|Year : 2020 | Volume
| Issue : 1 | Page : 84-90
Retrospective analysis of traumatic dental injuries in the western black sea region of Turkey
M Gokcek1, S Durmuslar2, F Kokturk3
1 Department of Pediatric Dentistry, Faculty of Dentistry, Karabük University, Karabük, Turkey
2 Department of Pediatric Dentistry, Faculty of Dentistry, Bülent Ecevit University, Zonguldak, Turkey
3 Department of Biostatistics, Faculty of Medicine, Bülent Ecevit University, Zonguldak, Turkey
|Date of Submission||25-Apr-2019|
|Date of Acceptance||09-Sep-2019|
|Date of Web Publication||10-Jan-2020|
Dr. M Gokcek
Department of Pediatric Dentistry, Faculty of Dentistry, Karabuk University, Karabuk
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: The incidence of traumatic dental injuries is affected by social, environmental, and socioeconomic variables. For this reason, epidemiological studies are an important tool for increasing social consciousness and guiding the necessary precautions about trauma. Objectives: The study aims to analyze the epidemiological and clinical data of traumatic dental injuries in patients attending Department of Pediatric Dentistry, Faculty of Dentistry, Bulent Ecevit University, from around Zonguldak, over a period of 3 years (between January 2014 and January 2017). Materials and Methods: Data obtained from trauma charts were analyzed for age, sex, the time elapsed between injury and referral to the clinic, cause of trauma, number, and type of the teeth, type of the trauma, treatment, and seasonal distribution. Results: In all, 188 patients, including 120 boys and 68 girls with a total of 316 traumatized teeth were evaluated. Most (61.7%) of the patients were 7–12 years old (the remaining 38.3% were 1–6 years old). The main cause of injury in both genders was falling. The most common types of trauma were subluxation in primary teeth and enamel dentin fracture in permanent teeth. In the primary dentition, examination and follow-up were the most applied treatments, whereas in permanent dentition, restorative treatments were the most applied treatments. Conclusion: Early intervention is important for the prognosis of the injured tooth. However, except for severe injuries, the rate of referral to the clinic after trauma was low. Therefore, the level of social awareness and knowledge of trauma should be increased.
Keywords: Dental trauma, permanent teeth, primary teeth, retrospective analysis
|How to cite this article:|
Gokcek M, Durmuslar S, Kokturk F. Retrospective analysis of traumatic dental injuries in the western black sea region of Turkey. Niger J Clin Pract 2020;23:84-90
|How to cite this URL:|
Gokcek M, Durmuslar S, Kokturk F. Retrospective analysis of traumatic dental injuries in the western black sea region of Turkey. Niger J Clin Pract [serial online] 2020 [cited 2020 Jan 26];23:84-90. Available from: http://www.njcponline.com/text.asp?2020/23/1/84/275615
| Introduction|| |
Trauma in the oral region comprises 5% of all injuries for which people require treatment, and dental injuries are the most frequent type of oral injuries. Dental trauma is the effect of an accidental event affecting the teeth and their supporting structures. In preschool children, dental traumas are the most frequent result of falls, whereas sports accidents or impacts usually occur in school-age children. Dental trauma can have short-term (e.g. discoloration, pain, infection, or loss of teeth) and long-term (e.g. malformation of permanent teeth, loss of alveolar bone, and insufficiency growth of jaws) consequences. These problems have a distressing effect on the physical, emotional, and psychological status of children and have a negative impact on their lives.
Parents' lack of knowledge about traumatic dental injuries and its consequences has revealed the need for informing them about traumatic dental injuries and benefits of early intervention. To inform parents about dental traumas, it is important to know how and where dental traumas occur, as well as the etiological factors and type of dental trauma. Therefore, epidemiological studies are needed before attempting to increase public awareness about dental trauma cases and the necessary precautions.
