paediatric dental-facial trauma in the ‘lockdown’ period: a UK perspective. Dent Traumatol. 2021;37(4):576-582. doi: 10.1111/edt.12667
-3232 - Kamalova MK, Fomenko I V, Dmitrienko DS, Matvienko N V, Arjenovskaya EN, Gevorkyan AG, et al. Reasons for 1-17-year-old children to visit a dentist during the COVID-19 pandemic. Eur J Mol Clin Med. 2020;7(7):546-58.,3838 - Simpson S, Sumner O, Holliday R, Currie C, Hind V, Lush N, et al. Paediatric Dentistry and the coronavirus (COVID-19) response in the North East of England and North Cumbria. medRxiv [Preprint]. 2020 [cited 2022 Dec 6]. Available from: https://doi.org/10.1101/2020.06.02.20114967
https://doi.org/10.1101/2020.06.02.20114...
,4040 - Yang F, Yu L, Qin D, Hua F, Song G. Online consultation and emergency management in paediatric dentistry during the COVID-19 epidemic in Wuhan: a retrospective study. Int J Paediatr Dent. 2021;31(1):5-11. doi: 10.1111/ipd.12722,4141 - Yang J, Yang G, Jin R, Song G, Yuan G. Changes in paediatric dental clinic after reopening during COVID-19 pandemic in Wuhan: a retrospective study. BMJ Open. 2022;12(1):e048430. doi: 10.1136/bmjopen-2020-048430carried out in emergency dental services provided to children/adolescents from 0 to 21 years old. The other studies were performed in dental centers for the general public, with an age range from 0 to 95 years old. Dental care patients observed were mainly males in both the pre-COVID-19 and COVID-19 periods.

Figure 2
Data extracted from the included studies

Qualitative analysis of the articles that do not compare the pre-COVID-19 period showed a prevalence of dental trauma, diagnosed in dental emergency services, ranging from 1.1%1818 - Alzahrani SB, Alrusayes AA, Alfraih YK, Aldossary MS. Characteristics of paediatric dental emergencies during the COVID-19 pandemic in Riyadh City, Saudi Arabia. Eur J Paediatr Dent. 2021;22(2):95-7. doi: 10.23804/ejpd.2021.22.02.2
https://doi.org/10.23804/ejpd.2021.22.02...
to 54.9%3131 - Ilyas N, Green A, Karia R, Sood S, Fan K. Demographics and management of paediatric dental-facial trauma in the ‘lockdown’ period: a UK perspective. Dent Traumatol. 2021;37(4):576-582. doi: 10.1111/edt.12667. The results varied as to the dentition and type of trauma involved. Only seven studies1313 - Patel N, Viswanathan A, Lee J, Barrow S, Cant A, Sanghvi R, et al. Paediatric dental A&E service during the COVID-19 pandemic in the Greater London area. Eur Arch Paediatr Dent. 2021;22(3):507-13. doi: 10.1007/s40368-020-00589-9
https://doi.org/10.1007/s40368-020-00589...
,1919 - Amin S, Zaheer K, De Souza M. Dental public health in action: utilising a telephone triage system to run an urgent dental care hub during the COVID-19 pandemic. Community Dent Health. 2021;38(3):161-4. doi:10.1922/CDH_00023Amin04
https://doi.org/10.1922/CDH_00023Amin04...
,2424 - Davies A, Howells R, Lee SMG, Sweet CJ, Dominguez-Gonzalez S. Implementation of photographic triage in a paediatric dental, orthodontic, and maxillofacial department during COVID-19. Int J Paediatr Dent. 2021;31(4):547-53. doi: 10.1111/ipd.12773,3030 - Ilyas N, Agel M, Mitchell J, Sood S. COVID-19 pandemic: the first wave - an audit and guidance for paediatric dentistry. Br Dent J. 2020;228(12):927-31. doi: 10.1038/s41415-020-1702-8

31 - Ilyas N, Green A, Karia R, Sood S, Fan K. Demographics and management of paediatric dental-facial trauma in the ‘lockdown’ period: a UK perspective. Dent Traumatol. 2021;37(4):576-582. doi: 10.1111/edt.12667
-3232 - Kamalova MK, Fomenko I V, Dmitrienko DS, Matvienko N V, Arjenovskaya EN, Gevorkyan AG, et al. Reasons for 1-17-year-old children to visit a dentist during the COVID-19 pandemic. Eur J Mol Clin Med. 2020;7(7):546-58.,4040 - Yang F, Yu L, Qin D, Hua F, Song G. Online consultation and emergency management in paediatric dentistry during the COVID-19 epidemic in Wuhan: a retrospective study. Int J Paediatr Dent. 2021;31(1):5-11. doi: 10.1111/ipd.12722 mentioned the type of dentition, four studies1313 - Patel N, Viswanathan A, Lee J, Barrow S, Cant A, Sanghvi R, et al. Paediatric dental A&E service during the COVID-19 pandemic in the Greater London area. Eur Arch Paediatr Dent. 2021;22(3):507-13. doi: 10.1007/s40368-020-00589-9
https://doi.org/10.1007/s40368-020-00589...
,2424 - Davies A, Howells R, Lee SMG, Sweet CJ, Dominguez-Gonzalez S. Implementation of photographic triage in a paediatric dental, orthodontic, and maxillofacial department during COVID-19. Int J Paediatr Dent. 2021;31(4):547-53. doi: 10.1111/ipd.12773,3232 - Kamalova MK, Fomenko I V, Dmitrienko DS, Matvienko N V, Arjenovskaya EN, Gevorkyan AG, et al. Reasons for 1-17-year-old children to visit a dentist during the COVID-19 pandemic. Eur J Mol Clin Med. 2020;7(7):546-58.,4040 - Yang F, Yu L, Qin D, Hua F, Song G. Online consultation and emergency management in paediatric dentistry during the COVID-19 epidemic in Wuhan: a retrospective study. Int J Paediatr Dent. 2021;31(1):5-11. doi: 10.1111/ipd.12722 reported that dental trauma was more common in primary dentition, and three studies1919 - Amin S, Zaheer K, De Souza M. Dental public health in action: utilising a telephone triage system to run an urgent dental care hub during the COVID-19 pandemic. Community Dent Health. 2021;38(3):161-4. doi:10.1922/CDH_00023Amin04
https://doi.org/10.1922/CDH_00023Amin04...
,3030 - Ilyas N, Agel M, Mitchell J, Sood S. COVID-19 pandemic: the first wave - an audit and guidance for paediatric dentistry. Br Dent J. 2020;228(12):927-31. doi: 10.1038/s41415-020-1702-8,3131 - Ilyas N, Green A, Karia R, Sood S, Fan K. Demographics and management of paediatric dental-facial trauma in the ‘lockdown’ period: a UK perspective. Dent Traumatol. 2021;37(4):576-582. doi: 10.1111/edt.12667 reported that dental trauma was more common in permanent dentition. The trauma type was specified in nine studies,66 - Samuel SR, Mathew MG, Suresh SG, Varma SR, Elsubeihi ES, Arshad F, et al. Pediatric dental emergency management and parental treatment preferences during COVID-19 pandemic as compared to 2019. Saudi J Biol Sci. 2021;28(4):2591-7. doi: 10.1016/j.sjbs.2021.02.002,99 - Yang YT, Zhang W, Xie L, Li ZB, Li Z. Characteristic changes of traumatic dental injuries in a teaching hospital of Wuhan under transmission control measures during the COVID-19 epidemic. Dent Traumatol. 2020;36(6):584-9. doi: 10.1111/edt.12589,1010 - Woolley J, Djemal S. Traumatic dental injuries during the COVID-19 pandemic. Prim Dent J. 2021;10(1):28-32.doi: 10.1177/2050168420980994,2020 - Ball M, Akintola D, Harrington Z, Djemal S. Emergency dental care triage during the COVID-19 pandemic. Br Dent J. Forthcoming 2021. doi: 10.1038/s41415-021-3379-z,2323 - Carter E, Currie CC, Asuni A, Goldsmith R, Toon G, Horridge C, et al. The first six weeks: setting up a UK urgent dental care centre during the COVID-19 pandemic. Br Dent J. 2020;228(11):842-8. doi: 10.1038/s41415-020-1708-2,3030 - Ilyas N, Agel M, Mitchell J, Sood S. COVID-19 pandemic: the first wave - an audit and guidance for paediatric dentistry. Br Dent J. 2020;228(12):927-31. doi: 10.1038/s41415-020-1702-8,3131 - Ilyas N, Green A, Karia R, Sood S, Fan K. Demographics and management of paediatric dental-facial trauma in the ‘lockdown’ period: a UK perspective. Dent Traumatol. 2021;37(4):576-582. doi: 10.1111/edt.12667,3434 - Langella J, Magnuson B, Finkelman MD, Amato R. Clinical response to COVID-19 and utilization of an emergency dental clinic in an academic institution. J Endod. 2021;47(4):566-71. doi: 10.1016/j.joen.2020.11.025,3939 - Wu K, Li C, Yang Z, Yang S, Yang W, Hua C. Changes in the characteristics of dental emergencies under the influence of SARS-CoV-2 pandemic: a retrospective study. BMC Oral Health. 2021;21(1):174. doi: 10.1186/s12903-021-01499-y described as either enamel/dentine fracture, enamel-dentine-pulp fracture, crown root fracture, root fracture, concussion, subluxation, extrusion, lateral luxation, intrusion, or avulsion.

