Evaluation of the Prevalence of Different Types of Traumatic Injuries to Primary Anterior Teeth among Preschool Children in National Capital Region of Delhi, India: A Cross-sectional Study

INTRODUCTION

“Primary teeth are eventually replaced by permanent teeth” this notion has led to neglect in parents seeking for treatment of traumatic dental injuries (TDI) to their children’s deciduous teeth. Parents are unaware that such injuries affect the emotional well-being of children, impacting esthetics and function. It has also been studied that TDI may affect the odontogenic process and hence the developing permanent successor.¹

These injuries are caused by traumatic forces on the hard and soft tissues of the teeth. The extent of injury, i.e., involvement of dental structures, determines the severity of injury.² According to Ulf Glendor, one-third of all preschool children have suffered at least one TDI.³

The clinical presentation of dental injury is a result of multiple factors such as age, gender, location, and also surface of impact. According to the literature, boys and girls were equally impacted by TDIs.^4–7 Some studies reported that the highest frequency of TDIs was seen in the age-group of 12–36 months.^8–10 Most of the incidents were noted to be occurring due to falls.^10–12 As these children spend most of their time at home, most of these injuries occur at home.^13,14

Hence, the present study aims at evaluating the prevalence of different types of TDI in preschool children and to increase awareness about the importance of seeking immediate treatment for the same.

MATERIALS AND METHODS

This cross-sectional study was conducted after ethical clearance from the Ethics Committee, Santosh Dental College and Hospital, Ghaziabad, Delhi-NCR. Eighteen hundred children were enrolled in this study, aged 2–6 years, irrespective of gender. The participants were selected from 17 preschools in Delhi NCR, India, according to ICMR (1994) and Helsinki declaration (modified 2000) guidelines. The exclusion criteria were mixed or permanent dentition, exfoliated deciduous anteriors, and injury to the tooth supporting hard and soft tissues. The participants’ parents/guardians were asked to provide a written consent.

Only the anterior deciduous teeth were examined using basic diagnostic instruments by a solo examiner. The examiner had first practiced on 10 participants and studied the full range of traumatic injuries according to Anderson’s classification. The diagnostic criteria were then applied to the preselected 25 subjects to determine consistency. The frequency of examination was 25 subjects twice on successive days. Finally, a comparison was drawn between the two observations, and if the variation was large, additional examination was conducted till consistent results were obtained.

The data recorded included different types of dental hard and soft tissue injuries according to age and gender.

All data were analyzed using an SPSS statistical program (version 16.0). Chi-square test was used to study the association between socio-demographic variables and oral factors and TDI. A p-value < 0.05 was considered to be statistically significant.

The study spanned over 2 years. All the participants with evident TDI were sent to the Santosh Dental Clinic for treatment, and regular follow-ups were done.

RESULTS

Table 1 displays the distribution of participants with TDI according to hard tissue injury (n = 77) with enamel infarction 3.9%, enamel fracture 84.4%, enamel–dentin fracture 7.79%, and complicated crown fractures 3.9%.

Table 2 shows a correlation of hard dental tissue injury with age with an overall percentage of 25.16% with the highest number of enamel fractures in 5 years old (n = 24, 37.6%), followed by 4 years old (n = 14, 22.7%), 3 years old (n = 16, 20.7%), and 2 years old (n = 9, 15.5%). P-value was statistically insignificant.

Table 3 shows a correlation of dental hard tissue injury with gender with higher number of hard tissue injuries in females. Enamel fractures were most commonly seen in 51.9% girls and 32.46% boys. P-values were insignificant (0.7%).

Table 4 shows the distribution of participants with TDI according to type of injury to periodontal tissues (n = 229) as concussion (24.89%), subluxation (10.92%), extrusive luxation (7.86%), intrusive luxation (15.72%), lateral luxation (24.45%), and avulsion (16.6%).

Table 5 shows a correlation of periodontal injuries with age with highest number of concussion injuries in 5 years age-group (51.09%) followed by 3-year-old and 2-year-old (19.65% and 10.04%). The p-value was 0.5.

Table 6 shows a correlation of periodontal injuries with gender with a higher percentage of injuries in males (58.5%) than in females (41.4%). The p = 0.5 value was insignificant.

