|Year : 2015 | Volume
| Issue : 1 | Page : 86-89
Evaluation of traumatic dental injuries in a group of Turkish population
AZ Zengin1, P Celenk1, AP Sumer1, S Cankaya2
1 Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, University of Ondokuz Mayis, Samsun, Turkey
2 Department of Biostatistics, Faculty of Medicine, University of Ordu, Ordu, Turkey
|Date of Submission||01-Sep-2014|
|Date of Web Publication||15-Dec-2014|
A Z Zengin
Department of Oral Diagnosis and Radiology, Faculty of Dentistry, University of Ondokuz Mayis, Samsun 55139
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Traumatic dental injuries (TDIs) are significant clinical problems that may have complex etiologies and may cause physical and physiological impairment.
Aim: The aim of this study was to determine the demographic and clinical characteristics of TDIs in a group of Turkish subjects.
Materials and Methods: The prevalence of TDIs and the pattern of traumatized teeth were studied in relation to age, gender, cause, location, and type of injury. This study was carried out to include all age groups and teeth. TDIs were recorded using the World Health Organization classification modified by Andreasen et al.
Results: The prevalence of TDIs was found to be 4.4% (255 injured patients/5800 presented patients), and the injuries were most commonly observed in the age group of 11-20 years. Males were more affected than females (males, 153; females, 102). The most common cause of traumatic injury was falling (68.2%), and the most common place of trauma was outdoors (56.1%). 4, 7% of patients injured because of their systemic diseases. The most frequently injured teeth were the upper central incisors (primary teeth, 64.5%; permanent teeth, 72.5%), and the most common type of dental injury was uncomplicated crown fracture in both primary (63%) and permanent dentition (47%).
Conclusion: In the surveyed population, the prevalence of TDIs was found to be low. However, the teacher and family of adolescents and the caregivers of patients with some systemic diseases like epilepsy should be warned about TDIs.
Keywords: Dental trauma, etiology, prevalence
|How to cite this article:|
Zengin A Z, Celenk P, Sumer A P, Cankaya S. Evaluation of traumatic dental injuries in a group of Turkish population. Niger J Clin Pract 2015;18:86-9
|How to cite this URL:|
Zengin A Z, Celenk P, Sumer A P, Cankaya S. Evaluation of traumatic dental injuries in a group of Turkish population. Niger J Clin Pract [serial online] 2015 [cited 2020 Nov 30];18:86-9. Available from: https://www.njcponline.com/text.asp?2015/18/1/86/146985
| Introduction|| |
Oral health plays an important role in one's overall quality of life. Traumatic dental injuries (TDIs) constitute a significant clinical health problem;  these can not only cause the displacement or loss of teeth but can also cause medical, aesthetic, functional, and psychological problems.  These are accidental injuries, which can take place during infancy, childhood, adolescence, and adulthood.  TDIs and their sequelae often require advanced treatment, , and imply very high costs for patients insurance companies, and public health services. ,
There are some differences between studies and countries regarding the most effective etiological factors of TDI, although accidental falls appear to be the most common factor. ,,,,, A consideration of the factors that might cause TDIs are important to prevent a new generation from their effects. 
A limited number of studies regarding dental traumas have been carried out on children in Turkey. ,,,,, Studies conducted on adults generally focus on a particular group such as sportsmen. ,, In this study, which deals with a large age group, we aimed to determine the demographic and clinical characteristics of TDIs from the records of traumatized subjects who attended the Oral Diagnosis and Radiology Clinic of the Dentistry Faculty at Ondokuz Mayis University, Black Sea coastal region.
| Materials and Methods|| |
The records of traumatized patients who attended the Oral and Maxillofacial Radiology Clinic of the Dentistry Faculty at Ondokuz Mayis University in a 7 months period were retrieved. All patients were Turkish and from the Black Sea coastal region. Informed consent was obtained from all participating adults and from parents.
The dental trauma forms comprised the following items: Patient's age, gender, systemic disease, place of occurrence, cause and type of injury, intraoral and extraoral examinations, radiographic examination (periapical or/and panoramic radiographs), diagnosis and number, and type and localization of teeth involved. The unusual or uncommon causes were grouped as "other." The same calibrated investigator (intra-examiner calibration) performed the clinical and radiographic examinations of all subjects, who is a specialist at Oral and Maxillofacial Radiology and has 10 years of work experience.