Only two studies99 - Yang YT, Zhang W, Xie L, Li ZB, Li Z. Characteristic changes of traumatic dental injuries in a teaching hospital of Wuhan under transmission control measures during the COVID-19 epidemic. Dent Traumatol. 2020;36(6):584-9. doi: 10.1111/edt.12589,3131 - Ilyas N, Green A, Karia R, Sood S, Fan K. Demographics and management of paediatric dental-facial trauma in the ‘lockdown’ period: a UK perspective. Dent Traumatol. 2021;37(4):576-582. doi: 10.1111/edt.12667 mentioned the affected teeth, presenting higher prevalence of the anterior teeth in the maxillary arch. The cause of trauma was evaluated by four studies,99 - Yang YT, Zhang W, Xie L, Li ZB, Li Z. Characteristic changes of traumatic dental injuries in a teaching hospital of Wuhan under transmission control measures during the COVID-19 epidemic. Dent Traumatol. 2020;36(6):584-9. doi: 10.1111/edt.12589,1010 - Woolley J, Djemal S. Traumatic dental injuries during the COVID-19 pandemic. Prim Dent J. 2021;10(1):28-32.doi: 10.1177/2050168420980994,3131 - Ilyas N, Green A, Karia R, Sood S, Fan K. Demographics and management of paediatric dental-facial trauma in the ‘lockdown’ period: a UK perspective. Dent Traumatol. 2021;37(4):576-582. doi: 10.1111/edt.12667,3535 - Lentge F, Jehn P, Zeller AN, Spalthoff S, Rahlf B, Korn P. Changes in emergency patient presentation to a maxillofacial surgery department during the COVID-19 pandemic. J Oral Maxillofac Surg. 2021;79(10):2123.e1-2123.e6. doi: 10.1016/j.joms.2021.05.026 whether falls or trips, bicycle accidents, assaults, traffic accidents, interpersonal violence, sports accidents, etc.

The specific treatments for dental trauma are mentioned in eight studies,1818 - Alzahrani SB, Alrusayes AA, Alfraih YK, Aldossary MS. Characteristics of paediatric dental emergencies during the COVID-19 pandemic in Riyadh City, Saudi Arabia. Eur J Paediatr Dent. 2021;22(2):95-7. doi: 10.23804/ejpd.2021.22.02.2
https://doi.org/10.23804/ejpd.2021.22.02...
,2222 - Cagetti MG, Balian A, Camoni N, Campus G. Influence of the COVID-19 pandemic on dental emergency admissions in an urgent dental care service in North Italy. Int J Environ Res Public Health. 2021;18(4):1812. doi: 10.3390/ijerph18041812,2424 - Davies A, Howells R, Lee SMG, Sweet CJ, Dominguez-Gonzalez S. Implementation of photographic triage in a paediatric dental, orthodontic, and maxillofacial department during COVID-19. Int J Paediatr Dent. 2021;31(4):547-53. doi: 10.1111/ipd.12773,2626 - Elalouf A, Moran R, Yaron B, Oman M. Pediatric dental emergency visits and treatment during lockdown in the COVID-19 pandemic: a retrospective study. Int J Environ Res Public Health. 2022;19(7):3774. doi: 10.3390/ijerph19073774,3131 - Ilyas N, Green A, Karia R, Sood S, Fan K. Demographics and management of paediatric dental-facial trauma in the ‘lockdown’ period: a UK perspective. Dent Traumatol. 2021;37(4):576-582. doi: 10.1111/edt.12667,3232 - Kamalova MK, Fomenko I V, Dmitrienko DS, Matvienko N V, Arjenovskaya EN, Gevorkyan AG, et al. Reasons for 1-17-year-old children to visit a dentist during the COVID-19 pandemic. Eur J Mol Clin Med. 2020;7(7):546-58.,3636 - Pajpani M, Patel K, Bendkowski A, Stenhouse P. Rapid response: activity from a hospital based Urgent Dental Care Centre during the COVID-19 pandemic. Br J Oral Maxillofac Surg. 2020;58(9):e98-103. doi: 10.1016/j.bjoms.2020.07.004,3939 - Wu K, Li C, Yang Z, Yang S, Yang W, Hua C. Changes in the characteristics of dental emergencies under the influence of SARS-CoV-2 pandemic: a retrospective study. BMC Oral Health. 2021;21(1):174. doi: 10.1186/s12903-021-01499-y and included counseling, antibiotic/analgesic prescription, splinting, dressing, restorative procedures, and extractions. For dental emergencies in general, the main treatments reported were pulpotomy, pulpectomy, direct pulp cap, intraoral radiograph, and other conservative treatment management strategies.

Figures 3 and 4 show the quality assessment. The criteria evaluated in questions 1, 2, 3, 4, and 7 were present in all studies. The questions related to confounding factors were not applicable to the selected studies. The highest methodological variability was regarding the performance of statistical analysis, which was not mentioned in nine studies.1010 - Woolley J, Djemal S. Traumatic dental injuries during the COVID-19 pandemic. Prim Dent J. 2021;10(1):28-32.doi: 10.1177/2050168420980994,1313 - Patel N, Viswanathan A, Lee J, Barrow S, Cant A, Sanghvi R, et al. Paediatric dental A&E service during the COVID-19 pandemic in the Greater London area. Eur Arch Paediatr Dent. 2021;22(3):507-13. doi: 10.1007/s40368-020-00589-9
https://doi.org/10.1007/s40368-020-00589...
,1818 - Alzahrani SB, Alrusayes AA, Alfraih YK, Aldossary MS. Characteristics of paediatric dental emergencies during the COVID-19 pandemic in Riyadh City, Saudi Arabia. Eur J Paediatr Dent. 2021;22(2):95-7. doi: 10.23804/ejpd.2021.22.02.2
https://doi.org/10.23804/ejpd.2021.22.02...

