Braz Dent J (1998) 9(2): 101-104 ISSN 0103-6440
| Introduction | Material and Methods | Results and Discussion | References |
The purpose of this investigation was to estimate the prevalence of traumatic dental injuries in a sample of Brazilian pre-school children with limited access to dental care. The sample included 1,853 one-to-five-year-old children attending public nursery schools in the Federal District of Brazil. Dental injuries were clinically assessed as follows: 1) uncomplicated crown fracture, 2) complicated fracture, 3) crown discoloration, 4) intrusive luxation, 5) extrusive luxation, 6) exarticulation or extraction after trauma and 7) subluxation. The results showed that 10% (< 2 years), 12% (3-4 years) and 20% (5 years) of the children had suffered at least one type of injury clinically identified at the time of the examination. Boys and girls were similarly affected. Dental injuries were almost entirely restricted to the maxillary central incisors (88%). Single tooth injury was predominant in all age groups. In the youngest group the most common types of injuries were crown fracture (69% ) and crown discoloration (18%). However, from the age of three, crown discoloration showed percentages ranging from 41% to 47%. Prematurely lost tooth accounted for 11% of the injuries in 5-year-old children. The observed increase of dental injuries with age indicates accumulated treatment needs due to the children's limited access to dental care.
Key Words: dental injuries, trauma, primary dentition.
Traumatic dental injury to the primary dentition has been analyzed in its different aspects. Studies on its prevalence have normally included samples of children who benefitted from a public dental health care service (Andreasen and Ravn, 1972; Holm and Arvidsson, 1974; Jones et al., 1993; Norén et al., 1994). On the other hand, surveys on etiology, pathogenesis, treatment and sequelae of dental injuries have mainly comprised samples of children who were treated for dental injuries at university hospitals (Andreasen, 1981; Jones et al., 1993; Onetto et al., 1994; Norén et al., 1994; Fried and Erickson, 1995).
In Brazil, pre-school children are not enrolled in any organized public dental health care and no facilities are, therefore, available to examine this population. At present, only one investigation was published by Bijella et al. in 1990. In order to obtain a reliable sample the authors performed a house-by-house survey in the municipality of Bauru, São Paulo. Dental injuries were identified using a questionnaire followed by clinical and radiographic examination. In 576 children, the prevalence of dental injuries was 30.2% with luxation being the most frequent type of injury .
In the Federal District of Brazil pre-school children are accessible for examination at nursery schools. For this reason, we chose to sample children attending public nursery schools admitting children from low socio-economic status and with limited access to dental care (Agency for Social Development of the Federal District of Brazil, 1995).
The purpose of the present investigation was to estimate the prevalence of dental injuries in a sample of Brazilian pre-school children with limited access to dental care.
Material and Methods
The studied population consisted of 1,853 one-to-five-year-old children who attended public nursery schools in the Federal District of Brazil that comprises the city of Brasília and six satellite cities. In 1995, the total number of children in the Federal District of Brazil in each of the age groups was 31,000-34,000 (Central Bureau of Statistics-IBGE, 1995). The number of children attending public nursery schools was 3,500 of which more than half were included in the sample.
The data were collected between 1993-95 by the three authors. The children were examined at the nursery schools in selected rooms with good natural and artificial illumination. The field equipment included a portable light and plane mouth mirror. The children were laid on tables and had their teeth professionally cleaned and dried with gauze before examination.
Traumatic injuries affecting the teeth were clinically recorded based on objective signs: 1) uncomplicated crown fracture: fracture involving enamel or enamel and dentin without exposing the pulp, 2) complicated fracture: fracture involving dentin and exposing the pulp, 3) crown discoloration: tooth with discoloration of the crown indicating pulp damage, 4) intrusive luxation: tooth with infra-occlusion probably due to a traumatic injury, 5) extrusive luxation: tooth with supra-occlusion probably due to a traumatic injury, 6) exarticulation or extraction after trauma: tooth prematurely lost in comparison with the homologous tooth and 7) subluxation: tooth with increased mobility taking into account the physiologic mobility and comparing with the homologous tooth.
Results and Discussion
In Brazilian 1-5-year-old children the prevalence of dental injuries based on clinical signs ranged from 10% (<2 years) to 20% (5 years). A higher prevalence of dental injuries to the primary dentition of Brazilian children has been previously reported by Bijella et al. (1990), in a house-by-house survey. The authors found that 30% of the children had experienced dental injury revealed by questionnaire. A total of 27% was confirmed by clinical and radiographic examination. The lower prevalence observed in our study can be explained by the fact that neither a questionnaire was applied nor radiography taken. Thus, it may be assumed that the results represent the lowest values for the studied population.
