Endod Dent Traumatol 1994: 10: 223-227Primed in Denmark . At! rights reserved

Copyright r- Munksgaard 1994

Endodontics &Dental Traiunatology

ISSN 0109-2502

Dental trauma in children and adolescents inValparaiso, ChileOnetto JE, Flores MT, Garbarino ML, Dental trauma inchildren and adolescents in Valparaiso, Chile, Endod DentTraumatol 1994; 10: 223-227, © Munksgaard, 1994,

.Abstract • 1 his study analyzed traumatic injuries in the primaryand permanent dentition in children treated from 1990 to 1992al the Children's Dental Traumatology Service in Valparaiso,Chile, A total of 227 records from patients 2 to 21 years oldwas studied with regard to the cause of injury, location of injury,time elapsed before treatment, history of previous trauma, type ofinjury, number of injured teeth, and how patients seek treatment,A total of 73 patients had injuries to the primary dentition (pD)and 154 to the permanent dentition (PD) with a total of 357injured teeth (115 primary, 242 permanent). Ten to 12-year-oldchildren had the highest number of injuries (33%), Falling wasthe most common cause of injury in both groups (82% pD,58% PD), followed by striking against objects (13% pD, 19%PD) and bicycle accidents (9% PD), Most injuries in childrenwith primary dentition (68%) occurred at home, while childrenwith permanent dentition had most accidents at school (38%),Most children (61%) sought treatment after 24 h (52% pD, 65%PD), 61 children had suffered previous trauma (36% pD, 23%PD), The most common injuries in primary teeth were luxation(26%i), intrusion (21%) and subluxation (18%), Uncompli-cated crown fracture (34%,), followed by complicated crownfracture (21%), were the main injuries in permanent teeth. Therewas no difference in the number of teeth involved for eitherdentition, A single tooth injury was found in 54%, Two teethwere involved in 35%, and three or more teeth in 11%, Toothdevelopmental disturbances were seen in 10 children with 14permanent teeth involved, due to traumatic injuries that weretmattended in the primary dentition.

J. E. Onette. M. T. Fleres.M. L. GarbarineDepattmenf of Pedlafric Denfisfry, Facuify ofDenfisfry, Universify of Valparaiso, Cfiile,

Key words: dental ftaumafology: denfai ifijuries:foofti fracfure: fooffi tuxafion,

Marie Therese Fiores, Facuify of Denfislry,Univetsify of Valparaiso, Casilla 178-VVaiparaiso, Cfiiie,

Accepfed January 10, 1994

There are many epidemiological studies related todental trauma in children and adolescents that con-clude with similar results, in spite of having differentsources of information. Falls during play (1-7) arethe most frequent cause of tooth injury. Other com-mon causes include violence, traffic accidents (1, 2,+ ), striking against objects, and bicycle accidents: 1, 3, 4). Team and individual sports also contributeio tooth injury (4, 8, 9). With respect to location ofinjuries, home and school (1-4) are the most com-mon places. Time elapsed before treatment is closely

related to educational status and awareness level oforal health care. Garcia-Godoy (1) shows that 39%of patients seek treatment on the day of the accident,and 38% within 1 to 7 days. History of previoustrauma, an important issue affecting biological ca-pacities to respond to a new trauma, has been poor-ly investigated in epidemiological surveys.

Hospitals treat injuries of a wide spectrum, fromminor to severe (4, 5, 10), The age of the child is avariable that influences the type of injury. Displace-ment of teeth is typical in the primary dentition,

223

Onetto et ai.

