Traumatic dental injuries in schoolchildren and adolescents of Rural and Urban Areas of Aligarh, India: A prevalence study :Mohammad Kamran Khan, Mahendra Kumar Jindal, Saima Yunus Khan, Arjun Unnikrishnan, International Journal of Medical and Oral Research

ORIGINAL ARTICLE
Year : 2021 | Volume : 6 | Issue : 2 | Page : 27--30

Traumatic dental injuries in schoolchildren and adolescents of Rural and Urban Areas of Aligarh, India: A prevalence study

Mohammad Kamran Khan¹, Mahendra Kumar Jindal², Saima Yunus Khan³, Arjun Unnikrishnan¹,
¹ Junior Resident, Department of Pediatric and Preventive Dentistry, Faculty of Medicine, Dr. Ziauddin Ahmad Dental College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
² Professor, Department of Pediatric and Preventive Dentistry, Faculty of Medicine, Dr. Ziauddin Ahmad Dental College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
³ Associate Professor, Department of Pediatric and Preventive Dentistry, Faculty of Medicine, Dr. Ziauddin Ahmad Dental College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India

Correspondence Address:
Dr. Mohammad Kamran Khan
Hamdard Nagar A, Civil Line, Aligarh, Uttar Pradesh
India

Abstract

Introduction: Traumatic dental injury is becoming a public health problem and burden worldwide due to its higher prevalence, costly treatment procedures, and its sequelae. Materials and Methods: A cross-sectional epidemiological study was conducted among 1000 children aged 12 and 15 years of ten randomly selected schools of rural and urban areas of Aligarh, Uttar Pradesh, India, to evaluate the prevalence of traumatic dental injuries. The relevant findings of the study were collected by self-prepared pro forma and dental examination. Ellis and Davey's classification was used to record dental trauma in permanent teeth. SPSS 20 software was used to analyze the collected data from the study. Results: The overall prevalence of traumatic dental injuries in the present study was found to be as 13.5%. Children of 12 years of age (17.6%) were more affected with traumatic dental injuries as compared to adolescents of 15 years of age (12.8%). Schoolchildren of rural areas (15.2%) were traumatized greater than urban areas (11.8%) (P > 0.05). Conclusions: Dental trauma among schoolchildren was relatively higher in Aligarh and among which children of 12 years of age of rural areas were more traumatized with dental trauma than urban areas. Hence, preventive strategies must be implemented among children, adolescents, parents, and teachers to reduce the occurrence of such deleterious injuries.

How to cite this article:
Khan MK, Jindal MK, Khan SY, Unnikrishnan A. Traumatic dental injuries in schoolchildren and adolescents of Rural and Urban Areas of Aligarh, India: A prevalence study.Int J Med Oral Res 2021;6:27-30

How to cite this URL:
Khan MK, Jindal MK, Khan SY, Unnikrishnan A. Traumatic dental injuries in schoolchildren and adolescents of Rural and Urban Areas of Aligarh, India: A prevalence study. Int J Med Oral Res [serial online] 2021 [cited 2023 May 28 ];6:27-30
Available from: http://www.ijmorweb.com/text.asp?2021/6/2/27/319602

Full Text

Introduction

The healthy children and young individuals of every nation are the reflections of their prosperity and development. Oral health is also an integral part of the individual's overall health, and hence, any disease or traumatic injuries to oral and dental tissues influence the overall health. Only 1% of total body area make the oral region but it sustains injuries about 5% of overall human body.[1] Traumatic dental injury (TDI) is becoming a public health problem and burden worldwide due to its high prevalence, costly treatment procedures, and long-term sequelae.[2],[3] It has been seen that the occurrence of traumatic dental injuries and their sequelae may further increase the burden of caries and periodontal problems in the young age group.[4] Traumatic dental injuries in childhood and adolescence result in various problems such as physical, functional, aesthetic, social, economic, and psychological disturbances in children and their parents too.[5] Social activities such as speaking, laughing, and overall confidence are negatively influenced by such injuries.[6] TDI influences the physical development and education of schoolchildren. The consequences of such injuries are long term and patient has to suffer till adulthood. The quality of life is also affected by such dental injuries.[5],[6] The present study was the first epidemiological study conducted to evaluate the prevalence of dental trauma in schoolchildren of 12 years of age and adolescents of 15 years of age of rural and urban areas of Aligarh, Uttar Pradesh, India.

Materials and Methods

The present study was a cross-sectional epidemiological study conducted in rural and urban areas of Aligarh, Uttar Pradesh, India. The ethical clearance was obtained from the Institutional ethics committee of Faculty of Medicine, Aligarh Muslim University, Aligarh (D. No. 1030/FM). Then, a pilot study was conducted among 100 schoolchildren of rural and urban areas who were not part of the main sample to assess the feasibility for the conductance of the main study, and the self-prepared pro forma was modified accordingly. Sample size was calculated as 1000 comprising of 500 rural and 500 urban schoolchildren. The multistage sampling procedure was adopted for selecting the sample units (schoolchildren) for the present cross-sectional study. Ten schools (five schools in rural and five schools in urban areas) were randomly included from various areas of Aligarh city. All procedures performed in the study were conducted in accordance with the ethics standards given in 1964 Declaration of Helsinki, as revised in 2013. The informed consent was taken from the school authorities and parents of the children. The schoolchildren with the following inclusion and exclusion criteria were included in the sample.

Inclusion criteria

(1) The healthy schoolchildren of 12 and 15 years of age who were present in the school on the day of dental examination. (2) Children after obtaining informed consent from their parents/caretakers/guardians.

