|Year : 2017 | Volume
| Issue : 1 | Page : 38-42
Traumatic dental injuries to the anterior teeth among 12-year and 15-year-old schoolchildren of urban and rural areas of Bhopal District, Central India: A prevalence study
Vijayta Sharva1, Venugopal Reddy2, Ajay Bhambal2, Rohit Agrawal3, Manoj Gupta4
1 Department of Public Health Dentistry, Peoples Dental Academy, Peoples University, Bhopal, Madhya Pradesh, India
2 Department of Public Health Dentistry, Peoples College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
3 Department of Public Health Dentistry, Rungta College of Dental Sciences and RC, Chhattisgarh, India
4 Department of Public Health Dentistry, Vyas Dental College and RC, Jodhpur, Rajasthan, India
|Date of Web Publication||19-Dec-2016|
Department of Public Health Dentistry, Peoples Dental Academy, Peoples University, Bhopal - 462 001, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
Background: Traumatic dental injuries (TDIs) are one such condition that can occur at any age, but the trauma to children's teeth occurs quite frequently. TDIs involving the anterior teeth may not only lead to restriction in biting, phonetics, and esthetics but also have an impact on a child's personality and quality of life. The objective of this study was to assess the prevalence of the TDIs of the permanent anterior teeth among 12-year- and 15-year-old schoolchildren of urban and rural areas of Bhopal district, Central India. Materials and Methods: The descriptive cross-sectional survey was carried on 1100 schoolchildren. For the selection of schools, a three-stage sampling procedure was adopted. A specially prepared and pretested pro forma designed for collecting all the required and relevant general information and clinical findings. The pro forma including the demographic data and questions regarding history of injury to detect the cause, place, duration of trauma to anterior teeth as well as those seeking the treatment for concerned problem was recorded. For clinical examination of TDI to anterior permanent teeth, the World Health Organization (International Classification of Diseases to Dentistry and Stomatology) classification of tooth fracture was used. SPSS version 20 was used for the statistical analysis. The Chi-square test used for categorical data. P < 0.05 was considered statistically significant. Results: The overall prevalence rate of TDIs to permanent incisor teeth was 12.8%. The prevalence of TDI was higher in rural areas compared to urban areas. The major cause of TDI was sports activities. Conclusion: This indicates the need for community health activities and awareness program.
Keywords: Permanent anterior teeth, prevalence, traumatic dental injuries, urban and rural
|How to cite this article:|
Sharva V, Reddy V, Bhambal A, Agrawal R, Gupta M. Traumatic dental injuries to the anterior teeth among 12-year and 15-year-old schoolchildren of urban and rural areas of Bhopal District, Central India: A prevalence study. CHRISMED J Health Res 2017;4:38-42
|How to cite this URL:|
Sharva V, Reddy V, Bhambal A, Agrawal R, Gupta M. Traumatic dental injuries to the anterior teeth among 12-year and 15-year-old schoolchildren of urban and rural areas of Bhopal District, Central India: A prevalence study. CHRISMED J Health Res [serial online] 2017 [cited 2019 Oct 21];4:38-42. Available from: http://www.cjhr.org/text.asp?2017/4/1/38/196065
| Introduction|| |
Historically, diseases of the oral cavity have been viewed separately from those of the rest of the body. In recent years, however, efforts have been made to recognize oral health as an integral part of overall health. Moreover, the oral cavity has a multitude of functions in relation to daily life such as food intake, speech, social contact, and appearance. Poor oral health has thus the potential of hampering the quality of life. Decreased food intake because of oral pain or poor dental status can cause low growth in children and may worsen the nutritional status. Pain might also have a negative impact on the ability to engage in social relations, and children might not get the full benefit of their education if suffering from pain and discomfort. 
Traumatic dental injuries (TDIs) are one such condition that can occur at any age, but the trauma to children's teeth occurs quite frequently.  TDIs involving the anterior teeth may not only lead to restriction in biting, phonetics, and esthetics but also have an impact on a child's personality and quality of life. The majority of dental injuries involving the anterior teeth result from simple falls, accidents, sports activities, or childish pranks, which were not intended to harm.  During the school age, children actively indulge in outdoor play, especially organized bodily contact play. Careless activities increase the possibility of injuries. Although these activities are markers of growth and development of the child, loss of balance and impaired movements are the result of traumatic injuries. 
Trauma that affects the hard tissue of the teeth causes pulpal and periodontal lesions which are of great relevance to current dental practice; the magnitude of this problem is substantiated by statistical data which indicate that 6-34% of individuals suffer from TDIs during childhood or adolescence. , There is a consensus that the anterior teeth are the most commonly traumatized.  According to literature, the upper and lower centrals are more commonly traumatized because they tend to be the first to receive a direct blow producing fracture. The second most frequently injured teeth are maxillary lateral incisors and mandibular central and lateral incisors.
