Evaluate the Prevalence of Dental Trauma in Children: A Systematic Review and Meta-Analysis
Saeid Baghi1, Farzad Ziaei2*, Shiva Daneshmehr3, ArsalanEbrahimi Fard4
1DDS, MSc Pedodontist, Shiraz, Iran.
2DDS, Department of Prosthodontics, School of Dentistry, ShahidSadoughi University of Medical Science, Yazd, Iran.
3DDS, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran.
4DDS, Department of Oral and Maxillofacial Surgery, School of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran.
*Corresponding Author: FarzadZiaei, Email: [email protected]
ABSTRACT
Background and aim:Today understanding of dental trauma etiology among children is controversial. The aim of present Systematic review and meta-analysis was evaluate the prevalence of dental trauma in children.
Method:From the electronic databases, PubMed, Cochrane Library, Embase have been used to perform a systematic literature between 2010 and May 2021. Therefore, a software program (Endnote X8) has been utilized for managing the electronic titles. Prevalence with 95% confidence interval (CI), Random effect model and restricted maximum-likelihood (REML) method were calculated. Random effects were used to deal with potential heterogeneity and I2 showed heterogeneity. I2 values above 50% signified moderate-to-high heterogeneity. The Meta analysis have been evaluated with the statistical software Stata/MP v.16 (The fastest version of Stata).
Result:A total of 1201 potentially relevant titles and abstracts were found during the electronic and manual search. Finally, a total of ten publications fulfilled the inclusion criteria required for this systematic review. Prevalence of fall was Road traffic accidents, fall, sports, violence and other was 27%, 44%, 25% , 8% and 7.91% , Respectively.
Conclusion:The highest prevalence etiology of dental trauma was fall, road traffic accidents.
Planning to reduce the risk of falling in children is very important.
Keywords:dental trauma, children, Jaw Fractures 1 INTRODUCTION
One of the leading causes of morbidity and mortality among children is trauma[1, 2].This damage can cause esthetic[3, 4], psychological problems [5], and functional [6] for the face. Facial trauma is also called dental trauma, is any physical trauma to the face [7-9]. Accidents with motor vehicles, falls, sports injuries and remain road traffic accidents (RTA) are the main causes of facial fractures in children. The most common type of facial fractures in children of any age is a nasal fractures, but in hospital setting, mandibular fractures are very common [10-13].Studies conducted in different countries report various prevalence rates for traumatic dental injuries among children and adolescents[14, 15]. However Epidemiologically,Children and adolescents are less affected than the adult population[16]. About 15% or less of facial fractures occur in children[17], At the age of less than 5 years, it is very rare, but after the start of school and increased physical activity and unstable exercise, the prevalence of fractures increases[18].
In addition to the causes of facial fractures, some studies have shown that factors such as social, economic, and cultural differences can play an important role in the causes of dental damage[19- 24].Falling, fighting, sports, accidents and hitting equipment or people are common causes[25]. The
home, school, and street environment are the places with the most damage caused by tooth decay[26, 27]. The most important of these include enamel fractures and enamel and dentin fractures without pulp placement[28, 29]. Due to the heterogeneity between the results of the individual study and the importance of preventing trauma, it is important to accurately determine the prevalence of trauma using appropriate research methods. Identifying the influencing factors is also essential for better planning, decision making and intervention. Although a Systematic review and meta-analysis study done by Barbosa et al.[16]but the authors included only facial fractures and studies were not specific to children, also New studies have been conducted in this area. Today understanding of dental trauma etiology among children is controversial. According to importance of subject, the aim of present Systematic review and meta-analysis was evaluate the prevalence of dental trauma in children.
2 METHOD
2.1 Search strategy
From the electronic databases, PubMed, Cochrane Library, Embasehave been used to perform a systematic literature between 2010 and May 2021. Therefore, a software program (Endnote X8) has been utilized for managing the electronic titles. Searches were performed with mesh terms:
("Wounds and Injuries"[Mesh] OR "injuries" [Subheading]) OR "Facial Nerve Injuries"[Mesh]) OR "Microtrauma, Physical"[Mesh]) AND ( "DentalInjuries/epidemiology"[Mesh] OR
"DentalInjuries/etiology"[Mesh] OR "DentalInjuries/mortality"[Mesh] )) AND "Jaw Fractures"[Mesh]) AND "Mandibular Fractures/etiology"[Mesh]) OR "Maxillary Fractures/etiology"[Mesh]) AND ( "Child"[Mesh] OR "Adult Children"[Mesh] )) AND ( "Motor Vehicles"[Mesh] OR "Off-Road Motor Vehicles"[Mesh] )) AND "Accidental Falls/mortality"[Mesh]) AND "Accidents/etiology"[Mesh]) AND "Athletic Injuries/etiology"[Mesh]) OR "Wounds and Injuries/etiology"[Mesh]) AND ( "Accidents, Traffic/epidemiology"[Mesh] OR "Accidents, Traffic/etiology"[Mesh] OR "Accidents, Traffic/mortality"[Mesh] ). This systematic review has been conducted on the basis of the key consideration of the PRISMA Statement–Preferred Reporting Items for the Systematic Review and Meta-analysis[30], and PICO or PECO strategy (Table1).