This study was carried out to retrospectively analyze dental trauma records of patients referred to the Department of Pediatric Dentistry, Faculty of Dentistry, Bulent Ecevit University, from around Zonguldak between January 2014 and January 2017.
| Materials and Methods|| |
Department of Pediatric Dentistry, Faculty of Dentistry, Bulent Ecevit University in Zonguldak is an important center for pediatric patients in the Western Black Sea Region of Turkey. This retrospective study was conducted in this faculty using the documentation of 188 patients age 1–12 years with traumatic dental injury between January 2014 and January 2017. The study was ethically approved by the Clinical Research Ethics Commission of our Institute (2017-08-11/01).
The clinical and radiologic findings of patients were recorded on trauma charts by a pediatric dentist. Data obtained from these charts were analyzed for age, sex, the time elapsed between injury and referral to the clinic, cause of trauma, number, and type of the teeth, type of the trauma, treatment, and seasonal distribution. The causes of trauma were classified as falls, game accidents, sports accidents, physical violence, traffic accidents, and other reasons. The type of the trauma was classified according to the Andreasen and Andreasen trauma classification.
Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) for Windows, version 21. Chi-square test was used to determine the relationship between categorical variables. The level of significance was set at P < 0.05.
| Results|| |
During the 3-year period, we evaluated the dental trauma records of 188 patients, including 120 boys (63.8%) and 68 girls (36.2%), with a total of 316 traumatized teeth. Patients ranged between 1 and 12 years old (mean, 7.08 ± 3.21 years).
Statistical analyses were performed according to the total number of patients when the data were effective on the person and according to the total number of teeth when the data were effective on the teeth.
According to age groups, 38.3% of patients were 1–6 years old and 61.7% of patients were 7–12 years old. The highest frequency of trauma occurred at the age of 8 years (N = 29), followed by 10 (N = 25) and 9 (N = 24), years. In both age groups, males predominated, but this did not reach statistical significance (P = 0.588) [Figure 1].
|Figure 1: Distribution of Dental Injurries According to Gender and Age of Patients|
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The main cause of injury in both genders was falls (75%), followed by game accidents (20.2%) [Figure 2]. Dental traumas occurred most frequently in summer months (31.9%), and there were no statistically significant differences among the seasons (P = 0.649).
|Figure 2: Distribution of causes of traumatic injuries according to gender|
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Regarding the time elapsed until the first emergency treatment, 31.4% of injuries were seen within 24 h. Statistically, there was no significant difference between elapsed time intervals in the 1–6 years old group, but in the 7–12 years old group, ≥8-day referrals were statistically significant (P = 0.003) [Table 1].
|Table 1: Elapsed time following dental injury classified according to age group|
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Among all patients, 15.4% (N = 29) had concomitant soft tissue injury. Patients with soft tissue injuries tended to attend the clinic earlier, and there was a statistically significant difference between the first 24 h of appeals and late referrals (P = 0.001) [Table 2].
|Table 2: Elapsed time following dental injury classified according to concomitant soft tissue injury|
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The number of injured teeth per child was 1.68. Only one tooth was involved in 49.4% of the patients, two teeth were injured in 39.4%, and three or more teeth were injured in 11.2%. In addition, it was found that traumas affecting three and four teeth were seen more frequently in the 1–6 years old age group, but this did not make a statistically significant difference (P = 0.236).
Of the 316 affected teeth, 128 (40.5%) were primary teeth and 188 (59.5%) were permanent teeth. In all, 297 of the traumatized teeth (94%) were located in the maxillary arch and 19 (6%) were located in the mandibular arch. The maxillary central incisors were found to be the teeth most affected by dental trauma in both primary and permanent teeth, and both dentition right and left central incisors were affected in similar proportions [Figure 3].
The most common types of trauma were enamel-dentin fracture (N = 123), subluxation (N = 49), and avulsion (N = 38).
There were statistically significant differences between primary and permanent teeth according to trauma type (P = 0.001). Enamel-dentin fractures were more common in permanent teeth, while subluxation injuries were more common in primary teeth [Table 3].
Periodontal tissue injuries occurred significantly more often in primary teeth, and dental hard tissue injuries were found to be more frequent in the permanent teeth (P = 0.001) [Table 4]. The type of dental injury was found to be significantly associated with age. The 1–6 years old age group had more periodontal tissue injuries, whereas the 7–12 years old age group had more dental hard tissue injury (P = 0.000).