Several studies reported that the prevalence of these injuries has increased during the past few decades, ranging from 4% to 19.5%, and available epidemiological evidence indicates that TDI is a developing and challenging public health problem to oral health professional and it has been seriously neglected. , Hence, an attempt has been made to assess the prevalence of TDIs and its associated factors among the 12-year- and 15-year-old school-going children of urban and rural areas of Bhopal district.
| Materials and methods|| |
This cross-sectional study was conducted among 12-year- and 15-year-old, urban and rural school-going children of Bhopal district. It was conducted about 2-month duration from June 15, 2013, to August 15, 2013. Before initiating the survey, official permission was obtained from the district education department Bhopal, and ethical clearance was obtained from the Ethical Committee of People's College of Dental Sciences and Research Centre. Written consent for the participation of the children in the study was obtained from the principals of the concerned schools.
A pilot survey was done to assess the feasibility of the study and to assess the prevalence of oral diseases to calculate the sample size. One school was selected randomly, and the students who were present on that day were examined. Pilot study assessment was utilized for proper planning and execution of the main study and also to check the survey form to be used for collection of data.
The survey was carried on 1100 schoolchildren. For the selection of schools, a three-stage sampling procedure was adopted. During the first stage, stratification of urban and rural areas of Bhopal district was done. Then, in the second stage, total numbers of school in Bhopal district were listed out. During the third stage, students were selected from each class by simple random technique using the student's attendance register until the desired sample from each class was met. The investigator was trained in the Department of Public Health Dentistry, People's College of Dental Sciences and Research Centre.
A specially prepared and pretested pro forma designed for collecting all the required and relevant general information and clinical findings was used for recording the data. The pro forma including the demographic data and questions regarding history of injury to detect the cause, place, duration of trauma to anterior teeth as well as those seeking the treatment for concerned problem was recorded. For clinical examination of TDI to anterior permanent teeth, the World Health Organization (WHO [International Classification of Diseases to Dentistry and Stomatology [ICD-DA]]) classification  of tooth fracture was used. Injuries to the root such as fracture involving the cementum and root fracture were not included because radiograph was not taken during the clinical examination in urban and rural schools. All maxillary and mandibular anterior teeth from canine to canine were examined for traumatic injury.
- S02.50: Fracture of enamel only/enamel chipping
- S02.51: Fracture of crown of the tooth without pulpal involvement
- S02.52: Fracture of crown of the tooth with pulpal involvement
- S02.53: Fracture of root of tooth
- S02.54: Fracture of crown with root of tooth
- S02.57: Multiple fracture of teeth
- S02.59: Fracture of tooth unspecified.
SPSS version 20 (SPSS Pty Ltd., Chicago, IL, USA) was used for the statistical analysis. The Chi-square test used for categorical data. P < 0.05 was considered statistically significant.
| Results|| |
A total of 1100 schoolchildren consisting of 538 (48.9%) males and 562 (51.1%) females were examined for TDIs. It included 540 children from urban schools and 560 from rural schools. Among the children examined, 550 (50.0%) belonged to 12 years and 550 (50.0%) belonged to15 years age group, respectively.
One hundred and forty-one (12.8%) schoolchildren had trauma to the anterior teeth. In urban schools, 63 (11.6%) children had trauma to the anterior teeth. In rural schools, 78 (13.9%) children had trauma to the anterior teeth [Table 1].
Among 141 injured, 110 (20.4%) were boys and 31 (5.52%) were girls. Boys were found to have significantly higher number of fractures than girls [Table 2].
Out of 141 injured teeth, 115 (81.5%) teeth had only enamel fracture, 16 (11.3%) teeth had crown fracture without pulpal involvement, and 10 (7.09%) teeth had crown fracture with pulpal involvement [Table 3]. Among 141 fractured cases, a total of 80 (56%) children had incompetent lips at rest, and 37 (26.2%) children had excessive overjet.
|Table 3: Distribution of traumatic dental injuries according to the type of fracture|
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Out of 141 children who had TDIs, 97 (68.79%) children had fracture during sports activities, 11 (7.8%) children had fracture because of fall, 9 (6.3%) children had fracture because of collision, followed by due to pushing, violence, during eating, road traffic accidents, and 3% children were not aware. Hence, most frequent cause of trauma was during sports activity, reported in 68.7% of children [Table 4].
The majority of TDI occurred at playground (43.97%), followed by home, school premises, and fall on stairs, and 4.9% of children were not aware of the place of TDI [Table 5].
A total of 141 fractured cases, 132 (93.6%) cases did not take any type of treatment. Only 9 (6.3%) cases reported to the dentist indicating a very low level of awareness among the parents about the importance of dental treatment.
| Discussion|| |
Oral health is essential for general health and well-being throughout life and is a marker for overall health status. This study was targeted at school-going children because of the ease of accessibility. Importance of study group in this study is that the children during middle childhood are in formative period facing new challenges. Growth of the mid-face and lower face occurs gradually while loss of deciduous teeth is a dramatic sign of maturation replacing around four permanent teeth per year. Normality encompasses a wide range of physical signs, shapes, and abilities in school-aged children. Just as importantly, children's feelings about their physical attributes range from pride to shame to apparent nonchalance. The routine physical and oral examination at this age provides to elicit concerns and allay fears. 
