Dr. Ritesh Kalaskar et al. / IJRID Volume 3 Issue 3 May- June 2013 INTERNATIONAL JOURNAL OF RESEARCH IN DENTISTRY

Transcription

1 Available online at ISSN X Research- Article INTERNATIONAL JOURNAL OF RESEARCH IN DENTISTRY PAEDIATRIC TRAUMATIC DENTAL INJURIES IN HOSPITAL OF CENTRAL INDIA. A 2.5 YEAR RETROSPECTIVE REVIEW. Dr. Ritesh Kalaskar 1*, Dr. Gopal S Tawani 1, Dr. Ashita Kalaskar 2 1. Dept. of Pedodontics, Government Dental College & Hospital, Nagpur, Maharashtra, India 2. Dept. Of Oral Medicine & Radiology, VSPM Dental College & Research Centre, Nagpur, Maharashtra, Received: 10 Apr 2013; Revised: 2 May. 2013; Accepted: 16 June 2013; Available online: 5 July ABSTRACT Objective: Traumatic dental injury in children is considered as an important public health problem because of high prevalence and lack of education. In the present study we investigated the type of Paediatric Traumatic Dental Injuries according to aetiology and age of the patients. Materials and methods: The records of over a period of 2.5 years of patients aged 15 years and below who presented with traumatic dental injury were retrieved and examined. Children s demographic profile, reasons for injury and type of Traumatic Dental Injuries were obtained and analyzed. Results: A total of 188 patients were reported during the study period of which males were 145 (73.23) while female accounted for 53 (26.76 ). Fall at home/school was the most common etiologic factor (44.9), followed by sport and violence accounted for 18.1 and 16.1 respectively. Children in the age range of years had highest number of injuries (33.3) followed by 8-11 years (23.2), 1-3 years (22.2) and 4-7 years (21.2 ). Soft tissue injuries in the form of contusion, abrasion, laceration accounted for Conclusion: There is need to educate the parents and teacher regarding age related TDIs so that correct preventive measures can be taken at home and school to minimize the menace of TDIs. Keywords: Paediatric, Traumatic dental injury, fall, Sport, Violence INTRODUCTION Traumatic dental injuries (TDIs) are of everyday occurrence in children and adolescents. Children often fall when crawling or walking, tumble of a toy, bump into furniture, collision while running and during sport 1. Pattern of traumatic dental injury in children varies from one region to another and is also influenced by the social, cultural and environmental factors 2, 3. Etiology of TDIs in children is influenced by the age related activities and exposures. Worldwide epidemiological statistical data indicate that 6-36 of the individuals suffer from TDIs during childhood and adolescence. In developing countries like India where the incidence of dental caries is declining, dental trauma has become a major oral health issue among children and teenagers 4. This is because of aggressive sport activities, violence and rash driving seen in the countries. Epidemiological 1 Dr. Ritesh Kalaskar et al. / IJRID Volume 3 Issue 3 May- June 2013