Inclusion criteria: Randomized controlled trials studies, controlled clinical trials, and prospective and retrospective cohort studies, in children, Full text, Prevalence of dental trauma, Etiology of dental trauma and publish in English. In vitro studies, case studies, case reports, reviews, adults and elderly population was excluded.
Table1: PICO OR PECO strategy PICO OR PECO
strategy
Description
P Population/ Patient:: children with dental trauma E Exposure/ Intervention: etiology of dental trauma
C Comparison: different continental
O Outcome: prevalence of dental trauma for each etiology
2.2 Data Extraction and method of analysis
The data have been extracted from the research included with regard to the study, years, study design, Country, number of Patient, mean/ range of age, etiology. The quality of the studies
included was assessed using the Newcastle-Ottawa Scale (NOS) [31]. The scale scores range from 0 (lowest grade) to 6 (highest grade).
For Data extraction, two reviewers blind and independently extracted data from abstract and full text of studies that included.Prior to the screening, kappa statistics was carried out in order to verify the agreement level between the reviewers. The kappa values were higher than 0.80.
Prevalence with 95% confidence interval (CI), Random effect model and restricted maximum- likelihood (REML) method were calculated. Random effects were used to deal with potential heterogeneity and I2 showed heterogeneity. I2 values above 50% signified moderate-to-high heterogeneity. The Meta analysis have been evaluated with the statistical software Stata/MP v.16 (The fastest version of Stata).
3 RESULTS
According to the purpose of the study, in the initial search with keywords, 1201 articles were found.
In the first step of selecting studies 1198 studies were selected to review the abstracts. Then, studies that did not meet the inclusion criteria were excluded from the study (1158 article). In the second step, the full text of 40 studies was reviewed in this step, 30 studies that data extraction is not consistent with the present study were excluded, finally, 10 studies were selected (Figure1).
Figure 1:Study Attrition
3.1 Characteristics
Ten studies (7retrospective study and 3prospective study) have been included. The numberof childrena total was 2863, and the ratio of boy to girl is equal 2.1:1. The range of age was 0-16 years.
3.2 Bias assessment
According to Newcastle-Ottawa Scale, all studies had a moderate risk of bias.
Studies identified (n=1201)
Studies after copies expelled (n=1198)
Studiesscreened (n=1198) Studiesexcluded (n=1158)
Full content article surveyed for eligibility
(n=40)
Full contentarticleexcluded (n=30)
The includedstudies (n=10)
IdentificationScreeningEligibilityIncluded
3.3 Overall Results
Prevalence of dental trauma resulting from Road traffic accidents among children:
Prevalence of Road traffic accidents was 27% (ES, 27% 95% CI 15%, 38%)among the nine studies and heterogeneity found (I2< 0%; P =0.92) (Figure2).
Prevalence of dental trauma resulting from fall among children:
Prevalence of fall was 44% (ES, 44%95% CI 29%, 59%) among the ten studies and heterogeneity found (I2 = 47.87%; P =0.05) (Figure3).
Prevalence of dental trauma resulting from Sports among children:
Prevalence of sports25% (ES, 25%95% CI 12%, 38%) among the seven studies and heterogeneity found (I2<0%; P =0.43) (Figure4).
Prevalence of dental trauma resulting from violence among children:
Prevalence of violence was 8% (ES, 8% 95% CI 4%, 21%) among the seven studies and heterogeneity found (I2<0%; P =0.99) (Figure5).
Prevalence of dental trauma resulting from other etiologies among children:
Prevalence of other etiologies was 7.91% (130) and effect 13% (ES, 13% 95% CI 1%, 25%) among the eight studies and heterogeneity found (I2<0%; P =0.90) (Figure6).
Table2: Studies selected for systematic review and meta-analysis.
