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Table of Contents
Year : 2021  |  Volume : 5  |  Issue : 3  |  Page : 110-114

Anterior tooth trauma among schoolchildren aged 10—19 years in Mewat district, India

1 Department of Dentistry, Shaheed Hasan Khan Mewati, Government Medical College, Nuh, Haryana, India
2 Department of Dentistry, Government Medical College, Ratlam, Madhya Pradesh, India
3 Department of Pathology, Kalpana Chawla Government Medical College, Karnal, Haryana, India
4 GRID Council, Delhi, India

Date of Submission15-May-2021
Date of Decision16-Aug-2021
Date of Acceptance19-Aug-2021
Date of Web Publication18-Oct-2021

Correspondence Address:
Sonam Sharma
Department of Pathology, Kalpana Chawla Government Medical College, Karnal, Haryana.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/SDJ.SDJ_90_21

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Background: Dental trauma is relatively common, with its incidence and prevalence varying not only within countries and states but also within different socioeconomic groups. A primary goal in oral health care is to prevent dental trauma. Objectives: The aim of the present study was to determine the prevalence of anterior tooth trauma (ATT) and to analyze factors associated with ATT among schoolchildren aged 10—19 years in Mewat district, an underdeveloped and underprivileged area in Haryana state, India. Methods: A cross-sectional study was conducted among 3043 schoolchildren residing in Mewat district. They were divided into the following age groups: 10—13, 14—16, and 17—19 years. Dental injuries to anterior teeth were recorded according to Ellis and Davey’s classification. Data were collected using a specifically designed questionnaire. The data were analyzed using IBM Statistical Package for Social Sciences for Windows (version 20.0). Categorical variables are presented as proportions (%), and Pearson’s χ2 test was used to analyze these variables. Tests were conducted at the significance level of 5%. Results: Of the 3043 schoolchildren (males, n = 2178; females, n = 865) examined in the study, 362 schoolchildren had experienced dental trauma, giving a prevalence rate of 11.89%. Males were more prone to ATT (13.36%), and an Ellis Class I fracture was the most frequent type of ATT (78%). The most common causes of ATT were falls (49.44%), followed by road traffic accidents. In addition, children with partial lip coverage and an overjet of more than 3 mm had an increased risk of ATT. Conclusion: The prevalence of ATT among schoolchildren in Mewat district was 11.89%, and the major etiological factor was a fall. There is an increased need for awareness of dental trauma in school-aged children.

Keywords: Anterior teeth, dental trauma, Ellis classification, schoolchildren

How to cite this article:
Sharma A, Sharma S, Sharma S, Sharma R. Anterior tooth trauma among schoolchildren aged 10—19 years in Mewat district, India. Sci Dent J 2021;5:110-4

How to cite this URL:
Sharma A, Sharma S, Sharma S, Sharma R. Anterior tooth trauma among schoolchildren aged 10—19 years in Mewat district, India. Sci Dent J [serial online] 2021 [cited 2022 Dec 7];5:110-4. Available from: https://www.scidentj.com/text.asp?2021/5/3/110/328427

  Background Top

Anterior tooth trauma (ATT) is a relatively common presentation in most dental offices. The word trauma implies a reasonably severe, non-physiological injury to any part of the body. Any thermal, chemical, or mechanical lesion that affects dentition should be considered as dental trauma and treated as a traumatic dental injury (TDI).[1] In addition to pain and possible infection, the consequences of dental trauma include alterations in physical appearance and speech, problems in chewing and biting, association with psychological and emotional impacts.[2] The untimely loss of an anterior tooth in a child may lead to low self-esteem, especially in cases in which it has adverse esthetic effects on a person’s smile and facial features.

School-aged children actively indulge in outdoor play. Although these activities are markers of healthy growth and development in a child, careless activities, loss of balance, and impaired movements can lead to TDIs.[3] The most common injuries to permanent teeth occur secondary to falls, followed by traffic accidents, fights, and sports.[2],[4],[5] All sporting activities have an associated risk of orofacial injuries due to falls, collisions, and contact with hard surfaces.[6]

The National Institution for Transforming India (NITI Aayog) is a policy think tank of the Government of India. The NITI Aayog declared Mewat as the most underdeveloped district of India in March 2018.[7] At present, there is only one medical institute in Mewat district catering to a large population: the newly established Shaheed Hasan Khan Mewati Government Medical College (SHKM GMC), Nuh. No studies have investigated the prevalence of dental trauma in Mewat district. The present study was undertaken by the Department of Dentistry, SHKM GMC to evaluate the prevalence and severity of ATT and associated risk factors among school-aged children in Mewat district, Haryana, India. The findings of the present study can be used to formulate public dental care strategies to combat the prevalence of ATT.

