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2]

Original Article

Incidence of Traumatic Dental Injuries in Children Aged

3–18 Years in Tirupathi
K. Veera Kishore Kumar Reddy, K. Naveen Kumar, R. Venkatasubramanian, Harshini Togaru, Srinivasan Kannakiah, Rohini Reddy
Department of Pedodontics, CKS Teja Institute of Dental Sciences, Tirupati, Andhra Pradesh, India

Abstract
Background: Traumatic dental injuries (TDI) are considered to be an important issue due to its high prevalence, mainly in areas of high social
privation. They have a strong impact on children’s and adolescent’s life quality because they cause physical and emotional distress, and in
children, they might have a high negative impact on the social relationships. Involvement of children in sports activities and increase in traffic
accidents have contributed to transform these TDI an emergent public health problem. Aim and Objectives: The current retrospective study
is to determine the prevalence of TDI reported to Department of Pedodontics and Preventive Dentistry, CKS Teja Dental College, Tirupathi,
during the years 2011–2016. Methodology: Sample size is the total number of patients reported to the Department of Pedodontics and Preventive
Dentistry, CKS Teja Dental College, Tirupathi, within the period of 2010–2016. The data were retrieved from medical records of patients who
reported to the department. Results: All recorded data were analyzed using the Statistical Package for the Social Sciences statistical software
program (2012). The results were evaluated by Chi‑square test. A total of 324 patients aged between 3 and 18 years met the inclusion criteria
and were enrolled in the study. The highest frequency of TDI was in the 10–12‑year‑old participants and lowest frequency was in 3–6‑year‑old
children. The etiology of TDI was analyzed; highest were caused by falls, followed by sports activities and then striking objectives and then
followed by accidents and cycling. The most common type of injury was uncomplicated crown fracture (without pulp exposure) followed
by avulsion and complicated crown fracture (with pulp exposure). Conclusion: Study observed the children in mixed dentition period as the
population at risk. Hence, prevention through health promotion and correction of predisposing risk factors should be carried out in early mixed
dentition period to reduce the prevalence of dental injury and to avoid the financial costs of treatment.

Keywords: Dental traumatic injuries, permanent dentition, prevalence, retrospective analysis

Introduction It is a dental emergency situation in young patients and

requires immediate assessment and management because
One of the greatest assets a person can have is a “smile” that
many permanent teeth continue their development in those
shows beautiful, natural teeth. An untreated and unsightly
ages.[4] The improvement of TDI in permanent teeth illustrates
fracture of an anterior tooth can affect the behavior of a child,
important aspects that must be carefully planned, requiring
his/her progress in school, and can have more impact on
several follow‑up appointments, mainly due to the possible
their daily living. Trauma to anterior teeth is undesirable, and
appearance sequels in the developing permanent dentition.[5]
prevention of this is beneficial to the personality development
of the child.[1] The importance of assessing the prevalence of traumatized
teeth by the survey was pointed out by Andreasen and
Dental injuries may occur throughout life, but traumatic
Andreasen in 1994. Epidemiological data provide a basis
dental injuries (TDI) are a very significant problem among
for evaluating the concepts of effective treatment, resource
children. The main etiology being accidents such as
allocation, and planning within any health environment.[6]
falls, fights, and during sports. They are associated with
biological, socioeconomic, psychological, and behavioral Address for correspondence: Dr. K. Veera Kishore Kumar Reddy,
factors. [2] The predisposing dental risk factors include Department of Pedodontics, CKS Teja Institute of Dental Sciences,
increased incisal overjet, open bite, protrusion, and lip Tirupati, Andhra Pradesh, India.
E‑mail: [email protected]
incompetence.[3]

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DOI: How to cite this article: Reddy KV, Kumar KN, Venkatasubramanian R,
10.4103/ijpr.ijpr_19_17 Togaru H, Kannakiah S, Reddy R. Incidence of traumatic dental injuries
in children aged 3–18 years in Tirupathi. Int J Pedod Rehabil 2017;2:73-6.

© 2017 International Journal of Pedodontic Rehabilitation | Published by Wolters Kluwer ‑ Medknow 73

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Reddy, et al.: Incidence of traumatic dental injuries in children aged 3–18 years in Tirupathi

