Goettems Marília Leão, Schuch Helena Silveira, Hallal Pedro Curi, Torriani Dione Dias, Demarco Flávio Fernando
Department of Social and Preventive Dentistry, Post-Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil.
Dent Traumatol. 2014 Aug;30(4):251-8. doi: 10.1111/edt.12102. Epub 2014 Mar 10.
To systematically review epidemiological articles assessing traumatic dental injuries (TDI) rates according to the physical activity habits and nutritional status.
A search was conducted using PubMed, ISI, Scopus, SciELO, LILACS, and gray literature in Brazilian Theses Databank. We searched for dental trauma, traumatic dental injuries, tooth injuries, tooth fractures, physical activity, motor activity, exercise, sedentary lifestyle, sports, obesity, body mass index (BMI), overweight, and fatness. Databases were searched in duplicate from their earliest records until 2012. Additional studies were identified by searching bibliographies of the articles. Two reviewers performed data extraction and analyzed study procedural quality using the Newcastle-Ottawa scale. PRISMA guidelines for reporting systematic reviews were followed.
We found 1159 articles, of whom 14 reports involving 13 studies were selected. One article was a birth cohort, one had a case-control design, and the others were cross-sectional. The quality of evidence varied across the studies and was high (9) in 3. Eleven of the studies included assessed influence of nutritional status: five show a positive association between dental trauma and overweight and six do not show any association. Regarding physical activity level, five studies assessed its effect on trauma occurrence: two detected that physical activity acts as a protective factor and two that physical active increases the risk of dental injuries, and one showed no differences in TDI occurrence. Physical activity estimated from questionnaires and BMI were the most frequently used measures, but methodological differences prevent the comparison of results.
The results suggest that no truly causal relationship exists between dental trauma and physical activity and nutritional status. Due to the relatively low level of evidence currently present, studies with more robust design, for example, prospective cohort should address this question, especially in view of the epidemic of obesity.
系统综述根据体育活动习惯和营养状况评估创伤性牙损伤（TDI）发生率的流行病学文章。
在PubMed、ISI、Scopus、SciELO、LILACS以及巴西论文数据库中的灰色文献中进行检索。我们检索了牙外伤、创伤性牙损伤、牙齿损伤、牙齿骨折、体育活动、运动活动、锻炼、久坐生活方式、运动、肥胖、体重指数（BMI）、超重和肥胖等关键词。从各数据库最早记录至2012年进行重复检索。通过检索文章的参考文献确定其他研究。两名评审员进行数据提取，并使用纽卡斯尔-渥太华量表分析研究程序质量。遵循PRISMA系统综述报告指南。
我们找到1159篇文章，其中选取了14篇报告，涉及13项研究。1篇文章为出生队列研究，1篇为病例对照设计，其他均为横断面研究。各研究的证据质量不同，3项研究证据质量高（9分）。11项纳入研究评估了营养状况的影响：5项研究显示牙外伤与超重之间存在正相关，6项研究未显示任何关联。关于体育活动水平，5项研究评估了其对创伤发生的影响：2项研究发现体育活动起到保护作用，2项研究发现体育活动增加牙损伤风险，1项研究显示TDI发生率无差异。通过问卷估计的体育活动和BMI是最常用的测量方法，但方法学差异妨碍了结果比较。
结果表明，牙外伤与体育活动及营养状况之间不存在真正的因果关系。鉴于目前证据水平相对较低，设计更严谨的研究，如前瞻性队列研究，应解决这一问题，尤其是考虑到肥胖的流行情况。
