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ORIGINAL ARTICLE
Year : 2021  |  Volume : 19  |  Issue : 1  |  Page : 76-80

Prevalence and risk factors associated with traumatic dental injuries among 12–15 year old school going children, Mathura city


1 Department of Public Health Dentistry, K.D. Dental College and Hospital, Mathura, Kota, Uttar Pradesh, India
2 Department of Pedodontis, K.D. Dental College and Hospital, Mathura, Kota, Uttar Pradesh, India
3 Department of Prosthodontist, K.D. Dental College and Hospital, Mathura, Kota, Uttar Pradesh, India

Date of Submission06-Aug-2019
Date of Acceptance11-Feb-2021
Date of Web Publication31-Mar-2021

Correspondence Address:
Roopali Gupta
Department of Public Health Dentistry, K. D. Dental College and Hospital, Mathura, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_87_19

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  Abstract 


Background: Traumatic dental injuries are a serious public dental health problem throughout the world. The incidence of traumatic injuries is increasing over the years. Trauma to the permanent anterior teeth is a common finding. Dental trauma is an irreversible pathology that after the occurrence is characterized by a life-long debilitating effect. Aims and Objectives: The aim of this study was to estimate the prevalence and assess factors related to traumatic injuries to permanent anterior teeth among 12–15-year-old children attending private and government schools in Mathura city. Materials and Methods: An epidemiological cross-sectional study was carried out among 1000 school children aged 12–15 years in which 500 children from both government and private schools, respectively, of five geographical zones of Mathura city were randomly selected. Children completed a questionnaire related to the history of trauma to their anterior teeth after which they were examined for type of lip coverage, Angle's molar relationship, and incisor nature of trauma sustained. Statistical analysis: SPSS 21 was carried out using Student's t-test (P < 0.05), Chi-square test, and Mantel–Haenszel test. Results: The prevalence of traumatic injuries was 8.9% and was higher among government school children compared to private school children. The boys and girls with a history of trauma were 67.4% and 32.6%, respectively. The main cause of trauma was fall in the playground (46.0%). The main reason of trauma was because of pushing (65.2%). The most predominant injuries were enamel fractures and the most common place for occurrence was school. Conclusion: The prevalence of dental injuries in Mathura city was high and it has a great potential to be considered as an emerging public health problem.

Keywords: Malocclusion, permanent teeth, prevalence, trauma, traumatic injury


How to cite this article:
Gupta R, Kaur N, Sharma V, Bhalla M, Srivastava M, Sisodia S. Prevalence and risk factors associated with traumatic dental injuries among 12–15 year old school going children, Mathura city. J Indian Assoc Public Health Dent 2021;19:76-80

How to cite this URL:
Gupta R, Kaur N, Sharma V, Bhalla M, Srivastava M, Sisodia S. Prevalence and risk factors associated with traumatic dental injuries among 12–15 year old school going children, Mathura city. J Indian Assoc Public Health Dent [serial online] 2021 [cited 2021 Jul 30];19:76-80. Available from: https://www.jiaphd.org/text.asp?2021/19/1/76/312651




  Introduction Top


The epidemic of common injuries is the most unconcerned health problem of the 21st century.[1] The accountability of all injuries is expected to be equal to that of all communicable diseases worldwide by 2020 and is expected to exceed in Latin America, China, and the Caribbean. In “Other Asia and Islands,” including Thailand, the burden has increased from 14.4% of all deaths in 1990 to 17.2% expected in 2020.[2]

The existence of dental caries as a major oral health problem in children has for long been established, but the prevalence of dental trauma, which is a serious dental public health problem, has not been studied often. Despite its importance, there are few reports available on the epidemiology of injuries to the teeth of children in developing and industrialized countries, especially when compared to the epidemiological data on dental caries and periodontal diseases.[2]

Traumatic dental injuries (TDI) are a serious public dental health issue throughout the world.[3] The incidence of traumatic injuries is increasing over the years. The face and the teeth being the most exposed parts of the body have a higher chance of fracture. Trauma to the permanent anterior teeth is a common finding.[4]