Study. Year Design Country
Number of Patient
Range
of age Etiology % (n) Bias assessment B/G
ratio
Kenawy et
al.2019 [32] Perspective Upper Egypt
63
0-16
Fall: 58.73%
(37) Road traffic
accidents:
(31.75%) (20) Assaults: 1.59%
(1) Sports: 3.17%
(2) Others:4.76%
(3)
3/6 3.5: 1
Bhutia et al.
2019 [33] Retrospective India
1212
0–16
Fall: 30.2%
(367) Road traffic
accidents:
(31.3%) (380) Sports: 38.5%
(465)
3/6 1.8: 1
Mukhopadhyay
et al.2018 [34] Retrospective India
89
0-12
Fall: 44.9%
(40) Road traffic
accidents:
(24.7%) (22) Assaults: 2.2%
(2) Sports: 0% (0)
Others: 1.1%
(1)
35/6 1.2:1
Singaram et al.
2016 [35] Retrospective India 4 0-10
Fall: 100% (4) Road traffic accidents: 0%
(0) Assaults: 0%
(0) Sports: 0% (0)
4/6
Boffano t
al.2015 [36] Perspective Europe
114
0-15
Fall: 41.04%
(36) Road traffic
accidents:
(19.38%) (17) Others: 18.24
(16) Assaults:
15.96% (14) Sports: 35.34%
(31)
3/6
2.6:1
Qing-Bin et
al.2013 [37] Retrospective China
470
7–14
Fall: 17% (80) Others: 10.2%
(48) Assaults: 8.5%
(40) sports: 5.1%
(24) Road traffic
accidents:
(4.2%) (19)
3/6 2.48:1
Yamamoto et al.2013
[38]
Retrospective Japan
287 0–3
4–6 10–12
Fall: 28.22%
(81) Road traffic
accidents:
3/6
1.8:1
13–15 (43.55%) (125) Sports: 21.8%
(15.33) Others: 9.4
(4.87) Assaults: 8.5%
(8.01)
Zhou et al. 2013
[39] Retrospective China 79 0–12
Fall: 44.3%
(35) Road traffic
accidents:
(31.7%) (25) Sports: 0 (0) Others: 6.3 (5) Assaults: 2.5%
(2) Bicycle-related
accidents:
15.2% (12)
3/6
Arvind et al.
2013 [40] Retrospective India
500
6–16
Fall: 23.8%
(119) Road traffic
accidents:
(34.8%) (174) Sports: 21.8%
(109) Others: 9.4 (47)
Violence: 10.2 (51)
3/6 2.1:1
Karim et al.
2010 [41] Perspective India
45
0–12
Fall: 53.33%
(24) Road traffic
accidents:
(28.88%) (13) Sports: 6.66%
(3) Others: 11.00
(5)
3/6 2:1
B: Boy, G: Girl
Figure2:Forest plots showed Prevalence of dental trauma resulting from Road traffic accidents among children.
Figure3:Forest plots showed Prevalence of dental trauma resulting from fall among children.
Figure4:Forest plots showed Prevalence of dental trauma resulting from sports among children.
Figure5:Forest plots showed Prevalence of dental trauma resulting from violence among children.
Figure6:Forest plots showed Prevalence of dental trauma resulting from other etiology among children.
4 DISCUSSION
The present systematic review and Meta-analysis findings shows the Prevalence of dental trauma resulting from RTA was 27%. Barbosa et al. (16) prevalence of Road traffic accidentsRTA was 34% among the 27 studies. These results are consistent with the present study. A recent review of dental fractures in the last 30 years, including all age groups, concluded that RTA is the most important mechanism worldwide, mainly in Africa and Asia, which is in agreement with the present systematic review for the young population. On the other hand, North America, Brazil, and Europe have shown a tendency to decrease RTA, which is partially explained by the more severe traffic laws[42]. Singhal et al.[42] Also reported that RTA was the most common mode of dental trauma (57.27%) in children and adolescents. According to reports, the main cause of mandibular fractures is RTA [43-45]. RTA accounts for about a third of the cases, indicating the need for strict enforcement of traffic laws[46, 47]. The present systematic review and Meta-analysis findings shows the Prevalence of dental trauma resulting from fall was 44%. Barbosa et al. [16] prevalence of fall was 31% among the 27 studies. These results were almost identical to the present study. Also After road traffic accidents, the next most relevant etiology of dental trauma in children corresponds to falls.Road traffic accident and fall from height are the common causes’ of these injuries. Scariot et al. [21] reported that Prevalence of fall (38%) is the most common cause of these injuries. Also fall from height remains the most common cause of facial bone fracture in children[48]. The present systematic review and Meta-analysis findings shows the Prevalence of dental trauma resulting from sports was 25%. according to recent systematic review by Barbosa et al. [16] prevalence of sports was 4%. There is a difference in the percentage of prevalence and this can be due to the fact that the selected studies are different in different time periods. And now training can reduce sports injuries.
