Printer Friendly

PATTERN AND CAUSES OF TRAUMATIC INJURIES TO PERMANENT TEETH IN CHILDREN OF AGE 7 TO 14 YEARS.

Byline: ILYAS M., SHAH S. M. A., KHATTAK M. S. K. AND KUNDI J. A.

ABSTRACT

Background and Objective: The aim of this study was to determine the pattern and causes of traumatic dental injuries (TDI's) to permanent teeth in children of age 7 to 14 years.

Methods: An analytical cross sectional study was carried out from July 2016 to June 2017. A total of 79 injured teeth in 58 patients were included in this study. The Federation Dentaire Internationale System of tooth numbering and Ellis's classification of traumatic dental injuries (TDI's) was used for teeth fractures. Kruskal-Wallis and Mann-Whitney U tests were used to assess pattern of injury and type of teeth involved. P value a$? 0.05 was considered significant.

Results: Boys had more injuries as compared to girls with ratio of 1.4:1. The most frequent age involved was 12 years. Amongst causes; fall was the most common cause (39.24%) followed by accident (24.05%) and bicycle (17.72%). The most prevalent tooth involved was right maxillary central incisor n = 26 (32.91%, p = 0.001) and Ellis's classification III (37.97%, p = .001) of teeth fracture was common.

Conclusion: The study concluded that the most frequent cause was fall and right central incisor and Elis's II classification were the most common amongst traumatic dental injuries.

Keywords: Dental traumatic injuries, Central incisor, Permanent teeth, Risk factors, Pakistan.

INTRODUCTION

Traumatic dental injuries(TDIs)is an enclosed injury to the teeth or the oral cavity resulted from an external impact on the teeth and surrounding tissues that occur suddenly and usually require prompt care.1 TDIs often involve anterior teeth that may cause restriction in biting, phonetics, esthetics as well as social and psychological effects. The cost involved for the correction is the further complication encounter by those having TDIs.2

The prevalence of TDIs is very high in children and most of the children that are affected by TDIs seen in between ages of 8 and 11 years.3 The incidence of maxillary teeth involvement is 48% - 60%. Nineteen percent of the injuries occur due to fall elsewhere while over 16% are reported to happen in the school environment.4 Primary tooth involvement is 30% while 20% permanent dentition sustain injuries.5 Epidemiological studies show that the prevalence of TDIs will soon surpass caries and periodontal disease among children.6

The major causes of TDIs despite of severity are falls, being struck by an object, bicycle accidents, assaults, and motor vehicle accidents.7,8

The prognosis of traumatized teeth depends on the sudden and suitable treatment.9 Prompt care is required for avulsed permanent teeth as the prognosis is better if transplanted within 30 minutes and further depends on the periodontal ligaments attached to the tooth.10 The role of school teachers and parents in this regard is very important and because of knowledge inadequacy about TDIs in teachers and parents their attitude does not bring reduction in TDIs.11,12

Thus, it is imperative to carried out a study which reveals not only the pattern and causes of TDIs but also the type of TDI sage and teeth involved in order to contribute effective strategies regarding dental injuries in permanent teeth. The aim of this study is to determine the pattern, causes and age involved in TDIs in permanent teeth amongst 7 - 14 years old children.

METHODOLOGY

An analytical cross-sectional study was carried out in the Department of Oral and Maxillofacial Surgery, Sardar Begum Dental College and Hospital, Peshawar from July 2016 to June 2017. A total of 79 permanent injured teeth in 58 patients through convenience sampling technique were selected. After taking informed consent from the patient, a well-documented proforma having demography and history of the complaint were elicited. The face was thoroughly cleaned with warm water or swabs before going to clinical examination. All the information regarding gender, age, number of injured teeth, type of the teeth, type of injury and cause of injury was carefully recorded. The Federation Dentaire Internationale (FDI) system of tooth numbering was followed in the study. The examination was done using Ellis's classification of TDIs.13,14 Intra-oral periapical (IOPA) x-rays and vitality tests were carried out where deemed necessary. The data was analyzed using SPSS 22.0.

Mean and standard deviation was computed for quantitative variable like age. Frequency and percentage were calculated for qualitative variables like gender, risk factors and pattern of trauma. Kruskal-Wallis and Mann-Whitney U tests were used to compare pattern of traumatic dental injuries and type of teeth involved. P value a$? 0.05 was considered significant.

RESULTS

The mean age at presentation was 10.5 +- 2.5 years. The most frequent gender involved was male (n = 34, 58.62%) and female (n = 24, 41.38%) with a male to female ratio was 1.4:1. The total teeth affected were 79.