2 data on TDIs in children is important as it has obvious implications for targeting of preventive measures, improving traffic rules, improving quality care by educating the children, parents and school teachers 5. A review of the literature showed no information on epidemiological data for TDIs in central India. The present study is aimed at determining the type of traumatic dental injury in children of central India according to etiology and age of the patients. Material & methods: Retrospective study on TDI of children was conducted at Government Dental College & Hospital of central India. The case files of over a period of 2.5 years (January 2010 June 2012) of patients aged 15 years and below who reported with TDIs were retrieved and examined. Details such as demographic profile, reasons for injury and type of TDIs were obtained and analyzed using SPSS version. A value of less than 0.05 was considered as significant. Results: A total number of patients were reported to the department during the study period of which 198 patients were with TDIs. Out of the 198 patients with TDIs, males were 145 (73.23) while female accounted for 53 (26.76 ), (Table 1). The age of the patients with TDIs ranged from 1 year to 15 years, mean years. The difference between mean age of males and females years was statistically significant [Chi-square test, P value - <0.05], (Table 1). Fall at home/school was the most common etiologic factor accounting for 44.9 of cases followed by sport and violence accounted for 18.1 and 16.1 respectively. Other etiologic factors accounted were collision- 4.5, road traffic accident -10.6, animal injury , biting on hard object and others (Table 2). Overall sport related accident accounted for about18.1, moreover when considered separately 14.6 of the accidents were due to cricket alone (Table 2). Fall while at play accounted for about 57.3 followed by fall from tree (12.3), bed (20.2) and during walking (20.2) and this was frequently seen among 1-3 years and 4-7 years age groups. The difference is statistically significant [Chi-square test, P value - <0.05], (Table 3). Approximately 42 of the fall was seen in the age group of 1-3 years which is nearly double to that seen in the age groups of the aged of 4-7, 8-11 and years of age (Table 3). Traumatic dental injuries increase with the age. Children in the age range of years had highest number of injuries accounted for 66 (33.3), (Table 4). This was followed by 8-11 years (23.2), 1-3 years (22.2) and 4-7 years (21.2 ) age categories (Table 4). There was an association between age and cause of injury. For children 1-7 years old, the main cause of injury was fall at home or school, while for children 8-15 years old, it was sport activities followed by violence, fall, road traffic accident (RTA) and collision. The difference is statistically significant [Chi-square test, P value - <0.05], (Table 4). 2 Dr. Ritesh Kalaskar et al. / IJRID Volume 3 Issue 3 May- June 2013

3 Soft tissue injuries in the form of contusion, abrasion, laceration accounted for Other anatomical sites involved were dento-alveolar fracture (72.2), mandible fracture (6.06) and mid-face fracture (1.01), (Table 5). The pattern of injury was observed to vary significantly with the age of the child. Thus, soft tissue injuries occurred more in children aged 7 and below, while older children 8 years and above had more of skeletal fractures (dento-alveolar fracture, mandible and mid-face fracture) [Chi-square test, P value - <0.05], (Table 6). Distribution of mandibular fracture is presented in Table 7. The body of mandible is the most frequently involved site (66.0) followed by the condyle (16.6) and parasymphyseal fractures (16.6). Discussion: The prevalence of TDIs found in the current study is This data is not in accordance with the prior studies conducted in India and worldwide. The reported prevalence of TDIs in the Americans, Europe and Brazilian adolescents ranged from Studies conducted among adolescent in India reported prevalence ranged from Comparatively low prevalence in the current study has been related to methodological inadequacies particularly concerning to the adoption study design and sample collection. In the current study retrospective data was collected form hospital records whereas the studies with high prevalence were crosssectional studies conducted in various schools. Therefore comparing our results with other studies that have used other methodologies is inappropriate. Most of the world wide studies showed male predominance for TDIs 2, 16. Result from the current study also confirms that boys are more prone to TDIs than girls and the approximate ratio is 3:1. This observation from the current study corroborates the findings of other studies conducted in India, Iraq, and Sweden 13, 17, 18. This may be attributed to the behavioral factors, with the boys tending to be more energetic and inclined toward vigorous outdoor activities, contact sports and violence as compared to girls. The main cause of TDIs in children is fall. The result of the current study showed fall as the main etiological factor accounting for approximately 45 of the cases. This result is in accordance with the earlier reports from India 19, 20. However, comprehensive literature review revealed inconsistent findings regarding the main cause of TDIs. Studies conducted in Brazil supports collision as the major etiological factor for TDIs A more recent study result identified play ground or sports related accidents as the most common cause for TDIs 25. Similarly the study that used data from Medline, Cochrane, Social Citation Index and CINAHL from 1995 reported that violence related TDIs has increased during the past few decades 26. However, in the current study sport and violence were found to be the main etiological factors for TDIs in the age group of years. Possible explanation for these inconsistent findings: 1) fall related TDIs occurs in the age group of 1-7 years and are mainly soft tissue injuries sustained as a result of a fall in the home or school environment, whereas injuries in the age group of 8 and above are mostly sport related and violence; 2) Secondly, increased incidence of sport 3 Dr. Ritesh Kalaskar et al. / IJRID Volume 3 Issue 3 May- June 2013

