Etiological factors related to dental injuries in Norwegians aged 7–18 years

Abstract  – Prevention of diseases and injuries is a field of priority for the health authorities in Norway. In 1990, an interdepartmental project was established in order to reduce the number of accidents, including dental injuries. The purpose of the present study was to examine the causes of dental injuries, the place of event and the possibilities for prevention. During a 1-year period, all new trauma episodes affecting children aged 7–18 years were registered by calibrated dentists in the public dental health service in the county of Nord-Trøndelag and in the capital city of Oslo. A distinction was made between school and leisure time accidents. The severity of injuries was classified as mild, moderate or severe, and the dentists were asked to judge whether the severe injuries were preventable. Nearly half of the 1275 injured individuals (48%) were injured at school. Almost half of the leisure time injuries occurred during children's play. Sports and traffic accidents were less common. Sports accidents represented only 8% of the total number of injuries, the same as the number of individuals injured by violence. Statistically significant associations were observed between the cause of injury and county ( P  < 0.001) and the cause of injury and age group ( P  < 0.001). In total, 4% of all injuries were classified as severe, of which only one-third were assumed to be preventable. In summary, because of the complexity of etiological factors, it is neither easy to prevent dental injuries nor to make guidelines on prevention.     

Primary tooth injuries in Norwegian children (1–8 years)

Abstract –  This prospective study examined the yearly incidence of traumatic injuries to primary teeth. The aim of the study was to find out more about dental injuries to primary teeth in Norwegian children. The study was performed in one county of Norway involving approximately 20 000 children in the age group 1–8 years. Twenty-seven public dental clinics and 42 dentists participated. The dentists attended information and calibration meetings and received illustrations of the classification of dental trauma as well as examples of how to fill in the forms correctly. Two hundred and sixty-six children were involved, including 447 primary teeth, recorded during a 1-year registration period (2003). The dental trauma incidence was 1.3% with 3.5-year old being the most accident-prone. Boys were significantly more often injured than girls, 164 versus 102 ( P  < 0.001). The upper central incisors were most involved (92%), with a non-significant difference between the right and left side. The minor periodontal injuries dominated (59%). Hard tissue injuries were far less frequent (13%). Avulsions were observed in 6.5% and intrusions in 7.5% of the injured children, being 5.5% and 5% of the injured teeth. Most of the injuries occurred either at home (38%) or at kindergarten (32%). Sixty-two percentage were falling accidents often sustained during children's play, and 25% were pure playing accidents.
Conclusion:  In Norwegian children aged 1–8 years, with a predominance of boys, the most common primary tooth injuries were minor luxations of the maxillary central incisors, sustained at an age of 3.5 years. As the traumas often occurred during children's play and/or were the consequence of falls, these are difficult to prevent. However, follow ups should be carried out to disclose pulpal or periodontal complications and/or developmental disturbances of the permanent successors.     

Traumatic tooth injuries to primary teeth of children aged 0–3 years

Abstract –  The purpose of this study was to analyze data according to gender, age, cause, number of traumatized teeth, type of tooth and trauma, from the records of traumatized children (0–3 years) referred to the Ondokuz Mayıs University, Dental Faculty, Department of Pedodontics in middle Black Sea region of Turkey. A total of 563 boys and girls participated in the study. Traumatic dental injuries were recorded using the classification of the World Health Organization modified slightly by Andreasen & Andreasen. Traumatic dental injuries were identified in 17.4% of the children. The largest percentage of injuries were in the 13–18 months old children with no significant gender differences ( P  > 0.05). Periodontal tissue injuries were the most common (84.7%) with no statistical difference between different ages or gender ( P  > 0.05). The main etiological factor of traumatic dental injury was falls (73.5%) and it was not different between age and gender ( P  > 0.05). The maxillary central incisors were involved in a higher percentage of traumatic injuries (98%), with no differences between the right and the left sides ( P  > 0.05). Treatment was sought for 37.4% of children within 1–7 days. It is suggested that parents should be informed about prevention of traumatic injuries and to contact a dentist immediately.     