TDI are commonly seen in 92% of patients presenting with oral injuries. Epidemiological studies worldwide and in the past four decades have noticed the varying prevalence of TDI in children and adolescents. In the 0–18-year-old group, the prevalence ranged from 8% to 76%. In most studies, the 0–6-year-old group varied from 9.4% to 40%. In Sweden, the incidence of TDI in rural areas has been reported to be 11.7%. In Taiwan, East Asia, research indicated 16.5% of children in the central region and 19.9% of children in the southern region had a positive history of dental trauma. In South Asia, one Indian study revealed a relatively high prevalence of TDI in children 4–6 years old.[4]

During childhood, the development of the occlusion both functionally and esthetically is dependent on the satisfactory presence of teeth.[5] High levels of violence, traffic accidents, and a greater participation of children in sports have contributed to transform dental traumatic injuries into a public health problem.[6] Unfortunate and disastrous results can occur when a trauma is inadequately treated, causing conditions such as malformed teeth, premature tooth loss, and pulpal death with abscess formation.[5] About 10.3% of patients seeking orthodontic treatment have suffered from dental trauma. Maxillary incisors are the most vulnerable teeth to TDI, with increased overjet, protrusion of upper incisors, open bite, epilepsy, and incompetent lip coverage considered to be the most significant predisposing factors.[3] Maxillary teeth are most frequently traumatized than mandibular teeth and there is general agreement that maxillary central incisors are injured most frequently, probably due to their vulnerable position. When they are lost at the beginning or even in the middle of their biological cycle, there are esthetic alterations with a reduction of the child's self-esteem, making speech difficult or even contributing to install deleterious habits.[7]

In order to introduce appropriate preventive measures for traumatic injuries, the association between their prevalence and the risk factors involved must be better understood.[8] To determine efficiently the extent of injury and correctly diagnose injuries to the teeth, periodontal ligament, and associated structures, a systematic approach to the traumatized child is essential. Subsequent to the initial management of the dental injury, continued periodic monitoring is indicated to determine clinical and radiographic evidence of successful intervention.[9]

The aim of my study is to estimate the prevalence and risk factors related to traumatic injuries to permanent anterior teeth in 12–15-year-old children attending private and government schools in Mathura city.


  Materials and Methods Top


A cross-sectional survey was carried out on 1000 school children aged 12–15 years, of both genders attending government and private schools of Mathura City. The ethical clearance was obtained from the institutional ethical clearance committee (THE/147 C). The map of Mathura city was procured and divided into five zones, namely north, east, west, south, and central zone.

Inclusion criteria

  • All the available subjects who were in the age range of 12–15 years and willing to participate in the survey.


Exclusion criteria

  • School children with extensive caries in the anterior teeth
  • School children with dental anomalies in tooth structure such as amelogenesis imperfecta, dentinogenesis imperfecta, or enamel or dentin hypocalcification
  • Subjects not willing to participate in the survey and those who were absent on the day of examination
  • Subjects suffering from major systemic illness.


The pilot study was conducted to estimate the prevalence of TDI among the study participants of four schools selected randomly.

The sample size was determined using the following formula:

n = Z2 × P (1 − P)/e2

Based on the prevalence obtained for TDI, it was necessary to take 382 as the maximum sample size. However, a total of 1000 school children from private and government schools were examined in the age group 12–15 years to increase the accuracy of the study.

In order to cover the total sample size of 1000, 100 school children of both private and government schools from each of the five zones of Mathura city were randomly selected, out of which 500 children were from government schools and 500 children were from private schools. In total, 200 school children were selected from each zone.

Before examining the children, the consent was obtained from the Principal/Headmaster/Head Mistress of the respective schools of Mathura city. A closed-ended proforma was prepared to collect data.

The ADA type-3 technique was used for examination.[5] The age at which injury occurred, type of damage sustained, incisor overjet, type of lip coverage, and Angle's molar relationship were recorded. CPITN probe was used to measure the degree of overjet as described by the 1997 WHO Basic Oral Health Survey Guidelines.[5]

Hamilton et al.[5] classification of traumatic injuries to anterior teeth was used to assess the TDI to anterior teeth.