In sports, the use of preventive measures is less frequent than in motor vehicles. The importance of preventive measures should be emphasized. Supervising adults, i.e., coaches, administrators, teachers and parents should be educated. The present systematic review and Meta-analysis findings shows the Prevalence of dental trauma resulting from violence was 8%. according to recent systematic review by Barbosa et al. [16] prevalence of violence was 11%. It is almost in line with the results of the present study. Studies show that violence can also be a major cause of facial
fractures in children[49, 50]. Some studies have also shown that interpersonal violence is an important cause of facial fractures. In addition, the report said the attack and the gunshot wounds were caused by a fracture of the mandible[51, 52]. The results of the present study can help to increase public awareness, parents to prevent jaw fractures and if help. This trend can also be helped by conducting forward-looking epidemiological studies. It is recommended that parents of children and all those who deal with children obtain sufficient information about the relationship between these causes and dental trauma.
5 CONCLUSION
Thehighest prevalence etiology of dental trauma was fall, road traffic accidents. Planning to reduce the risk of falling in children is very important. Safety precautions are taken at home in cases that are more common in traumatic dental accidents.
REFERENCES
1.Fraga AMA, Bustorff-Silva JM, Fernandez TM, Fraga GP, Reis MC, Baracat ECE, et al. Children and adolescents deaths from trauma-related causes in a Brazilian City. World journal of emergency surgery. 2013;8(1):52.
2.Khumalo-Mugabi L, Moffatt S, Bekker W, Smith M, Bruce J, Laing G, et al. Penetrating trauma in children and adolescents in Pietermaritzburg. South African journal of surgery. 2020;58(1):33-6.
3.Booth PW, Eppley B, Schmelzeisen R. Maxillofacial trauma and esthetic facial reconstruction:
Elsevier Health Sciences; 2016.
4.da Nóbrega LM, Bernardino ÍdM, Barbosa KGN, e Silva JAL, Massoni ACdLT, d'Avila S.
Pattern of oral‐ maxillofacial trauma from violence against women and its associated factors.
Dental traumatology. 2017;33(3):181-8.
5.Santos LM, Bernardino IM, Porto AVF, Barbosa KGN, da Nóbrega LM, d’Avila S. Aggression Using a Knife or Other Sharp Instruments and Oral-Maxillofacial Trauma: Incidence, Risk Factors, and Epidemiologic Trends. Journal of Oral and Maxillofacial Surgery. 2018;76(9):1953. e1-. e11.
6.Bregagnolo LA, Bregagnolo JC, Silveira Fd, Bergamo AL, Santi LNd, Watanabe MGdC. Oral and maxillofacial trauma in Brazilian children and adolescents. Brazilian dental journal.
2013;24(4):397-401.
7.Nam AJ, Davidson EH, Manson PN. Assessment of the Patient With Traumatic Facial Injury.
Facial Trauma Surgery: Elsevier; 2020. p. 1-15.
8.Choi J, Lorenz HP, Spain DA. Review of facial trauma management. Journal of Trauma and Acute Care Surgery. 2020;88(4):e124-e30.
9.Hogrefe C. Facial Trauma. Sports-related Fractures, Dislocations and Trauma: Springer; 2020. p.
753-802.
10.Rêgo ICQ, Vilarinho SMM, Rodrigues CKF, Correia PVdAR, Junqueira JLC, Oliveira LB. Oral and cranio‐ maxillofacial trauma in children and adolescents in an emergency setting at a Brazilian hospital. Dental Traumatology. 2020;36(2):167-73.
11.Kambalimath H, Agarwal S, Kambalimath DH, Singh M, Jain N, Michael P. Maxillofacial injuries in children: a 10 year retrospective study. Journal of maxillofacial and oral surgery.
2013;12(2):140-4.
12.d'Ávila S. Social determinants of health and maxillofacial injuries in children and adolescents victims of violence: A novel GIS-based modelling application. International journal of paediatric dentistry. 2019;29(3):375-83.
