|Year : 2015 | Volume
| Issue : 3 | Page : 234-238
Liaison amid problem behavior and traumatic dental injury among children aged 12-15 years in Bhopal
Naveen S Yadav1, Vrinda Saxena2, Manish Jain2, Kapil Paiwal3
1 Department of Prosthodontics, Peoples Dental Academy, Bhopal, India
2 Department of Public Health Dentistry, Peoples Dental Academy, Bhopal, India
3 Department of Oral Pathology, Daswani Dental College and Hospital, Kota, Rajasthan, India
|Date of Web Publication||14-Sep-2015|
Department of Public Health Dentistry, People's Dental Academy, Bhopal - 462 038, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: Liaison amid problem behavior and traumatic dental injury among children aged 13-15 years are consequential due to multifactorial dental, orofacial skeletal, psycosocial behavior pattern. The probable etiology is been equated overjet; inadequate lip coverage is the major etiological factors accountable for traumatic dental injuries. Aims: The aim was to assess the relationship of problem behavior, type of lip coverage, and the size of overjet with the traumatic dental injury among children aged 12-15 years. Materials and Methods: A cross-sectional study was conducted among 200 children aged 12-15 years in Bhopal, India. Data were collected through clinical examinations in children and interviews with parents. Traumatic injuries were recorded according to Garcia-Goday's classification. The informant - rated version of the strengths and difficulties questionnaire was used to identify problems behavior. Results: About 16.4% subjects had more than 5 mm overjet, and 20.4% subjects had inadequate lip coverage. The largest number of injuries were presented by 15-year-old children (43.90%) followed by 14 and 13 years old children. The traumatic dental injury showed 6.8% association with problem behavior, age, sex, type of lip coverage, and the size of overjet. Conclusion: Problem behavior along with the type of lip coverage and the size of overjet plays a role in the occurrence of traumatic dental injury.
Keywords: Lip coverage, overjet, problem behavior, traumatic dental injury
|How to cite this article:|
Yadav NS, Saxena V, Jain M, Paiwal K. Liaison amid problem behavior and traumatic dental injury among children aged 12-15 years in Bhopal. J Indian Assoc Public Health Dent 2015;13:234-8
|How to cite this URL:|
Yadav NS, Saxena V, Jain M, Paiwal K. Liaison amid problem behavior and traumatic dental injury among children aged 12-15 years in Bhopal. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2020 Feb 27];13:234-8. Available from: http://www.jiaphd.org/text.asp?2015/13/3/234/165217
| Introduction|| |
The decline in the prevalence and severity of dental caries among pediatrics globally  may have made traumatic dental injuries a more serious dental public health problem. , The main cause of traumatic dental injuries reported is falls and collisions, sporting activities, traffic accident.  It is likewise well-documented that amplified incisal overjet of the teeth and inadequate lip coverage significantly increase the chances to have a dental injury when folks have accidental injuries. 
Problem behavior as per definition and literal mean is a behavior that is socially, defined as a problem, as a source of concerned, or as undesirable by the social and/on legal norms of conventional society and its institutions of authority. It is behavior that usually elicits some form of social response, whether minimal, such as a statement of disapproval, or extreme, such as incarceration by Jessor and Jessor.  Behavior and social environmental risk factors for dental injury have been overlooked. Socioeconomic status was rarely measured, if measured the results were conflicting. Voluminous studies used area-based measures of deprivation and showed a positive relationship. , Conversely, another study that used parental years of schooling as a measure of socioeconomic status demonstrated that children from parents with higher levels of education had a more dental injury than from parents with a lower level of education.  Andreasen  advocated that the different types of dental injuries vary according to place study is conducted. Consequently found that within the hospital environment, luxation, and bone injuries are the most predominant. Problem behavior has never been studied before as a determinant of traumatic dental injuries. Association could be the imperative indicator of a psycho-social indicator of traumatic dental injuries.