  • Class I – Fracture confined to enamel
  • Class II – Fracture involving dentine
  • Class III – Fracture with pulp exposed
  • Class IV – Intrinsic discoloration
  • Class V – Abnormal mobility
  • Class VI – Infra-occlusion
  • Class VII – Presence of sinus or swelling in the mucosa over a tooth


The survey data were coded and all the results were analyzed using “Statistical Package for Social Sciences” 21 (IBM Corporation –Armonk, New York, US) software. Data analysis included descriptive statistics (frequency distribution and cross-tabulation). Chi-square test was employed to compare qualitative data and determine the statistical significance. The level of statistical significance was set at P ≤ 0.05. The strength of association between the variable (lip coverage, molar relationship, and incisal overjet) and the outcome was calculated using the Mantel–Haenszel test. Student's t-test was used to assess the quantitative data for comparing two groups.


  Results Top


On examination of 1000 school children, it was seen that 89 (8.9%) children sustained traumatic injuries to anterior teeth [Table 1]. The boys and girls with a history of trauma were 60 (67.4%) and 29 (32.6%), respectively, and the results were found to be statistically significant (P ≤ 0.01) [Table 2]. The main cause of trauma was fall in the playground, i.e., 46 (51.7%), and a statistically significant difference was obtained (P ≤ 0.02). The main reason of trauma was because of pushing found among 58 (65.2%) children; the difference was statistically significant (P ≤ 0.05).
Table 1: Distribution of study subjects according to the history of trauma involving their teeth among private and government school children

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Table 2: Gender wise distribution of study subjects according to trauma involving their teeth

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The most common place for occurrence of trauma was school in 51 (57.3%) children; no statistically significant difference was obtained. Maxillary central incisor was the most common tooth affected by trauma in 85 (8.5%) children [Figure 1]. A total of 70 (60.3%) children suffered enamel fractures and no statistically significant difference was found (P = 0.41) [Figure 2].
Figure 1: Distribution of study subjects according to teeth affected by trauma among private and government school children

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Figure 2: Distribution of study subjects according to type of trauma among private and government school children

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Children with inadequate lip coverage showed less number of injuries, i.e., 28 (31.5%) than in children with adequate lip coverage, i.e., 61 (68.5%), and the results were not found to be statistically significant (P = 0.92) [Table 3]. Maximum, i.e., 62 (69.7%) children with injured teeth had Class I malocclusion and the difference was not statistically significant (P = 0.90) [Table 4]. Furthermore, the maximum injuries occurred in 75 (84.2%) children with overjet 3–5 mm, followed by those having > 5 mm overjet, i.e., 14 (15.8%) and the results were not statistically significant (P = 0.14) [Table 5].
Table 3: Comparison of trauma in children in relation to lip coverage among private and government school children

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Table 4: Distribution of study subjects according to type of malocclusion and history of trauma among private and government school children

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Table 5: Distribution of study subjects according to incisor overjet and history of trauma among private and government school children

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  Discussion Top


Traumatic dental injury is not a result of disease but a consequence of several factors that will accumulate throughout life if not properly treated.[6]

For this study, children between 12 and 15 years of age were chosen, as during this period, there is the maximum physiologic growth and development and the children are actively involved in lot of outdoor activities. The prevalence of traumatic injuries in this study was 8.9% that corroborates the results of various recent studies.[6] The prevalence noted was lower as compared to the earlier studies done by Kaur and Hiremath[7] (14.5%), Traebert et al.[8] (18.9%), Bendo et al.[10] (17.1%), Baldava and Anup[9] (14.9%), and Gupta et al.[11] (13.8%) in which prevalence was found to be higher.

In our study, boys and girls with a history of trauma were 60 (67.4%) and 29 (32.6%), respectively, and the difference was found to be statistically significant. Similar findings were observed in the study conducted by Ingle et al.[12] and Ravishankar et al.[13] in which more boys were affected by trauma. The higher percentage of traumatic injuries in the boys could be attributed to the fact that boys engage in leisure activities or sports of a generally more aggressive nature or with a greater accident risk than the girls do.[6]

The main cause of trauma was fall in the playground in 46 (51.7%) children. These findings are similar to the study conducted by Patel and Sujan[6] Bhayya and Shyagali[14] Rouhani et al.,[15] Govindaranjan et al.,[3] and Ingle et al.[12] in which 43.8%, 60%, 42.9%, 41.9%, and 57.0% had trauma due to fall in playground, respectively. However, in contrast to the study conducted by Prabhu et al.,[16] Malikaew et al.,[17] Baldava and Anup,[9] and Gupta et al.[11] in which 58%, 60%, 49.9%, and 42% of children, respectively, with a history of trauma had trauma due to sports.