19 - Amin S, Zaheer K, De Souza M. Dental public health in action: utilising a telephone triage system to run an urgent dental care hub during the COVID-19 pandemic. Community Dent Health. 2021;38(3):161-4. doi:10.1922/CDH_00023Amin04
https://doi.org/10.1922/CDH_00023Amin04...

20 - Ball M, Akintola D, Harrington Z, Djemal S. Emergency dental care triage during the COVID-19 pandemic. Br Dent J. Forthcoming 2021. doi: 10.1038/s41415-021-3379-z
-2121 - Blackhall KK, Singh RP. Dental emergencies presenting to maxillofacial units during the COVID-19 pandemic: a five-centre UK hospital study. Br Dent J. Forthcoming 2021. doi: 10.1038/s41415-020-2499-1,2424 - Davies A, Howells R, Lee SMG, Sweet CJ, Dominguez-Gonzalez S. Implementation of photographic triage in a paediatric dental, orthodontic, and maxillofacial department during COVID-19. Int J Paediatr Dent. 2021;31(4):547-53. doi: 10.1111/ipd.12773,3030 - Ilyas N, Agel M, Mitchell J, Sood S. COVID-19 pandemic: the first wave - an audit and guidance for paediatric dentistry. Br Dent J. 2020;228(12):927-31. doi: 10.1038/s41415-020-1702-8,3636 - Pajpani M, Patel K, Bendkowski A, Stenhouse P. Rapid response: activity from a hospital based Urgent Dental Care Centre during the COVID-19 pandemic. Br J Oral Maxillofac Surg. 2020;58(9):e98-103. doi: 10.1016/j.bjoms.2020.07.004

Figure 3
Distribution of the quality assessment among studies included according to pre-established criteria for Systematic Reviews (Joanna Briggs Institute Critical Appraisal Checklist for Analytical for Cross Sectional Studies).

Figure 4
Quality assessment for Systematic Reviews (Joanna Briggs Institute Critical Appraisal Checklist for Analytical for Cross Sectional Studies): author’s judgments for each included study

Regarding quantitative analysis, 10 studies55 - Madi M, Kumar M, Varchas P, Vineetha R, Pentapati KC. Changing trends in the outpatient dental visits during the COVID–19 pandemic in a tertiary care hospital. Saudi J Biol Sci. 2021;28(8):4437-41. doi: 10.1016/j.sjbs.2021.04.038,66 - Samuel SR, Mathew MG, Suresh SG, Varma SR, Elsubeihi ES, Arshad F, et al. Pediatric dental emergency management and parental treatment preferences during COVID-19 pandemic as compared to 2019. Saudi J Biol Sci. 2021;28(4):2591-7. doi: 10.1016/j.sjbs.2021.02.002,2222 - Cagetti MG, Balian A, Camoni N, Campus G. Influence of the COVID-19 pandemic on dental emergency admissions in an urgent dental care service in North Italy. Int J Environ Res Public Health. 2021;18(4):1812. doi: 10.3390/ijerph18041812,2626 - Elalouf A, Moran R, Yaron B, Oman M. Pediatric dental emergency visits and treatment during lockdown in the COVID-19 pandemic: a retrospective study. Int J Environ Res Public Health. 2022;19(7):3774. doi: 10.3390/ijerph19073774,2828 - Guo H, Zhou Y, Liu X, Tan J. The impact of the COVID-19 epidemic on the utilization of emergency dental services. J Dent Sci. 2020;15(4):564-7. doi: 10.1016/j.jds.2020.02.002,3333 - Kumar U, Gupta A, Goyal A, Gauba K. Impact of COVID-19 pandemic on characteristics of dental emergencies and treatment services at tertiary care centre. Saudi Dent J. 2021;33(8):1018-1023. doi: 10.1016/j.sdentj.2021.06.004,3535 - Lentge F, Jehn P, Zeller AN, Spalthoff S, Rahlf B, Korn P. Changes in emergency patient presentation to a maxillofacial surgery department during the COVID-19 pandemic. J Oral Maxillofac Surg. 2021;79(10):2123.e1-2123.e6. doi: 10.1016/j.joms.2021.05.026,3737 - Petrescu NB, Aghiorghiesei O, Mesaros AS, Lucaciu OP, Dinu CM, Campian RS, et al. Impact of COVID-19 on dental emergency services in Cluj-Napoca metropolitan area: a cross-sectional study. Int J Environ Res Public Health. 2020;1722;17(21):7716. doi: 10.3390/ijerph17217716,3939 - Wu K, Li C, Yang Z, Yang S, Yang W, Hua C. Changes in the characteristics of dental emergencies under the influence of SARS-CoV-2 pandemic: a retrospective study. BMC Oral Health. 2021;21(1):174. doi: 10.1186/s12903-021-01499-y,4141 - Yang J, Yang G, Jin R, Song G, Yuan G. Changes in paediatric dental clinic after reopening during COVID-19 pandemic in Wuhan: a retrospective study. BMJ Open. 2022;12(1):e048430. doi: 10.1136/bmjopen-2020-048430 were included to assess the frequency of a dental trauma diagnosis (Figure 5), with odds ratio of 0.76 and confidence interval from 0.52 to 1.12. Despite a lower number of dental emergencies during the pandemic, meta-analysis presented no statistically significant differences in dental trauma between the pre-COVID-19 and COVID-19 periods. However, a considerable level of heterogeneity obtained by the I2 test indicated that the studies included were heterogeneous (I2=84%) in their reported effect size.

Figure 5
Forest plot summarizing the frequency of dental trauma diagnoses in dental emergencies during the pre-COVID-19 and COVID-19 periods

For subgroup analyses that classified dental trauma (Figure 6), all participants in the two studies99 - Yang YT, Zhang W, Xie L, Li ZB, Li Z. Characteristic changes of traumatic dental injuries in a teaching hospital of Wuhan under transmission control measures during the COVID-19 epidemic. Dent Traumatol. 2020;36(6):584-9. doi: 10.1111/edt.12589,1010 - Woolley J, Djemal S. Traumatic dental injuries during the COVID-19 pandemic. Prim Dent J. 2021;10(1):28-32.doi: 10.1177/2050168420980994 included experienced traumatic dental injuries. The meta-analysis results presented no statistical differences by type of trauma in the evaluated periods, with only moderate heterogeneity (I2=41%), odds ratio of 1.15, and confidence interval of 0.80 to 1.65. Only the intrusive luxation subgroup by occurrence of trauma in the COVID-19 period was without statistical heterogeneity (I2=0%).

Figure 6
Forest plot summarizing the subgroup analysis for the type of dental trauma during the pre-COVID-19 and COVID-19 periods

Discussion

This study presented no differences in the frequency of dental trauma diagnosed in the total number of dental emergencies between the evaluated COVID-19 pandemic period and the pre-COVID-19 period. Likewise, we observed no differences in the subgroups by type of dental trauma in these same periods.