Hence, the present study was an attempt an assessment of traumatic dental injuries related to problem behavior and to endorse the relationship between traumatic dental injuries and size of overjet and type of lip coverage. The age and sex were the prime predictors to be analyzed the intentions are attentive on (a) the prevalence of traumatic injuries to permanent incisors and canines, and (b) their distribution according to type in a population sample of school children from the city of Bhopal.
| Materials and methods|| |
A cross-sectional study was conducted among 200 schools going children aged between 12 and 15 years who were examined in Bhopal from January to February, 2014. Before starting the study, prior permission was taken from the school authority. Informed consent was collected from their parents for a clinical examination. In order to collect the representative sample, a multistage sampling procedure was executed. At the first stage, four rural areas and four urban areas were selected randomly from each zone of Bhopal. Later at the second stage, four largest schools in the each selected location were selected randomly. Snowball sampling was employed thus 100 students were obtained from all the schools who had traumatic dental injury from January to February, 2014 and they matched by age and sex with other 100 children who did not have traumatic injury.
Data were collected through clinical examinations and interviews. The diagnosis of traumatic dental injury for the definition of cases and controls, whether the incisal overjet was >5 mm and whether lip coverage was adequate, was carried out under the optimum condition. The examination of children was done under natural light with the help of probe and mouth mirror by a single examiner (type-III examination). Intra examiner variability was assessed by kappa statistics, which was 0.85. Traumatic injuries were recorded according to Garcia-Goday's classification. 
The informant - rated version of the strengths and difficulties questionnaire  was used to identify problems behavior. This questionnaire was filled by 200 parents of selected samples. Pretest of the questionnaire was done before starting the study. Pretest of the questionnaire was filled by 20 parents of both urban and rural subjects. The questionnaire composed of 25 questions under the headings conduct disorder (e.g. often sights with other children or bullies them) prosocial behavior (e.g. often volunteers to help others such as parents, teachers, other children), hyperactivity/inattention (e.g. restless, overactive, cannot stay still for long), peer relationship problem (e.g. picked on or bullied by other children), and emotional symptoms (e.g., many fears, easily scared). Each of the above-mentioned categories was provided with the options not true, somewhat true and certainly true. A score of 0 was assigned to the answer "not true," a score of 1 to the answer "some - what true" and a score of 2 to "certainly true."
The Chi-square test, multiple regression analysis, and Pearson correlation coefficients were applied by using SPSS version 19.0. (Chicago Inc., IBM company, USA), and P value was fixed at ≤0.05.
| Results|| |
Most of the subjects (44.3%) were 15-year-old. Inadequate lip coverage was among 20% of children among rural inhabitants while in urban students 30% children had adequate lip coverage. Among rural students 16.5% children had more than 5 mm overjet [Table 1].
|Table 1: Frequency distribution of age, sex, father's level of education, mother's level of education, and type of lip coverage |
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The prevalence of traumatic injuries to permanent incisors and canines was 50% (30% in boys and 20% in girls). Of 100 injured children, total 123 teeth were traumatized. The largest numbers of injuries were presented by 15-year-old children (22%) followed by 14 and 13 years old [Table 2].
|Table 2: Distribution of children with traumatized teeth by age and sex |
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Boys had more injured teeth than the girls. The most common type of injury in both sexes was the enamel - dentin fracture (71.9%) followed by crown fracture with pulp exposure (11.6%) [Table 3].
Multiple regression analysis showed association of traumatic dental injury with various independent variable such as emotional symptoms, gender, lip coverage, age, conduct disorder, mother education, peer relationship, prosocial behavior, hyperactivity, size of overjet, father education. The amount of variation was 6.8% with all independent variables [Table 4].
|Table 4: Multiple regression analysis with traumatic dental injury as a dependent variable |
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Pearson correlation coefficients between traumatic dental injury and problem behavior showed that the traumatic dental injury had a significant correlation with emotional symptoms, which was 0.237 [Table 5].
|Table 5: Pearson correlation coefficients between traumatic dental injury and problem behavior |
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| Discussion|| |
This cross-sectional study reveals the association among problem behavior and traumatic dental injury. The findings of the present study showed that emotional symptom was significantly associated with higher levels of traumatic dental injuries. It was expected that hyperactivity behavior would increase the probabilities to have a traumatic injury. This suggested that not all types of problem behavior are related to traumatic dental injuries. The results also showed that the type of lip coverage and type of overjet affected the traumatic dental injury. The traumatic dental injury also shows significant correlation with emotional symptoms, which was 0.237.