Table 7 shows a comparison of types of TDI between hard and soft dental tissue injury with age. In the age-group of 2 years, the number of children with hard dental tissue injury was 12 and soft tissue injury was 23; in the age-group of 3 years, the number of children with hard dental tissue injury was 16 and soft tissue injury was 45; in the age-group of 4 years, the number of children with hard dental tissue injury was 17 and soft tissue injury was 23; in the age-group of 5 years, the number of children with hard dental tissue injury was 29 and soft tissue injury was 117; and in the age-group of 6 years, the number of children with hard dental tissue injury was 3 and periodontal tissue injury was 21.

Table 8 shows a comparison of types of TDI between hard dental tissue injury and periodontal tissue injury with gender. The total no. of males with hard dental tissue injury was 38.9% against a total of 58.5% males with periodontal tissue injuries. The total no. of females with hard dental tissue injury was 61.03% against a total of 41.48% females with periodontal tissue injuries.

DISCUSSION

Although many studies have been undertaken in different parts of India and the world, no data are available regarding the prevalence of types of TDI in Delhi, NCR region.^15–24 Hence, this research was conducted.

According to some studies, enamel fracture is the most frequent type of dental hard tissue injury.^25–28 These results are consistent with the findings of this study. The main reason for TDI is a lack of motor coordination in preschool children.^12,29

Contrary to the findings of many studies regarding the higher prevalence of trauma among male patients, this study showed that higher rates of TDI were seen in girls than boys.^30–34 Since all children, irrespective of their gender age 1 month–6 years, are exposed to similar risk factors.³⁵ According to this study, traumatic injuries to primary teeth were the highest in 2–6-year-old children, which is in agreement with other reviewed studies.^36,37

Concussion was found to be the most prevalent type of periodontal injury in the present study. Second was lateral luxation, which is a unique finding since according to previous studies, subluxation has been documented to be the most prevalent.³⁸ Boys were more affected by periodontal injuries than girls.

Dental soft tissue injuries occurred 2–4 times more frequently (according to age-group) than hard dental tissue injuries, as reported by other studies.^39–42 This may be attributed to the elasticity of the periodontal ligament and alveolar bone resilience.

CONCLUSION

This study was the first to report data on the types of dental hard and soft tissue injuries to the primary dentition in Delhi, NCR region. There is a need to conduct more such studies in different regions of India and the world. The data can help develop awareness programs and educate parents and guardians regarding the prevalence of this very common occurrence and how they can effectively prevent its consequences.

REFERENCES

1. Lenzi MM, da Silva Fidalgo TK, Luiz RR, et al. Trauma in primary teeth and its effect on the development of permanent successors: A controlled study. Acta Odontol Scand 2019;77(1):76–81. DOI: 10.1080/00016357.2018.1508741.

2. Berti GO, Hesse D, Bonifácio CC, et al. Epidemiological study of traumatic dental injuries in 5- to 6-year-old Brazilian children. Braz Oral Res 2015;29:1–6. DOI: 10.1590/1807-3107BOR-2015.vol29.0103.

3. Glendor ULF. Epidemiology of traumatic dental injuries: A 12 year review of the literature. Dent Traumatol 2008;24(6):603–611. DOI: 10.1111/j.1600-9657.2008.00696.x.

4. Jacomo DRES, Campos V. Prevalence of sequelae in the permanent anterior teeth after trauma in their predecessors: A longitudinal study of 8 years. Dent Traumatol 2009;25(3):300–304. DOI: 10.1111/j.1600-9657.2009.00764.x.

5. Kramer PF, Zembruski C, Ferreira SH, et al. Traumatic dental injuries in Brazilian preschool children. Dent Traumatol 2003;19(6):299–303. DOI: 10.1046/j.1600-9657.2003.00203.x.

6. Andreasen JO, Andreasen FM. Textbook and Color Atlas of Traumatic Injuries to the Teeth. 3rd edition. Copenhagen: Mosby; 1994.

7. Oliveira LB, Marcenes W, Ardenghi TM, et al. Traumatic dental injuries and associated factors among Brazilian preschool children. Dent Traumatol 2007;23(2):76–81. DOI: 10.1111/j.1600-9657.2005.00413.x.

8. Lenzi MM, Jacomo DRES, Carvalho V, et al. Avulsion of primary teeth and sequelae on the permanent successors: Longitudinal study. Braz J Dent Traumatol 2011;2(2):80–84.

