{"id":19123,"date":"2018-03-25T10:12:50","date_gmt":"2018-03-25T10:12:50","guid":{"rendered":"http:\/\/biomedpharmajournal.org\/?p=19123"},"modified":"2018-11-14T10:14:12","modified_gmt":"2018-11-14T10:14:12","slug":"prevalence-of-permanent-anterior-teeth-trauma-in-children-between-8-12-years-in-urban-and-rural-districts-in-rohtak-haryana-india","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol11no1\/prevalence-of-permanent-anterior-teeth-trauma-in-children-between-8-12-years-in-urban-and-rural-districts-in-rohtak-haryana-india\/","title":{"rendered":"Prevalence of Permanent Anterior Teeth Trauma in Children Between 8-12 Years in Urban and Rural Districts in Rohtak, Haryana, India"},"content":{"rendered":"

Introduction <\/strong><\/p>\n

Trauma to the oral region occurs frequently and comprises of 5% of all injuries for which people seek treatment.1<\/sup>\u00a0In the permanent dentition, dental injuries increase in school going children due to vigorous playing and sports activities. 30 % of all children suffer trauma to primary dentition and 22% children suffer trauma to permanent\u00a0 dentition.2<\/sup>\u00a0The most common injuries in the permanent dentition are\u00a0 due to falls, followed by traffic accidents, acts of\u00a0 violence and sports.1<\/sup><\/p>\n

Traumatic dental injuries may range from simple enamel fracture to complete tooth loss which may have a bearing on child patients and their parents. The maxillary incisors are the most frequently injured teeth in both primary as well as permanent dentition and in most of the cases damage occurs to the crown.3<\/sup>\u00a0Because of their exposed position in the dental arch, maxillary incisors are the teeth most commonly involved. Incisal\u00a0 injury\u00a0 occurs more frequently in male children, children with\u00a0 prognathic maxillae and children with pronounced overjet.3<\/sup><\/p>\n

Epidemiological reports indicate that dental trauma is a serious dental public health problem in children and may exceed the occurrence rate of dental caries and periodontal diseases in a foreseeable future.4<\/sup><\/p>\n

Epidemiological data provide a basis for evaluation of the concepts of effective treatment, and planning within any health environment. Furthermore, in India there is a paucity of studies on the prevalence of trauma to the dentition as compared to dental caries and periodontal diseases\u00a0\u00a0\u00a0\u00a0\u00a0 Hence this study was designed\u00a0 as an effort to measure the prevalence of trauma to the trauma to the\u00a0 anterior teeth, in urban and rural areas in Rohtak,\u00a0 which could provide necessary\u00a0 information for future dental health planning and clinical practice.<\/p>\n

Aims and Objectives<\/strong><\/p>\n

The aims and objectives of this study are<\/p>\n

To assess and record the prevalence of traumatic injuries to the permanent dentition in 8-12 year children in urban and rural areas of district Rohtak.<\/p>\n

To ascertain the percentage of children seeking treatment<\/p>\n

Materials and Methods<\/strong><\/p>\n

Area Profile<\/strong><\/p>\n

Rohtak\u00a0is a\u00a0district\u00a0 located in the southeast of Haryana. It is located in the southeast of Haryana & northwest of\u00a0Delhi, bounded by\u00a0Jind\u00a0and\u00a0Sonipat\u00a0districts to the north,\u00a0Jhajjar\u00a0and\u00a0Sonipat\u00a0districts to the east and\u00a0Hissar,\u00a0Sirsa\u00a0and\u00a0Bhiwani\u00a0districts to the west.<\/p>\n

The district covers an area of 1668.47 km.\u00b2 The district consists of two tehsils – Rohtak and Meham. Rohtak tehsil is further divided into three community development blocks – Rohtak, Kalanaur and Sampla. Meham tehsil is further divided into two community development blocks – Meham and Lakhan-Majra.<\/p>\n

