title: Nutritional status and physical activity level as risk factor for traumatic dental injuries occurrence: a systematic review.
abstract: OBJECTIVE
  To systematically review epidemiological articles assessing traumatic dental injuries (TDI) rates according to the physical activity habits and nutritional status.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Social and Preventive Dentistry, Post-Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil.
authors.forename: Marília Leão
authors.initials: ML
authors.lastname: Goettems
authors.forename: Helena Silveira
authors.initials: HS
authors.lastname: Schuch
authors.forename: Pedro Curi
authors.initials: PC
authors.lastname: Hallal
authors.forename: Dione Dias
authors.initials: DD
authors.lastname: Torriani
authors.forename: Flávio Fernando
authors.initials: FF
authors.lastname: Demarco
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009043:Motor Activity; D009752:Nutritional Status; D012307:Risk Factors; D018677:Tooth Injuries / Q000453:epidemiology* / Q000503:physiopathology; D055815:Young Adult
keywords: nutrition disorders; physical activity; systematic review; tooth injuries