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Original Article
article info
abstract
Article history:
Background: Despite such a high prevalence of traumatic dental injuries (TDIs), very less
attention has been paid to TDIs, its etiology and prevention. Aim: The present study was
carried out to identify prevalence of TDIs to permanent anterior teeth in children aged
25 January 2016
Method: A cross-sectional study was conducted over a period of six months, 7983 children
of age 8e12 years were examined from 38 primary schools which were selected by
multistage random sampling.
Keywords:
Results: The prevalence of TDIs was 14.6% (1166 children); boys (17%) experienced more
Trauma
injuries than girls (12.3%). TDIs were more common in 12 years old (19.5%). Single tooth
TDIs
fracture (75%), maxillary central incisors (82%) and enamel fracture (80.1%) were the most
Prevalence
common types of TDIs. Falls were the main cause (38.3%). School (46.1%) & home (30.2%)
School children
were the most common places. Only 5.7% (67) were treated. TDIs were more common in
children with combinations of Angle's class II (16.6%), overjet >4 mm (23%) and in-adequate
lip coverage (23%). Public schools showed higher trauma prevalence than private schools
(15.9% and 12.3% respectively). There was a significant association between TDIs and type
of occlusion, overjet, lip coverage, crossbite, gender, age & school type. No association was
found between the presence of openbite, district & residence and TDIs.
Conclusion: The results showed the need of preventive measures against falls at school and
home and methods of providing 1st aid in TDIs.
2016 Japanese Society of Pediatric Dentistry. Published by Elsevier Ltd. All rights reserved.
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1.
p e d i a t r i c d e n t a l j o u r n a l 2 6 ( 2 0 1 6 ) 6 7 e7 3
Introduction
2.
took the sample from 8 years old to the end of primary stage at
12 years old as a safe edge [20]. The study was enrolled in both
rural and urban sectors. Sample size consisted of 7983 and
calculated according n t2 p1 p=m2 formula [21] with
selecting almost equal number of boys and girls (3992 boys
and 3991 girls). Thirty eight schools were randomly selected
from public and private schools were included with a sampling by a probability proportional to the school size from five
districts of Dakahlia which selected by multistage cluster
random sample. It was selected on the basis of ease of
accessibility. First 5 centers were selected from Dakahlia,
Egypt (from all geographical sides: Mansoura at the center,
Talkha east, Dekrnas west, Sherbin north and El-Sinbelween
south.) then schools were selected from urban and rural
areas of each center and then from each school one class was
selected from each grade of both sexes. The approvals of the
Ethics Committee, students and their parents were obtained.
The planning schedule had included time for: Introducing the
examiner to the school directorates, choosing an appropriate
class room to carry out the examination and setting up the
equipments. It started at October 2013 and finished at April
2014. Examination of each child took about 3e4 min and the
number examined per day were about 60e80 children for
4e5 h/d by researcher and data were recorded by trained
school nurse. Infection control measures were taken. Students were examined in their seats during class hours while
sitting in straight-backed chairs with facing good natural day
light to receive maximum illumination and the examiner in
the front of them. Portable lighting device was used to provide
more illumination that may be needed for more accurate details. Only objective findings at the examination were registered as TDIs. Prior to oral examination, each child was asked
if they had an injury to the teeth at the front of the mouth. If
yes, where, when and how this happened and the circumstances that resulted in the injury were recorded. The children
in whom the permanent anteriors were lost due to caries or
cause other than trauma or those having partial/complete
anodontia involving permanent anteriors were not included
in this study. Visual inspection for lip coverage was noticed
when the subject entered the examination area without subject's awareness. The following data were obtained from each
record: Patient demographic criteria like age and sex, size of
incisal overjet, cause, site and type of TDIs, number of teeth
involved, time elapsed between the time of TDIs and seeking
care, reasons for delayed presentation after trauma and
presence of any clinical signs related to TDIs. Type of injury
was recorded according to Andresen's epidemiological classification of TDIs to anterior teeth including WHO codes [22]. It
is a comprehensive system which allows for minimal subjective interpretations [4] as the following codes: i) Code 0: No
injury, ii) Code 1: Treated dental injury, iii) Code 2: Enamel
fracture only, iv) Code 3: Enamel/dentin fracture, v)Code 4:
Pulp injury, vi) Code 5: Missing tooth due to trauma, vii) Code
6: Excluded tooth (Any missing tooth isn't related to trauma,
e.g. caries, orthodontic purpose or periodontal diseases).