I I B O Y S

IFig. I. Frequen

Data Fig, I,

Age group

< 4

4-6

7-9

10-12

13-15

>15

AGE GROUP

ty of traumatized children b\

Mall-

10

15

23

46

, «16

age group and sex

Female

10

17

15

28

I *9

while crown fractures are more frequent in the per-manent dentition (4, 8, 9, 10), Soft tissue injuriesrather than other types of injuries, are more oftenseen in the Emergency Room (2, 3, 11), Most acci-dents comprise single tooth injuries (12, 13, 14),although there are also reports of two or more teethhaving been injured (4, 10, 15, 16),

The purpose of this study was to analyze thefollowing: cause of injury, location of injury, timeelapsed before treatment, history of previoustrauma, type of injury, number of injured teeth,and how patients seek treatment. The subjects werechildren treated at the Children's Dental Traumato-logy Service, Faculty of Dentistry, University ofValparaiso, Chile between 1990 and 1992,

fflateriai and methods

,'\ total of 227 records from patients examined and/or treated at the Children's Dental TraumatologyService, from January 1990 through December1992, were analyzed.

The data recording form used at the service is theone suggested by Andreasen & Andreasen (9), Datarelated to cause of injury, location of injury, timeelapsed before treatment, history of previoustrauma, type of injury, number of injured teeth,and how patients seek treatment were taken fromthe records. Operational definitions used were takenfrom Oikarinen (4), Data was analyzed by the EpiInfo software package (17), When used, the chi-square test was defined at a 0.05 level of significance.

Results

Of the 227 patients, 134 were boys and 93 girls. Atotal of 357 teeth were injured. The ages ranged

Table 1, Distribution of ohildren by cause df injury, sex and denfifion.

Sox

Cause dfinjury

Boys Primary

• p<0,05* " p < 0,001

Baby walkerFallsIndivid sportsTeam sportsBioyoieVioienoeTraffio aooidenfsSfriking objoofsOffiers

Tofai

1 (1)78 (60)-1

524

311

130

(6)(4)-(1)(3)

(24)-I(1)

165

12

10

36

(1)(74)1

(1)(2)

(11)-

(3)(7)-J

258

(3)

•~ 2 (3)-

9 (13)J

-85

1101327

281

(58) n

(1)(7)(9 ) -

(1)(5)

(19) J

2143

1101527

371

224

e 2. Distribution of children by location ol injury, sex and dentition

Sex (•) Denfifion 1

tuoationof injury

Boys Primary Permanent

n n (%) n (%) Tofai

Home 37 (31) 38 (47) 42 (68) 33 (24) 75Scfiool 41 (35) 15 (19) 5 (8) 51 (38) 56Sfreef 33 (28) 24 (30) 12 (19) 45 (33) 57Offiers 7 (6) 3 (4) 3 (5) 7 (5) 10

Total 118 62 136 198

• p<0,05•" p < 0,001

from 2-21 years old, with a mean of 10,00 ±4,2,The group most frequently seeking treatment was10 to 12-year-old children (Fig, 1),

A total of 73 children had injuries to their pri-mary dentition (pD group) and 154 had injuries totheir permanent dentition (PD group). Falls werethe most common cause of injury in both groupsof children. Bicycle accidents and striking againstobjects were more frequently recorded in the PDgroup (p<0,05). Regarding sex, striking againstobjects was more frequently seen among boys thanamong girls (p<0,001) (Table 1).

With respect to location of injury, there was adifference between boys and girls (p<0.05), in thatboys were injured more often at school (35%) thangirls (19%). Home was the most common place ofinjury in the pD group (68%). However, schools(38%) and the street (33%) were more commonlocations of injury in the PD group (p< 0.0001)(Table 2). '

The distribution of children by time elapsed be-fore treatment showed no difference by sex anddentition group. More than 60% of the childrensought treatment after 24 h (52% pD group, 65%P D V O U P ) (Table 3).

The history of previous trauma did not differlietween sexes. However, there were differences

Dental trauma in Valparaiso, Chile

(p<0.05) between the pD group (36%) and thePD group (23%) (Table 4),

The most common injuries in the primary teethwere luxations (referred to as either extrusive orlateral displacement of the tooth, 26%), intrusions(21%), and finally subluxations and concussions(18%), Uncomplicated crown fracture (34%), com-phcated crown fracture (21%), subluxation (9%),periodontal hard-tissue injuries (8%) and avulsion(7,4%) were the main injuries in the permanentteeth. In the primary teeth there were 73% peri-odontal injuries, 15% hard-tissue injuries, and 9%with both. In the permanent teeth there were 19%periodontal injuries, 65%) hard-tissue injuries and8%, both (Table 5),

