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Year : 2014  |  Volume : 14  |  Issue : 2  |  Page : 65-68

Dental trauma and its relation with problem behavior amongst 12-15-year old children

Department of Public Health Dentistry, Swami Devi Dyal Hospital and Dental College, Panchkula, Haryana, India

Date of Web Publication9-Oct-2014

Correspondence Address:
Amandeep Chopra
Department of Public Health Dentistry, Swami Devi Dyal Hospital and Dental College, Golpura, Barwala, Panchkula, Haryana - 134 009
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1319-6308.142346

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Aim : The aim of this study was to assess the relationship between problem behavior and traumatic dental injury amongst children aged 12-15 years. Further, it also aimed to analyze by age and sex, a) the prevalence of traumatic injuries to permanent incisors and canines, and b) their distribution according to type of fracture. Materials and Methods: A cross-sectional study was conducted among 200 children aged 12-15 years in Panchkula, India. Data was collected through clinical examinations and interviews. A hospital based matched (age and sex) case-control design was adopted. A questionnaire was answered by either the children themselves through interview or by any one of their parents. Results: In case study, it was revealed that 16.4% subjects had more than 5 mm overjet and 20.4% subjects had inadequate lip coverage. The largest number of injuries were presented by 15 year old children (43.90%) followed by 14 and 13 years old children. In specification, boys had more injured teeth compared to girls. Conclusion: Problem behavior plays an important role in the occurrence of traumatic dental injury.

  Abstract in Arabic 

إصابات الأسنان و علاقتها بمشكلات السلوك وسط الأطفال بين عمر 12 ــ 15 سنة
هدف الدراسة: كان هدف الدراسة تقييم العلاقة بين مشكلات السلوك و إصابات الأسنان بين الأطفال الذين تتراوح أعمارهم بين الثانية عشرة و الخامسة عشرة. كما هدفت الدراسة إلى تحليل إصابات القواطع ا والأنياب الدائمة و وتوزيعها حسب العمر و الجنس وفقا لنوع الإصابة.
العينات و منهج الدراسة: أجريت الدراسة على مائتي طفل تراوحت أعمارهم بين الثانية عشرة و الخامسة عشرة في ( بانشكولا ــ الهند ) وقد جمعت البيانات من خلال الفحوص السريرية و المقابلات الشخصية و قد صممت استبانة اعتمد فيها على إجابات الأطفال أنفسهم ، أو إجابات أحد والديهم.
النتائج : من خلال دراسة الحالات تبين أن 14.6% من عينة الدراسة أظهرت أسنانهم بروزابمقدار خمسة مليمترات، و 20.4% منهم لا تغطي شفافهم أسنانهم. كما أظهرت الدراسة أن أكثر الإصابات (43.9%) كانت في الأطفال في سن الثالثة عشرة و الرابعة عشرة.و كانت الإصابات في الأولاد أكثر من البنات.
الخلاصة : تؤدي مشكلات السلوك دورا مهما في حدوث إصابات الأسنان بين الأطفال

Keywords: India, overjet, problem behavior, traumatic dental injury

How to cite this article:
Chopra A, Lakhanpal M, Rao N C, Gupta N, Vashisth S. Dental trauma and its relation with problem behavior amongst 12-15-year old children . Saudi J Sports Med 2014;14:65-8

How to cite this URL:
Chopra A, Lakhanpal M, Rao N C, Gupta N, Vashisth S. Dental trauma and its relation with problem behavior amongst 12-15-year old children . Saudi J Sports Med [serial online] 2014 [cited 2023 Dec 8];14:65-8. Available from: https://www.sjosm.org/text.asp?2014/14/2/65/142346

  Introduction Top

Dental trauma due to sport is devastating to any athlete but is made worse when the athlete is young and still growing. Orofacial trauma is relatively common in the pediatric population and can have significant management problems. Continued maxillary and alveolar growth, development, and maturation of individual teeth, as well as behavioral considerations create unique challenges in the management of this population. Children and youths have increased risk factors for dental trauma due to sports, including untreated malocclusions, an increase in risk-taking behavior, and undeveloped coordination and skill levels. [1]