School children who didn't remember the cause of trauma
were grouped in cannot recollect the cause of trauma. Injuries such as concussion, root fracture and alveolar bone
fracture were not included in this study since no radiographs
were taken. The occlusion of the subject was judged using
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p e d i a t r i c d e n t a l j o u r n a l 2 6 ( 2 0 1 6 ) 6 7 e7 3
3.
Results
446
157
127
108
88
11
229
1166
38.3%
13.5%
10.9%
9.3%
7.5%
0.9%
19.6%
100%
School
Home
Street
Other
Total
537
353
185
91
1166
46.1%
30.2%
15.9%
7.8%
100%
Table 1 e Prevalence of TDIs according to gender and age and correlation between them.
N
Gender
Boys
Girls
Age
8e9
9e10
10e11
11e12
12
Mean SD
% Within Trauma
X2 (P value)
R (P)
Trauma
No Trauma
Total
677
489
3315
3502
3992
3991
17%
12.3%
58.1%
41.9%
35.442 (0.00)
0.067 (0.00)
79
175
286
311
315
10.15 1.3
914
1450
1825
1325
1303
993
1625
2111
1636
1618
8%
10.7%
13.5%
19%
19.5%
6.8%
15%
24.5%
26.7%
27%
112.393 (0.00)
0.116 (0.00)
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p e d i a t r i c d e n t a l j o u r n a l 2 6 ( 2 0 1 6 ) 6 7 e7 3
4.
Discussion
337
67
270
827
1166
28.9%
5.7%
23.2%
71.1%
100%
Time Elapsed
142
113
82
337
42.1%
33.5%
24.3%
100%
Home Negligence
Dentist Negligence
Total
916
205
1121
81.7%
18.3%
100%
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p e d i a t r i c d e n t a l j o u r n a l 2 6 ( 2 0 1 6 ) 6 7 e7 3
Occlusion
Overjet
Lip Coverage
Openbite
Crossbite
Class I
Class II
Class III
0-4 mm
4 < mm
Adequate
In-adequate
Present
Absent
Present
Absent
Trauma
No Trauma
Total
898
253
15
856
310
494
672
14
1152
14
1152
5439
1274
104
5781
1036
4640
2177
126
6691
170
6647
6337
1527
119
6637
1346
5134
2849
140
7843
184
7799
% Within trauma
X2 (p)
14.2%
16.6%
12.6%
12.9%
23%
9.6%
23.6%
10%
14.7%
7.6%
14.8%
77%
21.7%
1.3%
73.4%
26.6%
42.4%
57.6%
1.2%
98.8%
1.2%
98.8%
6.0591 (0.048)
92.138 (0.00)
286.491 (0.000)
2.424 (0.120)
7.394 (0.007)
District
Residence
School type
Mansoura
Talkha
Dekrnas
Sherbin
Sinbelween
Urban
Rural
Public
Private
Trauma
No Trauma
Total
396
176
214
175
205
596
570
1002
164
2177
1011
1196
1264
1169
3504
3313
5647
1170
2573
1187
1410
1439
1374
4100
3883
6649
1334
% Within trauma
X2(P value)
15.4%
14.8%
15.2%
12.2%
14.9%
14.5%
14.7%
15.1%
12.3%
34%
15.1%
18.4%
15%
17.6%
51.1%
48.9%
15.1%
12.3%
8.690 (0.069)
0.033 (0.857)
6.865 (0.009)
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5.
Conclusions
Conflict of interest
[2]
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references
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p e d i a t r i c d e n t a l j o u r n a l 2 6 ( 2 0 1 6 ) 6 7 e7 3
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