Etiology and environment of dental injuries in 12- to 14-year-old Ontario schoolchildren

Abstract –  This study reports on the etiology and environment where dental injuries occurred and assesses the relationship between dental trauma, socio-economic status and dental caries experience. A population-based, matched case-comparison study was undertaken in 30 schools in two Ontario communities. Dental hygienists calibrated in the use of the Dental Trauma Index (DTI) screened 2422 children aged 12 and 14 years using DTI and Decayed, Missing and Filled Teeth indices. Cases ( n  = 135) were children with evidence of dental injury. Controls ( n  = 135) were children randomly selected after screening and matched with cases according to age and gender. Questionnaires were mailed to parents and children. Prevalence of dental injury was 11.4%, mostly minor injuries 63.7% (enamel fracture not involving dentin), affecting one upper central incisor (70.4%). The mean age at the time of dental injuries was 9.5 years (SD = 1.49; range: 6–13 years). Dental trauma most often occurred among boys at school because of falls or while playing sports. The relationship between dental injuries and the socio-economic indicators chosen was not statistically significant. However, a statistically significant direct relationship ( P  < 0.001) was shown between increased caries experience and dental injuries. This should focus attention on possible common-risk factors such as health-related behavioral problems that may affect both dental disease and dental injuries.     

Traumatised permanent teeth in 11–16-year-old Saudi Arabian children with a sensory impairment attending special schools

Abstract  – The aim of this study was to determine the prevalence of traumatised permanent teeth among sensory (visual (VI) and hearing (HI)) impaired children attending special schools in Riyadh, Saudi Arabia. All the dental injuries involved incisor teeth, and trauma was noted in 33 (6.7%) children attending government schools (control group) compared to 7 (9%) VI children and 24 (11.4%) HI children. Differences in the dental trauma only reached statistical significance between the HI and control group ( P  < 0.05). Gender differences were only apparent in the HI group, with males having higher levels of traumatised teeth. In addition, HI children aged 11–12 years were more prone to trauma than children in the control group of the same age ( P  < 0.05). In conclusion, sensory impaired children do have a tendency for more dental trauma. However, this was only statistically significant for HI children. Whereas a gender difference was most noticeable for the HI group, with males having higher levels of trauma, this was noticeable by its absence among VI children.     

Dental emergencies presenting to a dental teaching hospital due to complications from traumatic dental injuries

Abstract  – In Jordan, only two surveys of dental trauma have been carried out. The aim of this study was to determine the incidence and pattern of dental emergencies resulting from traumatic injuries, as well as treatment provided to children presenting with these dental emergencies. Over a 1-year period, 620 children presented to our pediatric dental clinics with dental emergencies; 195 (31%) of these emergencies were a consequence of dental trauma to 287 teeth and were included in the study. The average time between the trauma and the dental emergency was 5 months. Pain or sensitivity was the most frequent presenting symptom (31.3%) followed by swelling or sinus tract (17.4%). The age of these patients ranged from 15 months to 14 years, with an average age of 9.3 years. Males accounted for 75.4% of the children in the samples, whereas females accounted for only 24.6%. The main cause of dental trauma was falling during play (58.5%); the least common cause was motor vehicle accidents, accounting for only 1.5% of all injuries. Most of the dental injuries occurred at home (41.5%), around noon time. The most commonly involved teeth were permanent maxillary central incisors accounting for 79.5% of all teeth involved by dental trauma. The most frequently encountered type of trauma in this sample was crown fracture seen in 76.6% of the teeth . Soft tissue injuries were estimated to occur in 16.9% of the children. The treatment received by the children in the sample ranged from no active treatment (6.2%) to elaborate dental procedures such as pulp therapy (41.3%) and prosthetic replacement of missing teeth (5.1%).     

Traumatic injuries to permanent teeth in Turkish children, Ankara

Abstract –  The aim of this study was to identify the types and etiologies of dento-alveolar injuries among patients who were treated for injuries to maxillary and/or mandibular permanent teeth at the Gulhane Medical Academy, Department of Pediatric Dentistry, Center of Dental Sciences in Ankara, Turkey to provide a basis for determining optimal treatment approaches and educational needs. From a total of 4956 children aged 6–12 years (mean age: 8.91 ± 1.95) applying to the Center, 472 children (9.5%) were found to have suffered dental injuries during a period of 2 years. Injuries were classified according to drawings and texts based on the WHO classification system, as modified by Andreasen and Andreasen. Injury rates were highest among children age 6 and ages 8–10. The most frequently injured permanent teeth were the maxillary central incisors (88.2%), and the maxillary right central permanent incisor made up 47.2% of all injured teeth. The most common cause of dental trauma was falling while walking or running (40.3%). Most injuries involved a single tooth (64.8%). The most common type of injury was enamel fracture (44.6%). There was a significant difference in gender, where boys more often suffered from a dental hard tissue and pulp injury than girls ( P  = 0.019), whereas there was no difference in gender ( P  = 0.248) in the distribution of periodontal injuries. Injuries were found to occur more frequently during the summer ( P  < 0.001). Children with increased overjet were 2.19 times more likely to have dental injuries than other children. Considering that the incidence of traumatic dental injury is highest among children ages 6 and ages 8–10 as well as the fact that patients with increased overjet are more prone to dental trauma, preventive orthodontic treatment in early mixed dentition may play an important role in reducing traumatic dental injuries.     