For this study, the main reason of trauma was because of pushing in 58 (65.2%) children. However, in contrast to the study conducted by Malikaew et al.,[17] the main reason of trauma was because of slipping in 14.9% of children.

In the present study, the most common place for occurrence of trauma was school in 51 (57.3%) children. Similar results were seen in a study done by Batra et al.[18] in which 67 (38.7%) children had suffered trauma at school. In contrast in the study conducted by Bendo et al.,[10] Kaur and Hiremath,[7] Rouhani et al.,[15] and Patel and Sujan,[6] 41.8%, 35.4%, 47.4%, and 43.8% of children with a history of trauma had suffered trauma at home, respectively.

In our study, the maxillary central incisor was the most common tooth affected by trauma in 85 (8.5%) children. In contrast in the study conducted by Prasad et al.[19], Ingle et al.,[12] Tumen et al.,[20] and Batra et al.,[18] 46 (37.1%), 115 (72.2%), 36 (29.3%), and 123 (72.3%) children had trauma in maxillary central incisor, respectively. Injury to maxillary incisors was more frequent than mandibular incisors because blows to mandibular teeth are dissipated due to the nonrigid connection of the mandible to the cranial base.

For this study, the most predominant injuries were enamel fractures, i.e., in 70 (60.3%) children. In contrast in a study conducted by Kaur and Hiremath,[7] 81.6% of children had fracture confined to the enamel.

Children with inadequate lip coverage, i.e., 28 (31.5%) showed less number of injuries than with adequate lip coverage, i.e., 61 (68.5%) in the present study. In contrast in the study conducted by Batra et al.,[18] Francisco et al.,[21] Gupta et al.,[22] Pavan Baldava and Anup,[9] and Marcenes et al.[23] in which 136 (13.6%), 101 (14.8%), 19 (43.2%), 21 (7.3%), and 58 (6.5%) children with history of trauma had adequate lip coverage, while 37 (23.1%), 25 (30.9%), 25 (56.8%), 34 (41.0%), and 29 (14.9%) children with history of trauma had inadequate lip coverage, respectively.

Children having Class I malocclusion, i.e., 62 (69.7%) suffered more from trauma. Similarly, in a study conducted by Kaur and Hiremath,[7] 227 (78.5%) children with a history of trauma had Class I malocclusion and 60 (20.8%) children with a history of trauma had Class II malocclusion.

Maximum injuries occurred in children with overjet 3–5 mm, i.e., 75 (84.2%), followed by those having >5 mm, i.e., 14 (15.8%). In contrast in the study conducted by Marcenes et al.[23] and Gupta et al.,[22] 7.6% and 52.3% of children, respectively, with a history of trauma had 3–5 mm incisor overjet, and 11.5% and 47.7% of children, respectively, with a history of trauma had >5 mm overjet.

The limitation of my study was that further studies are required with a larger sample size and more variables are needed to investigate the personal and social factors that increase the risk of damage to the anterior teeth. Such information is necessary to develop and implement effective preventive strategies for reducing the prevalence and cost of traumatic dental injury treatment.


  Conclusion Top


In the present study, the prevalence of traumatic injuries was 8.9% and was higher among government school children compared to private school children. On the whole, the prevalence was more in boys when compared to girls. The prevalence of traumatic injuries was more among children with adequate lip coverage, Angle's Class I malocclusion, and with 3–5 mm incisor overjet. Maxillary central incisors were most commonly affected by trauma and maximum children had fracture confined to the enamel.

Traumatic dental injury is not a result of disease but a consequence of several factors that will accumulate throughout life if not properly treated. The most important factors significantly contributing to TDI are lip coverage, molar relationship, and incisor overjet. Hence, correction of these predisposing factors may help in the prevention of traumatic injuries.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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7.
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[PUBMED]    
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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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