4 and violence related TDIs in the age group of could be due to increased violence and intensity and type of sport activities played in the country. Children in this age group neither have in-depth knowledge of the sports nor do they use preventive approach to reduce the severity of injury. Traumatic dental injuries increase with the increasing age 27. Several studies have shown a bimodal pattern of distribution of injury across the age 28, 29. However, the result of the current study showed increased TDIs with the increasing age. The possible explanation for this can be, as the child learns to walk and run, the incidence of falls increases because co-ordination and motor skills are poorly developed at this stage. As the children grow older there is increase in the injuries arising from sports, violence, collision, biting on hard object and RTA. Violence causes a great damage to the physical and mental health and has become a serious public health problem all over the world. In the current study, violence (16.1 of cases) emerges as the third most common etiological factor for TDIs. A cross-sectional study that collected data from the police occurrence records to domestic physical aggression between 2001 and 2005 reported that aggression was an important etiologic factor of TDIs 30. The aggression was inflicted by use of force only i.e., without the use of weapons or other objects. Similarly a study conducted in the 5th and 6th grade Arab schoolchildren pointed out violence as the second most common cause of TDIs 31. Studies conducted in north and east India reported that injuries as a result of interpersonal violence are increasing day by day The observed violence prevalence (16.1) in the current study is much higher than those reported in most developed countries. In the current study violence related TDIs were seen mostly in children above 8 years of age. However, the result of the current study is in contrary with reported result worldwide which showed that violence related TDIs occurred in children above 10 years of age On the contrary most of the studies conducted on violence were not conducted on specific age group. This difference world-wide may be due to the peculiar ethno-religious practices in the central part of India where male children are left roaming on the streets at a very early age without parental care and guidance. This may readily expose them to societal vices and they may also develop violent tendencies. Soft tissue injury and dento-alveolar fracture are generally observed in children below 7 years and above 8 years of age respectively 2, 23. In the current study, of the 20.7 of soft tissue injuries approximately 16 were observed in children below 7 years of age, whereas of the 72.2 of dento-alveolar fracture 60 were observed in children above 8 years of age. The result of the current study is in agreement with reported result in the literature which states that facial fracture is rare before seven year of life 34. The possible explanation for this peculiar pattern of TDIs in children is that includes a higher cranial to facial skeletal size, softer and more elastic bones, protective thick soft tissues and lack of pnuematization of the paranasal sinuses 35. Condyle is the most common site of mandibular fracture 36, 37. In the current study mandibular body was the most common fractured site. The observation of the current study differs from that of Ogunlewe et al 38 who found the parasymphyseal region as the most frequently fractured mandibular site. The observed differences 4 Dr. Ritesh Kalaskar et al. / IJRID Volume 3 Issue 3 May- June 2013

5 may be due to varying injury mechanisms and kinetics which may differ from place to place 2. There were no sharp differences between the pattern of skeletal injuries in younger children and older ones except for fractures of the mid-facial skeleton which was limited to the zygoma and was seen only in the adolescents. In the current study apart from fall sport and violence emerged as the other major etiological factors for TDIs. The majority of incidents occurred at home and school during leisure and sports activities. The health policy makers seeking prevention of accidents should implement educational and preventive strategies that could reduce the probability of occurrence of TDIs. These could include; 1) Care takers and educational institutions should provide safe environments and equipments for children activities; 2) children should be encouraged to use helmets, mouth guards or any other protective device during sport activities; 3) sports such as contact sports or the sport which involves aggression should be played under competent supervision on appropriate surfaces; 4) national and local campaigns to increase social awareness about TDIs; 5) education of the parents and teachers regarding the TDIs and their consequences; 6) specific local laws requiring and regulating the use of safety equipment are necessary. Conclusion: Although fall still remains the leading cause of TDI, the role of sport and violence cannot be neglected in the etiology of TDIs. There is a need to implement educational and preventive strategies aimed at minimizing the menace of fall, sport and violence- related accidents. Tables: Table1: Distribution of TDI children according to age and sex Age (Years) Male n () Female n () Total n () (5.7) 13(6.5) 24 (12.1) (15.6) 26 (13.1) 57(28.7) (21.7) 9 (4.5) 52 (26.2) (30.3) 5 (2.5) 65 (32.8) Total 145 (73.2) 53 (26.7) 198 (100.0) [Chi-square test, P value ]. 5 Dr. Ritesh Kalaskar et al. / IJRID Volume 3 Issue 3 May- June 2013