13.de Macedo Bernardino Í, da Nóbrega LM, da Silva JRC, de Alencar CRB, de Olinda RA, d’Ávila S. Social determinants of health and maxillofacial injuries in children and adolescents victims of violence: A novel GIS‐ based modelling application. International journal of paediatric dentistry. 2019;29(3):375-83.
14.Bolhuis J, Baarda D, Leurs J, Flögel G. Incidence and prevention of dental injuries in sports hockey. Nederlands tijdschrift voor tandheelkunde. 1986;93(7-8):283-7.
15.Cagetti MG, Marcoli PA, Berengo M, Cascone P, Cordone L, Defabianis P, et al. Italian guidelines for the prevention and management of dental trauma in children. Italian journal of pediatrics. 2019;45(1):1-14.
16.Barbosa KGN, de Macedo Bernardino Í, d’Avila S, e Ferreira EF, Ferreira RC. Systematic review and meta-analysis to determine the proportion of maxillofacial trauma resulting from different etiologies among children and adolescents. Oral and maxillofacial surgery.
2017;21(2):131-45.
17.Sheta M, Shoushan M, Hussein M, Elaal SA. Evaluation of using microplates osteosynthesis for pediatric mandibular fractures. Tanta Dental Journal. 2015;12(3):149-55.
18.Liu FC, Le T-MT, Oleck NC, Halsey JN, Hoppe IC, Lee ES, et al. Pediatric pedestrian facial fracture patterns and management following motor vehicle collisions. Journal of Craniofacial Surgery. 2020;31(1):265-8.
19.Li Z, Li Z-B. Characteristic changes of pediatric maxillofacial fractures in China during the past 20 years. Journal of oral and maxillofacial surgery. 2008;66(11):2239-42.
20.Skeie M, Raadal M, Strand G, Espelid I. The relationship between caries in the primary dentition at 5 years of age and permanent dentition at 10 years of age–a longitudinal study. International journal of paediatric dentistry. 2006;16(3):152-60.
21.Scariot R, Oliveira IAd, Passeri LA, Rebellato NLB, Müller PR. Maxillofacial injuries in a group of Brazilian subjects under 18 years of age. Journal of applied oral science. 2009;17(3):195- 8.
22.Aslam F, Maqsood A, Asim MA, Abbasi A, Muzzafar A. Association of maxillofacial injuries with their etiological factors, a retrospective analysis. Isra Medical Journal. 2019;11(2).
23.Shah N, Patel S, Sood R, Mansuri Y, Gamit M, Rupawala T. Analysis of mandibular fractures:
A 7-year retrospective study. Annals of Maxillofacial Surgery. 2019;9(2):349.
24.Weihsin H, Thadani S, Agrawal M, Tailor S, Sood R, Langalia A, et al. Causes and incidence of maxillofacial injuries in India: 12-year retrospective study of 4437 patients in a tertiary hospital in Gujarat. British journal of oral and maxillofacial surgery. 2014;52(8):693-6.
25.Traebert J. Accidents, sports, and physical leisure activities are the most frequent causes of traumatic dental injury and the rate of pulp necrosis is high following its occurrence in Pilsen, The Czech Republic. Journal of Evidence Based Dental Practice. 2011;11(2):102-4.
26.Hegde SG, Tawani G, Warhadpande M, Raut A, Dakshindas D, Wankhade S. Guided endodontic therapy: Management of pulp canal obliteration in the maxillary central incisor. Journal of conservative dentistry: JCD. 2019;22(6):607.
27.Maidwell-Smith M. The role of the dental surgeon in a case of suspected non-accidental injury occurring in a child. Its aetiology, recognition and management. Apex. 1980;12(1):11-2.
28.Jabbar NSA, Aldrigui JM, Braga MM, Wanderley MT. Pulp polyp in traumatized primary teeth–
a case–control study. Dental Traumatology. 2013;29(5):360-4.
29.Krishna A, Malur MH, Swapna D, Benjamin S, Deepak CA. Traumatic dental injury—An enigma for adolescents: A series of case reports. Case reports in dentistry. 2012;2012.
30.Moher D, Liberati A, Tetzlaff J, Altman DG, Altman D, Antes G, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement (Chinese edition). Journal of Chinese Integrative Medicine. 2009;7(9):889-96.
31.Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. European journal of epidemiology. 2010;25(9):603-5.
32.Kenawy A, Amer I, Gafar A, El-Sharkawy K. Pediatric maxillofacial trauma in Upper Egypt, a prospective study. Sohag Medical Journal. 2019;23(1):50-6.
