Traumatic dental injuries in preschoolchildren from Santo Domingo

Traumatic dental injuries in schollchildren from Santo Domingo

Franklin Garcia-Godoy, Fernando Morban-Laucer, Luis R. Corominas, Rafaela A. Franjui and Miriam Noyoia Center for Pediatrie Odontology and Autonomous University of Santo Domingo, Santo Domingo, Dominican Republic

Garcia-Godoy F, Morban-Laucer F, Corominas LR, Franjul RA, Noyola M; Traumatic dentai injuries in schoolchildren from Santo Domingo. Community Dent Oral Epidemiol 1985; 13: 177-9. Abstract - The purpose of this retrospective study was to analyze, by age and sex, 1) the prevaience of traumatic injuries to permanent incisors and canines, and 2) their distribution according to type in schoolchildren from the city of Santo Domingo in the Southern part of the Dominican Republic, which is located in the Caribbean Archipelago. The sample consisted of 1200 children aged 6-17 yr enrolled in eight public and private schools. GARCfA-GoDOY's classification for traumatic injuries was used. The prevalence of injuries was 12.2% (13.1% in boys and 11.2% in girls). The largest number of injuries was presented by the 14-yr-old children (17.4%) followed by the 13- and 12-yr-oids (i5.7% and 11.7%, respectiveiy). More boys injured their teeth than girls (not significantly) with a boy-to-girl ratio of I.i; 1. The most common type of injury in both sexes was enatnel-dentin fracture, followed by enamel fracture.

Traumatic dental injuries in schooichiidren have been reported by many authors. In the Dominican Republic, nine studies have been performed regarding injuries to teeth. Of these, three anaiyzed the occurrence of coronal fractures (1-3) using ELLIS' classification (4); one studied the prociination of teeth and its relationship with traumatic injuries (5), and the other five (6-10) recorded other types of injuries such as concussions, luxations, intrusions, extrusions and avulsions, us-

Key words: dental injuries: epidemiology, oral: teefh, trauma Franklin Garcia-Godoy, Centro de Odontologia Pediatrica, P.O. Box 2753, Santo Domingo, Dominican Republic Accepted for publication 28 July 1984

tive study was to analyze, by age and sex, 1) the prevalence of traumatic injuries to permanent incisors and canines, and 2) their distribution according to type in a population sample of schoolchildren frotn the eity of Santo Domingo, in the Southern part of the Dominican Republic, which is located in the Caribbean Archipelago.

enamei fractures and enaniel-dentin fractures in two dilTerent categories. No broad terms such as "complicated" or "uncomplicated" fractures are used. In the present sfudy, root fractures were not recorded as no denfai radiographs were faicen. The statistical analysis of the material was performed using the chi-square test.

Material and Methods

Resuits

The sample of this study consisted of Prevalence - The prevalence of traumatic 1200 children from the city of Santo Do- injuries to permanent incisors and ca(6, 8). Of these last five studies, the first (6) mingo, Dominican Republic. The chil- nines was 12.2% (13.1% in boys and was a prospective one and did not ana- dren, 600 boys and 600 girls, ranged in i i .2% in girls). The average number of lyze the prevalence of traumatic injuries, age from 6 to 17 yr and were enrolled in teeth injured in boys was 1.2 and in girls but rather their etiology, seasonal vari- eight public and private schools. For i.i. Tiie i46 injured children presented ation, number of teeth involved and type each age, an equal nutnber of boys and 172 traumatized teeth. The largest numof injury to primary and permanent teeth girls were studied. A popuiation percent- ber of injuries were presented by the 14of children treated in a private pediatric age of 10 or slightly higher frotn each yr-old chiidren (17.4%), followed by the dental practice. The second and third sfu- school was examined. The students were 13- and i2-yr-oids (15.7% and 11.7%, dies (7, 9) examined preschool Domi- randomly chosen from each classroom respectively) (Table 1). More boys injured their teeth than girls (not signican children. The fourfh study (8) and sent to the examination room. The chiidren were examined in each nificantly) with the ratio of boy-to-girl examined a population sample of schoolschooi under natural lighting, by a visual being 1.1:1. Boys had more actual teeth children from a small city in the Southeastern part of the Dominican Republic and digital examination, as suggested by injured than girls (not significantly) (Taand the fifth one oniy examined chiidren HARGREAVES & CRAIG (1 i), with the aid ble 2). Type of ityury - The most common from private schoois (10). No study has of mouth mirrors and probes. Traumatic been conducted in chiidren frotn public injuries to the maxiiiary and mandibuiar type of injury in bofh sexes was the and private schoois from the city of San- permanent incisors and canines were re- enamel-dentin fracture (62.8%; 61.2% in to Domingo reporting the prevalence of corded according to GARCIA-GODOY'S boys and 64.9% in girls), followed by traumatic dental injuries using GARCIA- classification (12). One of the main differ- enamel fracture (21.5%; 25.5% in boys ences between this classification and and 16.2% in girls). Concussions were GODOY'S classification. The purpose of the present retrospec- others is that the former separates observed in 4.7% of the traumatized ing the classification of GARCIA-GODOY

178

GARCIA-GODOY ET AL.