There were no statistically significant differencesin the number of teeth involved in either dentitionor age group. It was observed that the under 4-year-old group had only one or two teeth involved,and that in the group older than 15, 26% of thecases had 3 or more teeth involved (Fig, 2),

To date, patients can only be treated during anormal weekday schedule. Of the 227 patients, 44%w ere referred by hospitals and services of the Nation-al Health System, 38% of the patients sought treat-ment on their own initiative, and 18% were referredby private-practice dentists.

Discussien

Since 1990 the Children's Dental TraumatologyService of the Faculty of Dentistry, University ofValparaiso has been treating acute dental traumaand performing follow-up examinations. Thus, theChildren's Dental Traumatology Service receivesreferrals for dental trauma from throughout theregion.

With regard to sex, the boy: girl ratio was 1,4: 1,This finding is in agreement with other studies re-porting ratios ranging from 1,1 : 1 to 2,7: 1, (1-4,7-9, 11, 15, 16, 18, 19),

The 10 to 12-year-old group had the greatest

Table 3, Disfribufion of cfliidren by fime eiapsed before freafmenf, sex and dentition.

Sex Denfition

treatment

30 min31-60 min61-90 min91 min - < 2 4 fl>24li

n

975

1040

Bdys

(%)

(13)(10)

(7)(14)(56)

n

1158

1568

Girls

(%)

(10)(5)(7)

(14)(64)

Primt

n

747

1030

iiy

(%)

(12)

(')(12)

(1')(b2)

Permanenf

n

1386

1578

(%)

(11)

(7)(5)

(12)(65)

Toft

20

121326

1U8

Total

225

Onetto et al.

Table 4. Distribution of children by history of previous trauma, sex anddentition.

Previoustrauma

PositiveNegative

Total

Sex

Boys

n (%)

38 (28)96 (72)

134

Giris

n

2370

93

(%)

(25)(75)

Dentition (*)

Primary

n

2647

73

(*)

(36)(64)

Permanenf

n

35119

154

(%)

(23)(77)

Tofal

61166

227

• p<0 ,05

Tabie 5, lype of injuries by denfifiofi.

Primary

n (%)

Permanent

n (%)

Tofai

n (%)

Periodontal tissue injuriesSubluxation (')Luxation ('*)IntrusionAvtilsioii

84 (73) 45 (19) 129

21 21 42

30 5 35

24 1 25

9 18 27

(36)

Hard tissue injuriesUnoomplioafed crown fraofureComplioafed crown fraofureCrown-roof fraofure

17103

(15) 157825214

(65) 174925514

(49)

Root fraofure

Periodontal-hard tissueInjuriesDevelopmental disturbancesDther

Total teetb

4

10

4

115

(9)

(3)

9

20

146

242

(8)

(6)(2)

13

30

1410

357

(8)

(4)(3)

(100)

p < 0,0001(•) Inoludes ooncussion (4)

(") Inoludes laferai iuxafion and exfrusion (4)

frequency of tooth injuries, 69%) of the patientsranged from 7 to 15 years. Our study agreed withOikarinen & Kassila (4), who found the mean ageof the patients to be 11 years. Their study wasperformed in a Public Dental Health Clinic with asimilar schedule.

In our study on Valparaiso, 10 of the patientswere observed to have suffered serious dentaltrauma at an early age, but they had not soughtattention yet. It was suggested that when childrenreach adolescence aesthetics becomes a reason forseeking treatment. In Chile there exists little publicawareness about dental trauma and its compli-cations.

Falls, with 66% (81 % pD - 58% PD), and strikesagainst objects, with 17%> (13% pD-19% PD),were the main causes of injury. These results weresimilar to those reported in most epidemiologicalstudies (1-4, 6-7, 11). Bicycle accidents were found

PERCENTAGE

3ORMORETEE111

AGEGROIJP

Fig. 2. Percentage distribution of simultaneously injured teeth

by age group.