The present study was\u00a0 undertaken by the Department of Pedodontics and Preventive Dentistry, Government Dental College, Rohtak from\u00a0 September 2008 to August 2009 with the aim of\u00a0 obtaining\u00a0 data regarding\u00a0 injuries to the permanent\u00a0 anterior\u00a0 teeth. The survey was carried out on 2000 school children of both genders whose age ranged from 8-12 years. Children from both Government and private schools of urban and rural areas of Rohtak formed the study population.\u00a0 Consent was obtained from concerned authorities of schools. The Principals and head teachers\u00a0 of\u00a0 the schools were informed about\u00a0 survey schedule for permission and cooperation.<\/p>\n

Children whose permanent anteriors had erupted , or at least 3\/4ths the crown had emerged into the oral cavity and in\u00a0 the age group of 8-12 years were included in the study. Those children receiving orthodontic treatment or had undergone orthodontic treatment were excluded from the study.<\/p>\n

The clinical examination was carried out under daylight with subjects seated on a chair. A sufficient number of mouth mirrors, probes, tweezers, kidney trays, gloves, pads, cotton were packed and sterilized for each day of work. A tooth was considered fractured , when a part of it was missing due to trauma. Types of anterior teeth were classified according to Ellis and Davey Classification.5<\/sup><\/p>\n

Results<\/strong><\/p>\n

Table 1: Distribution of traumatic cases according to age and sex<\/p>\n\n\n\n\n\n\n\n
Age Group<\/strong><\/td>\nSex<\/strong><\/td>\nTotal<\/strong><\/td>\n<\/tr>\n
Male (%)<\/strong><\/td>\nFemale<\/strong><\/td>\n<\/tr>\n
8-10<\/td>\n49(24.7%)<\/td>\n33 (26.4%)<\/td>\n8 \u00a0(25..4%)<\/td>\n<\/tr>\n
11-12<\/td>\n149 (75.3%)<\/td>\n92 (73.6%)<\/td>\n241(74.6%)<\/td>\n<\/tr>\n
Total<\/td>\n198<\/td>\n125<\/td>\n323<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Chi Square =0.110, p.> 0.05<\/p>\n

Table 1 depicts the Prevalence of dental trauma according to age and sex. Of\u00a0 323 children who suffered\u00a0 dental injuries,\u00a0\u00a0 198 were males and 125 were females. The difference between\u00a0 the distribution of\u00a0 dental trauma in\u00a0 age groups of 8-10 and 11-12 in both the sexes was found to be statistically insignificant(p> 0.05).The difference between\u00a0\u00a0 the distribution of\u00a0 dental trauma in\u00a0 urban and\u00a0 rural\u00a0 areas in both the sexes was found to be statistically insignificant(p.> 0.05)<\/p>\n

Table 2: Distribution of traumatic cases according to causes of injury and sex<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n
Cause<\/strong><\/td>\nTraumatic cases<\/strong><\/td>\nTotal<\/strong><\/td>\n<\/tr>\n
Male<\/strong><\/td>\nFemale<\/strong><\/td>\n<\/tr>\n
Fall<\/td>\n106<\/td>\n86<\/td>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 192<\/td>\n<\/tr>\n
Collision<\/td>\n20<\/td>\n27<\/td>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 47<\/td>\n<\/tr>\n
Sports<\/td>\n24<\/td>\n5<\/td>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 29<\/td>\n<\/tr>\n
Road Traffic Accident<\/td>\n6<\/td>\n2<\/td>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 8<\/td>\n<\/tr>\n
Biting\u00a0 Hard<\/td>\n0<\/td>\n2<\/td>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 2<\/td>\n<\/tr>\n
Don\u2019t Know<\/td>\n42<\/td>\n3<\/td>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 45<\/td>\n<\/tr>\n
Total<\/td>\n198<\/td>\n125<\/td>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 323<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Chi Square =38.94,,p<0.001<\/p>\n