Dental trauma in adults in Switzerland

Abstract –  Most epidemiologic studies of dental trauma are restricted to children and sports. The goal of the present study was to collect information on dental trauma in as many Swiss adults as possible. For that purpose data of the largest insurance company of Switzerland (SUVA) were evaluated and compared for the years 1992 and 2002. In these 2 years 23 000 dental injuries were reported to all insurance companies in Switzerland. Most often the upper central incisors were injured. However, in 20% posterior teeth were also affected. In 1992 most of the dental trauma was experienced by 30–39 year olds, in 2002 by 40–49 year olds. Regardless of the year, most of the injuries occurred at home; more than one-fifth of the injuries were sports related. Most common injuries were crown fractures without pulp involvement. In less than 10% of all cases more complicated injuries like avulsions or crown-root fractures occurred. Most traumatic injuries were treated by direct fillings and custom-made crowns; more involved treatments were required less often. Comparison of the years 1992 and 2002 showed that the numbers of and causes for injuries had hardly changed in these 10 years. However, the choice of therapy was related to the general development of dental medicine, which became especially apparent in the fields of adhesive dentistry and implantology.     

Traumatic anterior dental injuries in 7- to 12-year-old Brazilian children

Abstract –  The aim of this study was to determine the prevalence and risk factors of dental trauma in the permanent anterior teeth of schoolchildren in Campina Grande, Brazil. A sample of 448 schoolchildren, 228 boys and 220 girls, aged 7–12 years, were randomly selected from 17 public schools in an urban area. The sample selection was carried out in two stages: first, schools were selected by simple sampling and then children were chosen using a proportionality coefficient. Data were collected through clinical examinations and interviews, after examiner calibration. Overjet (OJ) was considered a risk factor when it presented values higher than 3 mm, while lip coverage was classified as adequate or inadequate. Yates' chi-squared test verified the association between the variables and odds ratio. Significance level was set at 5%. The prevalence of dental injuries was 21%. Boys experienced more injuries than girls, 21.9% and 20%, respectively ( P  > 0.05). Falls and collisions were the main causes of dental trauma, 63.8% and 24.5%, respectively. There was a statistically significant difference between traumatic dental injuries (TDI) and OJ (95% CI 0.22–0.63) ( P  < 0.001) and between TDI and inadequate lip coverage (95% CI 9.16–34.93) ( P  < 0.001). Data indicated that boys presenting an OJ size >3 mm and inadequate lip coverage were more likely to have TDI in Campina Grande, Brazil.     

Traumatized Primary Teeth in Children Assisted at the Federal University of Santa Catarina, Brazil

Abstract  – The goal of the present study was to identify the factors related to the occurrence of dental trauma in deciduous teeth. Over a period of 25 months, 85 children between 10 months and 6 years of age were assisted by the staff of the Pediatric Dentistry Clinic of the Federal University of Santa Catarina (UFSC) Florianópolis, Brazil. The children, all assisted by only one professional, a dentist working as a trainee in the Pediatric Dentistry Clinic, had 157 traumatized teeth treated. The occurrence of trauma was higher in male patients (51.8%) and in children between 1 and 3 years old. The average age was about      = 2.7 years. The 54.1% of the assisted children had more than one traumatized tooth and the repeat trauma occurred 16.7% of the time. Anterior teeth represented 98.7% of the cases and 76.4% of the trauma were on the maxillary central incisor teeth. Both sides of the mouth had approximately the same number of traumatic injuries. Luxations were more frequent (85.4%) than fractures (14.6%). Subluxations represented 38.8% of the luxated teeth. Falls were the main cause of trauma (78%). A percentage of 41.9 children were assisted by a dental professional during the first 24 h after the incident. The study concluded that the deciduous dentition is mostly affected by luxations (subluxations) that occur specially on the maxillary central incisor teeth, in patients between 1 and 3 years of age. Falls are the most common etiological factor and more than one traumatized tooth is common. Some of the cases were repeat traumatic injuries.     

