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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 4  |  Page : 278-282

Assessment of negligence of traumatic dental injuries among school-going children


Department of Pediatric and Preventive Dentistry, Dr. Ziauddin Ahmad Dental College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India

Date of Submission27-Jun-2021
Date of Decision25-Jul-2021
Date of Acceptance13-Aug-2021
Date of Web Publication20-Dec-2021

Correspondence Address:
Mohammad Kamran Khan
Hamdard Nagar-A, Civil Line, Aligarh, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrr.jdrr_116_21

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  Abstract 


Introduction: Dental health is important for the overall health and well-being of an individual. Traumatic dental injuries (TDI) need to be treated on time with proper dental care. This study was done to assess the negligence of TDIs among schoolchildren by evaluating the time elapsed between TDI and seeking the dental treatment. Materials and Methods: A cross-sectional study comprised 1000 school-going children of age group 12 and 15 years of schools randomly included from the urban and rural regions. Permanent teeth were examined, and dental traumatic injuries were recorded using Ellis and Davey's classification in the pro forma. Study data were analyzed using SPSS version 20. Results: The majority of affected children of rural (48.7%) and urban (44.1%) schools had no treatment of any kind (P < 0.05); 0% rural and 1.7% urban traumatized children sought treatment in <24 h of TDI event. About 6.6% rural and 10.2% urban affected children with dental trauma had treatment only when pain was experienced. About 26.3% rural and 44.1% urban affected schoolchildren were not able to remember about the time of injury and treatment obtained. Conclusion: The study results indicated the lack of awareness and motivation for the prevention of dental injuries and its consequences. The study's findings also reflected the negligence by children, parents, and teachers for seeking timely optimal dental care.

Keywords: Awareness, cross-sectional study, negligence, schoolchildren, traumatic dental injuries


How to cite this article:
Khan MK, Jindal MK, Khan SY. Assessment of negligence of traumatic dental injuries among school-going children. J Dent Res Rev 2021;8:278-82

How to cite this URL:
Khan MK, Jindal MK, Khan SY. Assessment of negligence of traumatic dental injuries among school-going children. J Dent Res Rev [serial online] 2021 [cited 2022 Jan 18];8:278-82. Available from: https://www.jdrr.org/text.asp?2021/8/4/278/332914




  Introduction Top


The quality of life of an individual is influenced by its health status. Optimum health of oral and dental tissues is an essential aspect of overall well-being. Only 1% of total body area constitutes the oral region, but it sustains injuries about 5% of all the body parts.[1] Dental trauma has been emerging as a significant public dental health concern among schoolchildren and adolescents in both developing and developed countries.[2] The prevalence of traumatic dental injuries (TDIs) has shown a wide range (i.e. 6%–59%).[3]

The quality of life of a human being is mainly influenced by its health condition.[4] The dental health status of an individual affects the physical and psychological aspects such as mastication, phonetics, social interaction, and self-esteem.[4] It has also been observed that the quality of life of children is greatly influenced by untreated dental traumatic injuries.[5] Treatment of such injuries make a crucial health promotional strategy which can significantly reduce or even can avoid the negative biological and social effects of dental trauma such as restoring the ability to eat, smile, and perform routine activities without any social embarrassment.[5]

The literature review demonstrates the variable and higher prevalence of TDIs worldwide, but yet such injuries are not treated promptly and properly due to the lack of awareness, motivation among children and parents. Seeking immediate dental care, early diagnosis, and treatment of dental injuries are very significant for the better prognosis of most of the TDIs. Hence, the present study was done to assess the negligence of TDIs among school-going children of rural and urban areas by evaluating the time elapsed between TDI and seeking the dental treatment.


  Materials and Methods Top


This cross-sectional study consisted of 1000 children (boys and girls) of age group 12 and 15 yearsof randomly selected schools of rural and urban regions was carried out in the year 2018.

Ethical approval and informed consent

Before the commencement of the study, the ethical approval was obtained from the institutional ethics committee (D. No. 1030/FM). The informed consent was obtained from the participated schools and the parents/guardians of school children. This study was conducted in accordance with the ethical principles of the World Medical Association Declaration of Helsinki (2013). Infection control measures were followed throughout the study.

Sampling method

The sample size was determined using the following formula: n = (Z2p(1 – p))/d2 (where n = sample size Z = z statistics for given level of confidence = 1.96 (for 95% confidence interval [CI]); P = expected prevalence = 39.5%; d = Precision = 5.0%). It was calculated as 1000 (500 each for rural and urban regions). Multistage sampling method was used to include the study participants. First, randomly 10 schools (coeducational school) of different locations of rural and urban regions of the city were included in the present study and then, the children of Class 6th to 8th were screened for 12 years of age group, whereas children of Class 9th to 10th for the 15-year age group were selected as a sampling unit.

