Prevalence of Traumatic Dental Injuries
among School Children age 9-12 years in
KHARTOUM STATE
Magda M. Mutwakil MSc, PhDHead of Paediatric Dentistry, Faculty of Dentistry - University of Khartoum
Head of Paediatric Dentistry Council – Sudan Medical Specialization Board
Outline
Definition of T.D.I
Classification
T.D.I Globally
T.D.I in Sudan
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Traumatic Dental Injuries (TDI)
• Definition:
Trauma means a wound or injury ,it could be physical
or psychic.
Physical trauma applies when a wound or injury is
inflicted on the body by an external force and that
may lead to dystrophic changes and/or inflammatory
response of the affected part.
Dorland's Pocket Medical Dictionary, 25th ed. Philadelphia: W. B. Saunders; 1995. P. 829.
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Traumatic dental injuries:-
• Pain
• Esthetic
• Psychological impact
• Morbidity
• Mortality
Classification of TDI
• 1942 Sweet solely on radiographic examinations
• 1945 Ellis started by 4 categories then modified by the
same author in (1948) to 8 classes
• 1978 W.H.O. developed a classification for dental
injuries which was modified by Andreasen and
Andreasen in (1990) .Variations in luxation and intrusion
injuries
• 1981 Garcia Godoy classification that consists of ten
categories, then modified by the same author in 1983.
(1) Sweet CA. Fractured anterior permanent teeth. Am Dent Assoc J 1942; 29: 97-9.
(2) Ellis RG, Davey KW. The classification and treatment of injuries to the teeth of children, 5th ed. Year book. Chicago: Medical Publishers
Inc; 1970. P. 32.
(3) Application of the international classification of diseases and stomatology. ICD DA, 3rd ed. Geneva: World Health Organization; 1992.
(4) Andreasen JO, Andreasen FM. Classification, etiology and epidemiology of traumatic dental injuries. Text Book and Colour Atlas of
Traumatic Injuries to the Teeth, 3rd ed. Copenhagen: Munksgaard; 1994. P. 151-177.
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TDI Globally • Epidemiological studies indicate the annual incidence
of dental trauma globally is at about 4.5%.
Approximately one-third of children and toddlers
(primary teeth) and one-fifth of adolescents and
adults (permanent teeth) sustained a traumatic dental
injury. (1)
• The incidence of traumatic dental injuries is 1%–3%,
and the prevalence is steady at 20%–30%. (2)
• Etiologic factors vary between countries and with
age groups. (2)
(1) Lam R Epidemiology and outcomes of traumatic dental injuries: a review of the literature. Aust Dent
J. 2016 Mar;61 Suppl 1:4-20
(2) LarsAndersson Epidemiology of Traumatic Dental Injuries Journal of Endodontics Volume 39, Issue
3, Supplement, March 2013, Pages S2-S56
TDI in Sudan
Baghdady et al conducted a comparative study 1981:
• A prevalence of 19.5% for TDI in boys at the age of 12
years in Iraq
Compared to 16.5% in boys in the same age group in
Sudan
• A prevalence of 16.1% for TDI among girls of the
same age group in Iraq.
Compared to 3.6% in girls in the same age group in Sudan
• A recent study on TDI in Wad Madani revealed
prevalence of 9.2%
(1)Virgin B, Leonore J, Ghose S, Helmute NKE. Traumatized anterior teeth in Iraqi and Sudanese children. A comparative study. J Dent
Res 1981; 60 (3): 667-76.
(2) Sahar M Elyas prevalence of traumatic Dental Injuries and associated risk factors among Sudanese school children Pediatric
Dentistry , MSc, Sudan, University of Khartoum. 2015
justification
• Prevalence of traumatic injuries among school
children in Khartoum has not been investigated
since 1981, a period during which social, cultural
and economical changes had occurred and indeed
its reflection on prevalence of trauma is expected.
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Prevalence of T. D. I.
Main objective
To estimate the prevalence of traumatized anterior
teeth in school children age 9-12 years in Khartoum
state.
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Methodology• Study Area:
Khartoum State : seven localities ,three major localities, greater Khartoum, greater Omdurman and greater Khartoum north were selected as study areas.
• Sample size: 1920 school children age 9-12 years
• Design: Multistage stratified sampling technique
• Both private and public schools (sampling units) .
• Cases were Randomly selected (inquiry unit).
Prevalence of T. D. I.
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2 public schools
(160 students)
Age 9-40 student
Age 10-40 student
Age 11-40 student
Age 12-40 student
2 private schools
(160 students)
Age 9-40 student
Age 10-40 student
Age 11-40 student
Age 12-40 student
Sample distribution chart-Khartoum State
(1920) -24 schools
Greater
Khartoum
(640student)
8 Schools
Greater
Omdurman
(640student)
8 Schools
Khartoum
North
(640student)
8 Schools
4 boys schools
(320 students)4 girls schools
(320 students)
2 private
schools
(160 students)
2 public
schools
(160
Students)
Prevalence of T. D. I.
