prevalence of traumatic dental injuries among school children … of traumatic... · 2019-01-30 ·...

Prevalence of Traumatic Dental Injuries

among School Children age 9-12 years in

KHARTOUM STATE

Magda M. Mutwakil MSc, PhDHead of Paediatric Dentistry, Faculty of Dentistry - University of Khartoum

Head of Paediatric Dentistry Council – Sudan Medical Specialization Board

Outline

Definition of T.D.I

Classification

T.D.I Globally

T.D.I in Sudan

2

Traumatic Dental Injuries (TDI)

• Definition:

Trauma means a wound or injury ,it could be physical

or psychic.

Physical trauma applies when a wound or injury is

inflicted on the body by an external force and that

may lead to dystrophic changes and/or inflammatory

response of the affected part.

Dorland's Pocket Medical Dictionary, 25th ed. Philadelphia: W. B. Saunders; 1995. P. 829.

3

4

Traumatic dental injuries:-

• Pain

• Esthetic

• Psychological impact

• Morbidity

• Mortality

Classification of TDI

• 1942 Sweet solely on radiographic examinations

• 1945 Ellis started by 4 categories then modified by the

same author in (1948) to 8 classes

• 1978 W.H.O. developed a classification for dental

injuries which was modified by Andreasen and

Andreasen in (1990) .Variations in luxation and intrusion

injuries

• 1981 Garcia Godoy classification that consists of ten

categories, then modified by the same author in 1983.

(1) Sweet CA. Fractured anterior permanent teeth. Am Dent Assoc J 1942; 29: 97-9.

(2) Ellis RG, Davey KW. The classification and treatment of injuries to the teeth of children, 5th ed. Year book. Chicago: Medical Publishers

Inc; 1970. P. 32.

(3) Application of the international classification of diseases and stomatology. ICD DA, 3rd ed. Geneva: World Health Organization; 1992.

(4) Andreasen JO, Andreasen FM. Classification, etiology and epidemiology of traumatic dental injuries. Text Book and Colour Atlas of

Traumatic Injuries to the Teeth, 3rd ed. Copenhagen: Munksgaard; 1994. P. 151-177.

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TDI Globally • Epidemiological studies indicate the annual incidence

of dental trauma globally is at about 4.5%.

Approximately one-third of children and toddlers

(primary teeth) and one-fifth of adolescents and

adults (permanent teeth) sustained a traumatic dental

injury. (1)

• The incidence of traumatic dental injuries is 1%–3%,

and the prevalence is steady at 20%–30%. (2)

• Etiologic factors vary between countries and with

age groups. (2)

(1) Lam R Epidemiology and outcomes of traumatic dental injuries: a review of the literature. Aust Dent

J. 2016 Mar;61 Suppl 1:4-20

(2) LarsAndersson Epidemiology of Traumatic Dental Injuries Journal of Endodontics Volume 39, Issue

3, Supplement, March 2013, Pages S2-S56

TDI in Sudan

Baghdady et al conducted a comparative study 1981:

• A prevalence of 19.5% for TDI in boys at the age of 12

years in Iraq

Compared to 16.5% in boys in the same age group in

Sudan

• A prevalence of 16.1% for TDI among girls of the

same age group in Iraq.

Compared to 3.6% in girls in the same age group in Sudan

• A recent study on TDI in Wad Madani revealed

prevalence of 9.2%

(1)Virgin B, Leonore J, Ghose S, Helmute NKE. Traumatized anterior teeth in Iraqi and Sudanese children. A comparative study. J Dent

Res 1981; 60 (3): 667-76.

(2) Sahar M Elyas prevalence of traumatic Dental Injuries and associated risk factors among Sudanese school children Pediatric

Dentistry , MSc, Sudan, University of Khartoum. 2015

justification

• Prevalence of traumatic injuries among school

children in Khartoum has not been investigated

since 1981, a period during which social, cultural

and economical changes had occurred and indeed

its reflection on prevalence of trauma is expected.

8

9

Prevalence of T. D. I.

Main objective

To estimate the prevalence of traumatized anterior

teeth in school children age 9-12 years in Khartoum

state.

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Methodology• Study Area:

Khartoum State : seven localities ,three major localities, greater Khartoum, greater Omdurman and greater Khartoum north were selected as study areas.

• Sample size: 1920 school children age 9-12 years

• Design: Multistage stratified sampling technique

• Both private and public schools (sampling units) .

• Cases were Randomly selected (inquiry unit).