The inclusion criteria were as follows

  • Participants with the age of 12 and 15 years and with informed consent from parents.


Exclusion criteria were as follows

  • Participants who were not willing for the dental examination and were without consent
  • Participants with undergoing or undergone orthodontic treatment.


Data collection

A single calibrated and trained investigator performed the dental examination and also recorded its findings and the responses of a structured interview of study participants in the self-constructed pro forma. Investigator was trained and calibrated as per the WHO guidelines (Oral health survey-basic methods, 5th edition, WHO, 2013). Intraexaminer consistency was evaluated by kappa statistics (0.85) and by performing reexamination on 10% of participants (oral health survey, 5th edition, WHO, 2013). The pro forma consisted of two sections; the first section was for recording the general information of the participants (i.e. name, age, and sex) and the second section was for collecting the data about the dental trauma history including the time elapsed between TDI and seeking the dental treatment and oral examination findings of the children. Question regarding the time elapsed between TDI and seeking the dental treatment was asked in the local language of the participants by explaining the six options (alternatives) from the pro forma.

The options for the question, the time elapsed between TDI event and seeking the dental treatment were written on pro forma as follows:

  1. No treatment was sought for the TDI
  2. Treatment was sought in <24 h of the dental trauma event
  3. Treatment was received in more than 24 h but before a week
  4. Treatment was sought during the 1st month following dental trauma
  5. Treatment was sought only when pain or discomfort experienced
  6. Participant not able to recall about the TDI event and its treatment.


TDIs were recorded using Ellis and Davey's classification. However, Ellis Class-VI (tooth with root fracture) was not considered due to the nonavailability of radiographic facility in the schools. Ellis Class-IX was also not assessed as only permanent teeth were examined.

Only sterilized diagnostic instruments were used for the dental examination, and new disposable masks and gloves were used for each study participant. Oral examination of schoolchildren was done in a relaxed manner in the school hours within the school premises. Oral examination was performed in children seated upright in chair with adequate illumination of natural daylight. Teeth were first cleaned with gauze pieces to examine for the presence of TDIs.

Statistical analysis

The collected data were entered into the Microsoft Excel Sheet 2010 and then analyzed in the SPSS20 (IBM, Corp, Armonk NY, USA). Pearson's Chi-square test was used to evaluate the association between variables; the level of significance (α) and CI were set at 5% and 95%, respectively. The normality of study data was tested by Shapiro–Wilk test.


  Results Top


A total of 1000 children including both boys and girls aged 12 and 15 years from the schools of rural and urban regions were examined in this study.

[Table 1] demonstrates the time elapsed between TDI event and treatment obtained with respect to age and area of the study participants. In rural regions, the majority of 12-year (31.8%) and 15-year (71.9%) old participants did not seek treatment for TDI. Twenty-five percent and 28.1% of affected children of 12 and 15 years of age, respectively, were not able to recall about the TDI event and treatment. About 20.5% of 12-year and 11.8% of 15-year age had delayed treatment (during 1 month following TDI event). About 11.4% of 12 years aged and 0% of 15-year old children had treatment only when the pain was felt. 0% affected children of 12- and 15-year age sought treatment in <24 h of TDI event (P < 0.05).
Table 1: Time elapsed between traumatic dental injuries event and treatment taken in respect to age and area of the study participants

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While in urban regions as shown in [Table 1], mostly 12-year (50%) and 15-year (31.6%) old participants did not seek treatment. Forty percentage and 52.6% affected children of 12- and 15-year age, respectively, were not able to recall about TDI and treatment. Both 12 (10%) and 15 (10.5%) aged children had treatment only when the pain was experienced. Zero percentage of 12 years and 5.3% of 15 years aged participants had treatment in <24 h of TDI event.

[Table 2] presents the time elapsed between TDI event and treatment sought with respect to area and sex of the study participants. In rural regions, the majority of affected males (46.3%) and female (51.4%) participants did not seek treatment for TDI. About 17.1% male and 5.7% females had sought delayed treatment (1 month following TDI). About 4.9% male and 8.6% of female participants had treatment only when the pain was experienced. Zero percentage male and female participants had treatment in <24 h of TDI event.
Table 2: Time elapsed between traumatic dental injuries event and treatment sought in respect to area and sex of study participants

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While in urban regions as shown in [Table 2], the majority of male participants (44.4%) were not able to recall about the TDI event and treatment, whereas the maximum of female children (52.25) had no treatment for TDI. About 13.9% of male and 4.3% of female participants had treatment only when pain or discomfort was felt. About 2.8% of male and 0% of female participants had treatment on the same day of TDI event.