Several reports have shown that the prevalence of traumatic dental injuries in the permanent dentition ranges from 18% to 22%. ,,, Lower prevalence have been reported in most of the earlier studies. ,,,,,,, While in our study prevalence of traumatic dental injuries in the permanent dentition was so high that is, 61.5%.
Some studies have found that traumatic injuries to the permanent dentition are most frequently between 9 and 10 years of age. ,,,,, Despite some other studies report a range from 7 to 10 years as the peak ages for injuries to the permanent dentition, , but in contrast present study showed that 15-year-old children sustained more traumatic dental injuries to the teeth (22%). This result of our study was similar to study conducted by Garcia-Godoy et al.  which showed that 14-15 years old children had more 17.4% and 8.7% traumatic dental injury. It was also similar to study conducted by García-Godoy et al.  which showed that 14-year-old children had more traumatic dental injuries to the teeth (19.4%).
Garciá-Godoy et al.  found concussion as the most predominant injuries in the primary dentition and enamel dentin fracture in the permanent dentition in the private pedodontic practice. While in our study, the enamel dentin fracture in the permanent dentition was most predominant. The result also showed that the type of lip coverage and type of overjet also affected the traumatic dental injury. This might be expected as adequate lip coverage that would provide some protection to children with, pronounced overjet when they have a harmful event.
Most of the studies in the literature show that boys suffer injuries to the permanent teeth more ,,,,,,,,, in comparison to girls. García-Godoy et al.  reported that more girls suffered injuries than boys with a ratio of 0.93:1. While the present study shows a boys to girls ratio of 1:1. It has been stated that careful attention should be paid when analyzing the type of injury because this can vary according to place where the study was conducted. ,,,
| Conclusion|| |
Problem behavior along with type of lip coverage and size of overjet plays a role in the occurrence of traumatic dental injury and the prevalence of dental injuries in the Bhopal is high, and it has a great potential to be considered as an emerging public health problem. It is necessary to develop an effective health promotion strategy to prevent traumatic dental injury.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Petersson GH, Bratthall D. The caries decline: A review of reviews. Eur J Oral Sci 1996;104:436-43.
Andreasen JO, Andreasen FM. Dental trauma: Quo vadis. Tandlaegebladet 1989;93:381-4.
Marcenes W, al Beiruti N, Tayfour D, Issa S. Epidemiology of traumatic injuries to the permanent incisors of 9-12-year-old schoolchildren in Damascus, Syria. Endod Dent Traumatol 1999;15:117-23.
Andreasen JO, Andreasen FM. Textbook and Colour Atlas of Traumatic Injuries to the Teeth. 3 rd
ed. Copenhagen: Munksgaard; 1994.
Jessor R, Jessor SL. Problem Behaviour and Psycholsocial Development. New York: Academic Press; 1977.
Hamilton FA, Hill FJ, Holloway PJ. An investigation of dento-alveolar trauma and its treatment in an adolescent population. Part 1: The prevalence and incidence of injuries and the extent and adequacy of treatment received. Br Dent J 1997;182:91-5.
Marcenes W, Murray S. Social deprivation and dental injuries among 14-year old school children in Newham, London. Endod Dent Traumatol 2000;16:1-4.
Cortes MI, Marcenes W, Sheiham A. Prevalence and correlates of traumatic injuries to the permanent teeth of school children aged 9-14 years in Belo Horizonte, Brazil. Endod Dent Traumatol 2001;17:22-6.
Andreasen JO. Etiology and pathogenesis of traumatic dental injuries. A clinical study of 1,298 cases. Scand J Dent Res 1970;78:329-42.
Garcia-Goday F. A classification for traumatic injuries to primary and permanent teeth. J Pedod 1981;5:295-7.
