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Critical appraisal of confounding factors of observational studies on the association between dentofacial features and dental trauma in a Brazilian population

Evidence-Based Dentistry volume 24, page 44 (2023)Cite this article

Subjects

Abstract

Aims/objectives

Dental trauma is a highly prevalent dental emergency. Children and adolescents without inadequate lip coverage, increased overjet, and anterior open bite are associated with the occurrence of traumatic dental injuries. Observational studies do not allow the inference of causality, one of the reasons being: the potential confounding factors. Therefore, this review aimed to critically appraise the confounding factors considered in epidemiological studies that associate dentofacial features with the occurrence of dental trauma in Brazilian children and adolescents.

Methods

Studies included in the qualitative synthesis of a recently published comprehensive systematic review and meta-analysis on the topic were screened. Studies that only mentioned the performance of bivariate analyzes or that did not mention the performance of multivariate analyzes were excluded. Evaluation of control statements for possible confounders and bias consideration was performed for each selected study. Confounding factors in these studies were also identified and categorized according to their domains.

Results

Fifty-five observational studies were screened, of which 11 were excluded due to the mention of only bivariate analyzes or the lack of multivariate analyses. The remaining 44 studies were critically appraised. Of these, 9 studies specifically mentioned the term confounding, and 12 studies mentioned the term bias. However, only 14 studies mentioned limitations on confounding factors in their findings. Among the 99 different variables identified, the most used were type of trauma, followed by sex and age.

Conclusion

Most studies did not acknowledge the control for possible confounding factors and rarely stressed the need for caution in interpreting their results. Cross-sectional studies do not allow inferring a cause-and-effect relationship between dentofacial features and dental trauma.

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Fig. 1: PRISMA flowchart.
Fig. 2: Absolute Frequency of viarables.
Fig. 3: Microarray plot.

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Funding

This study was partially financed by Coordination of Improvement of Higher Education Personnel of the Ministry of Education (CAPES) - Finance Code 001. We are thankful for the support of CAPES, CNPq and FAPEMIG.

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Authors and Affiliations

  1. Universidade CEUMA, Faculdade de Odontologia, Programa de Pós-Graduação em Odontologia, São Luiz, MA, Brasil

    Ana Carla Souza Costa

  2. Universidade Federal de Uberlândia, Faculdade de Odontologia, Uberlândia, MG, Brasil

    Caio Melo Mesquita

  3. Departamento de Odontologia Restauradora, Divisão de Endodontia, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas, Piracicaba, SP, Brasil

    Walbert A. Vieira & Adriana de-Jesus-Soares

  4. Universidade Federal do Amazonas, Faculdade de Odontologia, Divisão de Endodontia, Manaus, AM, Brasil

    Emílio Carlos Sponchiado-Júnior

  5. Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brasil

    Cauane Blumenberg

  6. Universidade Federal de Uberlândia, Faculdade de Odontologia, Departamento de Odontologia Social e Preventiva, Uberlândia, MG, Brasil

    Luiz Renato Paranhos

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Contributions

ACSC: Conception and design, acquisition of data, analysis and interpretation of data, drafting the paper, final approval. CMM: Acquisition of data, analysis and interpretation of data, drafting the paper, final approval. WAV: Analysis and interpretation of data, drafting the paper, final approval. ECSJ: Drafting the paper, final approval. AJS: Drafting the paper, final approval. CB: Acquisition of data, drafting the paper, final approval. LRP: Conception and design, analysis and interpretation of data, drafting the paper, final approval.

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Costa, A.C.S., Mesquita, C.M., Vieira, W.A. et al. Critical appraisal of confounding factors of observational studies on the association between dentofacial features and dental trauma in a Brazilian population. Evid Based Dent 24, 44 (2023). https://doi.org/10.1038/s41432-023-00854-y

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