Document resource
Objectives Traumatic dental injuries (TDIs) in the primary teeth often occur when children are unsupervised, which may result in them going unnoticed, particularly in cases of low-severity TDIs, such as concussion and subluxation. Consequently, these injuries can lead to crown discolouration with variable presentations and may be one of the first clinical signs of a TDI. However, many of these crown discolourations can be transient and benign, potentially leading to overdiagnosis when used as the sole diagnostic criterion. Therefore, this historical cohort study aimed to evaluate the potential overdiagnosis when considering crown discolouration as an indicator of TDIs in the primary teeth.Method A sample of children who suffered TDI and attended a reference centre for TDI in primary teeth in São Paulo (Brazil) were evaluated for crown discolouration. The colour changes were classified according to the type of colour (other colours, such as yellow and brown compared to grey discolouration), duration from TDI to the occurrence of discolouration, possible colour changes (if it was stable, improved or worsened), and other variables related to the children and traumatised teeth. Frequency and respective 95% confidence interval adjusted by the cluster (95%CI) of teeth with crown discolouration that did not suffer any undesirable event in the follow-up were calculated. The undesirable events could be premature tooth loss, pathological root resorptions, osseogingival pathologies and pulp necrosis. Variables associated with these adverse outcomes were evaluated through multilevel logistic regression, and odds ratio (OR) and 95%CI were derived.Results We evaluated 634 primary upper central incisors in 423 children with TDI; 226 teeth (35.6%; 95%CI = 31.8 to 39.7%) presented crown discolouration. Of these 226 teeth, around one-third presented some adverse outcome. Therefore, since 153 teeth did not suffer any sequelae, the potential overdiagnosis can be estimated at 67.7% (95%CI = 60.6 to 74.1%). The variables associated with adverse events were the type of colour and duration from TDI to discolouration occurrence. Compared to greyish changes and changes that occurred in longer times, other colours presented fewer adverse events. However, in the multiple analysis, only the type of colour remained significant (type of colour: OR; 95%CI = 2.88; 1.42 to 5.85; duration for discoloration: OR; 95%CI = 0.99; 0.96 to 1.01).Conclusions In conclusion, crown discolouration due to TDIs in the primary teeth is a potential clinical sign that leads to overdiagnosis, and crown discolouration other than greyish changes is more associated with a benign course.