PATTERN OF CROWN FRACTURES IN 9 18 YEARS OLD STUDENTS IN DISTRICT KHAIRPUR MIRS, SINDH

Transcription

1 ORIGINAL ARTICLE PATTERN OF CROWN FRACTURES IN 9 18 YEARS OLD STUDENTS IN DISTRICT KHAIRPUR MIRS, SINDH Kashif Ali Channar 1 SubuhiGhani 2 Naresh Kumar 3 Abdul Bari Memon 4 Shahid Ali Mirani 5 Faisal Bhangar 6 BDS, FCPS BDS, MCPS BDS, PhD BDS BDS,MSc BDS, FCPS OBJECTIVE: To observe the pattern of crown fractures in schoolchildren aged 9-18 years. METHODOLOGY: Nine public and 4 private Primary to higher secondary schools of KhairpurMirs District, Sindh, were included in this cross sectional study.selected study participants were examined with disposable tongue spatula under daylight by a single examiner. Data related to gender, age, tooth involved, number of teethinvolved, type of tissue injuryand treatment taken for coronal trauma were recorded. RESULTS:The male/female ratio was recorded as 2:1. Atotal of 4.32% males and 3.28% females exhibited crown fractures.central incisor was the most affected tooth (64.47%) followed by maxillary lateral incisor (10.52%), mandibular central incisor (7.89%), mandibular lateral incisor (5.26%), maxillary canine (2.63%) and mandibular canine (1.31%). In addition, single tooth trauma was identified in most of the cases. Fracture observed in enamel was 52.6%, which was significantly greater than fracture in enamel & dentine with or without pulp involvement. CONCLUSION: An overall 4% occurrence of coronal trauma among 9-18 year-old students of district khairpurmirs, Sindh, Pakistan was identified. Maxillary central incisor and fracture involving enamel only were the most common findings. KEY WORDS: Dental trauma, Crown fracture, Enamel fracture, School-children How to cite this article: Channar KA, Kumar N, Ghani S, Memon AB, Mirani SA, Bhangar F. Prevalence of crown fractures in 9 18 years old students in khairpurmirs, Sindh. J Pak Dent Assoc 2013;22(2): D INTRODUCTION ental trauma is a common health problem among children and teenagers worldwide. Maxillary incisors are more prone to traumatic injuries, which lead to 1. Assistant professor Oral & maxillofacial surgery Department Institute of dentistry LUMHS, Jamshoro. 2. Assistant Professor, Department of Orthodontics, Institute of dentistry, LUMHS, Jamshoro. 3. Assistant Professor Science of Dental Materials Department Institute of dentistry LUMHS, Jamshoro. 4. Institute of dentistry LUMHS, Jamshoro 5. Resident Community Dentistry Institute of dentistry LUMHS,Jamshoro. 6. Assistant Professor Operative Dentistry Department Institute of Dentistry LUMHS, Jamshoro Correspondence: Dr Kashif Ali Channar <kashif_omfs@yahoo.com> Cell: psychological problems among children. The lack of awareness regarding traumatic injuries and associated risks is evident in public. In addition, people are not aware of preventive measures of dental trauma. Generally the incidence of dental trauma is underestimated by health professionals including dentists. Most clinicians prefer treatment rather than preventive measures of traumatic injuries. 1 Traumatic dental injury (TDI) mostly occurs in children and teenagersdue to falls, sport injuries, and violence 2,3 Trauma to oral structures is the sixth most common injuryof the body. 1 The proportion of tooth injury varies from 4% to 33% worldwide. 4-6 It has been reported by various investigators that most dental injuries occur during first two decades of life, usually around 8-12 years. 7 The occurrence of trauma is significantly higher in maxillary central incisors followed by maxillary lateral incisors and mandibular incisors. 7,8 Incidence of coronal trauma is higher in boys as compared togirls. Generally, prevalence of tooth trauma has not been JPDA Vol. 22 No. 02 Apr-June