Table 2 shows that in male children, 106 suffered\u00a0 dental trauma due to falls, 20 suffered\u00a0 injuries\u00a0 due to collision, 24 suffered trauma due to sports, 6 due to road traffic accidents .42 male\u00a0 children were unaware of the cause of dental trauma. Table 2 \u00a0shows that dental trauma is significantly (p<0.001) associated\u00a0 to the cause of injury.<\/p>\n

Table 3: Distribution of traumatic cases by cause of injuries and type of fracture<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n
Causes<\/strong><\/td>\nType of Fracture<\/strong><\/td>\n\u00a0<\/strong><\/td>\nTotal<\/strong><\/td>\n<\/tr>\n
Type I<\/strong><\/td>\nType II<\/strong><\/td>\nType III<\/strong><\/td>\nType IV<\/strong><\/td>\nType V<\/strong><\/td>\nType VII<\/strong><\/td>\nType VIII<\/strong><\/td>\n<\/tr>\n
Fall<\/td>\n141<\/td>\n41<\/td>\n4<\/td>\n7<\/td>\n0<\/td>\n0<\/td>\n0<\/td>\n192<\/td>\n<\/tr>\n
Collision<\/td>\n40<\/td>\n4<\/td>\n1<\/td>\n2<\/td>\n0<\/td>\n0<\/td>\n0<\/td>\n47<\/td>\n<\/tr>\n
Sports<\/td>\n23<\/td>\n3<\/td>\n1<\/td>\n1<\/td>\n1<\/td>\n0<\/td>\n0<\/td>\n29<\/td>\n<\/tr>\n
Road Traffic Accident<\/td>\n5<\/td>\n2<\/td>\n0<\/td>\n0<\/td>\n0<\/td>\n1<\/td>\n0<\/td>\n8<\/td>\n<\/tr>\n
Bite-Hard<\/td>\n2<\/td>\n0<\/td>\n0<\/td>\n0<\/td>\n0<\/td>\n0<\/td>\n0<\/td>\n2<\/td>\n<\/tr>\n
Don\u2019t Know<\/td>\n44<\/td>\n1<\/td>\n0<\/td>\n0<\/td>\n0<\/td>\n0<\/td>\n0<\/td>\n45<\/td>\n<\/tr>\n
Total<\/td>\n254 78.6%<\/td>\n51 15.8%<\/td>\n6 1.8%<\/td>\n103%<\/td>\n10.3%<\/td>\n10.3%<\/td>\n0<\/td>\n323 100%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Table 3 shows In 323 children who had suffered traumatic anterior teeth, Type I ie fracture involving enamel and very little dentin (78.6%;254\/323) was the most common injury, followed by Type II (15.8%;51\/323), type IV injuries were3%(10\/323), type III injuries were%(6\/323). The least common was Type VII (0.3%; 1\/323) and Type V (0.3%; 1\/323).<\/p>\n

Table 4: Over all distribution of cases according to lip competency<\/strong><\/p>\n\n\n\n\n\n\n\n
Lip Competency<\/strong><\/td>\nGroup<\/strong><\/td>\nTotal<\/strong><\/td>\n<\/tr>\n
Traumatic<\/strong><\/td>\nNontraumatic<\/strong><\/td>\n<\/tr>\n
Incompetent<\/td>\n169<\/td>\n\u00a0\u00a0\u00a0 78<\/td>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 247<\/td>\n<\/tr>\n
Competent<\/td>\n154<\/td>\n1599<\/td>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 1753<\/td>\n<\/tr>\n
Total<\/td>\n323<\/td>\n1677<\/td>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 2000<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Chi square= 546.12, p<0.001<\/p>\n

Among 2000 children who were examined, 247\u00a0 had\u00a0\u00a0 inadequate lip coverage and\u00a0 1753 had adequate lip coverage ( Table 4).<\/p>\n