Table 1. Distribution of children wifh fraumafized fcefh by age and sex

Age 6 7

8 9 10

11 12

13 14 15 16 17

Total

No. of boys

Boys with injured teeth

No. of girls

9 3

50 50

6 5

50 50

10

8 15

10.2

6

50

7

13

9.0

7,0 10.2 12.3 13.0 13.7

50 50 50

50

Girls with injured teeth

No. of children with injured teeth

5 1 2

14 4

No. of teeth

3

4.8 2.0

12 4 9 18 (4 12 20 27 30 15 8 3

146

100.0

172

50 50 50 50 50 50 50 50

4

50

6

10

9 10 II 11 4 1

50 50 50 50 50 50

6 8 8 9 3 2

15

600

79

600

67

9.6 2.8 5.4

18 19 20

7

7.0 2.3 5.2

10.4 8.1 7.0

11.7 15.7 17.4 8.7 4.7 1.8

100.0

13, 14, 20, 21, 24, 25, 27-30). GARCIA-

Table 2. Number of teeth traumatized according to type Classification

Class 1: enamel fracture Class 2: enamel-dentin fracture Class 3: crown fracture with pulp exposure Class 4: enamel-dentin cementum fracture Class 5: root fracture* Class 6: concussion Class 7: luxation (partial displacement) Class 8: intrusion Class 9: extrusion Class 10: avulsion (total displacement) Total

Boys No. of fccfh % 25 60

25.5 61.2

are the most frequent between the ages of 9 and 10 years (13, 14, 2i-24). Two other studies report a range Irom 7 to 13 yr as the peak ages for injuries to the permanent dentition (25, 26). In Southeastern Dominican children, GARCIAGODOY et al. (8) Ibund that the 14-yrolds followed by the 12-yr-oid children sustained more traumatic injuries to their teeth. In children from private schools from Santo Domingo, the 6-8-yr-olds presented the largest number of injuries. The present study agrees with fhe results found in Southeastern Dominican chiidren (8). Most of the studies in the literature show that boys suffer injuries to their permanent teeth more often than girls (6,

Girls No. of feefh % 12 48

Total No. of teeth %

16.2 64.9

37 108

21.5 62.8

9.4

11

6.4

4

2.3

et al. (8) reported that more girls (not significantly) suffered injuries than boys with a ratio of 0.93; 1. The present study shows a boy-to-girl ratio of 1.1:1. GODOY

Type ol injury 4.1

4.1

4.7

5.4

I

i.O

3

4.1

4

2.3

98

100.0

74

100.0

172

iOO.O

* Not analyzed.

teeth; crown fracture with pulp exposure in 6.4% and enainel-dentin-cementum fracture and avulsion in 2.3yo each. No luxations, partial dispiacements, intrusions or extrusions were observed. Discussion Prevalence

Severai reports have shown that the prevaience of traumatic dental injuries in the permanent dentition ranges from i8 to 22% (8, 13-15). Lower prevalences have been reported in most of the earlier studies (1, 4, 16-20). The results of the present study are difficult to compare with the results of other studies because different materials and methods have been used. For example, the present study used the ciassification of GARCIA-GODOY (6, 8, 9) to categorize traumatic dental injuries

(which has been recently modified to be more specific (12)) and most of the other studies used ELLIS' classification (4). The oniy two previous studies in schooi-aged children that also used GARCIA-GODOY'S classification were the ones conducted by GARCIA-GODOY et at. (8), in a Southeastern Dominican population sample, and GARCIA-GODOY (10) in children from private schoois in Santo Domingo. The former study found that i8.i"/o of the schoolchildren examined presented some type of traumatic injury to permanenf incisors and canines. The latter one found a prevaience of 10%. The present study showed a figure of 12.2%. We cannot explain why the chiidren from the city of Santo Domingo suffered fewer traumatic dental injuries than those from a smail Southeastern city. Some studies have found that traumatic injuries to the permanenf dentition

It has been stated that careful attention should be paid when analyzing the type of injury, because fhis can vary according to the place where the study is conducted (7-9, 31). Within a hospital setting, ANDREASEN (31) found thaf iuxations and bone injuries were the most predominant traumas. RAVN & ROSSBN (24), in a

school dentai service, GARCIA-GODOY et al. (6), in a private pediatric denfal practice, and the present study, in randomiy examined schooichildren, reported enamei-dentin fractures as the most predominant injuries to permanent incisors and canines. However, GARCMA-GODOY

et al. (8) found in Dominican chiidren Irom a small Southeastern city thaf enamel fracture was the mosf IVequcnf frauma and GARCIA-GODOY (10), in children from private schools from Santo Domingo, Ibund that concussion was the most common trauma. Because of fhis, it was suggested fhat further studies shouid anaiyze the prevaience of traumatic injuries in children from urban and rural communities as well as in large and small cities (8). In epidemioiogic studies of popuiation sampies to determine the prevalence of a condition, two main sources of error termed sampling and non-sampling error can occur. The sampiing error depends mainly on the merits of fhe sample finally examined, whereas non-sampling error

Traumatic dental ittjuries mostiy depends on the reliabiiify of the rnethods used to coiiect and process tiie d a t a (26). One other aspect that shouid be taicen i n t o consideration is that in retrospective studies, some injuries couid have missed being recorded as they would only have been registered if signs and/or symptoms j^gppened to exist at the time of the examination, such as concussion, intrusions, extrusions and luxations. In prospective studies, injuries will be only recorded if the patient seeics dentai care, which rareiy happens if they suffered xTiiid dentai injuries, such as concussions, enamel fractures and some enamel-dentin fractures (6, 7, 25). Because of this, it h a s been suggested that further studies shouid anaiyze the reasons why tlie patient demands treatment and when the traumatic injuries were detected.

179

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