Most of the studies included presented high quality assessment. The studies showing moderate quality lacked reporting statistical analysis. We did not apply criteria on identification and strategies dealing with confounding factors in the included studies, since the articles did not mention (and did not find) variables that could influence a diagnosis of dental trauma.

The COVID-19 pandemic had repercussions on all the health services, especially in dental care regarding dental trauma and urgent care, which continued working during the pandemic.44 - Alharbi A, Alharbi S, Alqaidi S. Guidelines for dental care provision during the COVID-19 pandemic. Saudi Dent J. 2020;32(4):181-6. doi: 10.1016/j.sdentj.2020.04.001 In this study, we observed a worldwide concern regarding the care of patients with dental trauma, with studies carried out in emergency services in many countries, including the United Kingdom, China, India, Saudi Arabia, and Germany.

Dental trauma is a public health problem and requires activities such as planning, intervention, prevention, management, and considering the causes of trauma. Dental trauma needs further study to assess frequencies and factors involving sex, age, and type of trauma. This study presented a predominance of dental trauma in male patients, as previously reported in the literature.88 - Vieira WA, Pecorari VG, Figueiredo-de-Almeida R, Carvas N Junior, Vargas-Neto J, Santos EC, et al. Prevalence of dental trauma in Brazilian children and adolescents: a systematic review and meta-analysis. Cad Saude Publica. 2021;37(12):e00015920. doi: 10.1590/0102-311X00015920,4343 - Azami-Aghdash S, Azar FE, Azar FP, Rezapour A, Moradi-Joo M, Moosavi A, et al. Prevalence, etiology, and types of dental trauma in children and adolescents: systematic review and meta-analysis. Med J Islam Repub Iran. 2015;29(4):234. The literature reports greater involvement of children and adolescents in dental trauma, with a large age range.4444 - Petti S, Glendor U, Andersson L. World traumatic dental injury prevalence and incidence, a meta-analysis: one billion living people have had traumatic dental injuries. Dent Traumatol. 2018;34(2):71-86. doi: 10.1111/edt.12389,4545 - Milani AJ, Castilho T, Assaf AV, Antunes LS, Antunes LAA. Impact of traumatic dental injury treatment on the oral health-related quality of life of children, adolescents, and their family: systematic review and meta-analysis. Dent Traumatol. 2021;37(6):735-48. doi: 10.1111/edt.12697 In this systematic review, 12 studies66 - Samuel SR, Mathew MG, Suresh SG, Varma SR, Elsubeihi ES, Arshad F, et al. Pediatric dental emergency management and parental treatment preferences during COVID-19 pandemic as compared to 2019. Saudi J Biol Sci. 2021;28(4):2591-7. doi: 10.1016/j.sjbs.2021.02.002,1313 - Patel N, Viswanathan A, Lee J, Barrow S, Cant A, Sanghvi R, et al. Paediatric dental A&E service during the COVID-19 pandemic in the Greater London area. Eur Arch Paediatr Dent. 2021;22(3):507-13. doi: 10.1007/s40368-020-00589-9
https://doi.org/10.1007/s40368-020-00589...
,1818 - Alzahrani SB, Alrusayes AA, Alfraih YK, Aldossary MS. Characteristics of paediatric dental emergencies during the COVID-19 pandemic in Riyadh City, Saudi Arabia. Eur J Paediatr Dent. 2021;22(2):95-7. doi: 10.23804/ejpd.2021.22.02.2
https://doi.org/10.23804/ejpd.2021.22.02...
,2424 - Davies A, Howells R, Lee SMG, Sweet CJ, Dominguez-Gonzalez S. Implementation of photographic triage in a paediatric dental, orthodontic, and maxillofacial department during COVID-19. Int J Paediatr Dent. 2021;31(4):547-53. doi: 10.1111/ipd.12773,2626 - Elalouf A, Moran R, Yaron B, Oman M. Pediatric dental emergency visits and treatment during lockdown in the COVID-19 pandemic: a retrospective study. Int J Environ Res Public Health. 2022;19(7):3774. doi: 10.3390/ijerph19073774,2727 - Goswami M, Gogia M, Bhardwaj S. From lockdown to slow release: pediatric dental services during covid-19 pandemic - emergency preparedness and impact on future. Int J Clin Pediatr Dent. 2021;14(3):398-402. doi: 10.5005/jp-journals-10005-1962,3030 - Ilyas N, Agel M, Mitchell J, Sood S. COVID-19 pandemic: the first wave - an audit and guidance for paediatric dentistry. Br Dent J. 2020;228(12):927-31. doi: 10.1038/s41415-020-1702-8

31 - Ilyas N, Green A, Karia R, Sood S, Fan K. Demographics and management of paediatric dental-facial trauma in the ‘lockdown’ period: a UK perspective. Dent Traumatol. 2021;37(4):576-582. doi: 10.1111/edt.12667
-3232 - Kamalova MK, Fomenko I V, Dmitrienko DS, Matvienko N V, Arjenovskaya EN, Gevorkyan AG, et al. Reasons for 1-17-year-old children to visit a dentist during the COVID-19 pandemic. Eur J Mol Clin Med. 2020;7(7):546-58.,3838 - Simpson S, Sumner O, Holliday R, Currie C, Hind V, Lush N, et al. Paediatric Dentistry and the coronavirus (COVID-19) response in the North East of England and North Cumbria. medRxiv [Preprint]. 2020 [cited 2022 Dec 6]. Available from: https://doi.org/10.1101/2020.06.02.20114967
https://doi.org/10.1101/2020.06.02.20114...
,4040 - Yang F, Yu L, Qin D, Hua F, Song G. Online consultation and emergency management in paediatric dentistry during the COVID-19 epidemic in Wuhan: a retrospective study. Int J Paediatr Dent. 2021;31(1):5-11. doi: 10.1111/ipd.12722,4141 - Yang J, Yang G, Jin R, Song G, Yuan G. Changes in paediatric dental clinic after reopening during COVID-19 pandemic in Wuhan: a retrospective study. BMJ Open. 2022;12(1):e048430. doi: 10.1136/bmjopen-2020-048430 involved dental services provided only to children and adolescents, while the others were carried out in dental centers for the general public and presented a broad age range.

The results showed fewer traumatic events at dental emergencies during the COVID-19 pandemic. This decrease may be due to social isolation, reduced risk factors for trauma, reduced violence, less practice of sports with physical contact, and reduced outdoor activities.1010 - Woolley J, Djemal S. Traumatic dental injuries during the COVID-19 pandemic. Prim Dent J. 2021;10(1):28-32.doi: 10.1177/2050168420980994,4141 - Yang J, Yang G, Jin R, Song G, Yuan G. Changes in paediatric dental clinic after reopening during COVID-19 pandemic in Wuhan: a retrospective study. BMJ Open. 2022;12(1):e048430. doi: 10.1136/bmjopen-2020-048430 Although the trauma numbers and emergency dental visits were lower during the COVID-19 pandemic, there were no differences in the frequency or types of dental trauma diagnosed before and during the pandemic, which is likely due to the lower number of events in the sample size. Since we evaluated a convenience sample, i.e., a population seeking care in trauma services, the studies only present internal validation. Therefore, is necessary to interpret such results with caution, as they cannot be assumed for the world population. Considering this heterogeneity, the statistical test used for meta-analysis was the random-effects model.