Table 5: Overall distribution of cases according to incisal overjet<\/strong><\/p>\n\n\n\n\n\n\n\n\n
Incisal overjet<\/strong><\/td>\nTrauma Group<\/strong><\/td>\nNon trauma group<\/strong><\/td>\nTotal<\/strong><\/td>\n<\/tr>\n
Decreased<\/td>\n8 (5.9%)<\/td>\n113 (94.1%)<\/td>\n121<\/td>\n<\/tr>\n
Normal<\/td>\n212 (12.9%)<\/td>\n1409 (87.1%)<\/td>\n1621<\/td>\n<\/tr>\n
Increased<\/td>\n\u00a094 (42.7%)<\/td>\n126 (57.3%)<\/td>\n220<\/td>\n<\/tr>\n
Open Bite<\/td>\n\u00a010 (25.6%)<\/td>\n29 (74.4%)<\/td>\n39<\/td>\n<\/tr>\n
Total<\/td>\n323<\/td>\n1677<\/td>\n2000<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Chi square= 136.85, p<0.001<\/p>\n

Table 5 shows that in trauma group , 42.7% \u00a0had increased\u00a0\u00a0 overjet.\u00a0 Table 5 shows that overall chisquare value of\u00a0 overjet is statistically highly significant(p<0.001).<\/p>\n

Discussion<\/strong><\/p>\n

The present\u00a0 cross-sectional study was a survey about prevalence, causes and associated risk factors of traumatic injuries to permanent anterior teeth in school going children in the age group of 8-12years in Rohtak.<\/p>\n

Prevalence of Anterior Teeth Trauma<\/strong><\/p>\n

This study found a prevalence of 16.1% traumatic dental injuries in 2000 school going children aged between 8-12 years. This result corroborates the assertion that dental injuries among children frequently present the prevalence between 10% and 20%6<\/sup>. Prevalence of traumatic dental injuries found in this study (16.1%)was higher than those found in the studies done by Tangade P.S7 <\/sup>(4.41%), Tandon S8<\/sup> \u00a0(13.8%). Soriano E P9\u00a0<\/sup>et al observed\u00a0 prevalence of dental injuries to be 10.5%. Prevalence of traumatic dental injuries found in this study (16.1%) was lower than those found in the studies done by Tovo10 <\/sup>( 17%), Traebert11<\/sup> et al ( 17.3%) and\u00a0 Garcia Godoy F 12<\/sup>\u00a0 who reported prevalence rate of 28.4%.<\/p>\n

Prevalence of Anterior Teeth Trauma according to sex<\/strong><\/p>\n

In the present study, boys (18.4%) presented more traumatic dental injuries than girls (13.6%) in the ratio of(1.5:1)and significant gender influence on the occurrence of trauma was observed with more boys (18.4%) than girls (13.6%). This corroborates the other studies from different part of the world ( Nick- Hussein N et al23 <\/sup>Malaysia; Rocha13<\/sup> et al, Brazil; Rai S et al14<\/sup>;RavnJ J15<\/sup> ). Tangade P.S7 <\/sup>reported a prevalence of 4.96% in males and 3.33% in females, which was found to be significant. In a study conducted by Cortes,16<\/sup>\u00a0it was found that boys were 1.7 times more likely to have dental injuries than girls. Tovo10\u00a0<\/sup>in a study reported no significant difference between boys and girls and this is in contrast to the present study. This disparity may be attributed to difference in sociodemographic and behavioral factors.<\/p>\n

