Saudi Cultural Missions Theses & Dissertations
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Item Restricted The Association Between Head and Neck Injuries Requiring Medical Attention and Behavioural Problems Among 7- and 14-Year-Old Adolescents Living in the United Kingdom A Secondary Data Analysis of the UK Millennium Cohort Study (MCS)(University College London, 2024-09) AlRugaibah, Norah; Blokland, Alex; Sifaki, MariaBackground: Injuries are major public health problems that affect children’s lives. Behavioural problems have been linked to increased risk of injury incidence. However, few studies discussed the association between externalising and internalising behavioural problems and head and neck injuries among children and adolescents. Aim: This study aims to examine the association between head and neck injuries requiring medical attention and behavioural problems among 7- and 14-year-old youth living in the UK. Methods: A secondary analysis of data from the Millennium Cohort Study (MCS) was conducted using the fourth and sixth sweeps when the participants were 7 and 14 years old. The outcome indicated whether the child had sustained any head and neck injuries since the last survey. Behavioural problems were assessed using the Strengths and Difficulties Questionnaire (SDQ) subscales of externalising and internalising behaviour. In the analysis both scales were dichotomised (10% highest scores) to discern those experiencing severe difficulties. Demographic, family, and socioeconomic factors were used as covariates. Weighted analysis using regression modelling was used to examine the associations between behavioural problems and head and neck injuries. Results: The prevalence of head and neck injuries for 7- and 14-year-olds were 9.35% and 6.23% respectively. Externalising behavioural problems at age 7 were reported for just under 10% of the children, and nearly 9% were reported to experience Internalising problems. At age 14, over 10% of the sample presented with externalising behavioural problems, and nearly 8% with Internalising behaviours. Children aged 7 years who presented with externalising difficulties had a significantly higher risk of head and neck injuries in the crude model (OR=1.41, 95%CI: 1.02–1.93). However, this association became non-significant after controlling for child characteristics. In the crude model, there was no difference in head and neck injury odds between children with internalising behavioural problems and their peers at age 7 (OR=1.00, 95%CI: 0.67–1.48). The association remained non-significant after subsequent adjustments. For 14-year-olds, those who with externalising problems appeared to have higher odds of head and neck injuries compared to their peers, although not statistically significant in the crude model (OR=1.25, 95%CI: 0.79–1.98) or after adjustments (final model: OR=1.27, 96%CI: 0.80 – 2.02). There was no difference between children aged 14 experiencing internalising difficulties and their peers in the crude model (OR=0.69, 95%CI: 0.35–1.36) or after adjustments (final model: OR=0.69, 96%CI: 0.36 – 1.32). Conclusion: This study indicated that children aged 7 with externalising behavioural problems were at higher risk for head and neck injuries. However, after adjusting for confounding factors, this association became non-significant. In early adolescence (age 14), such injuries were not significantly associated with externalising difficulties. Internalising problems showed no significant association with head and neck injuries in either age group.13 0Item Restricted Optimisation of Laser Doppler Flowmetry to detect pulpal blood flow in permanent maxillary Incisor Teeth(King's College London, 2024-06) Alzahrani, Ahmed; Harrison, MikeBackground: Traumatised teeth can present a challenge in diagnosis where pulp sensibility tests and radiographic findings can occasionally be unclear or unreliable, especially in children. Pulp vitality testing through laser Doppler flowmetry (LDF) provides objective, painless, and quantitatively monitors pulp blood perfusion instead of relying on subjective sensibility pulp tests and the child’s responses. Aim: To evaluate the clinical utility of LDF in determining reliable pulpal blood flow (PBF) signals in healthy, traumatised, and non-vital mature permanent maxillary incisor teeth, and to establish a diagnostic protocol in the Dental Centre Department in St Thomas’ Hospital. Methods and design: LDF measurements of PBF in maxillary incisors were taken using the MoorVMS-LDF1 instrument. Participants had either traumatised or root canal-treated incisors alongside contralateral healthy incisors, and a control group with healthy incisors. A silicone stent was used to stabilise the LDF probe. This project measured mean flux values, sensitivity, specificity, flux cut-off value, PBF measurements distribution across the vital and non-vital ranges, and the repeatability of LDF tests. Statistical analysis included descriptive statistics, the Kruskal-Wallis test (P >0.05), receiver operating characteristic (ROC) analysis, and interclass correlations coefficient (ICC). Results: 21 participants aged 12 to 59 years old (mean age =24.24 ±13.56) had their 42 permanent maxillary incisors tested. A total of 84 PBF measurements were categorised into three groups: vital/control (n = 62), trauma (n = 14), and non-vital/root canal-treated (n = 8). The mean PBF values of the trauma group were similar to the mean PBF values of the vital/control and non-vital/root canal-treated groups (P = 0.137). Specifically, participants with a healthy tooth and a contralateral traumatised tooth showed no significant difference in mean PBF values (P = 0.182). However, participants with a healthy tooth and a contralateral non-vital root-treated tooth exhibited a significant difference in mean PBF values (P = 0.009). ROC analysis comparing vital and non-vital pulps showed a sensitivity of 87.5% and a specificity of 69.4%. The analysis identified a cut-off value of 4.65 flux and an area under the curve of 0.693, P = 0.031 with a 95% confidence interval of 0.517–0.868. All LDF tests showed good repeatability in measuring with an ICC of 0.785. Conclusion: LDF fails to differentiate non-vital from vital pulps accurately and it cannot distinguish between vital and non-vital pulp readings among traumatised incisors. Although the device used is marketed to assess pulpal blood flow, further optimisation is required before clinical implementation26 0Item Restricted Development of Pulp Necrosis Following Lateral Luxation Injuries in Fully Formed Roots and its Relationship to Trauma, Patient or Treatment related Factors(Saudi Digital Library, 2018-10-01) Alsharafi, Eman; Mannocci, DjemalAim: The aim of this study was to investigate the frequency of pulp necrosis following lateral luxation injury and to assess the possible relation of pulp necrosis development with a set of factors including delay of treatment, presence of a second attempt of repositioning, presence of a concomitant crown fracture, presence of gingival laceration, presence of a pre-existing restoration, history of previous trauma, achievement of complete positioning and patient age. Methodology: A group of 90 patients with 156 laterally luxated teeth was retrospectively investigated with regard to the development of pulp necrosis. Data was drawn from a database of all recorded individuals who received dental management following traumatic dental injuries at the Dental Trauma Centre in King’s College Dental Hospital between 2012 and 2016. Radiographs, clinical photographs and patients’ medical notes were thoroughly assessed to extract the relevant information. Results: Pulp necrosis occurred within 6 months following lateral luxation injury. Factors that were found to be of significance in increasing the risk of pulp necrosis development included the delay of treatment for 1 day (p value 0.034), presence of a concomitant enamel-dentin fracture (p value 0.004), complete repositioning (p value 0.009) and previous repositioning (p value 0.014). Other factors such as gingival laceration, enamel fracture and delays of treatment for 2 days were found to be of borderline significance. Presence of pre-existing restoration, history of previous trauma or age were found of no significance to pulp necrosis development. Conclusion: This study revealed that the delay of treatment for one day, presence of a concomitant enamel-dentin fracture, presence of previous repositioning and incomplete repositioning were found to be associated with an increased frequency of pulp necrosis. In view of these findings, management of any dental trauma should be carried out promptly and crown fractures should be restored as soon as possible to decrease the possibility of developing post- traumatic pulp necrosis. Further prospective studies recruiting higher numbers of patients should be carried out to ascertain the effect of other variables and to test different means of management.12 0