6 Table 2: Distribution of Etiological factors for TDI in children Etiological Factors Frequency Sport related Cricket, 29 Hockey 2 36 (18.1) Skating Basket ball 4 1 Fall at home/ school 89 (44.9 ) Violence 32 (16.1) Collision 9 (4.5) Road traffic accident 21 (10.6) Animal injury 4 (2.02) Biting on hard object 3 (1.5) Others 4 (2.02) Table 3: Distribution of falls according to age in 89 patients. Variable play Tree/wall Bed/ sofa walking Total Age in years (24.7 ) 0 (0.0 ) 13 (14.6) 2 (2.2 ) 37 (41.5 ) (22.4 ) 0 (0.0 ) 3 (3.3) 1 (1.1 ) 24 (26.9 ) (5.6 ) 2 (2.2) 1 (1.1 ) 4 (4.5 ) 12 (13.4) (4.5 ) 9 (10.1) 1 (1.1 ) 2 (2.2 ) 16 (17.9 ) Total 51 (57.3) 11 (12.3) 18 (20.2 ) 9 (10.1 ) 89 (100 ) [Chi-square test, P value ] 6 Dr. Ritesh Kalaskar et al. / IJRID Volume 3 Issue 3 May- June 2013

7 Table 4: Distribution of Etiological factors for TDI in children according to age. Age in years Sport Fall Violence Collisi on RTA Animal Injury BHO Others ( 0.0) ( 20.2) ( 0.0) ( 0.0) ( 2.02) ( 0.0) ( 0.0) ( 0.0) ( 0.0) (13.6 ) (1.01 ) ( 2.02) ( 2.52) ( 1.51) ( 0.50) ( 0.0) (4.04) (6.06 ) (7.07 ) (2.5 ) (1.51 ) ( 0.0) ( 1.01) ( 1.01) ( 14.1) ( 5.05) (8.08 ) ( 0.0) (4.5 ) ( 0.50) ( 0.0) ( 1.01) Total (18.1) (44.9 ) (16.1) 4.5) (10.6) (2.02) (1.5) (2.02) [Chi-square test, P value ] Total 44 ( 22.2) 42 (21.2 ) 46 (23.2 ) 66 (33.3 ) 198 Table 5: Distribution of Maxillofacial Injuries as per anatomical site. Sr. No Site Number 1 Only soft tissue injury 41 (20.7) 2 Dento- alveolar fracture 143(72.2) 3 Mandible fracture 12(6.06 ) 4 Mid face fracture 2(1.01) Total 198 Table 6: Distribution of Maxillofacial Injuries in children according to age. Age in Soft Tissue Dento-alveolar Mandible Mid- face Total years injury fracture fracture fracture (5.5 ) 7 (3.5) 0(0.0) 0(0.0) 18(9.09) (10.6) 15 (7.5) 4(2.2) 0(0.0) 40 (20.2) (2.02 ) 51 (25.8) 5(2.5 ) 0(0.0) 60(30.3) (2.52) 70 (35.4 ) 3(1.5) 2(1.01) 80(40.4) total 41 (20.7) 143(72.2) 12(6.06 ) 2(1.01) 198 (100) [Chi-square test, P value ] 7 Dr. Ritesh Kalaskar et al. / IJRID Volume 3 Issue 3 May- June 2013