In the forms, TDIs were recorded according to the World Health Organization (WHO) classification system  that was slightly modified by Andreasen et al.,  which included:
- Injuries to the hard dental tissues and pulp: Crown infraction, uncomplicated and complicated crown fracture, complicated and uncomplicated crown-root fracture, and root fractures
- Injuries to the periodontal tissues: Concussion, subluxation, extrusive luxation, lateral luxation, intrusive luxation, and avulsion.
Data were analyzed using Chi-square (χ2 ) test and Z-test. χ2 analysis was applied to determine whether patients' injury ratio was statistically dependent on age and/or gender. Z-test was then utilized to identify any further differences between the injury ratio for each age group of the same gender (between 5-10 and 11-20, 0-10 and 21-30, 11-20 and 21-30, etc.) and between genders of each age group (0-10, 11-20, 21-30, 31-40, etc.). All the computational work was performed using MINITAB (MINITAB 2000, MINITAB Statistical Software, Release 13.20; Minitab Inc. State College, PA, USA).
| Results|| |
During the 7-month period, a total of 5800 patients of all ages presented to our clinic. Of these patients, 255 were found to have suffered from TDIs. The age range was 5-55 years. TDIs were most frequently observed in the age group of 11-20 years (P = 0.01), followed by the age group of 5-10, 21-30, 31-40, 41-50, and 50 + years. TDIs were most commonly seen in males (n: 153, 60%) as compared to females (n: 102, 40%; male/female = 3/2). The highest frequency in females was seen in the age group of 5-10 years, followed by the age groups of 11-20, 21-30, 31-40, 41-50, and 50+ years. The highest frequency in males was seen in the age group of 11-20 years, followed by the age groups of 5-10, 21-30, 31-40, 41-50 and 50 + years. However, no statistical differences were observed between other age groups (P > 0.05).
Traumatic dental injuries mostly took place outdoors (143, 56.1%), followed by at school (72, 28.2%), and finally at home (40, 15.7%). The three main etiologies of TDIs were falling (57.6%), hitting an object (31.8%), and collision (10.6%). Twelve patients (4.7%) had injuries because of their systemic diseases which included spasticity, myasthenia gravis, schizophrenia, hypotension, mental retardation, and epilepsy.
Two hundred and fifty-five patients had 405 injured teeth (374 permanent teeth and 31 primary teeth). The mean number of injured teeth per injured patient was 1.7. Some patients (108, 42.4%) had injured more than one tooth. Of the 374 permanent teeth, 333 (89%) were maxillary, 41 (11%) were mandibular, 356 (95.2%) were incisors, 6 (1.6%) were premolars, and 12 (3.2%) were molars. In addition, 182 (48.7%) teeth were on the right side, and 192 (51.3%) teeth were on the left.
No statistical difference was observed between the right and left sides of the maxilla and mandible (P > 0.05). Except for a canine tooth, the other injured primary teeth were upper incisors. And 16 (51.6%) primary teeth were right, and 15 (48.4%) primary teeth were left teeth.
In both permanent and primary teeth, the most frequently injured teeth were maxillary central incisors (primary, 64.5%; permanent, 72.5%), followed by maxillary lateral incisors (primary, 32.3%; permanent, 12.6%). [Table 1] and [Table 2] show the distribution of injured permanent and primary teeth according to their location.
|Table 1: Distribution of injured permanent teeth according to their location |
Click here to view
|Table 2: Distribution of injured primary teeth according to their location |
Click here to view
The most common dental hard tissue and pulp injury observed was uncomplicated crown fracture in both primary and permanent dentition (primary, 63%; permanent, 47%).
In the permanent dentition, enamel fracture, complicated crown fracture, root fracture, enamel fracture, uncomplicated crown-root fracture and complicated crown-root fracture and in the primary dentition complicated crown fracture were also observed respectively.
[Table 3] shows the distribution of permanent and primary teeth according to the injuries to the periodontal tissue.
|Table 3: Distribution of permanent and primary teeth according to the injuries to the periodontal tissue |
Click here to view
| Discussion|| |
Traumatic dental injuries are significant clinical problems that have complex etiologies. They may cause physical and physiological impairment  and often require long-term management. ,, The causes and incidences of TDIs have been widely studied, and different classification systems have been used. ,, While Noori and Al-Obaidi  assessed TDIs according to the Garcia-Godoy's classification, Ajayi et al.  used WHO classification slightly modified with Ellis and Davey's, Navabazam and Farahani  used Ellis's classification modified by Holland; most of the previous studies have , used Andreasen et al. classification.  We also used Andreasen et al. classification based on the classification adopted by WHO. 