Primary studies quantified traumatic injury causes, such as sports, hobbies, traffic, occupational accidents, interpersonal violence, falling, tripping, alcohol, and exercise. However, in general, the cause evaluation was not specifically described for dental trauma, only for dental emergencies. Moreover, most of the studies ignored possible causes or performed no comparative analyses between the periods, showing a limitation of primary studies and, consequently, of this systematic review.

The most affected teeth by trauma are the upper central incisors, due to their vulnerability, i.e., their position in the arch.4646 - Teshome A, Muche A. A Two-year retrospective study on the pattern of dental trauma and its etiology, northwest Ethiopia. J Health Care Poor Underserved. 2017;28(1):216-27. doi: 10.1353/hpu.2017.0018,4747 - Patidar D, Sogi S, Patidar DC, Malhotra A. Traumatic dental injuries in pediatric patients: a retrospective analysis. Int J Clin Pediatr Dent. 2021;14(4):506-11. doi: 10.5005/jp-journals-10005-2004 This was also revealed in the two primary studies in this review, which reported the highest trauma frequency in maxillary anterior teeth, both in primary and permanent dentition.99 - Yang YT, Zhang W, Xie L, Li ZB, Li Z. Characteristic changes of traumatic dental injuries in a teaching hospital of Wuhan under transmission control measures during the COVID-19 epidemic. Dent Traumatol. 2020;36(6):584-9. doi: 10.1111/edt.12589,3131 - Ilyas N, Green A, Karia R, Sood S, Fan K. Demographics and management of paediatric dental-facial trauma in the ‘lockdown’ period: a UK perspective. Dent Traumatol. 2021;37(4):576-582. doi: 10.1111/edt.12667

Traumatic injuries involve damage to dental structures and may affect the crown and/or the root of the dental element, which are associated or not with damage to the support structure, and may cause dislocations, avulsion, or alveolar fractures.4848 - Cho J, Sachs A, Cunningham LL Jr. Dental trauma and alveolar fractures. Facial Plast Surg Clin North Am. 2022;30(1):117-24. doi: 10.1016/j.fsc.2021.08.010 Due to the diversity of impacts that can occur, treatment of dental trauma presents great variability. The patient requires adequate diagnosis, planning, case follow-up, and the most appropriate guidance for treatment.3131 - Ilyas N, Green A, Karia R, Sood S, Fan K. Demographics and management of paediatric dental-facial trauma in the ‘lockdown’ period: a UK perspective. Dent Traumatol. 2021;37(4):576-582. doi: 10.1111/edt.12667,4848 - Cho J, Sachs A, Cunningham LL Jr. Dental trauma and alveolar fractures. Facial Plast Surg Clin North Am. 2022;30(1):117-24. doi: 10.1016/j.fsc.2021.08.010 Dental pulp involvement is an important factor that guides decision-making, and must be correctly diagnosed, whether at the time of trauma or not, since intervention is not always immediate endodontics.4949 - Krastl G, Weiger R, Ebeleseder K, Galler K. Present status and future directions: Endodontic management of traumatic injuries to permanent teeth. 2022;55 Suppl 4:1003-19. doi: 10.1111/iej.13672 Imaging exams are also important diagnostic tools to verify the involvement of dental structures and the extent of injury.4848 - Cho J, Sachs A, Cunningham LL Jr. Dental trauma and alveolar fractures. Facial Plast Surg Clin North Am. 2022;30(1):117-24. doi: 10.1016/j.fsc.2021.08.010

After evaluation and diagnosis, the appropriate treatment must be offered as soon as possible, especially in cases of major structural damage, such as coronary fractures with pulp exposure, dental dislocations, and avulsion, which are types of dental emergencies. Time is a crucial prognostic factor to reduce the chance of pulp necrosis or an early loss of the affected tooth.4949 - Krastl G, Weiger R, Ebeleseder K, Galler K. Present status and future directions: Endodontic management of traumatic injuries to permanent teeth. 2022;55 Suppl 4:1003-19. doi: 10.1111/iej.13672

50 - Ferrazzano GF, Ingenito A, Cantile T. COVID-19 disease in children: What dentists should know and do to prevent viral spread. The Italian point of view. Int J Environ Res Public Health. 2020;17(10):3642. doi: 10.3390/ijerph17103642
-5151 - Luzzi V, Ierardo G, Bossù M, Polimeni A. Paediatric Oral Health during and after the COVID-19 pandemic. Int J Paediatr Dent. 2021;31(1):20-6. doi: 10.1111/ipd.12737

Knowledge is also essential for correct management of trauma and treatment success. One study performed by a questionnaire for dentists revealed the need to improve the professionals’ knowledge about dental trauma management, especially avulsion.5252 - Mazur M, Jedliński M, Janiszewska-Olszowska J, Ndokaj A, Ardan R, Nardi GM, et al. Knowledge of emergency management of avulsed teeth among Italian dentists-questionnaire study and next future perspectives. Int J Environ Res Public Health. 2021;18(2):706. doi: 10.3390/ijerph18020706,5353 - Abdulrahman S, Aboalshamat K, Dewedar A, Gazzaz N, Almabdi A. Dental professionals management of avulsed teeth and implementation of COVID-19 related safety precautions. J Res Med Dent Sci. 2021;9(2):1-7. Likewise, health professionals presented insufficient knowledge concerning traumatic dental injuries.5454 - Tewari N, Jonna I, Mathur VP, Goel S, Ritwik P, Rahul M, et al. Global status of knowledge for the prevention and emergency management of traumatic dental injuries among non-dental healthcare professionals: a systematic review and meta-analysis. Injury. 2021;52(8):2025-37. doi: 10.1016/j.injury.2021.06.006 This reflects the need to implement educational programs for health professionals to enable adequate care during the management of traumatic dental injuries.5252 - Mazur M, Jedliński M, Janiszewska-Olszowska J, Ndokaj A, Ardan R, Nardi GM, et al. Knowledge of emergency management of avulsed teeth among Italian dentists-questionnaire study and next future perspectives. Int J Environ Res Public Health. 2021;18(2):706. doi: 10.3390/ijerph18020706

53 - Abdulrahman S, Aboalshamat K, Dewedar A, Gazzaz N, Almabdi A. Dental professionals management of avulsed teeth and implementation of COVID-19 related safety precautions. J Res Med Dent Sci. 2021;9(2):1-7.
-5454 - Tewari N, Jonna I, Mathur VP, Goel S, Ritwik P, Rahul M, et al. Global status of knowledge for the prevention and emergency management of traumatic dental injuries among non-dental healthcare professionals: a systematic review and meta-analysis. Injury. 2021;52(8):2025-37. doi: 10.1016/j.injury.2021.06.006

To minimize this problem, one study proposed a dental trauma course for medical students, which yielded wide acceptance by students and positive perceptions for their future professional careers.5555 - Yeng T, O’Sullivan AJ, Shulruf B. Medical students’ perception of an online dental trauma course in medical education. Aust Endod J. 2022;48(1):51-57. doi: 10.1111/aej.12601 Another strategy used for the implementation of teaching about dental trauma while still in graduation was the development of an online mobile application with traumatic dental injury instructions for Dentistry students. Evaluation of the results demonstrated an improvement in diagnosis and treatment of such injuries.5656 - Mladenovic R, Davidovic B, Tusek I, Trickovic-Janjic O, Mladenovic K. The effect of a mobile application for learning about traumatic dental injuries during the COVID-19 pandemic. Srp Arh Celok Lek. 2021;149(3-4):202-7. doi: 10.2298/SARH201110007M Besides health professionals and students, preventive care and basic guidelines in trauma management should also be disseminated to the general population.

