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Year : 2015  |  Volume : 7  |  Issue : 2  |  Page : 95-99

Severity of dental trauma and its associated factors in 11-16 years old school children in Davangere city, India

1 Department of Pedodontics and Preventive Dentistry, Syamala Reddy Dental College, Bengaluru, Karnataka, India
2 Department of Pedodontics and Preventive Dentistry, Dr. M R Ambedkar Dental College, Bengaluru, Karnataka, India
3 Department of Preventive and Community Dentistry, Bharati Vidyapeeth Deemed University Dental College, Sangli, Maharashtra, India

Date of Web Publication17-Nov-2015

Correspondence Address:
Dr. M Kirthiga
Department of Pedodontics and Preventive Dentistry, Syamala Reddy Dental College, Bengaluru, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-8844.169755

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Introduction: Dental trauma till date has been one of the most common injuries affecting school children. Aim: The aim was to evaluate the prevalence and associated factors on dental trauma in 11-16 year old school going children of Davangere city. Materials and Methods: A cross-sectional study was conducted among 2000 school children who were randomly selected. A questionnaire was given to the children that included personal demographic details, place and cause of injury. Ellis and Davis classification was used to record traumatic dental injury. The values were subjected to Chi-square test and multivariate logistic regression analysis. Results: The prevalence of dental trauma was found to be 10.6%. Chi-square test showed significant results obtained with respect to all the variables-age, gender, type of school, profile, and overjet. Most commonly affected teeth were maxillary central incisor (79.6%). Conclusion: The prevalence of dental trauma was found to be comparable when compared to various studies done all over the world.

Keywords: Ellis and Davis, school children, traumatic dental injuries

How to cite this article:
Kirthiga M, Praveen R, Umesh W. Severity of dental trauma and its associated factors in 11-16 years old school children in Davangere city, India. J Orofac Sci 2015;7:95-9

How to cite this URL:
Kirthiga M, Praveen R, Umesh W. Severity of dental trauma and its associated factors in 11-16 years old school children in Davangere city, India. J Orofac Sci [serial online] 2015 [cited 2023 May 30];7:95-9. Available from:

  Introduction Top

Traumatic dental injury (TDI) is a major public health problem today due to its high prevalence rate, expensive treatment cost, and long-term consequences to oral health, including extensive treatment throughout a patient's life. [1] In various epidemiologic studies, the prevalence of these injuries has been reported to range between 6% and 37%. [2] The prevalence of TDI among adolescents in the American and European continents ranged from 15%-23% and 23-35%, respectively. The correspondence prevalence rates in Asia and Africa ranged from 4%-35% and 15-21%. [3] This variation in prevalence can be explained by differences in places/environment, socioeconomic, behavioral and cultural diversities, diagnostic criteria and examination methods. [1] There is evidence suggesting TDI have an impact on the quality of life (QoL) of the individual. On an average, children with an untreated TDI were 20 times more likely to report an impact on QoL because of the injury when compared with children without any TDI. [4] TDI can cause pain, have permanent esthetic and functional impacts, disturb the development of the orofacial structures and exert a negative psychological effect on both children and parents. [5] TDIs and their sequelae often require advanced treatment [6],[7] and imply very high costs for patients and public health services. [8],[9] The present study is hence undertaken to assess the prevalence of permanent anterior teeth fractures and to evaluate its associated risk factors among 11-16 year old school children in Davangere region of South India.

  Materials and Methods Top

Study design

A cross-sectional survey was conducted among 2000, 11-16 years old school going children who belonged to Davangere, a city in India.

Ethical issues

Prior to the study, ethical clearance was obtained from the Institutional Review Board of the College of Dental Sciences. Permission from Deputy Director of Public Instructions, Principals of respective schools was sought prior to commencement of the study. A letter was sent to all parents or guardians of the selected children explaining the objectives, characteristics and importance of the study in the local language. Within each school, the study was conducted only on children whose parents or caretakers signed the consent form.