There is a large variability in the reported prevalence of injuries because of the different types of studies used. Sources of variability include the classification of traumas and the choice of different study groups.  In Asia, the prevalence of traumatic injuries among adolescents range from 4% to 35%; , in the Middle East, injuries among the different ethnic groups was reported as 7.4%.  Little information is available on the reported prevalence of TDI in Turkey, and especially, they have been conducted on children (17.4% and 4.9%) ,,,,, and about subjects who participate in sports (7.4%). ,
In the present study, the prevalence of TDIs was found to be 4.4% (255 injured patients/5800 presented patients). This result was lower than that recorded by most of the previous studies, ,,, but was similar to the results of Nik-Hussein  (4.1%) and Eyuboglu et al. studies  (4.9%). The differences might be, as a result, of the definition of injury, data collection method, dentition research, and age variations.
In the present study, TDIs were most frequently observed in the age group of 11-20 years. This result is similar to that recorded by Gulinelli et al.,  and may be attributed to young people usually engaging in more activity and being more heavily involved in sports.
The results of the present study are similar to the previously reported data, in that they suggest that males generally suffer more TDIs than females, ,,, especially in the age group of 11-20 years. Osunde et al.  confirm that males are more prone to maxillofacial injuries than females. Rajab  and Eyuboglu et al.  have suggested that males may be more active than females.
In our study, 4, 7% of patients were injured because of their systemic diseases. Therefore, the family or caregivers nurse of these patients should be warned about TDIs to prevent and minimize the effect of trauma that may be occurred. Furthermore, we consider that more studies are needed to find the epidemiology of injuries caused by systemic diseases and their types.
In accordance with other studies, the mean number of injured teeth per injured patient was 1.7. , According to the results of this study, the most frequently injured teeth were the maxillary central incisors, in both permanent and primary dentition, as found in other studies. ,,, In the permanent dentition, the most commonly injured teeth were the maxillary central incisors, followed by the maxillary lateral incisors and mandibular central incisors. And for the primary dentition, the maxillary central incisors, lateral incisors, and canines were the most commonly affected. There was no record of injuries to the primary molar and primary mandibular teeth.
Although Navabazam and Farahani  reported that the left maxillary incisors were affected more than the other side, in the present study, no differences were found between the right and left sides. In accordance with the other studies, the most common injury observed was uncomplicated crown fracture in both primary and permanent dentition. ,
There is little variation between the studies regarding the etiological factors of dental trauma. Similar to the previous reports, ,,,,,,, the results of the present study showed that the main cause of injury was falling.
In this paper, the demographic and clinical characteristics of TDIs were presented for a group of Turkish patient from Black Sea coastal region.
| References|| |
Andreasen JO, Andreasen FM, Andersson L. Textbook and Color Atlas of Traumatic Injuries to the Teeth. 4 th
ed. Copenhagen: Blackwell Munksgaard; 2007.
Cortes MI, Marcenes W, Sheiham A. Impact of traumatic injuries to the permanent teeth on the oral health-related quality of life in 12-14-year-old children. Community Dent Oral Epidemiol 2002;30:193-8.
Andreasen JO, Andreasen FM. Dental traumatology. Endod Dent Traumatol 1990; 6:78-80.
Kuo J, Lin J YT. Treatment of traumatized maxillary central incisors. J Dent Sci 2011; 6: 239-244.
Skucha-Nowak M, Cieslik-Wegemund M, Skaba D, Tanasiewicz M, Pawliszyn E. Transverse fracture of a tooth as a consequence of long-term traumatic occlusion-A case report. J Dent Sci 2010; 5: 237-241.
Borum MK, Andreasen JO. Therapeutic and economic implications of traumatic dental injuries in Denmark: An estimate based on 7549 patients treated at a major trauma centre. Int J Paediatr Dent 2001;11:249-58.
Wong FS, Kolokotsa K. The cost of treating children and adolescents with injuries to their permanent incisors at a dental hospital in the United Kingdom. Dent Traumatol 2004;20:327-33.
Avsar A, Topaloglu B. Traumatic tooth injuries to primary teeth of children aged 0-3 years. Dent Traumatol 2009;25:323-7.
Altay N, Güngör HC. A retrospective study of dento-alveolar injuries of children in Ankara, Turkey. Dent Traumatol 2001;17:201-4.
Lam R, Abbott P, Lloyd C, Lloyd C, Kruger E, Tennant M. Dental trauma in an Australian rural centre. Dent Traumatol 2008;24:663-70.