The prevalence was studied according to:
• Age
• Gender
• Socioeconomic status of the Parents.
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Prevalence of T. D. I.
• The correlation between :-
The occlusion status;
The overjet;
The over bite;
The upper lip position and prevalence of trauma was investigated.
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Results
Prevalence of T. D. I.
prevalence of traumatic dental injuries
28%
72%
with trauma
without trauma
542 students had 633 fractured teeth.
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Boys showed a slight increase in prevalence of fractured
anterior teeth than girls ( 52%,48% respectively) but this was
not significant among all age groups (p = 0.99).
19.119.5
28
23.8
9.6
0
16.9
25.427.7
30
0
5
10
15
20
25
30
%
9 yrs 10 yrs 11 yrs 11 yrs 12 yrs
public private
boys
girls
p = 0.99
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School children from private schools showed a slight
increase in prevalence of traumatic injuries
28.1 27.3
71.9 72.7
30.626.9
69.4 73.1
0
10
20
30
40
50
60
70
80
%
with trauma without trauma with trauma without trauma
public private
boys
girls
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Findings:-
The Prevalence was found to:-
• Increase with the increase in the father's educational level (P=0.01).
• Not affected by the mother’s educational level p (0.7)
• Decreased in children of working mothers (30%)
• Increased in children of non-working mothers (69%).
Prevalence of T. D. I.
19
0100200300400500600700800900
Bo
ys
Gir
ls
Bo
ys
Gir
ls
Pri
ma
ry
Se
co
nd
ary
Pri
ma
ry
Se
co
nd
ary
P ublic P rivate F athers '
educational
levels
Mothers '
educational
levels
With trauma
Without trauma
P=0.01
p 0.7
P=0.7
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Most of the trauma happened at home
(55.7%) and school play ground (15.6%).
Prevalence of T. D. I.
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The most common etiological factor was falls followed by
collision .
21.820.7
1.7
0.7 0.9 0.9
5.8
21.4
18
1.10 0.5 0.3
6.1
0
5
10
15
20
25
falls collision with
objects or person
contact sport
bicycles road traffic accidents
violence or fights
don't remember
%
causes
b…girls
22
0
5
10
15
20
25
30
35
40
45
50
canine lateral central canine lateral central
Right Left
%maxilla (upper)
mandible (lower)
The most common affected teeth were the
maxillary central incisors (86.7%).
23
0
10
20
30
40
50
60
70
80
90
Ax
is T
itle
boys girls boys girls boys girls boys girls
9 yrs 10 yrs 11 yrs 12 yrs
enamel frac ture
enamel dent
enamel dentwith pulpintrus ion
extrus ion
avuls ion
dis c ol
The most common type of trauma was enamel fracture
(89.7%).
Enamel and dentin fracture (6.5%)
24
71.7
28.3
68.6
31.2
89.5
10.5
70.3
29.7
0
10
20
30
40
50
60
70
80
90
class 1 class 2
Div.1
class 2
Div. 2
class 3
Relation of trauma to anteroposterior occlusion
without trauma
withtrauma
Class division I showed statistically significant
relationship with trauma to the anterior teeth .
P=0.04
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< 0 Overjet
0-4.9
5-8.9mm > 9 N.R.
No % No % No % No %
Without Trauma 1 100 1164 77.4 184 58.1 5 33.3 24 1378
With Trauma 0 0 339 22.6 133 41.9 10 66.7 60 542
Total 1 1503 317 15 84 1920
Distribution of Traumatized Children in Relation to Overjet
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Upper lip position showed a statically highly
significant relation to trauma to the anterior teeth.
Prevalence of T. D. I.
33.3
66.762.6
37.4
71.2
28.8
76.5
23.5
0
10
20
30
40
50
60
70
80
%
0 1 2 3
upper lip positions
with trauma
without trauma
P= 0.000
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Following trauma 32 cases only out of 542
traumatized cases consulted the dentist .
Prevalence of Traumatic Dental Injuries
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Prevalence of Traumatic Dental Injuries
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The prevalence of traumatic dental
injuriesIn conclusion:
The prevalence of traumatic dental injuries among school children in Khartoum State is 28%
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Recommendation
Although it is difficult to prevent trauma occurrence
Health educational programs to the
Parents
School children and school staff
Training doctors on dealing with emergency
cases, might help reducing the number of missing
teeth due to trauma.
Acknowledgement
• Deep thanks and gratitude to my supervisor
Professor Ahmed M Suleiman
Director of University of Khartoum BDS (U of K), MSc (UK), FFDRCS (UK), PhD, (UK )
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Thank you
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