2 researched much in comparison to periodontal problems and caries. 10 Although, many research articles published internationally on the epidemiology of traumatic injury of anterior teeth, but not a single article on the above mentioned area has published in Pakistan according to authors knowledge. The objective of this study is to observe the pattern of coronal trauma in 9-18 years old children. METHODOLOGY This cross sectional study was conducted to observe the pattern of dental trauma in students of rural areas of KhairpurMirs District, Sindh, Pakistan studying in primary to higher secondary (private & public) schools.nine public and 4 private schools of district khairpurfrom 04 October 2010 to 20 December 2010 were included in this study. The schools were selected in accordance with the number of schoolchildren registered in that particular community. A sample size of 322 children from schoolchildren was chosen using a statistical calculation. A randomized selection of the schools and children was made in the current study. Students of age from 9-18 years of either gender & dentition participated the current study. Whereas the students above the age of 18 years, the students below the 14 years whose parents/guardians refused to participate in this research study and students with amelogenesisimperfecta and dentinogenesisimperfecta were excluded. Out of 2000 students 1904 students (males and females) fulfilled the inclusion criteria. All of them were examined with disposable tongue spatula under daylight by a single examiner. Radiographic examination for the root fracture was not conducted. However, treatment Fractures of anterior teeth were clinically recorded according to the following classification 11 based on clinical signs. Class 1 Enamel fracture only Class 2 Enamel and dentine fracture but no pulp involvement Class 3 Enamel and dentine fracture with pulp involvement Class 4 Restored tooth with either composite or crown following fracture Data with regards to sex, age, tooth involved, number of involved teeth, affected coronal portion and treatment taken for coronal trauma were recorded. For testing the statistical differences of coronal trauma in relation to age, gender and prevalence of fractured teeth and its anatomic site, Chi square test was used. RESULTS Among the study groups examined,4.32% malesand 3.28% females presented with crown fractures. An occurrence of crown fractures of 4.7% and 3.7% was found in the age group 9-12 years (mixed dentition) and (permanent dentition) respectively. None of the students with coronal trauma received any therapeutic measure. No statistically significant difference in coronal trauma in relation to age groups and sex was identifiedas shown in Table 1. TABLE 1: PREVALENCE OF FRACTURED TEETH AND TREATMENT RECEIVED IN RELATION WITH AGE & GENDER. taken was recorded. Maxillary central incisor was the most commonly affected 109 JPDA Vol. 22 No. 02 Apr-June 2013

3 tooth (64.47%)followed by maxillary lateral incisor (10.52%), mandibular central incisor (7.89%), mandibular lateral incisor (5.26%), maxillary canine (2.63%) and mandibular canine (1.31%). In majority of the cases, trauma in a single tooth was identified while only five students reported involvement of two teeth. None of the child presented with three or more affected teeth (Table 2). TABLE 2: CORONAL TRAUMA INVOLVING TEETH In terms of anatomic tooth structures, 52.6% fracture was observed in enamel, whereas enamel & dentinefracture with the involvement of pulp was the least common site of crown fracture (Table 3). TABLE 3: CORONAL TRAUMA INVOVING ANATOMIC STRACTURE OF TOOTH DISCUSSION In the current survey pattern of crown fractures in schoolchildren of District khairpurmirs, Province Sindh, Pakistan was evaluated. The ultimate goal was to highlight the facts and figures which may assist the policy makers in the designing of appropriate preventive measures. Overall, a low occurrence of coronal trauma was found in the current survey, and was relatively lower than old Americans identified in NHANES III study 12. This variation among surveys may be attributed to differences in sampling techniques employed. Moreover, present study did not record any previous trauma history such as avulsed teeth, which may have underrated the prevalence of trauma. Current study suggested that girls are relatively less affected by coronal trauma compared with boys and is in agreement with other studies. 