9. Assunção LRDS, Ferelle A, Iwakura MLH, et al. Effects on permanent teeth after luxation injuries to the primary predecessors: A study in children assisted at an emergency service. Dent Traumatol 2009;25(2):165–170. DOI: 10.1111/j.1600-9657.2008.00759.x.

10. Colak I, Markovic D, Petrovic B, et al. A retrospective study of intrusive injuries in primary dentition. Dent Traumatol 2009;25(6):605–610. DOI: 10.1111/j.1600-9657.2009.00838.x.

11. Glendor ULF. Aetiology and risk factors related to traumatic dental injuries – A review of the literature. Dent Traumatol 2009;25(1):19–31. DOI: 10.1111/j.1600-9657.2008.00694.x.

12. Skaare AB, Jacobsen I. Primary tooth injuries in Norwegian children (1-8 years). Dent Traumatol 2005;21(6):315–319. DOI: 10.1111/j.1600-9657.2005.00362.x.

13. Carvalho V, Jacomo DRES, Campos V. Frequency of intrusive luxation in deciduous teeth and its effects. Dent Traumatol 2010;26(4):304–307. DOI: 10.1111/j.1600-9657.2010.00893.x.

14. Gabris K, Tarjan I, Rozsa N. Dental trauma in children presenting for treatment at the Department of Dentistry for Children and Orthodontics, Budapest, 1985-1999. Dent Traumatol 2001;17(3):103–108. DOI: 10.1034/j.1600-9657.2001.017003103.x.

15. Prasad MG, Radhakrishna AN, Kambalimath HV, et al. Oral health status and treatment needs among 10126 school children in West Godavari district, Andhra Pradesh, India. J Int Soc Prevent Community Dent 2016;6(3):213–218. DOI: 10.4103/2231-0762.183102.

16. Kumar S, Dixit G. Prevalence and risk factors for traumatic dental injuries in adolescent children attending special needs schools in India: A comparative study. Int J Adolesc Med Health 2016;29(5):11–19. DOI: 10.1515/ijamh-2015-0114.

17. Abbas I, Mohammad SA, Peddireddy PR, et al. Oral health status of underground coal mine workers of Ramakrishnapur, Adilabad District, Telangana, India – A cross-sectional study. J Clin Diagn Res 2016;10(1):ZC28–ZC31. DOI: 10.7860/JCDR/2016/15777.7059.

18. Maran S, Shashikiran ND, Ahirwar P, et al. Prevalence of dental caries and traumatic dental injuries among 6- to 12-year-old children in Bhopal City, India. Int J Clin Pediatr Dent 2017;10(2):172–176. DOI: 10.5005/jp-journals-10005-1429.

19. Garg K, Kalra N, Tyagi R, et al. 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):218–224. DOI: 10.4103/ccd.ccd_133_17.

20. Goyal N, Singh S, Mathur A, et al. Traumatic dental injuries prevalence and their impact on self-esteem among adolescents in India. J Clin Diagn Res 2017;11(8):ZC106–ZC110.

21. Hegde R, Agrawal G. Prevalence of traumatic dental injuries to the permanent anterior teeth among 9- to 14-year-old schoolchildren of Navi Mumbai (Kharghar-Belapur Region), India. Int J Clin Pediatr Dent 2017;10(2):177–182. DOI: 10.5005/jp-journals-10005-1430.

22. Sharva V, Reddy V, Bhambal A, et al. 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(1):38–42. DOI: 10.4103/2348-3334.196065.

23. Juneja P, Kulkarni S, Raje S. Prevalence of traumatic dental injuries and their relation with predisposing factors among 8–15 years old school children of Indore City, India. Clujul Med 2018;91(3):328–335. DOI: 10.15386/cjmed-898.

24. Gupta A, Babu AK, Bansal P, et al. Changing trends in maxillofacial trauma: A 15 years retrospective study in the southern part of Haryana, India. Indian J Dent Res 2018;29(2):190–195. DOI: 10.4103/ijdr.IJDR_202_17.

25. Taiwo OO, Jalo HP. Dental injuries in 12-year old Nigerian students. Dent Traumatol 2011;27(3):230–234. DOI: 10.1111/j.1600-9657.2011.00997.x.