Sample size determination

Sample size was determined using data of TDI prevalence from an Indian study. We fixed type one error at 5% and allowable error at 10% of prevalence. Prevalence of anterior teeth trauma was found to be 18.25%. A sample size of 1822 school children was calculated.

Selection criteria

  • Inclusion criteria: School children aged 11-16 years old, willing to participate in the study.
  • Exclusion criteria: Mentally retarded children, children with congenital anodontia, children who were undertaking orthodontic treatment.

Calibration of examiner

All the examinations were carried out by a single examiner. The investigator was trained to diagnose dental trauma using Ellis classification by a gold standard examiner among children who visited the out-patient department of the college of dental sciences for a duration of 1-month. The Intra and inter-examiner reliability was calculated on 30 children who were randomly selected. The kappa statistics of 0.85 and 0.90 for intra- and inter-examiner reliability was found, which reflected a high degree of conformity in the examination.

Study sampling

Two stages random sampling procedure was adopted for selection of the sample. In the first stage, 6 government schools and 6 private schools were selected from the total number of schools (190) with the help of simple random sampling. In the second stage, a total cluster of 167 children were selected from the already selected schools with the help of simple random sampling.

Data collection

It was done using a questionnaire and clinical examination. Questionnaire regarding the patients age, gender, cause and place of injury were collected during the study wherever applicable.

Clinical examination

Clinical examination was conducted in a suitable classroom using a mouth mirror and probe under natural light. Cotton rolls were used to clean the teeth off food debris and to dry them. TDI was recorded using Ellis classification by Ellis and Davis. Overjet was measured using a William's periodontal probe which was dichotomized to ≤3 mm and >3 mm during the analysis. Facial profile was recorded as straight, concave or convex according to the three reference points-nasion, point A, and pogonion.

Statistical analysis

Descriptive summary statistics was obtained for all independent variables. Difference in proportion was tested using Chi-square test. Analysis was performed using Statistical Package for Social Sciences (SPSS) version 17. Statistical significance was considered when P < 0.05. Logistic regression was used for assessment of potential predictors of TDIs. Odds ratio (OR) were also calculated and adjusted for significantly associated variables to identify the independent contribution of each variable and avoid any possible confounding effect. The inclusion criterion of the independent variables to enter the model was set at 0.05.

  Results Top

A total of 2000 children from ages 11 to 16 years participated in the study. Of them, 1173 (58.7%) were boys and 827 (41.3%) girls. The overall prevalence of TDIs was 10.6% (211 children). [Table 1] shows distribution characteristics of study participants with respect to gender, type of school, overjet, profile and other variables. The type of fracture most commonly seen was Ellis I, followed by Ellis II, III and IV, respectively. Type V, VI, VII, and VIII were not detected in our study. The most common cause of TDI was unknown (41.7%), followed by falls (38.4%) and the most common place of injury was also unknown (40.3%), followed by street (22.7%).
Table 1: Distribution characteristics of study participants

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[Table 2] shows the number of teeth affected by TDI, which was a total of 215. Nearly 80% (168) of all the TDI occurred in the maxillary central incisor which was the most commonly affected tooth, followed by maxillary lateral incisor (31).
Table 2: Distribution of TDI according to the teeth involved

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[Table 3] shows the distribution of TDI according to characteristics of the gender, type of school, overjet, facial profile, and age. Significant results were obtained with respect to all the variables. Logistic regression analysis between the variables studied and the TDIs concealed that overjet, profile, and age had a significantly higher rate of TDI, while gender and type of school had no significant association with TDI [Table 4].
Table 3: Distribution of TDI according to characteristics of the gender, type of school, overjet, facial profile and age

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Table 4: Logistic regression analysis of variables related to TDI

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  Discussion Top

The present study reported prevalence of anterior teeth trauma (ATT) to be 10.5%. However, previous studies in India estimated the prevalence of ATT 5.29-15.1%. [10],[11],[12],[13],[14],[15] This variation in prevalence might be due to a number of factors such as the trauma classification used, status of the dentition, geographical, and behavioral differences India estimated the prevalence of ATT 5.29%-15.1%. [10],[11],[12],[13],[14],[15] Variation in the sampling and diagnostic criteria between different studies may also explain different findings. [16]