The decline in the prevalence and severity of dental caries amongst children in many countries may have made traumatic dental injuries, a more serious dental public health problem among the young. [2],[3] The dental literature contains many reports of injuries to primary and permanent teeth in children, most of them treated at dental hospital. The main causes of traumatic dental injuries reported in the literature are falls and collisions, sporting activities and traffic accidents. [4]

It is also well known that increased incisal overjet of the teeth and inadequate lip coverage significantly increase the chances of having a dental injury when people have an accident. [4] Problem behavior has been defined as "behavior that is socially defined as a problem, a source of concerned or as undesired by norms of conventional society and its occurrence usually elicits some kind of social response." [5] Problem behavior has never been studied before as a determinant of traumatic dental injuries.

Behavior and social environmental risk factors for dental injury have been over looked. Socioeconomic status was rarely measured, if measured the results were conflicting. Two studies used area-based measures of deprivation and showed a positive relationship. [6],[7] Conversely, another study that used parents' years of schooling as a measure of socioeconomic status demonstrated that children from parents with higher levels of education had more dental injury than from parents with lower level of education. [8] Andreasen [9] suggested that the different types of dental injuries vary according to the place where the study is conducted. He found that within a hospital environment, luxation and bone injuries are the most predominant.

The present study was conducted to test whether traumatic dental injuries are related to problem behavior, to confirm the relationship between traumatic dental injuries and size of overjet and type of lip coverage and to analyze the prevalence and type of traumatic injuries to permanent incisors and canines and their distribution according to age and gender, in a population sample of 12-15 years old school children of district Panchkula, Haryana.

  Materials and methods Top

A cross-sectional study was conducted among 200 school children, aged between 12-15 years belonging to the schools adopted by the dental institution.

Data was collected from January-March 2013 through clinical examinations and interviews.The students were chosen from each classroom by convenience sampling. Examinations of children were done under natural light with the help of probe and mouth mirror (type-III examination). Ethical clearance was obtained from ethical committee of the dental college. Before starting the study, prior permission was taken from the school authority. Out of 200 children, 100 children had traumatic dental injury matched by age and sex with other 100 children who did not have traumatic dental injury.

Traumatic injuries were recorded according to Garcia-Godoy's classification. [10] The informant-rated version of the strengths and difficulties questionnaire (SDQ) [11] was used to identify problems behavior. Pre-test of questionnaire was done before starting the study.

The questionnaire composed of 25 questions under the heading, conduct problems (e.g. often fights with other children or bullies them) prosocial behavior (e.g. often volunteers to help others such as parents, teachers, other children), hyperactivity/inattention (e.g. restless, over active, cannot stay still for long), peer relationship problem (e.g. picked on or bullied by other children) and emotional symptoms. (e.g. many fears, easily scared).

Each of the above mentioned categories were provided with the options 'not true', 'somewhat true' and 'certainly true'. A score of 0 was assigned to the answer 'not true', a score of 1 to the answer 'somewhat true' and a score of 2 to 'certainly true'.

  Results Top

[Table 1] reveals the frequency distribution of age, gender, father's level of education, mother's level of education, size of overjet and type of lip coverage in the sample. "Case and control" were perfectly matched by age and sex. More boys injured their teeth than the girls. Among these cases, 24.4% of subjects were having inadequate lip coverage. While in the control group, 19.9% subjects were having inadequate lip coverage. Among these cases, 16.4% subjects were having more than 5 mm of overjet.
Table 1: Frequency distribution of age, sex, father's level of education, Mother's level of education and type of lip coverage in a sample of 200 children aged 12-15 years

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[Table 2] reveals the prevalence of traumatic injuries to permanent incisors canines was 61.5% (50.83% in boys and 11.2% in girls). Out of 200 injured children, 123 presented traumatized teeth. The largest number of injuries was presented by 15 years old children (43.90%) followed by the 14 and 13 years old.
Table 2: Distribution of children with traumatized teeth by age and gender