The most common age involved was 12 years age in both genders, male = 18.96%, female = 12.1% followed by 10 years age in male 12.1% and in female 8.62% as shown in the figure 1. From 79 cases of traumatic injuries, in 31 cases (39.24%), the cause of trauma was found to be fall as shown in the figure 2. The most common TDIs in Ellis classification were class III with 37.97% (p =.001, Kruskal-Wallis test) followed by class II with 18.98% (p = .040, Kruskal-Wallis test). The most frequent tooth involved were right maxillary central incisor with n = 26, 32.91% (p = .001, Mann-Whitney U test) followed by left maxillary central incisor; n = 14, 17.72% (p = .045, Mann-Whitney U test). The least commonly involved tooth were mandibular left central incisor; n = 05 (6.3%) as shown in the table 1.

DISCUSSION

This cross sectional study has identified high prevalence in male than female and male to female ratio was 1.4:1. This study was in accordance with the results of the study conducted by Hedge et al15 in which male to female ratio was 1.6:1 and with study done by Hamdan et al16 where the male to female ratio was 1.7:1. The reason could be that boys are more prone to participation and involvement in the aggressive sports and outdoor activities. The low prevalence of TDIs in girls can be demonstrated by the fact that the girls are more mature in behavior than boys who are more energetic than girls. However, Gracia Godoy in his study found that the male to female ratio was 0.9:1 which contradict this study.17

The findings of the present study demonstrate that the most frequent age involved in children was 10 to 12 years age which is in consistent with study done by Govindarajan et al18 and Vanka et al19 in which they found that children of age 10 to 13 years were commonly encountered with TDI's while Hedge et al15 showed that 13 to 14 years age children were most frequently involved which opposes this study. The most common cause of TDIs in this study was fall which is in accordance with study conducted by Vanka et al,19 Rai et al20 and Dua et al21 in which they found fall as the most common cause of TDIs. The second most common cause in our study was RTA which is not in consistent with study by Hedge et al.15 The reason could be that children are more aggressive and take participation in outdoor activities.

Table 1: Frequency of Injuries according to Tooth Number.

Ellis###12###11###21###22###32###31###41###42###Total###P value*

Classification

Class I###02###04###02###01###02###01###0###01###13 (6.5%)###.063

Class II###01###07###03###01###0###0###01###02###15 (18.98%)###.040

Class III###04###10###05###02###03###02###03###01###30 (37.97%)###.063

Class IV###01###02###02###03###01###02###01###01###13 (16.5%)###.063

Class V###0###02###01###0###0###0###02###01###06 (7.6%)###.084

Class VI###0###0###0###0###0###0###0###0###0 (0%)###.105

Class VII###0###01###01###0###0###0###0###0###02 (2.5%)###.145

Total###08 (10.13%)###26###14###07###06###05###07###06###79 (100%)

###(32.91%)###(8.86%)###(8.86%)###(7.6%)###(6.3%)###(8.86%)###(7.6%)

P valueb###.053###.001###.045###.057###.069###.059###.057###.069

The right maxillary central incisor was the most frequently involved tooth in this study which accounted for 32.91% of TDIs followed by left maxillary central incisor with 17.72% and was statistically significant with TDIs. The present study is in argument with study conducted by Vanka et al19 in which they found right central incisor tooth to be the most prevalent with 39% of injuries. The Ellis classification III was high in this study (37.97%) followed by II (18.98%) and was statistically significant. This study is unlikely with the results of the study conducted by Gracia Godoy17 in which he showed that enamel fracture was the high in TDIs which opposes this. However, Rajab et al22 reported that the most common injury found was to be enamel and dentin fracture which is in agreement with this study.

The limitation of this study was that cause of injury may be different in girls than boys and in this study it was not discussed individually. The more over jet and lip incompetency in which more injuries to the teeth may be encountered were not discussed. Also the socioeconomic status of the patients were not elaborated which may affect the study. Apart from these limitations this study thoroughly evaluated the cause and pattern of TDIs in children. Studies are needed to know the factors that increase the TDIs to permanent teeth in children.

It is concluded that most frequently involved tooth amongst traumatic dental injuries was right maxillary central incisor and age involved were 10 to 12 years age. The most common cause of TDIs in permanent teeth was fall and Ellis classification II and III were the most prevalent injuries to the permanent incisor teeth in children of age 7 to 14 years.

A policy at the community level is mandatory which may include the education about the various modalities of avoiding TDIs. An interaction between school teachers and parents is necessary in order to encourage them to report the TDIs to the dentist at earliest.

ACKNOWLEDGEMENTS

None to declare.

Conflict of Interest

None to declare.

REFERENCES

1. Lam R, Abbott P, Lloyd C, Lloyd C, Kruger E, Tennant M. Dental trauma in an Australian rural centre. Dent Traumatol. 2008; 24: 663-70.

2. Garg K, Kalra N, Tyagi R, Khatri A, Panwar G.An Appraisal of the Prevalence and Attributes of Traumatic Dental Injuries in the Permanent Anterior Teeth among 7-14-Year-Old School Children of North East Delhi. Contemp Clin Dent. 2017; 8 (2): 218-24.

3. Mesgarzadeh AH, Shahamfar M, Hefzollesan A. Evaluating knowledge and attitudes of elementary school teachers on emergency management of traumatic dental injuries: A study in an Iranian urban area. Oral Health Prev Dent. 2009; 7 (3): 297-308.