The prevalence of TDIs among males is significantly more than females. Several other studies reported similar findings. [3],[14],[17],[18],[19] A recent review confirms this finding. [2] It was suggested that males participate more in contact sports, entertainment games or fights of a generally more aggressive nature or with a greater risk taking behavior than females do. [20],[21],[22] However, there was a study differing this result in a study done by Marcenes et al. in the 1999 where they found no significant difference with respect to gender. [23]

Our study showed a significantly higher prevalence of TDI among 11-12 years when compared to other age groups. Similarly, a study in Chile observed that the highest rate of dental injuries in a permanent dentition occurred in groups of 7-9 and 10-12 years olds. Results from many studies demonstrate that the majority of TDIs occur in childhood and adolescence. It is estimated that 71-92% of all TDIs sustained in a lifetime occur before the age of 19 years. [24],[25],[26]

Dental literature also exhibits that prevalence of TDI increases with age, because of the cumulative nature of traumatic injuries. [27],[28]

With regard to the type of school the children studying in government schools were 1.4 times affected more than private school children. These differences were statistically significant. When we estimated strength of this association, the OR declined from 1.35 to 1.042 when adjusted for gender, age, profile and overjet. This signifies that there is not much difference in risk of having TDI among government, and private school children. There exists a contradicting literature related to it. Few studies demonstrate higher prevalence in children of lower socioeconomic status. [15],[29],[30] and other studies found no association between socioeconomic status and TDIs. [31],[32],[33] Considering contradicting results on the association between socioeconomic status and TDI, more research is required to reach consensus.

In the present study subjects with <3 mm overjet had significantly lower prevalence of TDI and odds of having TDI is 40% lower than subjects with greater overjet. Numerous studies recognized an increased overjet when the value is >3 mm. [25],[26],[27] A systemic review concluded that children with an overjet >3 mm are approximately twice as much at risk of anterior tooth trauma than those with lesser overjet. [28] Others reported higher risk when it was more than 5 mm. [29],[30],[31] This confirms the evidence that subjects with accentuated overjet are at higher risk of encountering TDI.

The most commonly affected tooth by TDIs was the maxillary central incisor. This result correlated with other studies. [10],[11],[17] A study conducted in India reported that 95% of TDIs involved maxillary anterior teeth. [3]

The prominent position of the maxillary incisors is responsible for the most common involvement in the anterior trauma than other teeth. Enamel fractures are the most frequent injury, followed by fractures involving enamel and dentin, accordance with several other studies. [32],[33],[34] This finding highlights the necessity to attend the untreated teeth. This reflects a low priority of dental health relative to general health problems. Moreover, the cost of dental treatment may also act as a barrier.

Regarding the etiology and site of occurrence, falls and streets were the most cited, which is consistent with the literature. [35],[36],[37],[38] In addition, more than 40% of subjects who encountered TDIs did not know the cause which was in accordance with a study done on 10 and 17 years in North India. [39] TDI because of violence can be one of the reasons behind reporting unknown cause. There is evidence of the rise in TDIs because of violence among individuals. [21],[40],[41] It emphasizes the role of the dentist to detect children who had suffered physical abuse.

The results of this study should be interpreted with some caution because a cross-sectional design does not allow establishing a temporal relationship between TDI and independent variables; longitudinal studies are needed to assess the causal relationship. Understanding the predictors of TDI is important in establishing prevention strategies and minimizing possible harm stemming from such injuries.

  Conclusion Top

The study reveals prevalence of 10.6% with respect to TDI in a South Indian city of Karnataka.

The results of the study signify the urge for aimed measures at changing the attitudes and behavior of parents/guardians and children. Thus, informative campaigns, such as television ads, newspaper articles, distribution of pamphlets and web-based strategies, could be useful in the prevention of dental trauma.

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

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