Exclusion criteria

(1) Schoolchildren who were not willing to participate in the present study; (2) children with acute illness; physically and mentally challenged; (3) children underwent or undergoing orthodontic treatment; (4) schoolchildren with developmental dental anomalies; (5) children with tooth loss (avulsion) other than dental trauma; (6) children with congenital partial anodontia; (7) children with discolored teeth due to other reasons than trauma (intrinsic stain, e.g. dental fluorosis).

In the present study, the self-prepared pro forma was used to record the findings of interview and oral examination of the study participants. The questions from the pro forma were asked to children in local language. The intraexaminer reliability agreement was determined by kappa value of 0.85. Oral examination and recording the findings into the pro forma were done by a single calibrated investigator. Cross-infection control measures were adopted during entire present study. All the permanent teeth including molars except third molars were examined, and Ellis and Davey's Classification (1970) was used for recording TDI. The collected data was entered in Microsoft Excel sheet 2010 and analyzed by IBM SPSS Windows software, version 20 (IBM, Corp, Armonk, NY, USA). The association between categorical variables tested by Pearson's Chi-square test was used. The level of significance and confidence interval were 5% and 95%, respectively.

Results

The overall prevalence of traumatic dental injuries in the present study was found to be as 13.5% [Table 1]. The schoolchildren of rural areas (15.2%) were comparatively more affected with dental injuries than urban areas (11.8%), however, the difference between prevalence of TDI was not statistically significant (P = 0.11) [Table 1].{Table 1}

The 12 years of age schoolchildren of both rural (17.6%) and urban (16%) areas were observed to be more affected with TDI than 15-year-old children of both rural (12.8%) and urban areas (7.6%). However, the difference between prevalence in relation to age was statistically significant (P = 0.04) in schools of urban areas than rural areas (P > 0.05) [Table 1].

Discussion

In the present study, the overall prevalence of traumatic dental injuries of schoolchildren of Aligarh city was found to be as 13.5%, which is similar to the findings of previous studies.[6],[7],[8] The reason for the comparable prevalence of TDI in the present study may be due to lesser awareness, motivation among school-going children, teachers and parents/guardians for its prevention, and proper treatment. In contrast, the higher prevalence rates (23.7%–39%) have been reported in previous epidemiological studies[9],[10] while the lower prevalence (4.15%–8.79%) has been observed in previous researches.[11],[12],[13] The prevalence of TDI has been seen lower comparatively among Indian population than other countries.[14],[15],[16],[17] The reason for the lower prevalence of TDI in Indian children and adolescents has been reported due to relatively lack of outdoor activities, and there is more emphasis on education.[8]

In the current study, schoolchildren of rural area were more affected with TDI than urban areas. Similar findings were reported by Bilder L et al.,[17] Sharva et al.[6] and Dhingra et al.[5] and Jubana et al.[18] In the present study, the greater prevalence of traumatic dental injuries in rural areas than urban areas might be due to comparatively more vigorous and careless approach and attitude in outdoor activities that make them more prone to dental injuries, and children of urban areas are considered to be more disciplined toward leisure playing activities and have comparatively more awareness about the dental trauma and its consequences. Children and their parents of rural areas give relatively lesser importance and are lesser motivated to oral and dental problems and its proper treatment, lack of safe playing environment, sports teachers, and lack of accessible dental health services for emergency management for dental trauma in rural schools. Reasons for the higher prevalence of dental injuries in rural areas have been suggested in previous studies as the presence of more hazardous playgrounds, lack of wearing of protective gears during playing sports, lesser parental attention and supervision of their children during playing activities, more inclination of children of rural areas toward vigorous behavior activities while schoolchildren of urban areas have restricted and well-mannered behavior and that is also enforced and influenced by their cultural and social background.[6],[17] In contrast to our findings, the higher prevalence of TDI in urban areas has been reported in various previous studies.[12],[19],[20] The reason for higher prevalence of TDI in urban areas was suggested in a study done by Cavalcanti AL[20] and Lam[4] as the overcrowding places, violence activities, and more road traffic accidents and considering the school environment, there are more number of students in a classroom and in a school as well as more involvement in sports-related activities, greater ownership of cycles, skateboards.

In the present study, 12 and 15-year-old children were included because these age groups are WHO index ages.[9] Age has been reported frequently as a risk factor for the occurrence of dental trauma in various studies in which most of TDI occurred in younger population.[3],[4] The higher prevalence of dental injuries in 12-year-old children in the present study might be because as children of 12 years of age are lesser mature in behavior, more enthusiastic and have more free time for sports-related activities as compared to 15 years of age children. Fifteen-year-old children start thinking more logically and wisely in every aspects of life and take comparatively more precautions in risk-taking adventurous activities. In epidemiological studies of Carvalho et al[9] and Naidoo et al,[11] where 12 year age group was reported with higher prevalence of dental trauma than other age groups. Singh et al.[13] observed that dental trauma was higher in older children of age group 10–17 years than younger children of age group 3–5 years which was due to relatively physically weaker in early childhood and unable to take part in vigorous adventurous activities and therefore lesser chances of sustaining dental trauma in them. In contrast to the present study, Yadav et al.[21] and Bilder et al.[17] reported that children of 15 years of age sustained more dental trauma than 12-year-old children. It has been reported in previous researches that TDI increases with increase in age as it is cumulative in nature and it does not mean that older individuals are more vulnerable.[22]

Conclusions

The overall prevalence of dental injuries in Aligarh city of India was found to be 13.5% which was comparatively higher in rural areas than urban areas although not statistically significant. The children of 12 years of age were found to be more traumatized as compared to adolescents of 15 years of age. Hence, preventive strategies must be implemented among children, adolescents, parents, and teachers to reduce the occurrence of such injuries. The prevalence of dental injuries and its consequences can be minimized by adopting prevention at primary, secondary, and tertiary level.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

The authors thank all the participated school authorities and the schoolchildren for their cooperation in the present study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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