obtained from Institutional Ethical Committee, CKS Teja

Table 1: Number of traumatized teeth according to the
Dental College.
gender
Gender n % P
Sample size is the total number of patients reported to the
Department of Pedodontics and Preventive Dentistry, CKS
Male 217 67.2% .000
Teja Dental College, Tirupathi, within the period of 2010–2016.
Female 106 32.8% .000
The data were retrieved from medical records of patients who
reported to the department. Their distribution according to age,
gender, cause of the injury, type of injury, and teeth injured was
Table 2: Distribution of teeth according to the age of
recorded. Cases with incomplete documentation or TDI affecting
patients
primary dentition were excluded. The type of TDI was classified,
200 according to the system described by Ellis classification.
Age
180
A total number of 324 children reported, out of which 217 were
160
boys and 106 were girls between the age of 3 and 18 years
140
of age. All recorded data were analyzed using the Statistical
120
100
Package for the Social Sciences (SPSS, IBM Ltd, India)
80
statistical software program (2012). The results were evaluated
60 by Chi‑square test. The association between the occurrence of
40 dental injuries with relation to age, sex, and number of injured
20 teeth is statistically significant.
0
0-3 yrs 3-6 yrs 7-9 yrs 10-12 yrs 13-15 yrs 16-18 yrs
Results
A total of 324 patients aged between 3 and 18 years met the
inclusion criteria and were enrolled in the study [Tables 1 and 2].
Table 3: Distribution of teeth according to the type of the The highest frequency of TDI was in the 10–12‑year‑old
injury participants and lowest frequency was in 3–6‑year‑old children.
The distribution of patients by gender showed that males were
180 more often affected (67.2%) than females (32.8%).
160 When the etiology of TDI was analyzed, highest were caused
140
Series1 by falls, followed by sports activities and then striking
objectives and then followed by accidents and cycling.
120 The most affected teeth were the maxillary central incisors,
100
followed by the maxillary left lateral incisors and then
mandibular incisors.
80
The most common type of injury was uncomplicated
60 [Table 3] crown fracture (without pulp exposure) followed by
avulsion and complicated crown fracture (with pulp exposure)
40
[Tables 4-6]. When it comes to the type of occlusion, Class 2
20 div 2 type of malocclusion had increasing frequency of trauma.
0
type class 1 class 2 class 3 class 4 class 5 class 6 class 7 class 8 class 9 Discussion
Traumatic dental injury is not a result of disease but
a consequence of several factors that will accumulate
Hence, the purpose of the current retrospective study throughout life if not properly treated. For this study, children
was to determine the prevalence of traumatic injuries in between 3 and 18 years of age were chosen, as during
3–18‑year‑old children who reported to Department of this period, there is the maximum physiologic growth and
Pedodontics and Preventive Dentistry, CKS Teja Dental development and the children are actively involved in lot of
College, Tirupathi. outdoor activities.[6]
Epidemiological knowledge of TDI adds valuable information
Methodology on public health, and when associated with clinical observations
The present retrospective study was carried out in Department and trials, it provides essential evidence to all the science
of Pedodontics and Preventive Dentistry, CKS Teja Dental segments.[5] The retrospective epidemiological evaluation
College and Hospital, Tirupati, India. Ethical clearance was developed in the present study was based on the verification of

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Reddy, et al.: Incidence of traumatic dental injuries in children aged 3–18 years in Tirupathi

The present study has shown that gender is a predisposing

Table 4: Type of occlusion
factor in dental trauma. Increased frequency was seen among
boys than girls which was 67.2% which is in accordance
70
Series1
with many other studies. Similar result was found in
60
different geographical locations by Hamdan MA, Rajab LD,
50
Nik-Hussein NN, in their study.[7,8]
40
30 Age is another well‑established risk factor, and although
20
TDI has been reported in all age groups, it is more prevalent
10
in school children and teenagers. Previous studies have
demonstrated that the majority of TDIs occur in childhood
0
div 1 div 2 and adolescence.[9] Similar to previously reported findings,
class 1 class 2
the present study has also illustrated the greater prevalence of
TDI among children between 8 and 12 years.
occlusion
The maxillary central incisors were the most frequent injured
teeth. This is in line with the findings of Hamdan and Rajab
and Nik‑Hussein also found that maxillary central incisors were
Table 5: Distribution of teeth according to cause injured in 78% and 79.2% of traumatic cases, respectively.[10,11]
The main etiological factor of the dental trauma among our
140
Series1 study population was fall. Yassen et al.[12] also have shown
120
similar findings. Unlike previous studies, the second cause of
100 TDI in our study was sporting activities (26%); Borssén et al.
80 reported similar findings.[13,14]
60 The most common type of injury recorded in the present study
40 was uncomplicated crown fracture which is in line with the
studies conducted by Hamdan and Rajab and Nik‑Hussein.[10,11]
20

0 It is highly recommended to plan a trauma prevention

community targeting parents, children, and school staff. In
cause

fall

accident

cycling

sports

striking objects

addition, holding proper educational programs to enhance the

level of general knowledge about prevention and managing
these injuries seems necessary. In these programs, the
importance of proper treatment of traumatized teeth, be the
primary or permanent, should be stressed to prevent their
biologic and psychologic consequences.
Table 6: Distribution of teeth according to tooth injured
Conclusion
The study observed the children in mixed dentition period
as the population at risk. Hence, prevention through health
tooth injured
promotion and correction of predisposing risk factors should
MAX CI be carried out in early mixed dentition period to reduce the
MAX LI prevalence of dental injury and to avoid the financial costs of
MAX CANINE treatment. An effort can be made to reduce the prevalence of
MAN CI traumatic injuries by taking into consideration the following
MAN LI measures:
MAN CANINE • The use of intraoral and extraoral devices which protects
the face and teeth from trauma
• Elimination or reduction of predisposing factors in the
form of orthodontic treatment
• Educational programs whereby the children and their
parents are given information regarding the preventive and
the clinical records of patients with TDI treated at Department treatment aspects of this commonly occurring condition
of Pedodontics and Preventive Dentistry during the period of • Health promotion policies should aim to create an
2010–2016. appropriate and safe environment.

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Reddy, et al.: Incidence of traumatic dental injuries in children aged 3–18 years in Tirupathi

Financial support and sponsorship teeth: A retrospective study. SRM J Res Dent Sci 2014;5:11‑3.
7. Patel  MC, Sujan  SG. The prevalence of traumatic dental injuries to
Nil. permanent anterior teeth and its relation with predisposing risk factors
among 8‑13 years school children of Vadodara city: An epidemiological
Conflicts of interest study. J Indian Soc Pedod Prev Dent 2012;30:151‑7.
There are no conflicts of interest. 8. Glendor U. Epidemiology of traumatic dental injuries – A 12 year
review of the literature. Dent Traumatol 2008;24:603‑11.
9. Soriano EP, Caldas Ade F Jr., Diniz De Carvalho MV, Amorim Filho Hde A.
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