  Materials and Methods Top

A cross-sectional study was conducted among schoolchildren aged 10—19 years residing in Mewat district, Haryana, India. Official permission for the study was obtained from the District Education Officer (DEO) with oversight for surveys in various schools in the district. Written approval and informed consent were obtained from school authorities and the children’s parents, respectively. A pilot study was conducted on 100 schoolchildren aged 10—19 years, in which the prevalence rate of ATT was 12%. The sample size in the present study was calculated using this prevalence rate and a standard formula n = Z2P(1−P)/d2 (where n is the sample size, Z is the statistic corresponding to the level of confidence, P is the expected prevalence, and d is the precision) for obtaining results at the 95% confidence level, with an allowable error of 10%. Based on this formula, the minimum sample size was determined to be 2933.

A list of all the schools (government and private) in Mewat district was obtained from the DEO. Representative schools from all five blocks in Mewat district were selected from this list by the lottery method. The training and calibration of a single examiner (dentist) took place in the Department of Dentistry, SHKM GMC, and the intra-examiner reliability was found to be good (κ coefficient = 0.9).

Children with debilitating systemic diseases, missing teeth due to caries or physiological exfoliation, and children who failed to return the consent forms were excluded from the study. The dental examination was carried out in a spacious room with good sunlight. The children were comfortably seated on a chair and were examined using a set of autoclavable dental mouth mirrors and dental explorer. A specially designed questionnaire form was used in the study. The form was divided into two parts. The first part recorded sociodemographic data, including age and sex, and the second part consisted of the results of the clinical examination and recorded items pertaining to the type of dental trauma, overjet, lip competence, and cause of dental trauma. ATT was assessed according to Ellis and Davey’s classification.[8] Using a stratified random sampling method, a total of 3043 children were examined during the course of the study and were divided into the following age groups: 10—13, 14—16, and 17—19 years.

The data were analyzed using IBM Statistical Package for Social Sciences for Windows (version 20.0) (IBM, Armonk, NY, USA). Categorical variables are presented as proportions (%), and Pearson’s χ2 test was used to analyze these variables. Tests were conducted at the significance level of 5% (i.e., an association was considered significant if the P-value was less than 0.05).

  Results Top

[Table 1] shows the distribution of the study sample according to age and sex. Of the 3043 schoolchildren examined, 362 schoolchildren had ATT, giving a prevalence rate of 11.89%. An Ellis Class I (78%) fracture was the most frequent type, followed by Class II (13%) and Class III (6%) fractures [Figure 1]. [Table 2] shows the prevalence of traumatic injuries of anterior teeth according to age and sex. The prevalence of ATT in each age group was almost the same, with a P-value of 0.89, which was not significant. Males accounted for 291 (13.36%) of the ATT cases in the study, whereas females accounted for just 71 (8.20%) cases. Males experienced a higher number of TDIs than females, with a statistically significant difference (P = 0.0001). Lip coverage and overjet were important risk factors contributing to ATT, with statistically significant P-values of 0.0005 and 0.0032, respectively. Falls were the most common cause of dental trauma (49.44%), followed by road traffic accidents (RTAs) [Figure 2].
Table 1: Distribution of the study sample according to age and sex

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Figure 1: Distribution of the type of trauma among the study population (Ellis and Davey’s classification)

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Table 2: Prevalence of TDIs according to demographic variables and associated risk factors

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Figure 2: Prevalence of the traumatic injuries to anterior teeth according to cause of trauma

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  Discussion Top

Trauma to both primary and permanent dentition is common, particularly in school-aged children.[9] The prevalence of TDIs was 11.8% in the present study, which was similar to that (11%) found in a study of children aged 6—18 years.[10] Studies have reported wide variations in prevalence rates of TDIs in different populations and countries.[11],[12],[13] These variations can be attributed to a number of factors, such as different ages of the study populations, different locations, dentition status, sampling technique, and diagnostic criteria for dental trauma.