Prevalence of Anterior Teeth Trauma According to Age<\/strong><\/p>\n

In the present study, 74.6% of the children who suffered dental injuries were\u00a0 eleven and twelve years (11-12 years) of age, while the younger age group of eight to ten years (8-10 years) suffered far less injuries (25.4%). The difference between the distribution of dental trauma in age groups of 8-10 and 11-12 in both the sexes was found to be statistically insignificant(p> 0.05). The fact that the prevalence of dental injury increased with age does not mean that the older children were more vulnerable, but due to the fact that the measurement of dental injuries is cumulative. The peak occurrence of trauma was found to vary in different studies. In a study conducted by Cortes,16<\/sup>\u00a0the\u00a0 prevalence of traumatic injuries to permanent incisors was 8% at the age of nine years,13.6% at twelve years and reached 16.1% at the age of fourteen years. Saroglu I and SonMez17 <\/sup>reported that the trauma most frequently occurred at 11 years of age. Andreasen JO and Ravn JJ18 <\/sup>reported peak incidence of trauma at 9-10 years for both sexes. Ravn JJ15<\/sup> reported that the largest number of injuries in both the sexes occurred in the age of 8-9 years. The results of the present study is in contrast to a study by Oikarinen K, Kassila O19<\/sup> in which the prevalence was highest in the age group 7-10 years for girls and in the age group 11-15 for boys.<\/p>\n

Prevalence of Anterior Teeth Trauma\u00a0 according to teeth affect<\/strong>ed<\/strong><\/p>\n

The most commonly affected tooth in this study was the maxillary central incisor (88%), followed by the maxillary lateral incisor (6.2%). This is in agreement with the findings of Saroglu I et al,18<\/sup>\u00a0Tovo et al,10\u00a0<\/sup>Gabris et a1,20<\/sup>\u00a0Cortes16\u00a0<\/sup>and Glendor.21<\/sup>\u00a0In a study by Adekoya CA,22<\/sup>\u00a0it was reported that maxillary central incisors were most frequently affected (74.3%). The finding that maxillary incisors are the teeth most frequently traumatized is corroborated in a study by Lam et al23<\/sup> and national studies.5,24,25<\/sup>\u00a0In the present study, out of 528 teeth affected by trauma, 497 (94.1%) were maxillary teeth and 31(5.9%) were mandibular teeth. This is similar to the findings of Saroglu18<\/sup> who reported that maxillary arch was involved in 95.72% of traumatic cases.<\/p>\n

Prevalence of Anterior Teeth Trauma According to Cause of Trauma<\/strong><\/p>\n

In the present study, fall was the most frequent cause of dental trauma, occurring in 192 (59.4%) of all subjects, irrespective of the sexual variation (male-106 & female-86). This finding is in accordance with the studies done by Rai (45.40%),14<\/sup>\u00a0Soriano(30%).9<\/sup>\u00a0The next highest group of injury in the present study is due to collision(14.7%). This result is similar to the study\u00a0 by Nicolau B25 <\/sup>who\u00a0 found collision to be the cause in 15% of the traumatic cases. In comparison with the present study, collision as the cause of injury was reported by Soriano9\u00a0<\/sup>at a higher(18.2%) percentage and in a study by Saroglu18<\/sup>at lesser percentage 8.66% of dental injuries. In the present study, 45 children (13.9%) were unaware of the cause of injury. This can be compared with studies by Soriano9\u00a0<\/sup>(22.7%), Rai5<\/sup>(6.7%), Nicolau B25<\/sup>(40.6%),Traebert11\u00a0<\/sup>(40%). This may be attributed to the study being retrospective and that several children didn\u2019t remember the origin of trauma. Nicolau B25 <\/sup>had found that unknown etiology accounted for 40.6% of the injury in his study and concluded that as often, when damage is due to violence, the victim tends to report unknown cause.<\/p>\n

The present study also showed that sports activities (8.9%) and road accidents (2.5%) accounted for less percentage of dental traumas concurring with other
\nstudies by Soriano9 <\/sup>and Ravn.15\u00a0<\/sup>Our finding is similar to a study by Soriano9 <\/sup>in which etiology of\u00a0 sports (8.2%) and road accidents (2.7%) was reported. Saroglu18 \u00a0<\/sup>observed injuries due to sports (3.9%) and traffic accidents (8.6%).<\/p>\n

Prevalence of Anterior Teeth Trauma According to Type of Trauma <\/strong><\/p>\n