Data Fig, 2,

Age group 1 toolh 2 teeth

<44-67-9

10-1213-15

60,0 40,046,9 43,855,3 :i4,250,0 39,263,6 27,352,6 21,1

9,310,510,89,1

26,3

100100100100100100

only in 5% of the cases (3%, pD-9% PD), probablydue to the fact that Valparaiso is built on steep hills,thus allowing not much cycling.

Our survey agrees with previous studies reportingthat home is the main location for injuries in theprimary dentition (1-3, 4, 8), Children with perma-nent teeth, however, have most accidents at school(1,3,5),

61%) of the children sought treatment after 24 h(52% pD-65% PD), Similar results were found byGarcia-Godoy (1), who analyzed traumatic injuriesto primary teeth at a private pediatric dental center.The common delays in treatment seen in our study,might be due to the fact that children with dentaltrauma first seek treatment at Emergency Rooms inpublic hospitals that provide free medical and den-tal care to children, Chilean students are supposedto be covered by a School Insurance provided bythe Government and handled by public hospitalsbelonging to the National Health Service System

(NHSS). This system covers about 73% of the popu-lation (10,000,000 people). 40% of the patients at-tended by the NHSS are children aged 0-14 years.As the Children's Dental Traumatology Service isbecoming better known by the NHSS at the locallevel, patients are being referred by the EmergencyRoom more often. However, patients take anythingfrom a few hours to several days to arrive at theDental School. 27% of the children had a historyof previous dental truma and it was most frequentlyfocused in the primary dentition (36%).

It is known that because of the weakness of thesupporting tissue, children witb primary teeth read-ily suflfer periodontal injuries (2, 8, 9, 10). In thepermanent dentition, however, tbe energy of theimpact is resisted by the supporting structures andexceeds tbe shear strength of enamel and dentin(8-10, 20).

A single tooth injury was found in 54% of tbecases. Two teeth were involved in 35%, and threeor more teeth in 11%. These fmdings were in agree-ment with tbe results of Oikarinen (4), Ferguson(12), Ravn (13) and Zadik (14). Injuries affectingmore than one tooth have been reported by Andrea-sen to be common in patients seeking treatment athospitals.

Conclusions

T he fact tbat in Cbile prevalence of dental traumain school and preschool children is common, givesground to further studies in the field. In order thatpatients are referred in a timely fashion, it is necess-ary that Emergency Rooms at the local level getaware of tbe Children's Dental Traumatology Ser-vice. Additionally, it is important to direct preven-tive educational programs about traumatic dentalinjuries at parents, scboolteacbers and students.

Reforences

1. GARCIA-GODOY F, GARCIA-GODOY F, GARCIA-GODOY FM.

Primary teeth traumatic injuries at a private pediatric dentalcenter. Endod Dent Trmmatd 1987; 3: 126-9.

Dontal trauma in Vaiparaisc, Ciiilo

2. HARRINGTON MS, EBERHART AB, KNAPP JF. Dentofacial

trauma in children. J Dent Child 1988; 55: 334-8.3. O 'NEIL DW, CLARK MV, LOWE J W , HARRINGTON MS. Oral

trauma in children: a hospital survey. Oral Surg Oral MedOral Pathol 1989; 68: 691-6.

4. OIKARINEN K , K.-^SSILA O . Causes and types of traumatictooth injuries treated in a public dental health clinic. EndodDent Traumatol 1987; 3: 172-7.

5. MAJEWSKI R F , SNYDER CW, BERNATJE. Dental emergencies

presenting to a children's hospital. J Dent Child 1988; 55:339-43.

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8. ANDREASEN JO. Traumatic injuries of the teeth. Copenhagen:Munksgaard, 1981.

9. ANDREASEN JO, ANDREASEN FM. EssentiaLs of traumatic in-

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13. RAVN JJ. Developmental disturbances in permanent teethafter intrusion of their primary predecessors. Scand J DentRes 1976; 84: 137-41.

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