Due to the wide dissemination of the SARS-CoV-2 virus, in some dental services there was a need to assess priority emergency care and teledentistry was a good strategy.5757 - Gasparoni A, Kanellis M. COVID-19 and dental emergencies: reflections on teledentistry. Braz Dent Sci. 2020;23(2 Suppl 2):1-4. doi: 10.14295/bds.2020.v23i2.2270 Teledentistry is a viable, accessible, and low-cost alternative5858 - Telles-Araujo GT, Caminha RD, Kallás MS, Santos PS. Teledentistry support in COVID-19 oral care. Clinics (Sao Paulo). 2020;75:e2030. doi: 10.6061/clinics/2020/e2030 that some of the studies included1919 - Amin S, Zaheer K, De Souza M. Dental public health in action: utilising a telephone triage system to run an urgent dental care hub during the COVID-19 pandemic. Community Dent Health. 2021;38(3):161-4. doi:10.1922/CDH_00023Amin04
https://doi.org/10.1922/CDH_00023Amin04...
,2323 - Carter E, Currie CC, Asuni A, Goldsmith R, Toon G, Horridge C, et al. The first six weeks: setting up a UK urgent dental care centre during the COVID-19 pandemic. Br Dent J. 2020;228(11):842-8. doi: 10.1038/s41415-020-1708-2,2424 - Davies A, Howells R, Lee SMG, Sweet CJ, Dominguez-Gonzalez S. Implementation of photographic triage in a paediatric dental, orthodontic, and maxillofacial department during COVID-19. Int J Paediatr Dent. 2021;31(4):547-53. doi: 10.1111/ipd.12773 as a way to initially assess the patients, to provide guidance, such as counseling and drug-prescriptions (only analgesics/anti-inflammatory drugs), and to screen for clinical evaluation, since not all dental trauma cases are urgent and some can be managed remotely.

Teledentistry does not replace face-to-face care due to the need to carry out a careful clinical examination, with palpation and percussion tests, as well as complementary exams such as the acquisition of radiographs to obtain an accurate diagnosis. Despite the risks of transmission of COVID-19 in the dental environment, face-to-face care is necessary and must be available in emergency services with the use of adequate PPE by the entire dental team to protect health professionals and prevent the transmission of SARS-CoV-2. It has also been shown that when the appropriate PPE is used and biosafety protocols are implemented during emergency dental care services, although aerosols can be produced, this does not increase the risk contamination to professionals, as no contamination was reported during the studies cited.66 - Samuel SR, Mathew MG, Suresh SG, Varma SR, Elsubeihi ES, Arshad F, et al. Pediatric dental emergency management and parental treatment preferences during COVID-19 pandemic as compared to 2019. Saudi J Biol Sci. 2021;28(4):2591-7. doi: 10.1016/j.sjbs.2021.02.002,5959 - Grossman S, Sandhu P, Sproat C, Patel V. Provision of dental services at a single institution in the UK’s epicentre during the COVID-19 pandemic. Br Dent J. 2020;228(12):964-70. doi: 10.1038/s41415-020-1716-2

Studies that assess dental trauma in the context of the COVID-19 pandemic are of great relevance. Knowledge of this condition allows elaboration of preventive assistance strategies based on the population’s needs, allowing better targeting of care and better clinical case resolution.

Despite their importance, certain critical details remained unreported in various studies including: the type of dentition (deciduous or permanent), the most affected dental element, and in cases of trauma; the causes and treatments performed. This made it difficult to compare the results. Some studies included data on dental trauma as associated with other emergency conditions, making it impossible to use the information. Moreover, for being emergency services, samples were obtained by convenience, and according to the demand of the service, with no sample calculations performed; an intrinsic limitation in primary studies. Thus, future studies with better detailing of such characteristics, and allowing comparative analyses remain necessary.

Conclusion

Based on the present findings, this study revealed that the COVID-19 pandemic has not impacted on the frequency or type of dental trauma compared to previous periods. Further well-designed studies should be conducted to evaluate the particularities involved in patients who suffered dental trauma to help guide educational and preventive health care strategies for the most affected populations, optimizing planning and interventions.