Influence of the type of dental trauma on the pulp vitality and the time elapsed until treatment: a study in patients aged 0–3 years

Abstract  – The purpose of the present study was to determine the influence of the type of trauma on the pulp vitality and the time elapsed until seeking dental care in children aged 0–3 years seen at the Baby Clinic of the Araçatuba Dental School, UNESP. A total of 1813 records were analyzed. Two hundred and three patients, corresponding to 302 traumatized teeth, were assessed clinically and radiographically. Hard-tissue injuries were the most frequent (52%), with a predominance of enamel crown fractures (41.4%), followed by concussions (12.6%) and intrusions (11.6%). Clinical and radiographic examination revealed that 72% of the traumatized teeth maintained pulp vitality. In the case of supporting-tissue lesions, 51.1% of the patients sought care within 1–15 days after injury, while in the case of hard-tissue injuries, 52.7% sought care only after 16 days. The results showed that supporting-tissue injuries had a significant influence on the faster seeking of dental care.     

Dento-alveolar and maxillofacial injuries among different ethnic groups in Israel

Abstract –  An evaluation of dental and maxillofacial trauma in a level 1 trauma center in Israel was carried out to assess the causes of trauma and the relationship between the injuries to the patient's age, gender and ethnicity. Analysis was based on data from the Israel Trauma Registry. Patients hospitalized in a level 1 trauma center from January 1, 2000 to December 31, 2005 were analyzed according to age, gender, time, place, ethnicity and cause of injury. Files of 22 558 trauma patients were reviewed. Maxillofacial and tooth injuries were separated and further analyzed according to the above parameters. Maxillofacial or dental injuries were observed in 1668 (7.4%) of the trauma patients, caused by motor vehicle accidents (39.2%), falls (30.9%), and intentional injuries (21.2%). Most occurred on the street/road (46.5%), at home (18.8%), and in public buildings (12.4%). Arab patients suffered more from vehicle accidents while Jewish patients presented more intentional injuries. Men were hospitalized three times more than women, and young people were at greater risk. The most frequent age of trauma was 19–28 years (27.6%). Ethnic differences were particularly noticeable for intentional injuries and vehicle accidents. This emphasizes that a larger percentage of the Arab population suffered from dental and maxillofacial injuries. Further dental health education and training for primary caregivers are warranted.     

Dental and maxillofacial skeletal injuries seen at the University of Otago School of Dentistry, New Zealand 2000-2004

Abstract –  An epidemiological study of dental and facial trauma injuries was performed on patient presentations to the University of Otago School of Dentistry during the period 2000–2004. A total of 1287 patients were seen for dental injuries with 3473 tooth injuries. The mean age was 17.48 ± 13.13 years (range: 2–86), the highest number of injuries occurred in the 16–25 year group with a male to female ratio of 2.01:1. Uncomplicated crown fractures were the most common injury that required treatment and the variables of age, gender, tooth type, type of injury, cause of injury, location where injury occurred were similar to other studies. Falls, accidental contact, assault and motor vehicle accidents attributed to >60% of the causes of trauma and to more serious injuries. Dental injuries sustained during sporting activities reflected the potential for high impact contact and the pattern of injury suggested that preventative measures had a positive outcome in limiting the number and degree of complexity of injuries. The emergence of skateboard injuries was a feature of this study. Non-sport causes attributed to the majority of facial fractures while rugby union was the most common sport associated with bone fractures. This study shows that dental and facial injury rates and patterns in a New Zealand region are similar to other populations.     

Severe sequelae of acute dental trauma in the primary dentition – a case report

Abstract –  The incidence of traumatic injuries to primary teeth is high. Previous studies report frequencies ranging from 4% to 33% of all children. The damage limitation and the prevention of sequelae are goals that shall direct the treatment for dental trauma. Inappropriate approachs to dental trauma can cause more damage than the trauma itself. This article describes the diagnosis, management and follow-up of a 5-year-old boy who presented with uncommon sequelae of an inappropriate approach following a severe luxation of the primary maxillary right central incisors 2 years ago.     

Prevalence and determining factors of traumatic injuries to primary teeth in preschool children

Abstract –  The objective of the study was to assess the prevalence of dental injuries and the influence of determining factors in preschool children from Belo Horizonte, Brazil. A cross-sectional survey was carried out through clinical examinations and the application of a questionnaire to the parents of 419 children aged 0 to 5 years attending preschool. The sample was stratified by region, type of institution and age. The eighteen preschools visited were chosen randomly. The prevalence of traumatic injury to primary teeth was 39.1%. Enamel fractures were the most common traumatic injury (49.7%). Boys were 1.62 times more likely to have dental injuries than girls. Children with inadequate lip coverage were 3.75 times more likely to have a traumatic dental injury than those with adequate lip coverage. Children attending state preschools had nearly two times greater chances of having dental trauma than children attending private preschools. It was concluded that the prevalence of dental injuries in preschool children is high in Belo Horizonte, Brazil and constitutes a public health problem.     