4. Mohandas U, Chandan GD. Knowledge, attitude and practice in emergency management of dental injury among physical education teachers: A survey in Bangalore urban schools. J Indian Soc Pedod Prev Dent. 2009; 27 (4): 242-48.

5. Marcenes W, Al Beiruti N, Tayfour D, Issa S. Epidemiology of traumatic injuries to the permanent incisors of 9-12-year-old school children in Damascus, Syria. Endod Dent Traumatol. 1999; 15 (3): 117-23.

6. Andreasen JO, Andreasen FM. Dental traumatology: Quovadis. Endod Dent Traumatol. 1990; 6: 78-80.

7. Harrington MS, Eberhart AB, Knapp JF. Dentofacial trauma in children. ASDC J Dent Child. 1988 Sep-Oct; 55 (5): 334-8.

8. Glendor U. Aetiology and risk factors related to traumatic dental injuries-a review of the literature. Denl Traumatol. 2009; 25: 19-31.

9. Hashim R. Dental trauma management awareness among primary school teachers in the Emirate of Ajman, United Arab Emirates. Eur J Paediatr Dent. 2011; 12 (2): 99-102.

10. Lieger O, Graf C, El-Maaytah M, Von Arx T. Impact of educational posters on the lay knowledge of school teachers regarding emergency management of dental injuries. Dent Traumatol. 2009; 25 (4): 406-12.

11. Pani SC, Hillis H, Chaballout T, Al Enazi W, Al Attar Y, Aboramadan M. Knowledge and attitude of Saudi teachers of students with attention-deficit hyperactivity disorder towards traumatic dental injuries. Dent Traumatol. 2014; 30 (3): 222-26.

12. Feldens EG, Feldens CA, Kramer PF, da Silva KG, Munari CC, Brei VA. Understanding school teacher's knowledge regarding dental trauma: A basis for future interventions. Dent Traumatol. 2010; 26 (2): 158-63.

13. Pagadala S, Tadikonda DC. An overview of classification of dentaltrauma. IAIM. 2015; 2 (9): 157-64.

14. Ellis RG. The classification and treatment of injuries to the teeth of children. 5th ed. Chicago: Year Medical Book Publishers, 1970: 56-199.

15. Hegde R, Agrawal G. Prevalence of Traumatic Dental Injuries to the Permanent Anterior Teeth among 9to 14-year-old Schoolchildren of Navi Mumbai (KhargharBelapur Region), India. Int J Clin Pediatr Dent. 2017; 10 (2): 177-82.

16. Hamdan MA, Rock WP. A study comparing the prevalence and distribution of traumatic dental injuries among 10-12-year-old children in an Urban and in a rural area of Jordan. Int J Paediatr Dent. 1995 Dec; 5 (4): 237-41.

17. Gracia Godoy FM. Prevalence and distribution of traumatic injuries to the permanent teeth of Dominican children from private schools. Community Dent Oral Epedmiol. 1984; 12: 136-39.

18. Govindarajan M, Reddy VN, Ramalingam K, Durai KS, Rao PA, Prabhu A. Prevalence of traumatic dental injuries to the anterior teeth among three to thirteen-yearold school children of Tamilnadu. ContempClin Dent. 2012 Apr; 3 (2): 164-67.

19. Vanka A, Ravi KS, Roshan NM, Shashikiran ND. Analysis of reporting pattern in children aged 10 to 14 years with traumatic injuries to permanent teeth. Int J Clin Pediatr Dent. 2010; 3 (1): 15-9.

20. Rai SB, Munshi AK. Traumatic injuries to the anterior teeth among South Kanara school childrena prevalence study. J Indian Soc Pedod Prev Dent. 1998 Jun; 16 (2): 44-51.

21. Dua R, Sharma S. Prevalence, causes, and correlates of traumatic dental injuries among seven-to-twelve-yearold school children in Dera Bassi. Contemp Clin Dent. 2012 Jan; 3 (1): 38-41.

22. Rajab LD, Baqain ZH, Ghazaleh SB, Sonbol HN, Hamdan MA. Traumatic dental injuries among 12-year-old school children in Jordan: prevalence, risk factors and treatment need. Oral Health Prev Dent. 2013; 11 (2): 105-112.
COPYRIGHT 2017 Asianet-Pakistan
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2017 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Publication:Biomedica
Article Type:Report
Date:Dec 31, 2017
Words:2577
Previous Article:EPIDEMIOLOGICAL DISTRIBUTION OF PEDIATRIC ONCOLOGY IN LAHORE, PAKISTAN.
Next Article:ACCURACY OF DIAGNOSTIC ULTRASOUND IN DETECTION OF PANCREATIC HEAD CARCINOMA.
Topics:

Terms of use | Privacy policy | Copyright © 2022 Farlex, Inc. | Feedback | For webmasters |