Ellis Class I fractures were the most frequent types of traumatic injuries observed in the present study, as reported in other studies.[14],[15],[16],[17],[18] Dental trauma was significantly more common in males (13.36%) than in females (8.20%) (P = 0.0001). The higher prevalence of TDIs among males in the present study may be due to the composition of the study population (males, n = 2178; females, n = 865). According to the Official 2011 Census and 2019 Population Data for Mewat district, Muslims constitute 79.20% of the population in Mewat.[19] The cultural ethos in Muslim society is conservative and restricts the movement of women and girls outside the home.[20] Therefore, very few females attend schools in Mewat. This resulted in a wide disparity in the total number of males and females examined, among all age groups in the present study. The absence of females from schools is supported by the findings of a previous study, which reported that the literacy rate among females in rural areas of Mewat district was 33.71% when compared with 69.94% in males.[19] A similarly high prevalence of TDIs in males, as found in the present study, was reported by Chopra et al.[21] and Garg et al.,[22] but they attributed this finding to more participation of males in sports activities and high-risk-taking behavior, making them more prone to ATT than females.

Children with an overjet of more than 3 mm had a high risk of ATT in the present study when compared with those with an overjet of ≤ 3 mm, and the difference was statistically significant (P = 0.0032). This finding corroborates with that of various other studies.[15],[16],[22] In a meta-analysis, Nguyen et al.[23] concluded that children with an overjet larger than 3 mm have approximately twice as high a risk of ATT as those with a smaller overjet.

Hunter et al.[24] reported an increased frequency of dental trauma associated with incompetent lip closure. Competent lips provide cushioning and protective effects. Hence, lip incompetence increases the likelihood of trauma.[25] In the present study, lip coverage was assessed according to the criteria of Addy et al.[26] The results revealed a significant association between lip coverage and ATT (P = 0.0005). In our study, schoolchildren with partial lip coverage of maxillary incisors (14.53%) were more prone to ATT in comparison to those with complete coverage of maxillary incisors (8.70%). In contrast, the prevalence of ATT increased only marginally in those with maxillary labial gingiva exposed (16.05%) when compared with individuals with partial coverage of maxillary incisors (14.53%).

In the present study, the most common etiological factor responsible for ATT was falls (49.44%), as found in previous studies.[16],[27],[28] The terraces of the houses in Mewat district usually do not have parapet walls. As a result, children are prone to falls, especially while playing, flying kites, or sleeping on rooftops at night. RTAs were the second most common etiological factor for ATT in Mewat district (18.74%). The high rate of RTAs in Mewat district could be due to the highway that runs through the middle of the district and is used by heavy vehicles. Children are commonly seen playing on the highway, without the supervision of elders. In the present study, 4.69% of the participants could not recall the cause of their injury. This could be due to a slight enamel fracture going unnoticed, as it is not painful.

An analysis of background information on the incidence of orodental injuries in that community is essential for apt emergency management and institution of educational programs explaining the importance of prevention and treatment of dental trauma in the general public. The present study is an endeavor toward the same, as no studies have investigated the prevalence of dental trauma in Mewat, an underdeveloped area. We had a fairly large sample size; however, as discussed earlier, the enrollment of girls in the schools is generally lower and school dropout rates are higher compared with the boys in the Mewat region,[20] which makes the study findings, though representative of school children but not of those residing in the community at large. Moreover, this study is cross-sectional and offers a snapshot of the outcomes examined only for the study period. Additional prospective studies are required on representative populations that will help in the implementation of preventive strategies to reduce the frequency of dental trauma.

  Conclusion Top

This was a novel study of the prevalence of ATT (11.8%) and its association with various factors among schoolchildren aged 10—19 years in Mewat district. There is an urgent need to organize regular dental screening camps to make the residents of Mewat district aware of the importance of dental health and the risk factors for ATT. Government strategies are needed to improve the living conditions of the civilians in Mewat district, as these have indirect impacts on dental health.

Ethical clearance

Ethical clearance was obtained from the Institutional Ethical Committee (IEC Code No. 19/14).

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Table 1], [Table 2]


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