33.Bhutia DP, Singh G, Mohammed S, Ram H, Gamit J, Howlader D. Prevalence and Etiology of Pediatric Maxillofacial Injuries: A Unicenter-based Retrospective Study. International Journal of Clinical Pediatric Dentistry. 2019;12(6):528.
34.Mukhopadhyay S. A retrospective study of mandibular fractures in children. Journal of the Korean Association of Oral and Maxillofacial Surgeons. 2018;44(6):269-74.
35.Singaram M, Udhayakumar RK. Prevalence, pattern, etiology, and management of maxillofacial trauma in a developing country: a retrospective study. Journal of the Korean Association of Oral and Maxillofacial Surgeons. 2016;42(4):174-81.
36.Boffano P, Roccia F, Zavattero E, Dediol E, Uglešić V, Kovačič Ž, et al. European Maxillofacial Trauma (EURMAT) in children: a multicenter and prospective study. Oral surgery, oral medicine, oral pathology and oral radiology. 2015;119(5):499-504.
37.Qing-Bin Z, Zhao-Qiang Z, Dan C, Yan Z. Epidemiology of maxillofacial injury in children under 15 years of age in southern China. Oral surgery, oral medicine, oral pathology and oral radiology. 2013;115(4):436-41.
38.Yamamoto K, Matsusue Y, Horita S, Murakami K, Sugiura T, Kirita T. Maxillofacial fractures in children. Journal of Craniofacial Surgery. 2013;24(1):153-7.
39.Zhou H-H, Ongodia D, Liu Q, Yang R-T, Li Z-B. Incidence and pattern of maxillofacial fractures in children and adolescents: a 10 years retrospective cohort study. International journal of pediatric otorhinolaryngology. 2013;77(4):494-8.
40.Arvind RJ, Narendar R, Kumar PD, Venkataraman S, Gokulanathan S. Maxillofacial trauma in Tamil Nadu children and adolescents: A retrospective study. Journal of Pharmacy and Bioallied Sciences. 2013;5(1):S33.
41.Karim T, Khan AH, Ahmed SS. Trauma of facial skeleton in children: An indian perspective.
Indian journal of surgery. 2010;72(3):232-5.
42.Boffano P, Kommers SC, Karagozoglu KH, Forouzanfar T. Aetiology of maxillofacial fractures:
a review of published studies during the last 30 years. British Journal of Oral and Maxillofacial Surgery. 2014;52(10):901-6.
43.Kumar G, Dhupar V, Akkara F, Kumar S. Patterns of maxillofacial fractures in Goa. J Maxillofac Oral Surg. 2015 Jun 1; 14: 138-41.
44.Shah A, Nautiyal V, Gupta A, Ramola V. Trends of maxillofacial fractures in the Garhwal Himalayas at government medical college, Srinagar, Uttarakhand. National journal of maxillofacial surgery. 2016;7(1):80.
45.Kumar A, Shah SFH, Ali MH, Hassan SG. MANDIBULAR ANGLE FRACTURE. The Professional Medical Journal. 2019;26(03):430-3.
46.El-Abbasy S. Management of Mandibular angle fractures using three-dimensional strut plate: A comparison between transoral and transbuccal approaches. Egyptian Dental Journal. 2019;65(3-July (Oral Surgery)):2133-40.
47.Castillo-Manzano JI, Castro-Nuño M, López-Valpuesta L, Pedregal DJ. From legislation to compliance: The power of traffic law enforcement for the case study of Spain. Transport policy.
2019;75:1-9.
48.Mukherjee CG, Mukherjee U. Maxillofacial trauma in children. International journal of clinical pediatric dentistry. 2012;5(3):231.
49.Straker G. Faces in the revolution: The psychological effects of violence on township youth in South Africa: New Africa Books; 1992.
50.D’Arcy JW, Moffitt JK, Bartz-Kurycki M, Wainwright DJ, Anderson K, Demian N, et al. The trends of pediatric facial fractures due to violence in a level one trauma population. Journal of Craniofacial Surgery. 2019;30(7):1970-3.
51.Montovani JC, de Campos LMP, Gomes MA, de Moraes VRS, Ferreira FD, Nogueira EA.
Etiology and incidence facial fractures in children and adults. Brazilian journal of otorhinolaryngology. 2006;72(2):235-41.
52.Lee KH. Interpersonal violence and facial fractures. Journal of Oral and Maxillofacial Surgery.
2009;67(9):1878-83.