26. Navabazam A, Farahani SS. Prevalence of traumatic injuries to maxillary permanent teeth in 9- to 14-year-old school children in Yazd, Iran. Dent Traumatol 2010;26(2):154–157. DOI: 10.1111/j.1600-9657.2009.00861.x.

27. Malikaew P, Watt RG, Sheiham A. Prevalence and factors associated with traumatic dental injuries (TDI) to anterior teeth of 11-13-year-old Thai children. Community Dent Health 2006;23(4):222–227. PMID: 17194069.

28. Naidoo S, Sheiham A, Tsakos G. Traumatic dental injuries of permanent incisors in 11- to 13-year-old South African school children. Dent Traumatol 2009;25(2):224–228. DOI: 10.1111/j.1600-9657.2008.00749.x.

29. Onetto JE, Flores MT, Garbarino ML. Dental trauma in children and adolescents in Valparaiso, Chile. Endod Dent Traumatol 1994;10(5):223–227. DOI: 10.1111/j.1600-9657.1994.tb00074.x.

30. Avşar A, Topaloglu B. Traumatic tooth injuries to primary teeth of children aged 0–3 years (Turkey). Dent Traumatol 2009;25(3):323–327. DOI: 10.1111/j.1600-9657.2008.00695.x.

31. Chan YM, Williams S, Davidson LE, et al. Orofacial and dental trauma of young children in Dunedin, New Zealand. Dent Traumatol 2011;27(3):199–202. DOI: 10.1111/j.1600-9657.2011.00989.x.

32. Wendt FP, Torriani DD, Assunção MC, et al. Traumatic dental injuries in primary dentition: Epidemiological study among preschool children in South Brazil. Dent Traumatol 2010;26(2):168–173. DOI: 10.1111/j.1600-9657.2009.00852.x.

33. Robson F, Ramos-Jorge ML, Bendo CB, et al. Prevalence and determining factors of traumatic injuries to primary teeth in preschool children. Dent Traumatol 2009;25(1):118–122. DOI: 10.1111/j.1600-9657.2008.00725.x.

34. Choi SC, Park JH, Pae A, et al. Retrospective study on traumatic dental injuries in preschool children at Kyung Hee Dental Hospital, Seoul, South Korea. Dent Traumatol 2010;26(1):70–75. DOI: 10.1111/j.1600-9657.2009.00840.x.

35. Vuletić M, Škaričić J, Batinjan G, et al. A retrospective study on traumatic dental and soft-tissue injuries in preschool children in Zagreb, Croatia. Bosn J Basic Med Sci 2014;14(1):12–15. DOI: 10.17305/bjbms.2014.2284.

36. Cunha RF, Pugliesi DM, de Mello Vieira AE. Oral trauma in Brazilian patients aged 0-3 years. Dent Traumatol 2001;17(5):210–212. DOI: 10.1034/j.1600-9657.2001.170504.x.

37. Altun C, Cehreli ZC, Güven G, et al. Traumatic intrusion of primary teeth and its effects on the permanent successors: A clinical follow-up study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107(4):493–498. DOI: 10.1016/j.tripleo.2008.10.016.

38. Skaare AB, Maseng Aas A-L, Wang NJ. Enamel defects on permanent successors following luxation injuries to primary teeth and carers’ experiences. Int J Paediatr Dent 2015;25(3):221–228. DOI: 10.1111/ipd.12136.

39. Sennhenn-Kirchner S, Jacobs HG. Traumatic injuries to the primary dentition and effects on the permanent successors – A clinical follow-up study. Dent Traumatol 2006;22(5):237–241.

40. de Amorim LdeFG, da Costa LRRS, Estrela C. Retrospective study of traumatic dental injuries in primary teeth in a Brazilian specialized pediatric practice. Dent Traumatol 2011;27(5):368–373.

41. Eyuboglu O, Yilmaz Y, Zehir C, et al. A 6-year investigation into types of dental trauma treated in a paediatric dentistry clinic in Eastern Anatolia region, Turkey. Dent Traumatol 2009;25(1):110–114. DOI: 10.1111/j.1600-9657.2008.00668.x.

42. Nicolau B, Marcenes W, Sheiham A. The relationship between traumatic dental injuries and adolescents’ development along the life course. Community Dent Oral Epidemiol 2003;31(4):306–313. DOI: 10.1034/j.1600-0528.2003.t01-1-00019.x.