10,12-16 Whereas study by Garcia-Godoy et al. 17 contradict such findings since they observed higher rate of coronal trauma in girls in comparison to boys. 17 The male to female ratio (1.31) identified in this survey isnearly equal to that of the US inhabitants, The male/ female coronal trauma prevalence ratio stated in other researches ranged from 1.35 and 2.1 in Jordan and Syria respectively. 13,14,16 This may possibly as a result of that males have a tendency to take part in more tough activities for instance,contact sports and more destructive types of games. In our study prevalence of coronal fracture among age group 9-12 was 4.7%, which is not in agreement with study results of Marcenes et al 13 among school students of same age group while in age group prevalence was 3.73% which is also not in agreement with the study results of Faus-damia M et al. 18 Variations in the prevalence of dental injuries in mixed and permanent dentitions have been attributed to a number of aspects, for example study type, the diagnosis methodology age groups, composition of sample composition, the dentition studied, geographic discrepancy between study settings and countries It is evident in the literature that majority of children with coronal trauma did not consult any dental personnel and also most traumatized teeth remained untreated. 19 In this study none of the affected student received dental treatment which suggests the possible reasons namely, lack of dental facilities available in that area, unawareness about dental trauma and its management, huge treatment expenses and no set insurance policies to cover all expenses. The maxillary central incisors suffered from coronal trauma significantly greater than other teeth which is in accordance with other researches. 12,14-17,28 Also, the present study is in JPDA Vol. 22 No. 02 Apr-June

4 agreement with other surveys where single tooth fractures were identified substantially greater than multiple teeth fractures Bastone et al 15 reported multiple teeth injuries are mostly evident in hospital emergency rooms. The prominent location of the maxillary incisors is responsible for fractures than the lower teeth. 16 Maxillary incisors with an increased over-jet or protruding incisors 13,15,16,29 incompetent lips 13,15,29 and accident susceptibility are also major factors involved in coronal trauma. 15,16,29, The maxillary central incisors were the most frequently injured teeth in all studies for both the primary and secondary dentitions 15. The 2 nd frequently tooth was maxillary lateral incisors in all studies except that by Forsberg and Tedestam 30 where mandibular central incisors were the second most frequently injured teeth. Enamel was the most common site of trauma 52.6%, followed by trauma in enamel and dentin without pulp involvement. Several articles have also reported similar features as above. 31,32 CONCLUSION The findings of this study suggest an overall 4% prevalence of coronal trauma among 9-18 year-old students in district khairpurmirs, Sindh, Pakistan. Males (4.32%) were more susceptible to coronal trauma compared with females (3.28%). The commonly involved teeth and tooth structure were maxillarycentral incisors (64.47%) and enamel (52.6%) respectively. RECOMMENDATIONS Further investigations with regard to factors associated with coronal trauma are warranted. Dental education of the public, parents, teachers and health professionals regarding methods of preventing dental injuries in children is required. It would aid in designing polices to reduce the rate of dental traumatic injuries in Pakistan. Measures to correct overjet and incompetent lips(orthodontic treatment) to minimize trauma to maxillary central incisors be taken by the government. REFERENCES 1. Petersson EE, Andersson L, Sorensen S. Traumatic oral vsnonoral injuries. Swed Dent J 1997; 21: Glendor U, Marcenes W, Andreasen JO. Classification, epidemiology and etiology. In: Andreasen JO, Andreasen FM, Andersson L, editors. Textbook and Color Atlas of Traumatic Injuries to the Teeth, 4th ed. Oxford: BlackwelMunksgaard; p Glendor U. Aetiology and risk factors related to traumatic dental injuries a review of the literature. Dent Traumatol 2009; 25: Dewhurst SN, Mason C, Roberts GJ. Emergency treatment of orodental injuries: a review. Br J Oral MaxillofacSurg 1968; 36: Nair KB, Paul G. Incidence and aetiology of fractures of the facio-maxillary skeleton in Trivandrum: a retrospective study. Br J OralMaxillofac Surg.1986; 24: Hayter JP, Ward AJ, Smith EJ. Maxillofacial trauma in severely injured patients. Br J Oral MaxillofacSurg1991; 29: Bakland LK. Endodontic considerations in dental trauma. In: Endodontics, 5th ed. Ingle JI,Bakland LK eds, BC Decker, Hamilton 2002; Oztan MD, Sonat B. Repair of untreated horizontal root fractures: two case reports. DentTramatol 2001; 17: Ellis RG, Davey KW. The classification and treatment of injuries to the teeth of children. 