Navabazam A, Farahani SS. Prevalence of traumatic injuries to maxillary permanent teeth in 9- to 14-year-old school children in Yazd, Iran. Dent Traumatol 2010;26:154-7.
Siqueira MB, Gomes MC, Oliveira AC, Martins CC, Granville-Garcia AF, Paiva SM. Predisposing factors for traumatic dental injury in primary teeth and seeking of post-trauma care. Braz Dent J 2013;24:647-54.
Jesus MA, Antunes LA, Risso Pde A, Freire MV, Maia LC. Epidemiologic survey of traumatic dental injuries in children seen at the Federal University of Rio de Janeiro, Brazil. Braz Oral Res 2010;24:89-94.
David J, Astrøm AN, Wang NJ. Factors associated with traumatic dental injuries among 12-year-old schoolchildren in South India. Dent Traumatol 2009;25:500-5.
Eyuboglu O, Yilmaz Y, Zehir C, Sahin H. A 6-year investigation into types of dental trauma treated in a paediatric dentistry clinic in Eastern Anatolia region, Turkey. Dent Traumatol 2009;25:110-4.
Altun C, Ozen B, Esenlik E, Guven G, Gürbüz T, Acikel C, et al.
Traumatic injuries to permanent teeth in Turkish children, Ankara. Dent Traumatol 2009;25:309-13.
Toprak ME, Tuna EB, Seymen F, Gençay K. Traumatic dental injuries in Turkish children, Istanbul. Dent Traumatol 2014;30:280-4.
Karayilmaz H, Kirzioglu Z, Erken Gungor O. Aetiology, treatment patterns and long-term outcomes of tooth avulsion in children and adolescents. Pak J Med Sci 2013;29:464-8.
Cetinbas T, Yildirim G, Sönmez H. The relationship between sports activities and permanent incisor crown fractures in a group of school children aged 7-9 and 11-13 in Ankara, Turkey. Dent Traumatol 2008;24:532-6.
Keçeci AD, Eroglu E, Baydar ML. Dental trauma incidence and mouthguard use in elite athletes in Turkey. Dent Traumatol 2005;21:76-9.
Sepet E, Aren G, Dogan Onur O, Pinar Erdem A, Kuru S, Tolgay CG, et al.
Knowledge of sports participants about dental emergency procedures and the use of mouthguards. Dent Traumatol 2014;???:.
Application of the international classification of diseases to dentistry and stomatology. IDG-DA. WHO, Geneva 1995.
Gulinelli JL, Saito CT, Garcia-Júnior IR, Panzarini SR, Poi WR, Sonoda CK, et al
. Occurrence of tooth injuries in patients treated in hospital environment in the region of Araçatuba, Brazil during a 6-year period. Dent Traumatol 2008;24:640-4.
Noori AJ, Al-Obaidi WA. Traumatic dental injuries among primary school children in Sulaimani city, Iraq. Dent Traumatol 2009;25:442-6.
Ajayi DM, Abiodun-Solanke IM, Sulaiman AO, Ekhalufoh EF. A retrospective study of traumatic injuries to teeth at a Nigerian tertiary hospital. Niger J Clin Pract 2012;15:320-5.
Nik-Hussein NN. Traumatic injuries to anterior teeth among schoolchildren in Malaysia. Dent Traumatol 2001;17:149-52.
Hamdan MA, Rajab LD. Traumatic injuries to permanent anterior teeth among 12-year-old schoolchildren in Jordan. Community Dent Health 2003;20:89-93.
Lin S, Sela G, Haik J, Bigman G, Peleg K. Dento-alveolar and maxillofacial injuries among different ethnic groups in Israel. Dent Traumatol 2009;25:328-31.
Osunde OD, Amole IO, Ver-or N, Akhiwu BI, Adebola RA, Iyogun CA, et al.
Pediatric maxillofacial injuries at a Nigerian teaching hospital: A three-year review. Niger J Clin Pract 2013;16:149-54.
Rajab LD. Traumatic dental injuries in children presenting for treatment at the Department of Pediatric Dentistry, Faculty of Dentistry, University of Jordan, 1997-2000. Dent Traumatol 2003;19:6-11.
Ajayi MD, Denloye O, Abiodun Solanke FI. The unmet treatment need of traumatized anterior teeth in selected secondary school children in Ibadan, Nigeria. Dent Traumatol 2010;26:60-3.
Akama MK, Chindia ML, Macigo FG, Guthua SW. Pattern of maxillofacial and associated injuries in road traffic accidents. East Afr Med J 2007;84:287-95.
[Table 1], [Table 2], [Table 3]