8 Table 7: Distribution of mandible fracture according to age and site in 12 children. Age in years Body of mandible Condyle Parasymphyseal Total region 1-3 0(0.0) 0(0.0) 0(0.0) 0 (0.0 ) (16.6) 2 (16.6 ) 0(0.0 ) 4 (33.0) (25.0 ) 0 (0.0 ) 2 (16.6 ) 5 (41.6) (25.0) 0 (0.0 ) 0 (16.6 ) 3 (25.0) Total 8(66.0) 2 (16.6) 2 (16.6) 12 (100.0) Acknowledgment: The authors acknowledge the dental surgeons and interns of the Department Of Paediatric Dentistry, Government Dental College & Hospital, Nagpur for the data collection. REFERENCES 1. Marcenes W, Beiruti N, Tayfour D, Issa S. Epidemiology of traumatic dental injuries to permanent incisors of schoolchildren aged 9 to 12 in Damascus, Syria. Dent Traumatol 1999;15: Zimmerman CE, Troulis MJ, Kaban LB. Paediatric facial fractures: recent advances in prevention, diagnosis and management, Int J Oral Maxillofac Surg 2005; 34: Iida S, Matsuya T. Paediatric Maxillofacial Fractures: their aetiological characteristics and fracture pattern, J Craniomaxillofac Surg 2002; 30: Telgi LR, Mohapatra AK, Nagrajappa R, Telgi RC. Prevalence of traumatic dental injuries to permanent incisors among 12 year old school children in Davangere, South India. The Chinese journal of dental research 2010;13: Hogg NJ, Stewart TC, Armstrong JE, Giriotti MJ. Epidemiology of Maxillofacial Injuries at Trauma Hospitals in Ontario, Canada, between 1992 and J Trauma 2000; 49: Kaste LM, Gift HC, Bhat M, Swango PA. Prevalence of incisor trauma in persons 6 to 50 years of age: United States, J Dent Res 1996;75: O Brien M. (1994) Children s Dental Health in the United Kingdom In: Report of dental survey, Office of Population Censuses and Surveys. London: Her Majesty s Stationery Office. 8. Marcenes W, Murray S. Social deprivation and traumatic dental injuries among 14-year-old schoolchildren in Newham, London. Dent Traumatol 2001;17: Traebert J, Peres MA, Blank V, Bo ell RDAS, Pietruza JA. Prevalence of traumatic dental injury and associated factors among 12-year-old school children in Florianopolis, Brazil. Dent Traumatol 2003;19: Dr. Ritesh Kalaskar et al. / IJRID Volume 3 Issue 3 May- June 2013