5th ed, Year Book Publisher, Chicago.1970; Marcenes W, Alessi ON, Traebert J. Causes and prevalence of traumatic injuries to the permanent incisors of schoolchildren aged 12 years in Jaragua do Sul, Brazil. Int Dent J 2000; 50: Nawaf AH. Al-Dwairy A. Coronal fracture of anterior teeth among school children aged years old in the city of Zarka. Jordan,Mid East J Nursing 2007;1(2): 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(Spec Iss): Marcenes W, Al Beiruti N, Tayfour D, Issa S. Epidemiology of traumatic injuries to the permanent incisors of 9 12-yearold school children in Damascus, Syria. Endod Dent Traumatol 1999; 15: Jamani KD, Fayyad MA. Prevalence of traumatized permanent incisors in Jordanian children: according to age, sex and socio-economic class. Odonto-Stomatol Trop 1991; 14: Bastone EB, Freer TJ, Mcnamara JR. Epidemiology of dental trauma: a review of the literature. Aus Dental J 2000; 45: Oluwole TO, Leverett DH. Clinical and epidemiological 111 JPDA Vol. 22 No. 02 Apr-June 2013

5 survey of adolescents with crown fractures of permanent anterior teeth. Pediatr Dent 1986; 8: Garcia-Godoy F, Sanchez R, Sanchez JR.. Traumatic dental injuries in a sample of Dominican school children. Community Dent Oral Epidemiol 1981; 9: Faus-Damiá M, Alegre-Domingo T, Faus-Matoses I, Faus-Matoses V, Faus-LlácerVJ.Traumatic dental injuries among schoolchildren in Valencia, Spain.Med Oral Patol Oral Cir Bucal2011; 16:e Lin S, Levin L, Goldman S, Peled M. Dento-alveolar and maxillofacial injuries a retrospective study from a level 1 trauma center in Israel. Dent Traumatol 2007; 23: Shaul Lin, Liran Levin, Sharon Goldman, KobiPeleg. Dentoalveolar and maxillofacial injuries: a 5-year multicenter study. Part 1: General vs facial and dental trauma. Dent Traumatol 2008; 24: Skaare AB, Jacobsen I. Primary tooth injuries in Norwegian children (1 8 years). Dent Traumatol 2005; 21: Gulinelli JL, Hamata Saito TM, Garc a-junior IR, Panzarini SR, Poi WP, Sonoda CK et al. Ocurrence of tooth injuries in patients treated in hospital environment in the region of Aracatuba, Brazil during 6-year period. Dent Traumatol 2008; 24: Petti S, Tarsitani G. Traumatic injuries to anterior teeth in Italian schoolchildren: prevalence and risk factors. Endod Dent Traumatol 1996; 12: Rocha MJC, Cardoso MJC. Traumatized permanent teeth in Brazilian children assisted at the Federal University of Santa Catarina, Brazil. Dent Traumatol 2001;17: Hamilton FA, Hill FJ, Holloway PJ. An investigation of dentoalveolar trauma and its treatment in an adolescent population. Part 1: the prevalence and incidence of injuries and the extent and adequacy of treatment received. Br Dent J 1997; 182: Falomo B. Fractured permanent incisors among Nigerian school children. J Dent Child 1986; 53: Hunter ML, Hunter B, Kingdon A, Addy M, Drummer PMH, Shaw WC. Traumatic injury to maxillary incisor teeth in a group of South Wales school children. Endod Dent Traumatol 1990; 6: Wilson S, Smith GA, Preisch J, Casamassimo PS. Epidemiology of dental trauma treated in an urban pediatric emergency department. Pediatr Emergency Care 1997; 13: O Mullane DM. Some factors predisposing to injuries of permanent incisors in school children. Br Dent J 1973; 134: ForsbergCM,TedestamG.Ttaumatic injuries to teeth in Swedish children living in an urban area. Swed Dent J 1990; 14: Zaragoza AA, Catala M, Colmena ML, Valdemoro C. Dental trauma in schoolchildren six to twelve years of age. J Dent Child 1998; 65: Caldas AF, Jr, Burgos ME. A retrospective study of traumatic dental injuries in a Brazilian dental trauma clinic. Dent Traumatol 2001; 17: JPDA Vol. 22 No. 02 Apr-June