References

  • 1
    - Pereira LJ, Pereira CV, Murata RM, Pardi V, Pereira-Dourado SM. Biological and social aspects of Coronavirus Disease 2019 (COVID-19) related to oral health. Braz Oral Res. 2020;34:e041. doi: 10.1590/1807-3107bor-2020.vol34.0041
  • 2
    - Warnakulasuriya S. Protecting dental manpower from COVID-19 infection. Oral Dis. 2021;27 Suppl 3:651-4. doi: 10.1111/odi.13410
  • 3
    - Ayub K, Alani A. Acute endodontic and dental trauma provision during the COVID-19 crisis. Br Dent J. 2020;229(3):169-75. doi: 10.1038/s41415-020-1920-0
  • 4
    - Alharbi A, Alharbi S, Alqaidi S. Guidelines for dental care provision during the COVID-19 pandemic. Saudi Dent J. 2020;32(4):181-6. doi: 10.1016/j.sdentj.2020.04.001
  • 5
    - Madi M, Kumar M, Varchas P, Vineetha R, Pentapati KC. Changing trends in the outpatient dental visits during the COVID–19 pandemic in a tertiary care hospital. Saudi J Biol Sci. 2021;28(8):4437-41. doi: 10.1016/j.sjbs.2021.04.038
  • 6
    - Samuel SR, Mathew MG, Suresh SG, Varma SR, Elsubeihi ES, Arshad F, et al. Pediatric dental emergency management and parental treatment preferences during COVID-19 pandemic as compared to 2019. Saudi J Biol Sci. 2021;28(4):2591-7. doi: 10.1016/j.sjbs.2021.02.002
  • 7
    - Levin L, Day PF, Hicks L, O’Connell A, Fouad AF, Bourguignon C, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: general introduction. Dent Traumatol. 2020;36(4):309-13. doi: 10.1111/edt.12574
  • 8
    - Vieira WA, Pecorari VG, Figueiredo-de-Almeida R, Carvas N Junior, Vargas-Neto J, Santos EC, et al. Prevalence of dental trauma in Brazilian children and adolescents: a systematic review and meta-analysis. Cad Saude Publica. 2021;37(12):e00015920. doi: 10.1590/0102-311X00015920
  • 9
    - Yang YT, Zhang W, Xie L, Li ZB, Li Z. Characteristic changes of traumatic dental injuries in a teaching hospital of Wuhan under transmission control measures during the COVID-19 epidemic. Dent Traumatol. 2020;36(6):584-9. doi: 10.1111/edt.12589
  • 10
    - Woolley J, Djemal S. Traumatic dental injuries during the COVID-19 pandemic. Prim Dent J. 2021;10(1):28-32.doi: 10.1177/2050168420980994
  • 11
    - Bourguignon C, Cohenca N, Lauridsen E, Flores MT, O’Connell AC, Day PF, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations. Dent Traumatol. 2020;36(4):314-30. doi: 10.1111/edt.12578
  • 12
    - Walter E, von Bronk L, Hickel R, Huth KC. Impact of COVID-19 on dental care during a national lockdown: a retrospective observational study. Int J Environ Res Public Health. 2021;18(15):7963. doi: 10.3390/ijerph18157963
  • 13
    - Patel N, Viswanathan A, Lee J, Barrow S, Cant A, Sanghvi R, et al. Paediatric dental A&E service during the COVID-19 pandemic in the Greater London area. Eur Arch Paediatr Dent. 2021;22(3):507-13. doi: 10.1007/s40368-020-00589-9
    » https://doi.org/10.1007/s40368-020-00589-9
  • 14
    - Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. J Clin Epidemiol. 2021;134:178-89. doi: 10.1016/j.jclinepi.2021.03.001
  • 15
    - The Joanna Briggs Institute. The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews: checklist for analytical cross sectional studies [Internet]. Adelaide: The Joanna Briggs Institute; 2017 [cited 2022 Dec 6]. Available from: https://jbi.global/sites/default/files/2019-05/JBI_Critical_Appraisal-Checklist_for_Analytical_Cross_Sectional_Studies2017_0.pdf
    » https://jbi.global/sites/default/files/2019-05/JBI_Critical_Appraisal-Checklist_for_Analytical_Cross_Sectional_Studies2017_0.pdf
  • 16
    - Polmann H, Réus JC, Massignan C, Serra-Negra JM, Dick BD, Flores-Mir C, et al. Association between sleep bruxism and stress symptoms in adults: a systematic review and meta-analysis. J Oral Rehabil. 2021;48(5):621-31. doi: 10.1111/joor.13142
  • 17
    - Ali SA, Al-Qahtani AM, Al Banai SR, Albaker FJ, Almarri AE, Al-Haithami K, et al. Role of newly introduced teledentistry service in the management of dental emergencies during COVID-19 pandemic in Qatar: a cross-sectional analysis. Telemed e-Health. 202224;28(11):1623-32. doi: 10.1089/tmj.2021.0584
  • 18
    - Alzahrani SB, Alrusayes AA, Alfraih YK, Aldossary MS. Characteristics of paediatric dental emergencies during the COVID-19 pandemic in Riyadh City, Saudi Arabia. Eur J Paediatr Dent. 2021;22(2):95-7. doi: 10.23804/ejpd.2021.22.02.2
    » https://doi.org/10.23804/ejpd.2021.22.02.2
  • 19
    - Amin S, Zaheer K, De Souza M. Dental public health in action: utilising a telephone triage system to run an urgent dental care hub during the COVID-19 pandemic. Community Dent Health. 2021;38(3):161-4. doi:10.1922/CDH_00023Amin04
    » https://doi.org/10.1922/CDH_00023Amin04
  • 20
    - Ball M, Akintola D, Harrington Z, Djemal S. Emergency dental care triage during the COVID-19 pandemic. Br Dent J. Forthcoming 2021. doi: 10.1038/s41415-021-3379-z
  • 21
    - Blackhall KK, Singh RP. Dental emergencies presenting to maxillofacial units during the COVID-19 pandemic: a five-centre UK hospital study. Br Dent J. Forthcoming 2021. doi: 10.1038/s41415-020-2499-1
  • 22
    - Cagetti MG, Balian A, Camoni N, Campus G. Influence of the COVID-19 pandemic on dental emergency admissions in an urgent dental care service in North Italy. Int J Environ Res Public Health. 2021;18(4):1812. doi: 10.3390/ijerph18041812
  • 23
    - Carter E, Currie CC, Asuni A, Goldsmith R, Toon G, Horridge C, et al. The first six weeks: setting up a UK urgent dental care centre during the COVID-19 pandemic. Br Dent J. 2020;228(11):842-8. doi: 10.1038/s41415-020-1708-2
  • 24
    - Davies A, Howells R, Lee SMG, Sweet CJ, Dominguez-Gonzalez S. Implementation of photographic triage in a paediatric dental, orthodontic, and maxillofacial department during COVID-19. Int J Paediatr Dent. 2021;31(4):547-53. doi: 10.1111/ipd.12773
  • 25
    - Eggmann F, Haschemi AA, Doukoudis D, Filippi A, Verna C, Walter C, et al. Impact of the COVID-19 pandemic on urgent dental care delivery in a Swiss university center for dental medicine. Clin Oral Investig. 2021;25(10):5711-21. doi: 10.1007/s00784-021-03872-1
  • 26
    - Elalouf A, Moran R, Yaron B, Oman M. Pediatric dental emergency visits and treatment during lockdown in the COVID-19 pandemic: a retrospective study. Int J Environ Res Public Health. 2022;19(7):3774. doi: 10.3390/ijerph19073774
  • 27
    - Goswami M, Gogia M, Bhardwaj S. From lockdown to slow release: pediatric dental services during covid-19 pandemic - emergency preparedness and impact on future. Int J Clin Pediatr Dent. 2021;14(3):398-402. doi: 10.5005/jp-journals-10005-1962
  • 28
    - Guo H, Zhou Y, Liu X, Tan J. The impact of the COVID-19 epidemic on the utilization of emergency dental services. J Dent Sci. 2020;15(4):564-7. doi: 10.1016/j.jds.2020.02.002
  • 29
    - Hahn B, Hollenberger L, Schlagenhauf U, Böhm H, Haubitz IR, Soliman S, et al. The utilization of dental emergency services during COVID-19 pandemic in a German university center: Do we lose vulnerable patients? Quintessence Int. 2021;52(9):828-36. doi: 10.3290/j.qi.b1702163
    » https://doi.org/10.3290/j.qi.b1702163
  • 30
    - Ilyas N, Agel M, Mitchell J, Sood S. COVID-19 pandemic: the first wave - an audit and guidance for paediatric dentistry. Br Dent J. 2020;228(12):927-31. doi: 10.1038/s41415-020-1702-8
  • 31