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2 public schools

(160 students)

Age 9-40 student

Age 10-40 student

Age 11-40 student

Age 12-40 student

2 private schools

(160 students)

Age 9-40 student

Age 10-40 student

Age 11-40 student

Age 12-40 student

Sample distribution chart-Khartoum State

(1920) -24 schools

Greater

Khartoum

(640student)

8 Schools

Greater

Omdurman

(640student)

8 Schools

Khartoum

North

(640student)

8 Schools

4 boys schools

(320 students)4 girls schools

(320 students)

2 private

schools

(160 students)

2 public

schools

(160

Students)


The prevalence was studied according to:

• Age

• Gender

• Socioeconomic status of the Parents.

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• The correlation between :-

The occlusion status;

The overjet;

The over bite;

The upper lip position and prevalence of trauma was investigated.

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Results


prevalence of traumatic dental injuries

28%

72%

with trauma

without trauma

542 students had 633 fractured teeth.

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Boys showed a slight increase in prevalence of fractured

anterior teeth than girls ( 52%,48% respectively) but this was

not significant among all age groups (p = 0.99).

19.119.5

28

23.8

9.6

0

16.9

25.427.7

30

0

5

10

15

20

25

30

%

9 yrs 10 yrs 11 yrs 11 yrs 12 yrs

public private

boys

girls

p = 0.99

17

School children from private schools showed a slight

increase in prevalence of traumatic injuries

28.1 27.3

71.9 72.7

30.626.9

69.4 73.1

0

10

20

30

40

50

60

70

80

%

with trauma without trauma with trauma without trauma

public private

boys

girls

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Findings:-

The Prevalence was found to:-

• Increase with the increase in the father's educational level (P=0.01).

• Not affected by the mother’s educational level p (0.7)

• Decreased in children of working mothers (30%)

• Increased in children of non-working mothers (69%).


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0100200300400500600700800900

Bo

ys

Gir

ls

Bo

ys

Gir

ls

Pri

ma

ry

Se

co

nd

ary

Pri

ma

ry

Se

co

nd

ary

P ublic P rivate F athers '

educational

levels

Mothers '

educational

levels

With trauma

Without trauma

P=0.01

p 0.7

P=0.7

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Most of the trauma happened at home

(55.7%) and school play ground (15.6%).


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The most common etiological factor was falls followed by

collision .

21.820.7

1.7

0.7 0.9 0.9

5.8

21.4

18

1.10 0.5 0.3

6.1

0

5

10

15

20

25

falls collision with

objects or person

contact sport

bicycles road traffic accidents

violence or fights

don't remember

%

causes

b…girls

22

0

5

10

15

20

25

30

35

40

45

50

canine lateral central canine lateral central

Right Left

%maxilla (upper)

mandible (lower)

The most common affected teeth were the

maxillary central incisors (86.7%).

23

0

10

20

30

40

50

60

70

80

90

Ax

is T

itle

boys girls boys girls boys girls boys girls

9 yrs 10 yrs 11 yrs 12 yrs

enamel frac ture

enamel dent

enamel dentwith pulpintrus ion

extrus ion

avuls ion

dis c ol

The most common type of trauma was enamel fracture

(89.7%).

Enamel and dentin fracture (6.5%)

24

71.7

28.3

68.6

31.2

89.5

10.5

70.3

29.7

0

10

20

30

40

50

60

70

80

90

class 1 class 2

Div.1

class 2

Div. 2

class 3

Relation of trauma to anteroposterior occlusion

without trauma

withtrauma

Class division I showed statistically significant

relationship with trauma to the anterior teeth .

P=0.04

25

< 0 Overjet

0-4.9

5-8.9mm > 9 N.R.

No % No % No % No %

Without Trauma 1 100 1164 77.4 184 58.1 5 33.3 24 1378

With Trauma 0 0 339 22.6 133 41.9 10 66.7 60 542

Total 1 1503 317 15 84 1920

Distribution of Traumatized Children in Relation to Overjet

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Upper lip position showed a statically highly

significant relation to trauma to the anterior teeth.


33.3

66.762.6

37.4

71.2

28.8

76.5

23.5

0

10

20

30

40

50

60

70

80

%

0 1 2 3

upper lip positions

with trauma

without trauma

P= 0.000

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Following trauma 32 cases only out of 542

traumatized cases consulted the dentist .


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The prevalence of traumatic dental

injuriesIn conclusion:

The prevalence of traumatic dental injuries among school children in Khartoum State is 28%

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Recommendation

Although it is difficult to prevent trauma occurrence

Health educational programs to the

Parents

School children and school staff

Training doctors on dealing with emergency

cases, might help reducing the number of missing

teeth due to trauma.

Acknowledgement

• Deep thanks and gratitude to my supervisor

Professor Ahmed M Suleiman

Director of University of Khartoum BDS (U of K), MSc (UK), FFDRCS (UK), PhD, (UK )

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Thank you

prevalence of traumatic dental injuries among school children … of traumatic... · 2019-01-30 ·...

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