In the present study sample, class I fracture ie fractures involving enamel (78.6%) were the most frequent type of traumatic dental injuries observed, corroborating the findings of other studies (Cortes et aI,16<\/sup>\u00a0 Tovo et a117<\/sup> and Soriano et al9<\/sup>). The present study\u00a0 is in agreement with study by B Bastone 3<\/sup> in which it was reported that uncomplicated crown fracture without pulp exposure was the most common injury to permanent dentition in most studies. In the present study, the second most frequent type of fracture is type II (15.8%). The above findings are consistent with the findings of Rai,14<\/sup>\u00a0Garcia Godoy.12\u00a0<\/sup>These results from the present study are similar to a study by\u00a0 Al-Majed,26<\/sup>\u00a0in which the most prevalent dental trauma type in 12-14 year-old Saudi boys was fracture of enamel only, representing 74.3% of teeth injured. The proportions of enamel and dentin fracture were 15.2% . No type VIII injury was observed in this survey. This result is much similar to the study of Rai S14<\/sup><\/p>\n

Prevalence of Anterior Teeth Trauma According to overjet<\/strong><\/p>\n

The results of the present study showed a significant association between the presence of dental trauma and increased overjet, This finding concurred with findings of other studies done by Soriano,9<\/sup>\u00a0Tangade PS,7<\/sup>\u00a0Al Majed,26\u00a0<\/sup>Tandon S8 <\/sup>and Kahabuka.27<\/sup>\u00a0<\/sup>The results of the present study differs from a study by Tandon S,8 <\/sup>who showed relation between\u00a0 incidence of overjet and prevalence of fractured incisors was not statistically significant.<\/p>\n

Prevalence of Anterior Teeth Trauma According to lip Coverage and Locality<\/strong><\/p>\n

In the present\u00a0 study, 52.7% of traumatized children had incompetent lips. Compared to non-trauma group, this factor was highly significant. These results are in concurrence with Traebert,11<\/sup>\u00a0Cortes.16<\/sup>\u00a0They found that children with inadequate lip coverage were less likely to have a traumatic dental injury than their normal counterparts. The present study showed no statistical difference between prevalence of trauma in rural and urban area. This result is corroborated by Hamdan M. A.28 <\/sup>and is contrast to a study by Adekoya.23<\/sup><\/p>\n

Prevalence of Anterior Teeth Trauma According to Treatment done<\/strong><\/p>\n

This study showed that 97.3% of children with dental trauma remained untreated. This can be compared with (2.4%) reported by Al Majed26<\/sup> and 1.68% of cases having undergone treatment by Rai.14<\/sup>\u00a0In a study by Nik Hussein NN,29<\/sup>\u00a0it was found that the proportion of anterior teeth requiring treatment was 91% as compared to 97.3% in our study.<\/p>\n

In a study by Traebert,11<\/sup>\u00a0only 27.6% of traumatized were treated and this is higher than the present study. Tovo10\u00a0<\/sup>et al reported in their study that 20%(7) of the children who suffered dental trauma sought treatment and this value is higher than the present study. In a study by Hamilton30<\/sup> F. A et al, it was found that only 47% of the traumatized teeth needing treatment received any, and 59% of which was inadequate. This is in contrast to our study(2.7%) children having undergone treatment.<\/p>\n

Conclusions<\/strong><\/p>\n

Dental fractures must receive special attention since they may disturb the affected children\u2019s mastication and phonetics as well as adversely affecting the physical appearance and committing the patient to lifelong dental maintenance. Dental\u00a0\u00a0 injuries are preventable and preventive and promotive programmers should be encouraged to reduce the prevalence of dental injuries in children. Public Health Education regarding the epidemiology of dental injuries and its prevention through health promotion may play a major role in reducing the prevalence of traumatic dental injury and avoiding the cost of\u00a0 treatment in developing countries.<\/p>\n

Conflict of Interest<\/strong><\/p>\n

There is no conflict of interest<\/p>\n

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