  Discussion Top


The results of the current study indicated the lack of awareness and motivation among children, parents, and teacher toward seeking timely proper dental treatment of TDIs. The reasons for higher untreated dental injuries in schoolchildren might be due to lesser dental health education and the lack of availability of accessible dental health facilities. Social status and economical aspects might also be the reasons for not seeking immediate dental treatment for TDI.[6] Worldwide, the observations regarding the affected individuals with the lack of dental treatment reflect that TDIs are not recognized or perceived as a diseased condition.[6]

The findings of the present research are supported by the observations of the study done by Prasad et al.,[7] in which 0% injured children had treatment on the same day (<24 h); 3.4% had treatment within a week of TDI; 13.9% had treatment after 3 weeks (nearly month) of TDI; and 77.9% had treatment after 1 year of injury. Jesus et al.[8] also reported similar findings, in which most of the affected children reported late to dentist. Similarly, the findings of the study done by Saroğlu and Sönmez,[9] in which 61.3% of trauma patients reported to dentist late after 24 h and before 10 days.

In contrast to our findings, Atabek et al.[10] reported that most of the affected individuals (39.4%) had dental treatment within a week, whereas 24.2% of children with severe dental injuries (Avulsions) had reported dentist on the same day of TDI. Fear of losing teeth and blood from teeth were the two main reasons for early visit to dentist. While the uncomplicated crown fractures and periodontal injuries are not obtained seriously and recognized by children's parents because these are with fewer visible symptoms. The findings of the current study differ from the observation of a study done by Kallel I et al.,[11] in which 9% of children with dental trauma reported dentist before 24 h of TDI, whereas the majority (47%) of dental trauma patients seek dental treatment between 1 and 3 days. They suggested that the severity of dental injury perceived by caretakers was the factor in seeking dental management of injuries.

Time plays a very critical role for the prognosis of the treatment. Atabek et al.[10] in their retrospective study observed that time elapsed is significant for the prognosis of the treatment of injured tooth. Parents/caretakers should be made aware about the importance of immediate seeking dental care of the dental trauma of their children.[10] The knowledge and attitude of parents toward dental injuries influence the outcome of the treatment of dental injuries.[11],[12] Parents of both rural and urban areas should be educated and motivated for the dental injuries and seeking its timely emergency treatment.[12],[13] It has been reported that mostly parents lack knowledge about the management of tooth avulsion injury of their children.[13],[14] As schoolchildren and adolescents spend most of their time in the school premises and sustain dental injuries during school activities. Hence, the school teachers are the first ones who can provide prompt dental emergency treatment to injured students and can also bring them to the dental hospital for further proper management. School teachers need to have elementary knowledge about the management of TDIs and its prompt management.[15],[16],[17]

Prevention is an important aspect of any health-related condition. Prevention of TDIs should be at primary, secondary, and tertiary level (namely, using mouth guards, helmets, immediate dental care, restorative, orthodontic, and prosthodontic treatment, respectively).[18]

The findings of this study may help in encouraging and educating common people for preventing TDIs and seeking immediately proper dental care of such injuries. Dental professionals may also help in educating children and also general population through conducting dental educational camps in their nearby schools and regions.

The present study did not consider dentoalveolar trauma as the Ellis and Davey's classification used for assessing the injury. Hence, other more extensive classification for dental trauma might be used in future research for assessing all the aspects of dentoalveolar injuries. The present study included schoolchildren and teenagers of various schools of different areas of a city. Hence, longitudinal studies including many other age groups such as young adults and elderly adults of different cities may be conducted for evaluating more detailed status about awareness and negligence of TDI.


  Conclusion Top


The findings of this research indicated the lack of awareness and motivation for optimal dental care of TDIs among school children of both gender of rural and urban regions. Motivation and awareness should be imparted among children, parents, and teachers through dental educational camps about the significance of preventive measures for dental injuries and its early proper treatment to halt the complications. Dental health facilities should be readily accessible in both rural and urban areas.

Ethical clearance

The ethical clearance was obtained from the institutional ethics committee of faculty of medicine, A.M.U., Aligarh, Uttar Pradesh, India. It has been described in the material and method section of the article.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Ramos-Jorge J, Paiva SM, Tataounoff J, Pordeus IA, Marques LS, Ramos-Jorge ML. Impact of treated/untreated traumatic dental injuries on quality of life among Brazilian schoolchildren. Dent Traumatol 2014;30:27-31.  Back to cited text no. 5
    
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Jesus MA, Antunes LA, de Risso P, 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.  Back to cited text no. 8
    
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Saroğlu I, Sönmez H. The prevalence of traumatic injuries treated in the pedodontic clinic of Ankara University, Turkey, during 18 months. Dent Traumatol 2002;18:299-303.  Back to cited text no. 9
    
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Atabek D, Alaçam A, Aydintuğ I, Konakoğlu G. A retrospective study of traumatic dental injuries. Dent Traumatol 2014;30:154-61.  Back to cited text no. 10
    
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