9 10. Traebert J, Almeida ICS, Marcenes W. Etiology of traumatic dental injuries in 11 to 13-year-old schoolchildren. Oral Health Prev Dent 2003;1: Nik-Hussein NN. Traumatic injuries to anterior teeth among schoolchildren in Malaysia. Dent Traumatol. 2001;17: Hargreaves JA, Matejka JM, Cleaton-Jones PE, Williams S. Anterior tooth trauma in eleven-year-old South African children. J Dent Child 1995;62: Baldava P, Anup N. Risk factors for traumatic dental injuries in an adolescent male population in India. J Contemp Dent Pract 2007;8: Kumar A, Bansal V, Veeresha KL, Sogi GM. Prevalence of traumatic dental injuries among 12- to 15-year-old schoolchildren in Ambala district, Haryana, India. Oral Health Prev Dent 2011;9: Gupta S, Kumar-Jindal S, Bansal M, Singla A. Prevalence of traumatic dental injuries and role of incisal overjet and inadequate lip coverage as risk factors among 4-15 years old government school children in Baddi- Barotiwala Area, Himachal Pradesh, India. Med Oral Patol Oral Cir Bucal 2011;1;16:e Kotecha S, Scannell I, Monghan A, Williams RW. A four year retrospective study of 1062 patients presenting with maxillofacial emergencies at specialist paediatric hospital. Br J Oral Maxillofac Surg 2008; 46: Arass JN, Wesal AA-Obaidi. Traumatic dental injuries among primary school children in Sulaimani city, Iraq. Dent Traumatol 2009;25:442-6.Epub Borssén E, Källestål C, Holm AK. Treatment time of traumatic dental injuries in a cohort of 16-year-olds in northern Sweden. Acta Odontol Scand 2002;60: Jose A, Joseph MR. Prevalence of dental health problems among school going children in rural Kerala. J Indian Soc Pedod Prev Dent 2003;21: Dua R, Sharma S. Prevalence, causes, and correlates of traumatic dental injuries among seven-to-twelve-yearold school children in Dera Bassi. Contemp Clin Dent 2012;3: Piovesan C, Abella C, Ardenghi TM. Child oral health-related quality of life and socioeconomic factors associated with traumatic dental injuries in schoolchildren. Oral Health Prev Dent 2011;94: Soriano EP, Caldas AF Jr, Góes PS. Risk factors related to traumatic dental injuries in Brazilian schoolchildren. Dent Traumatol 2004;20: Malikaew P, Watt RG, Sheiham A. Prevalence and factors associated with traumatic dental injuries (TDI) to anterior teeth of year old Thai children. Community Dent Health 2006;23: Traebert J, Bittencourt DD, Peres KG, Peres MA, de Lacerda JT, Marcenes W. Aetiology and rates of treatment of traumatic dental injuries among 12-year-old school children in a town in southern Brazil. Dent Traumatol 2006; 22: Sabuncuoglu O et al. Traumatic dental injuries and attention-deficit/hyperactivity disorder: is there a link?. Dent Traumatol 2007;23: Glendor U. Aetiology and risk factors related to traumatic dental injuries--a review of the literature. Dent Traumatol 2009;25: Dr. Ritesh Kalaskar et al. / IJRID Volume 3 Issue 3 May- June 2013

10 27. Ferreira JM, Fernandes de Andrade EM, Katz CR, Rosenblatt A. Prevalence of dental trauma in deciduous teeth of Brazilian children. Dent Traumatol. 2009; 25: Oji C. Fractures of the facial skeleton in children: a survey of patients under 11 years. J Craniomaxillofac Surg 1998;26: Posnick JC, Wells M, Pron GE. Paediatric facial fractures: evolving pattern of treatment. J Oral Maxillofac Surg 1993;51: Garbin CA, Guimarães E Queiroz AP, Rovida TA, Garbin AJ.Occurrence of traumatic dental injury in cases of domestic violence. Braz Dent J 2012;231: Sgan-Cohen HD, Yassin H, Livny A. Dental trauma among 5th and 6th grade Arab schoolchildren in Eastern Jerusalem. Dent Traumatol 2008;24: Carroll MJ, Mason DA, Hill CM. Facial fractures in children. Br Dent J 1987;163: Battaineh AB. Etiology and Incidence of Maxillofacial Fractures in the North of Jordan Oral Surg Oral Med Oral Pathol Radiol, Endod 1998; 86: Adekeye EO. Paediatric Fractures of the Facial Skeleton: a survey of 85 cases from Kaduna, Nigeria, J Oral Surg 1980; 141: Kim DB, Sacapano M, Hardesty RA. Facial fractures in children. West J Med 1997 ;167: Fasola AO, Nyako EA, Obiechina AE, Arotiba JT. Trends in the characteristics of maxillofacial fractures in Nigeria. J Oral Maxillofac Surg 2003; 61: Adeyemo WL, Ladeinde AL, Ogunlewe MO, James O. Trends in the characteristics of oral and maxillofacial injuries in Nigeria: A review of the literature. Head and Face Medicine 2005; 1:7 38. Ogunlewe MO, James O, Ladeinde AL, Adeyemo WL. Pattern of Paediatric Maxillofacial Fractures in Lagos, Nigeria. Int J Paediatr Dent 2006; 165: Dr. Ritesh Kalaskar et al. / IJRID Volume 3 Issue 3 May- June 2013