Dento-alveolar and maxillofacial injuries – a retrospective study from a level 1 trauma center in Israel

Abstract –  To evaluate the frequency and causes of dental and maxillofacial trauma in hospitalized patients. From January 1, 2000 to December 31, 2003, data from hospitalized trauma patients in a level 1 trauma center in Israel were analyzed according to age, gender, time, place, and cause of injury. Maxillofacial and tooth injuries were separated and further analyzed according to the above parameters. The analysis was based on data from the Israel Trauma Registry (ITR). Of all 14 040 trauma patients, 1038 (7.4%) involved maxillofacial or dental injuries. Common causes of injury were motor vehicle crashes (41%), falls (27%) and intentional injuries (23%). Fifty percent occurred on the street/road, 17% at home and 14% in public buildings. Surgery was required in 55.5% of all maxillofacial injuries. Males were hospitalized three times more than females, and young people, ages 19–28, were at greatest risk (30.2%). Oral and maxillofacial trauma is common, requiring dental health training for primary caregivers.     

A 6-year investigation into types of dental trauma treated in a paediatric dentistry clinic in Eastern Anatolia Region, Turkey

Abstract –  The purpose of this study was to assess the frequency, the effective factors and the applied treatments for dental trauma among children aged 1–15 years from Eastern Anatolia in a 6-year period. The total frequency of trauma in this study was calculated as 4.9% during a 6-year period. The males were found to have more traumatic injury than females ( P  < 0.05). Also, the permanent teeth were more vulnerable to dental trauma than the primary teeth ( P  < 0.05). The highest frequency of traumas in the primary teeth was observed at the age of 5, whereas the rate for the permanent teeth was at the age of 10. The teeth mostly influenced by the traumas were the upper central incisors in both primary and permanent teeth. It was in October that traumas were mostly seen for the permanent teeth and in June for the primary teeth. The most frequent source of trauma in both genders and in both primary and permanent teeth were falls. The most common type of trauma in the primary teeth was lateral luxation, while it was enamel-dentin crown fracture in the permanent ones. Soft tissue injuries were observed in 143 of 653 dental traumatized children. The most common method of treatment was examination and follow up for the primary teeth, and only direct restoration for the permanent teeth without any endodontic treatment. 15% of the patients applied for treatment 1 year after injury event. Therefore, it was concluded that the patients, parents and teachers living in Eastern Anatolia should be informed about the necessity of early treatment of dental traumas and the consequence of a delay.     

Knowledge of first-aid measures of avulsion and replantation of teeth: an interview of 221 Kuwaiti schoolchildren

Abstract –  The prognosis of replantation of an avulsed tooth is determined by which first-aid measures are taken during the first 15 min after avulsion. Knowledge of the correct first-aid measures is therefore crucial to successful replantation. The aims of this study were (i) to assess the present knowledge level of emergency measures for tooth avulsion in Kuwaiti schoolchildren, and (ii) to design and test an interview form with structured standardized questions. A total of 221 Kuwaiti schoolchildren (aged 7–15 years old) were interviewed by professionals using a standardized method to score several areas of knowledge about tooth avulsion and replantation. Earlier experience of first-aid information and subjection to dental trauma was registered. The following fields of knowledge were assessed: general body injury treatment principles, tooth avulsion and replantation principles, avulsed permanent/primary teeth, cleaning of avulsed tooth before replantation, extra alveolar time and storage media. The form for interviewing children proved to be sufficiently structured in performing the interviews and data management. The results of the interviews showed that 30.3% of the children had been exposed to dental trauma in the past. Among children 7–9 years of age, 25% had received information on general first aid as compared with 75% in children 10 years and older. Children 10 years and older, in general, had a high knowledge level of general principles of how to manage injuries to the body. Regardless of age group, there were generally a low knowledge level regarding tooth avulsion, replantation, extra-alveolar time and storage media. We conclude that first-aid knowledge in Kuwaiti schoolchildren is low on avulsion and replantation of teeth despite a high knowledge level of body injuries. The knowledge level of first-aid measures on avulsion and replantation of teeth could be increased through intervention programs.