A statistically significant difference was found in both periodontal tissue injuries and tooth hard tissue injuries according to the time elapsed between trauma and referral to the clinic (P = 0.001). In periodontal tissue injury, it was found that there was a significant difference depending on the time elapsed and that the majority of patients reported to the clinic in the first 24 h. In dental hard tissue injuries, the majority of patients reported to the clinic in ≥8 days after injury, which was significantly higher than the first 24-h and 2- to 7-day referral groups [Table 5].
There were statistically significant differences between tooth type and treatment (P = 0.000) [Table 6]. In primary dentition examination, follow-up and extraction were the most applied treatments, whereas in permanent dentition, restorative treatments were mostly applied. It was determined that 60 teeth could not be treated after the clinical examinations because the patients did not attend treatment and follow-up appointments.
| Discussion|| |
Traumatic dental injuries are time-consuming and costly treatments, which are barriers to seeking treatment. Therefore, ways of protecting against dental traumas are being developed., The factors leading to trauma need to be fully understood when developing strategies to prevent dental trauma. Retrospective studies are an important method in providing information about how traumatic injuries occur and the underlying etiologic factors.
In our study, in accordance with other studies,,,,, boys were exposed to trauma more than girls. This might be due to the fact that boys take a more active role in their social lives and prefer more aggressive sports than girls.,, In addition, it is suggested that pubertal growth occurs later in boys and that girls mature at earlier ages. Girls also avoid risky behaviors, and this situation reduces their incidence of traumatic injuries., However, in some studies, it has been reported that there is no statistically significant difference in dental trauma incidence when comparing boys and girls., This might be because girls now participate in sports activities much more than in previous decades. On the other hand, girls might be more likely to seek treatment than boys, perhaps because of esthetic concerns.
In this study, the incidence of dental trauma was found to be higher in children between 7 and 12 years of age, and in line with the findings of Altun et al., more dental trauma occurred between the ages of 8 and 10 years. This might be because children in the 7–12 years old age group take a more active role in social life. Similar to other studies,,, falling was the most common cause of dental trauma in both age groups. In addition, it has been observed that game accidents occur more frequently in children age 7–12 years than in 1- to 6-year-old children. This might be because school-aged children start to spend time outdoors and their play involves more physical contact.
The seasonal distribution of dental traumas shows that the incidence of dental trauma increased in summer months, a finding that is similar to other studies., This situation might be associated with enhanced outdoor activities associated with the summer months. When children are outdoors, their physical activities might lead to an increase in dental trauma. In addition, parents or caregivers have difficulty in controlling children's movements in large playgrounds and parks.,
In a study conducted by Choi et al. in Korea, 62.8% of the children reported to the clinic within 24 h after dental trauma. Kurt et al. reported a 24.8% referral rate on the trauma day. In our study, 31.4% of patients were brought to the clinic within 24 h. This deficiency in early referral rates indicates that in our society, traumatic dental injuries are disregarded and patients do not always go to a dentist., On the other hand, Kırzıoǧlu et al. reported that awareness of dental trauma was increased by providing education to parents and teachers about traumatic dental injuries. In addition, Zencircioǧlu et al. reported that patients go to the nearest health facility in case of dental trauma because of the difficult access to dental services in Turkey. Our faculty is the only institution in Zonguldak and the surrounding provinces where there are specialist physicians to treat dental traumas seen in children, and this might be the reason for the low rate of admissions in the first 24 h.
It was observed that children who were exposed to traumatic dental injuries at a young age were brought to the clinic within a shorter time. This might be a result of parents' anxiety to seek treatment in young children.