    - Ilyas N, Green A, Karia R, Sood S, Fan K. Demographics and management of paediatric dental-facial trauma in the ‘lockdown’ period: a UK perspective. Dent Traumatol. 2021;37(4):576-582. doi: 10.1111/edt.12667
  • 32
    - Kamalova MK, Fomenko I V, Dmitrienko DS, Matvienko N V, Arjenovskaya EN, Gevorkyan AG, et al. Reasons for 1-17-year-old children to visit a dentist during the COVID-19 pandemic. Eur J Mol Clin Med. 2020;7(7):546-58.
  • 33
    - Kumar U, Gupta A, Goyal A, Gauba K. Impact of COVID-19 pandemic on characteristics of dental emergencies and treatment services at tertiary care centre. Saudi Dent J. 2021;33(8):1018-1023. doi: 10.1016/j.sdentj.2021.06.004
  • 34
    - Langella J, Magnuson B, Finkelman MD, Amato R. Clinical response to COVID-19 and utilization of an emergency dental clinic in an academic institution. J Endod. 2021;47(4):566-71. doi: 10.1016/j.joen.2020.11.025
  • 35
    - Lentge F, Jehn P, Zeller AN, Spalthoff S, Rahlf B, Korn P. Changes in emergency patient presentation to a maxillofacial surgery department during the COVID-19 pandemic. J Oral Maxillofac Surg. 2021;79(10):2123.e1-2123.e6. doi: 10.1016/j.joms.2021.05.026
  • 36
    - Pajpani M, Patel K, Bendkowski A, Stenhouse P. Rapid response: activity from a hospital based Urgent Dental Care Centre during the COVID-19 pandemic. Br J Oral Maxillofac Surg. 2020;58(9):e98-103. doi: 10.1016/j.bjoms.2020.07.004
  • 37
    - Petrescu NB, Aghiorghiesei O, Mesaros AS, Lucaciu OP, Dinu CM, Campian RS, et al. Impact of COVID-19 on dental emergency services in Cluj-Napoca metropolitan area: a cross-sectional study. Int J Environ Res Public Health. 2020;1722;17(21):7716. doi: 10.3390/ijerph17217716
  • 38
    - Simpson S, Sumner O, Holliday R, Currie C, Hind V, Lush N, et al. Paediatric Dentistry and the coronavirus (COVID-19) response in the North East of England and North Cumbria. medRxiv [Preprint]. 2020 [cited 2022 Dec 6]. Available from: https://doi.org/10.1101/2020.06.02.20114967
    » https://doi.org/10.1101/2020.06.02.20114967
  • 39
    - Wu K, Li C, Yang Z, Yang S, Yang W, Hua C. Changes in the characteristics of dental emergencies under the influence of SARS-CoV-2 pandemic: a retrospective study. BMC Oral Health. 2021;21(1):174. doi: 10.1186/s12903-021-01499-y
  • 40
    - Yang F, Yu L, Qin D, Hua F, Song G. Online consultation and emergency management in paediatric dentistry during the COVID-19 epidemic in Wuhan: a retrospective study. Int J Paediatr Dent. 2021;31(1):5-11. doi: 10.1111/ipd.12722
  • 41
    - Yang J, Yang G, Jin R, Song G, Yuan G. Changes in paediatric dental clinic after reopening during COVID-19 pandemic in Wuhan: a retrospective study. BMJ Open. 2022;12(1):e048430. doi: 10.1136/bmjopen-2020-048430
  • 42
    - Yu J, Zhang T, Zhao D, Haapasalo M, Shen Y. Characteristics of endodontic emergencies during coronavirus disease 2019 outbreak in Wuhan. J Endod. 2020;46(6):730-5. doi: 10.1016/j.joen.2020.04.001
  • 43
    - Azami-Aghdash S, Azar FE, Azar FP, Rezapour A, Moradi-Joo M, Moosavi A, et al. Prevalence, etiology, and types of dental trauma in children and adolescents: systematic review and meta-analysis. Med J Islam Repub Iran. 2015;29(4):234.
  • 44
    - Petti S, Glendor U, Andersson L. World traumatic dental injury prevalence and incidence, a meta-analysis: one billion living people have had traumatic dental injuries. Dent Traumatol. 2018;34(2):71-86. doi: 10.1111/edt.12389
  • 45
    - Milani AJ, Castilho T, Assaf AV, Antunes LS, Antunes LAA. Impact of traumatic dental injury treatment on the oral health-related quality of life of children, adolescents, and their family: systematic review and meta-analysis. Dent Traumatol. 2021;37(6):735-48. doi: 10.1111/edt.12697
  • 46
    - Teshome A, Muche A. A Two-year retrospective study on the pattern of dental trauma and its etiology, northwest Ethiopia. J Health Care Poor Underserved. 2017;28(1):216-27. doi: 10.1353/hpu.2017.0018
  • 47
    - Patidar D, Sogi S, Patidar DC, Malhotra A. Traumatic dental injuries in pediatric patients: a retrospective analysis. Int J Clin Pediatr Dent. 2021;14(4):506-11. doi: 10.5005/jp-journals-10005-2004
  • 48
    - Cho J, Sachs A, Cunningham LL Jr. Dental trauma and alveolar fractures. Facial Plast Surg Clin North Am. 2022;30(1):117-24. doi: 10.1016/j.fsc.2021.08.010
  • 49
    - Krastl G, Weiger R, Ebeleseder K, Galler K. Present status and future directions: Endodontic management of traumatic injuries to permanent teeth. 2022;55 Suppl 4:1003-19. doi: 10.1111/iej.13672
  • 50
    - Ferrazzano GF, Ingenito A, Cantile T. COVID-19 disease in children: What dentists should know and do to prevent viral spread. The Italian point of view. Int J Environ Res Public Health. 2020;17(10):3642. doi: 10.3390/ijerph17103642
  • 51
    - Luzzi V, Ierardo G, Bossù M, Polimeni A. Paediatric Oral Health during and after the COVID-19 pandemic. Int J Paediatr Dent. 2021;31(1):20-6. doi: 10.1111/ipd.12737
  • 52
    - Mazur M, Jedliński M, Janiszewska-Olszowska J, Ndokaj A, Ardan R, Nardi GM, et al. Knowledge of emergency management of avulsed teeth among Italian dentists-questionnaire study and next future perspectives. Int J Environ Res Public Health. 2021;18(2):706. doi: 10.3390/ijerph18020706
  • 53
    - Abdulrahman S, Aboalshamat K, Dewedar A, Gazzaz N, Almabdi A. Dental professionals management of avulsed teeth and implementation of COVID-19 related safety precautions. J Res Med Dent Sci. 2021;9(2):1-7.
  • 54
    - Tewari N, Jonna I, Mathur VP, Goel S, Ritwik P, Rahul M, et al. Global status of knowledge for the prevention and emergency management of traumatic dental injuries among non-dental healthcare professionals: a systematic review and meta-analysis. Injury. 2021;52(8):2025-37. doi: 10.1016/j.injury.2021.06.006
  • 55
    - Yeng T, O’Sullivan AJ, Shulruf B. Medical students’ perception of an online dental trauma course in medical education. Aust Endod J. 2022;48(1):51-57. doi: 10.1111/aej.12601
  • 56
    - Mladenovic R, Davidovic B, Tusek I, Trickovic-Janjic O, Mladenovic K. The effect of a mobile application for learning about traumatic dental injuries during the COVID-19 pandemic. Srp Arh Celok Lek. 2021;149(3-4):202-7. doi: 10.2298/SARH201110007M
  • 57
    - Gasparoni A, Kanellis M. COVID-19 and dental emergencies: reflections on teledentistry. Braz Dent Sci. 2020;23(2 Suppl 2):1-4. doi: 10.14295/bds.2020.v23i2.2270
  • 58
    - Telles-Araujo GT, Caminha RD, Kallás MS, Santos PS. Teledentistry support in COVID-19 oral care. Clinics (Sao Paulo). 2020;75:e2030. doi: 10.6061/clinics/2020/e2030
  • 59
    - Grossman S, Sandhu P, Sproat C, Patel V. Provision of dental services at a single institution in the UK’s epicentre during the COVID-19 pandemic. Br Dent J. 2020;228(12):964-70. doi: 10.1038/s41415-020-1716-2
  • Data availability statement
    The datasets generated during and/or analyzed during the current study are available in the SciELO Data repository, [DOI 10.48331/scielodata.78SHP1].

Edited by

Editor: Karin Hermana Neppelenbroek

Publication Dates

  • Publication in this collection
    03 Feb 2023
  • Date of issue
    2023

History

  • Received
    27 Sept 2022
  • Reviewed
    18 Nov 2022
  • Accepted
    29 Nov 2022
Faculdade De Odontologia De Bauru - USP Serviço de Biblioteca e Documentação FOB-USP, Al. Dr. Octávio Pinheiro Brisolla 9-75, 17012-901 Bauru SP Brasil, Tel.: +55 14 32358373 - Bauru - SP - Brazil
E-mail: jaos@usp.br