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[Table 3] reveals that boys had more injured teeth than the girls. The most common type of injury in both sexes was the enamel-dentin fracture (71.9%) followed by crown fracture with pulp exposure (11.6%).
Table 3: Percentage of teeth traumatized according to type

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[Table 4] reveals that subjects who had conduct problem and peer relationship problems, had more traumatic dental injury when compared to hyperactive and prosocial behavior.
Table 4: Mean problem behavior in relation to traumatic dental injury

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  Discussion Top

This study was done to reveal the association between problem behavior and traumatic dental injury. The result of this study showed that peer relationship problems were significantly associated with higher levels of traumatic dental injuries. It was expected that hyperactive behavior would increase the chances of having traumatic injury. This suggested that not all types of problem behavior are related to traumatic dental injuries. The results also showed that the type of lip coverage affected the relationship between type of overjet and traumatic dental injury.

Several reports have shown that the prevalence of traumatic dental injuries in the permanent dentition range from 18 to 22%. [12],[13],[14],[15] Lower prevalence has been reported in most of the earlier studies. [16],[17],[18],[19],[20],[21],[22] While in our study, prevalence of traumatic dental injuries in the permanent dentition was 61.5%.

Some studies have found that traumatic injuries to the permanent dentition are most frequent between 9 to 10 years of age [13],[14],[23],[24],[25],[26] while other studies report a range from 7 to 10 years as the peak ages for injuries to the permanent dentition. [27],[28] But in this study it was found that 15 years old children sustained more traumatic dental injuries to the teeth.

Garcia-Goday [29] found concussion as the most predominant injury in the primary dentition and enamel dentin fracture in the permanent dentition in the private pedodontic practice. While in our study, the enamel dentin fracture in the permanent dentition was most predominant. The result also showed that the type of lip coverage affected the relationship between type of overjet and traumatic dental injury. This might be expected as adequate lip coverage that would provide some protection to children with pronounced overjet when they have a harmful event.

Most of studies in the literature show that boys suffer more injuries to the permanent teeth. [13],[14],[22],[23],[26],[27],[30],[31],[32],[33] Garcia-Goday et al. [12] reported that more girls suffered injuries than boys with a ratio of 0.93:1. The present study shows boys to girls ratio of 1.1:1. Boys have more traumatic dental injury than the girls. It has been stated that careful attention should be paid when analyzing the type of injury because this can vary according to the place where the study is conducted. [16],[18],[34],[35]

  Conclusion Top

Traumatic dental injury is the most predominant cause of dental injury among children. The conclusion of the study was that boys comparatively had more traumatized teeth than the girls. To develop an effective health promotion strategy and to prevent traumatic dental injury, it is necessary to find the cause why people fall, fight or injure themselves when they have an accident. The administrators of youth, high school, and college football, lacrosse, and ice hockey have demonstrated that dental and facial injuries can be reduced significantly by introducing mandatory protective equipment.

  References Top

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Andreasen JO, Andreasen FM. Dental trauma: Quo vadis. Tandlaegebladet 1989;93:381-4.  Back to cited text no. 2
Marcenes W. Al Beiruti N, Tayfour D, Issa S. Epidemiology of traumatic injuries to the permanent incisors of 9-12 year old school children in Damascus Syria. Endod Dent Traumatol 1999;15:117-23.  Back to cited text no. 3
Andreasen JO, Andreasen FM. Textbook and colour atlas of traumatic injuries to the teeth. 3 rd ed. Co-penhagen: Munksgaard; 1994.  Back to cited text no. 4
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Hamilton FA, Hill FJ, Holloway PJ. An investigation of dento-alveolar 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;182:91-5.  Back to cited text no. 6
Marcenes W, Murray S. Social deprivation and dental injuries among 14-year old school children in Newham, London. Endod Dent Traumatol 2000;16:1-4.  Back to cited text no. 7
Cortes MI, Marcenes W, Sheiham A. Prevalence and correlates of traumatic injuries to the permanent teeth of schoolchildren aged 9-14 years in Belo Horizonte, Brazil. Endod Dent Traumatol 2001;17:22-6.  Back to cited text no. 8
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  [Table 1], [Table 2], [Table 3], [Table 4]


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