Goodman R. The Strengths and Difficulties Questionnaire: A research note. J Child Psychol Psychiatry 1997;38:581-6.
García-Godoy F, Sánchez R, Sánchez JR. Traumatic dental injuries in a sample of Dominican schoolchildren. Community Dent Oral Epidemiol 1981;9:193-7.
Andreasen JO, Ravn JJ. Epidemiology of traumatic dental injuries to primary and permanent teeth in a Danish population sample. Int J Oral Surg 1972;1:235-9.
Järvinen S. Fractured and avulsed permanent incisors in Finnish children. A retrospective study. Acta Odontol Scand 1979;37:47-50.
Ravn JJ. Dental injuries in Copenhagen schoolchildren, school years 1967-1972. Community Dent Oral Epidemiol 1974;2:231-45.
Mcewen JD, Mchugh WD. Predisposing factors associated with fractured incisor teeth. Eur Orthodont Soc Trans 1969;3:343-51.
Garcia-Goday F, Morban F. Prevalence of injuries in anterior teeth of 502 Dominican school children. venez odontol 1954;18: 47-51.
Ellis RJ. The Classification and Treatment of Injuries to the Teeth of Children. Chicago: Years Book Medical Publishers; 1945.
Gauba ML. A correlation of fractured anterior teeth to their proclination. J Indian Dent Assoc 1967;39:105-12.
Grundy JR. The incidence of fractured incisors. Br Dent J 1959;106:312-4.
Dua R, Sharma S. Prevalence, causes, and correlates of traumatic dental injuries among seven-to-twelve-year-old school children in Dera Bassi. Contemp Clin Dent 2012;3:38-41.
Zadik D, Chosack A, Eidelman E. A survey of traumatized incisors in Jerusalem school children. ASDC J Dent Child 1972;39:185-8.
Patel MC, Sujan SG. The prevalence of traumatic dental injuries to permanent anterior teeth and its relation with predisposing risk factors among 8-13 years school children of Vadodara city: An epidemiological study. J Indian Soc Pedod Prev Dent 2012;30:151-7.
Gutz DP. Fractured permanent incisors in a clinic population. ASDC J Dent Child 1971;38:94-5.
Hedegaard B. Stalhave J. A study of traumatized permanent teeth in children aged 7-15 years. Swed Dent J 1973;66:431-50.
Ravn JJ, Rossen L. Frequency and distribution of traumatic injuries of teeth among School Children. Dentists magazine 1969;71:1-9.
Haavikko K, Rantanen L. A follow-up study of injuries to permanent and primary teeth in children. Proc Finn Dent Soc 1976;72:152-62.
O'Mullane DM. Injured permanent incisor teeth: An epidemiological study. J Ir Dent Assoc 1972;18:160-73.
Garcia-Godoy F, Morbán-Laucer F, Corominas LR, Franjul RA, Noyola M. Traumatic dental injuries in schoolchildren from Santo Domingo. Community Dent Oral Epidemiol 1985;13:177-9.
Garciá-Godoy F, Garciá-Godoy F, Olivo M. Injuries to primary and permanent teeth treated in a private paedodontic practice. J Can Dent Assoc 1979;45:281-4.
Gelbier S. Injured anterior teeth in children. A preliminary discussion. Br Dent J 1967;123:331-5.
Macko DJ, Grasso JE, Powell EA, Doherty NJ. A study of fractured anterior teeth in a school population. ASDC J Dent Child 1979;46:130-3.
Ravishankar TL, Kumar MA, Ramesh N, Chaitra TR. Prevalence of traumatic dental injuries to permanent incisors among 12-year-old school children in Davangere, South India. Chin J Dent Res 2010;13:57-60.
Sundvall-Hagland I. Accidents Injuries to Taender and Prodontium during childhood. North Klin Odontol 1964;12:1-4.
Sánchez JR, Sánchez R, García-Godoy F. Traumatic injuries of the anterior teeth in preschool children. Acta Odontol Pediatr 1981;2:17-23.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]