The study indicates the prevalence of TDIs to anterior permanent teeth was 12.8%. This is similar to study reported by Gupta et al.  The TDI in various epidemiological studies differs considerably, ranging from 6% to 34% depending on trauma classification, dentition, and geographical and behavioral differences between study location and countries. 
In view of large population of children to be examined, the WHO (ICD-DA) classification for TDIs was used.
The prevalence of TDI was higher in rural schoolchildren (13.9%). This could be attributed to the reason that rural children are more inclined toward vigorous activities. The restricted behavior of urban children enforced by the conservative parents due to cultural and social conditions in India can be added to the possible factors. In this study, it was also shown that the maxillary central incisors were the most common teeth with TDI and the enamel fracture was the most common type of fracture as similar to the results of previous studies. ,
In this study, the most common type of injury was enamel fractures, which accounted for about 81.5%. This is in agreement with the previous studies done by Naqvi and Ogidan  and Marcenes et al. 
In this study, it was observed that 68.7% of fractures of permanent teeth occurred during sports activity followed by fall (7.8%). This observation is similar to the study done by Baldava and Anup,  where 49.1% of the dental injuries occurred during sports activities and 21.8% of injuries occurred due to fall. In this study, it was observed that 43.9% of fractures of permanent teeth occurred at playground followed by 38.3% at home and 10.6% in school. However, the studies were done by Gupta et al.  and Traebert et al.  have shown equal distribution at home, in school, and elsewhere.
In this study, of the total 141 children had fractured teeth, only 9 (6.4%) children reported to the dentist whereas remaining 132 (93.6%) did not receive any type of treatment, indicating a low level of awareness among the parents about the importance of dental treatment. The low rates of treatment provided observed worldwide may be because TDIs are not perceived as a disease.
| Conclusion|| |
TDIs constitute a major public health problem creating not only physical but also esthetic and psychological effects in children and their parents. Unfortunately, the public is unaware of the risk and does not have enough information to avoid traumatic injuries to the teeth. Although prevention of TDIs is the most desirable action, oral health promotion through well-structured oral health education program can create positive change in awareness for special groups such as school children. Reinforcement of knowledge is necessary which can be done by incorporating chapters on oral health in school textbooks. Furthermore, the teachers training programs can ensure continuity of reinforcement. It is essential that the oral health professionals must educate children, parents, teachers, and health-care professionals in correct emergency care after a traumatic injury has occurred.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Jürgensen N, Petersen PE. Oral health and the impact of socio-behavioural factors in a cross sectional survey of 12-year old school children in Laos. BMC Oral Health 2009;9:29.
Todd JE, Dodd T. Children Dental Health in the United Kingdom 1983. London: Social Survey Division and Her Majesty′s Stationary Office; 1985.
Forsberg CM, Tedestam G. Etiological and predisposing factors related to traumatic injuries to permanent teeth. Swed Dent J 1993;17:183-90.
Gupta K, Tandon S, Prabhu D. Traumatic injuries to the incisors in children of South Kanara District. A prevalence study. J Indian Soc Pedod Prev Dent 2002;20:107-13.
Hamilton FA, Hill FJ, Holloway PJ. An investigation of dento-alveolar trauma and its treatment in an adolescent population. Part 2: Dentists′ knowledge of management methods and their perceptions of barriers to providing care. Br Dent J 1997;182:129-33.
Burton J, Pryke L, Rob M, Lawson JS. Traumatized anterior teeth amongst high school students in Northern Sydney. Aust Dent J 1985;30:346-8.
Oliveira LB, Marcenes W, Ardenghi TM, Sheiham A, Bönecker M. Traumatic dental injuries and associated factors among Brazilian preschool children. Dent Traumatol 2007;23:76-81.
Marcenes W, Murray S. Social deprivation and traumatic dental injuries among 14-year-old schoolchildren in Newham, London. Dent Traumatol 2001;17:17-21.
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.
WHO′s (ICD-DA). Classification of Diseases to dentistry and stomatology. 3 rd
ed. World Health Organization, Geneva; 1995.
Mahesh Kumar P, Joseph T, Varma RB, Jayanthi M. Oral health status of 5 years and 12 years school going children in Chennai city - An epidemiological study. J Indian Soc Pedod Prev Dent 2005;23:17-22.
Bastone EB, Freer TJ, McNamara JR. Epidemiology of dental trauma: A review of the literature. Aust Dent J 2000;45:2-9.
Naqvi A, Ogidan O. Traumatic injuries of anterior teeth in first year secondary school children in Benin-City, Nigeria. Afr Dent J 1990;4:11-5.
Baldava P, Anup N. Risk factors for traumatic dental injuries in an adolescent male population in India. J Contemp Dent Pract 2007;8:35-42.
Traebert J, Bittencourt DD, Peres KG, Peres MA, de Lacerda JT, Marcenes W. Aetiology and rates of treatment of traumatic dental injuries among 12-year-old school children in a town in Southern Brazil. Dent Traumatol 2006;22:173-8.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]