The trauma type is also thought to be an important factor affecting the time of referral to clinics. In a retrospective analysis conducted by Ajayi et al., it was reported that the majority of patients who applied to the clinic within a week of trauma had a severe dental injury. Atabek et al. reported that 55.5% of the patients who applied to the clinic within 1 h had avulsion injury. In our study, in the presence of severe injuries, such as lateral luxation, extrusion, avulsion, and intrusion, the rates of referral to the clinic were higher in the first 24 h. It was also found that patients with periodontal tissue injuries were treated within a shorter time compared with patients with dental hard tissue injuries. Vuletić et al. reported that the time between the occurrence of trauma and referral to the clinic was shorter in hemorrhagic soft-tissue injuries, and this was due to the increased anxiety of the families when bleeding occurred. Similarly, in our study, patients with soft tissue injuries reported to the clinic within a shorter period of time. Zencircioǧlu et al. reported that approximately one-third of the patients apply to the emergency room after a dental trauma, even if there was no physical injury, but that they could not get proper treatment from emergency room physicians.
Glendor reported that the majority of traumatic injuries are related to a single tooth, and multiple tooth trauma is typically caused by sports, violence, and traffic accidents. In our study, 49.5% of patients had trauma to one tooth, and the average number of teeth affected was 1.68 per patient. There are similar studies in the literature.,, In a retrospective analysis conducted by Caldas and Burgos in young children, more teeth were affected, and more serious conditions occurred by traumatic dental injuries. This can be explained by the fact that the necessary motor coordination of young children is not fully developed, so they are more prone to traumas. In addition, the primary teeth are smaller in size so that they are positioned closer to each other in a narrower area, thus the risk of more teeth being affected. In addition, primary teeth are less resistant to tooth movement; the ability of the teeth to move more easily can lead to an increase of multiple dental traumas. In our study, we found that multiple dental trauma was more common in 1–6 years old group, but no significant relationship was found.
In our study, like many other studies, it was found that the most affected teeth in both primary and permanent teeth were maxillary incisors.,, The upper central incisors are positioned at the front of the dental arch and are generally more proclined than the other teeth, so trauma comes directly to them., In addition, when the maxillary incisor teeth are placed in the protruded position, the absence of sufficient lip support to absorb the incoming strike might cause these teeth to be more affected by traumas.,
In our study, it was observed that periodontal tissue injuries were the most frequent type of trauma in primary teeth, and dental hard tissue injuries were mostly detected in permanent teeth. This can be explained by the fact that the supportive tissues of the primary teeth are more elastic, the roots are shorter, and alveolar bone support is relatively less, so primary teeth are more prone to displacement. Permanent teeth are more susceptible to fracture by being held tighter to the alveolar bone. It is thought that the alveolar bone and periodontal ligament, which have more flexibility in primary teeth, absorb traumatic force relatively more, and thus cause tooth replacement before fracture of the dental hard tissue.,
The literature includes studies reporting different results for the most common types of trauma in primary teeth. Güler et al. reported that the most common trauma in the primary teeth was intrusive luxation, whereas Eyuboglu et al. reported that this was lateral luxation. In our study, the most common type of trauma in primary teeth was determined as a subluxation, similar to the results of Elbay et al. The most common type of trauma in permanent teeth was enamel-dentine fractures, which is similar to the results of other studies.,
In our study, we found that the most common treatments in primary teeth were examination and follow-up, while restorative treatments were applied mostly in permanent teeth, which is compatible with other studies in the literature., Atabek et al. reported that although the most common type of trauma in the permanent teeth was an uncomplicated crown fracture, the most common treatment was root canal treatment. This was accounted for by the loss of vitality of the tooth because of late referral to the clinic.
Based on a literature review, we propose that traumatic injuries are a serious social problem. However, the low rate of referral to clinics is a sign of a lack of social awareness in trauma cases. Dentists are responsible for informing the society, thereby increasing social awareness about emergency trauma treatment, especially among families, teachers, and sports trainers.
| Conclusion|| |
1)Traumatic dental injuries usually occur during daily activities at home or in schools.
2)Early intervention is important for the prognosis of the injured tooth but, except for severe injuries, the rate of referral to the clinic after trauma was low.
3)This situation is an indicator of the lack of social consciousness. Therefore, the level of social awareness and knowledge of trauma should be increased.
The study was presented as oral presentation at 1st International Congress of Preventive Dentistry
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]