Maxillofacial trauma due to traffic accidents and falls: an exploratory study of associated factors.

BACKGROUND: This study aimed to determine the pattern of Maxillofacial trauma (MFT) due to traffic accidents and falls in a reference hospital in a rural region of northeastern Brazil between December 2011 and December 2018 and to identify associated factors. MATERIAL AND METHODS: This was a cross-sectional study using 585 medical records of patients with MFT. The data were subjected to a Poisson-Tweedie multiple regression analysis to estimate the Prevalence ratio (PR), with a 95% confidence interval (95% CI) and a significance level of p<0.05. RESULTS: MFT due to traffic accidents was more prevalent among patients 21 to 40 years old (PR=2.30; 95% CI=1.20-4.41; p<0.001) diagnosed with zygomatic-orbital complex fractures (PR=1.80; 95% CI=1.08-2.98; p=0.023). Falls were more frequent among older groups of 41 to 60 years (PR=1.83; 95% CI=1.09-3.06; p=0.022) and over 61 years (PR=2.23; 95% CI=1.09-3.06; p=0.022). In traffic accidents, alcohol consumption increased the length of stay (PR=2.081; 95% CI=1.553-2.787; p<0.001), and patients who did not use personal protective equipment (PPE) had higher hospital costs (PR=179.964; 95% CI=1.485-1.994; p<0.001) for this etiology. Traffic accidents and falls are two of the main etiologies of MFT, especially for males in the young adult age group (traffic accidents) and those above 41 years (falls). Alcohol consumption and the nonuse of PPE influenced the length of the hospital stay and hospital costs. CONCLUSIONS: Strategies to confront this problem, such as road and highway improvements, effective enforcement of laws and intersectoral coordination involving the entire community to implement policies and prevention programs targeted at these populations, can be implemented.

Biomarkers of fluoride in children exposed to different sources of systemic fluoride.

There has been no comparison between fluoride concentrations in urine and nails of children exposed to different sources of systemic fluoride. The aim of this study was to compare the relationship between fluoride intake with urinary fluoride excretion and fluoride concentrations in fingernails and toenails of children receiving fluoride from artificially fluoridated water (0.6-0.8 mg F/L, n = 25), naturally fluoridated water (0.6-0.9 mg F/L, n = 21), fluoridated salt (180-200 mg F/Kg, n = 26), and fluoridated milk (0.25 mg F, n = 25). A control population was included (no systemic fluoride, n = 24). Fluoride intake from diet and dentifrice, urinary fluoride excretion, and fluoride concentrations in fingernails/toenails were evaluated. Fluoride was analyzed with an ion-selective electrode. Urinary fluoride excretion in the control community was significantly lower when compared with that in the fluoridated cities, except for the naturally fluoridated community. However, the same pattern was not as evident for nails. Both urinary fluoride output and fluoride concentrations in fingernails/toenails were significantly correlated to total fluoride intake. However, the correlation coefficients for fluoride intake and urinary fluoride output were lower (r = 0.28, p < 0.01) than those observed for fingernails/toenails (r = 0.36, p < 0.001), suggesting that nails might be slightly better indicators of fluoride intake at the individual level.

Dietary fluoride intake by children receiving different sources of systemic fluoride.

There has been no comparison of fluoride (F) intake by pre-school children receiving more traditional sources of systemic F. The aim of this study was to estimate the dietary F intake by children receiving F from artificially fluoridated water (AFW-Brazil, 0.6-0.8 mg F/L), naturally fluoridated water (NFW-Brazil, 0.6-0.9 mg F/L), fluoridated salt (FS-Peru, 180-200 mg F/Kg), and fluoridated milk (FM-Peru, 0.25 mg F). Children (n=21-26) aged 4-6 yrs old participated in each community. A non-fluoridated community (NoF) was evaluated as the control population. Dietary F intake was monitored by the "duplicate plate" method, with different constituents (water, other beverages, and solids). F was analyzed with an ion-selective electrode. Data were tested by Kruskall-Wallis and Dunn's tests (p<0.05). Mean (+/- SD) F intake (mg/Kg b.w./day) was 0.04+/-0.01(b), 0.06+/-0.02(a,b), 0.05+/-0.02(a,b), 0.06+/-0.01(a), and 0.01+/-0.00(c) for AFW/NFW/FS/FM/NoF, respectively. The main dietary contributors for AFW/NFW and FS/FM/NoF were water and solids, respectively. The results indicate that the dietary F intake must be considered before a systemic method of fluoridation is implemented.

Pulp therapy in a maxillary fused primary central incisor--report of a case.

This paper describes a case in which pulp therapy was provided in a fused maxillary primary central incisor in a 4-year-old patient with a history of fistula on the gingival mucosa. The tooth involved was larger than expected, suggesting fusion. The diagnosis of fusion was confirmed on radiographical examination. The clinical management of the case is described and the diagnosis and treatment discussed.

[Dental fluorosis in children from Princesa Isabel, Paraiba]. / Fluorose dentária em crianças de Princesa Isabel, Paraíba.

Several communities in Paraíba have moderate or high levels of fluoride naturally present in the drinking water. A moderate prevalence of dental fluorosis (30-40%) has been observed in some areas where the levels of fluoride are regarded as "optimal" for the region (0.6 ppm). The aim of the present study was to determine the prevalence of dental fluorosis in Princesa Isabel, a city with "sub-optimal" fluoride levels (0.4 ppm). The sample comprised 142 schoolchildren (10- to 15-year-old subjects) randomly selected and examined by means of the TF (Thylstrup & Fejerskov) index. The clinical exams were carried out under indirect natural light by three calibrated examiners. Prior to the examination the teeth were cleaned and dried. Approximately 20% of the subjects examined presented with some degree of fluorosis. Seventy per cent were classified as TF 1 while 30% were classified as TF 2 to 5. The prevalence of fluorosis was higher in male subjects and in premolars. Although the observed prevalence of dental fluorosis was within the expected levels, other sources of systemic fluoride must be controlled. The observed prevalence of dental fluorosis is not a public health problem in this community.