The distribution of children showing dental injuries according to gender and age groups is summarized in Table 1. No difference in the frequency of dental injuries was observed between boys and girls. In accordance with Fergusson and Ripa (1979) and Onetto et al. (1994), the findings disclosed the highest prevalence of dental injuries at the age of 5 indicating that these children accumulated treatment needs. However, in surveys that recorded any history of dental injury the highest prevalence was found among younger groups (Andreasen and Ravn, 1972; Bijella et al., 1990).
The number of injured teeth ranged from one to four (Figure 1). As demonstrated by other authors the majority of observations concerned a single injured tooth (Fergusson and Ripa, 1979; Onetto et al., 1994; Bezerra and Toledo, 1996; Carvalho et al., 1998). In children older than 3 years, a single injured tooth represented 2/3 of the total number of injuries. In the whole sample only two children had 3 injured teeth and two others 4 injured teeth.
There is general agreement that maxillary central incisors are injured most frequently (Perez et al., 1991; Jones et al., 1993; Fried and Erickson, 1995). In this survey the following results were recorded: maxillary central incisors (88.2%), maxillary lateral incisors (8.8%), maxillary canine and molars (1.4%) and mandibular incisors (1.4%).
Table 2 illustrates the percentage distribution of different types of dental injuries in relation to age groups. Andreasen and Ravn (1972), Bijella et al. (1990) and Onetto et al. (1994) have documented that luxation and subluxation were the most common types of injuries to the primary dentition. In contrast, we recorded crown fracture as the dental injury most frequent in children aged 1 to 4 as observed by Holm and Arvidsson (1972). Additionally, in 5-year-olds crown fracture was still very frequent (41%), but crown discoloration was identified more often (47%). It is, therefore, tempting to consider that in collected data some cases of luxation and subluxation which had occurred at an early age were identified as crown discoloration later on.
We conclude that the prevalence of dental injuries in pre-school children with limited access to dental care increases with age and that crown fracture and crown discoloration are the most common types of injuries.
Agency for Social Development of the Federal District of Brazil: Newsletter, 1995
Andreasen JO: Traumatic injuries of the teeth. Munksgaard, Copenhagen, 1981
Andreasen JO, Ravn JJ: Epidemiology of traumatic dental injuries to primary and permanent teeth in a Danish population sample. Int J Oral Surg 1: 235-239, 1972
Bezerra AC, Toledo OA. In: Odontopediatria. Fundamentos para a prática clínica, Toledo OA. ed. 2nd ed. 239-262. Editorial Premier, Colombia, 1996
Bijella MF, Yared FN, Bijella V, Lopes E: Occurrence of primary incisor traumatism in Brazilian children: a house by house survey. J Dent Child 57: 424-427, 1990
Carvalho JC, Vinkier F, Declerck D: Malocclusion, dental injuries and dental anomalies in the primary dentition of Belgian children. Int J Paed Dent (in press), 1998
Central Bureau of Statistics-IBGE: Population estimates in the Federal District of Brazil, 1995
Fegusson F, Ripa L: Prevalence and type of traumatic injuries to the anterior teeth of preschool children. J Pedod 3: 3-8, 1979
Fried I, Erickson P: Anterior tooth trauma in the primary dentition: incidence, classification, treatment methods, and sequelae: a review of the literature. J Dent Child July-August: 256-261, 1995
Holm A-K, Arvidsson S: Oral health in preschool Swedish children. Odonto Revy 25: 1-9, 1974
Jones ML, Mourino AP, Bouden TA: Evaluation of occlusion, trauma and dental anomalies in African-American children of metropolitan Headstart programs. J Clin Ped Dent 18: 1-54, 1993
Norén J, Koch G, Rasmussen P: Pedodontics - a clinical approach. Koch G, Modéer T, Poulsen S, Rasmussen P. eds. 250-274. Munksgaard, Copenhagen 1994
Onetto JE, Flores MT, Garbarino ML: Dental trauma in children and adolescents in Valparaiso, Chile. Endo Dent Trauma 10: 223-227, 1994
Perez R, Berkowitz R, McIlveen L, Forrester D: Dental trauma in children: a survey. Endo Dent Trauma 7: 212-213, 1991
Correspondence: Correspondence: Joana Carvalho, Av. Jupiter 91A - bte 1, 1190 Bruxelles, Belgique.
Accepted August 26, 1998
Electronic publication: April, 1999