TM Traumatic Injuries of Anterior Teeth

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE
TRAUMATIC INJURIES OF ANTERIOR TEETH:

A PREVALENT STUDY IN
SCHOOL CHILDREN OF COORG DISTRICT
By
Dr. PUNIT BHARADWAJ
Dissertation Submitted to the

Rajiv Gandhi University of Health Sciences,
Karnataka, Bangalore
in partial fulfillment of the requirements for the degree of
MASTER OF DENTAL SURGERY
IN THE SPECIALTY OF
PEDODONTICS AND PREVENTIVE DENTISTRY
Under the guidance of

Dr. SHANTHALA B.M. M.D.S.
Professor and HOD
DEPARTMENT OF PEDODONTICS AND PREVENTIVE DENTISTRY

COORG INSTITUTE OF DENTAL SCIENCES
VIRAJPET-571 218
COORG
2006 – 2009
BANGALORE, KARNATAKA
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation entitled “TRAUMATIC INJURIES OF
ANTERIOR TEETH: A PREVALENT STUDY IN SCHOOL CHILDREN OF
COORG DISTRICT” is a bonafide and genuine research work carried out by me
under the guidance of Dr. SHANTHALA B.M., Professor and Head, Department of
Pedodontics and Preventive Dentistry, Coorg Institute of Dental Sciences, Virajpet.
Date :
Place : Virajpet Dr. PUNIT BHARADWAJ
ii
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled “TRAUMATIC INJURIES OF
COORG DISTRICT” is a bonafide work done by Dr. PUNIT BHARADWAJ in
partial fulfillment of the requirements for the degree of Master of Dental Surgery in
the specialty of Pedodontics and Preventive Dentistry.
Date : Dr. SHANTHALA B.M.

Professor and Head
Place: Virajpet Department of Pedodontics and
Preventive Dentistry
Coorg Institute of Dental Sciences,
Virajpet - 571 218
iii
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,
KARNATAKA
ENDORSEMENT BY THE HOD, PRINCIPAL/
HEAD OF THE INSTITUTION
This is to certify that the dissertation entitled “TRAUMATIC INJURIES OF
COORG DISTRICT” is a bonafide research work done by Dr. PUNIT
BHARADWAJ under the guidance of Dr. B.M. SHANTHALA, Professor and Head
of the Department, Department of Pedodontics and Preventive Dentistry, Coorg
Institute of Dental Sciences, Virajpet.
Dept of Pedodontics and Coorg Institute of Dental sciences,

Preventive Dentistry Virajpet - 571218
Virajpet - 571 218
Date: Date:
Place: Virajpet Place: Virajpet
iv
COPYRIGHT
DECLARATION BY THE CANDIDATE
I hereby declare that the Rajiv Gandhi University of Health Sciences,
Karnataka shall have the rights to preserve, use and disseminate this dissertation /
thesis in print or electronic format for academic/research purpose.
Date:
Place: Virajpet Dr. PUNIT BHARADWAJ
© Rajiv Gandhi University of Health Sciences, Karnataka.
v
ACKNOWLEDGEMENT
Towards the completion of this dissertation and my course, I would like to
acknowledge the people who have guided and helped me through it.
I feel fortunate to have Dr. Shanthala B.M, Professor and Head, as my guide,
without whose knowledge and astute evaluation, I would not have been able to
achieve so much out of this course. I would like to take this opportunity to express my
deep gratitude to her for always encouraging me to excel in my work.
I am truly thankful to Dr. V.V. Narasimha Rao, Professor for his constant
encouragement, timely advice and valuable insight at every stage of this dissertation
and my post-graduate training.
I convey my sincere regards to Dr. Manoj Kumar M.G, Professor, for his
constant support, blessings and guidance during the course of my dissertation.
I thank Dr. Ameet Kurthukoti for his valuable support and guiding me
throughout my thesis writing. I also thank Dr. Lini Mathew and Dr.Chandru for
their help, advice and encouragement provided throughout these three years.
I thank Dr. Peter Simon Sequeira, Principal for his co operation and
guidance.
I thank Dr. Sunil Muddaiah, Managing Trustee, Coorg Institute of Dental
Sciences, Virajpet, for providing me support and the necessary facilities for the timely
fulfillment of this dissertation.
I am also grateful to Dr. Lancy D’Souza, Professor (Biostatistics and
Psychology) Mysore University, for their help in the statistical analysis of this study.
vi
A Special thanks to my friend Dr. Bobby Wilson, II year post graduate,
Department of Pedodontics, with out whose support and personal involvement at
every stage of this dissertation, it was not possible to complete this dissertation.
I also thank my colleagues Dr. Ajay Reddy M. and Dr. Arun Roy James,
my juniors, Dr. Deepesh S. Nair, Dr.Sheen Ann John, Dr. Anoop Harris and
Dr. Pranjal Sharma for always standing by me and for their constant
encouragement and support.
I am very thankful to all the parent, children and teachers of various schools
of Coorg district for there co-operation during my dissertation.
I would like to acknowledge the patience and support of all the chair side
assistants and the non teaching staff in the department.
Words are not sufficient to convey my gratitude to my loving parent and my
sisters. It is because of their encouragement, love, great sacrifices and innate
confidence, without which I would not have been where I am today. I am eternally
grateful to them for all that they have done for me.
Above all I thank the Almighty for his blessings and kindness.
Date:
Place: Virajpet Dr. Punit Bharadwaj
vii
LIST OF ABBREVIATIONS
CPITN : Community Periodontal Index and Treatment Need
HS : Highly Significant
i.r.t : In relation to
NS : Non Significant
WHO : World Health Organization
viii
ABSTRACT
Background and Objectives
A traumatic dental injury and its sequelae are of concern to both the clinicians
and the parents of affected children. Most of the available retrospective studies
present a contrasting volume of prevalence data that may be attributed to differences
in experimental design among the studies, differences in the population studied and
variation in the age or the size of the sample.
The paucity of available studies on Coorg population initiated us to
undertake the present study to determine the prevalence of traumatic injuries in school
going children of Coorg district and correlate it with the cause, place of occurrence of
trauma, age distribution of trauma and over-jet of the traumatized teeth.
Methods
The sample consisted of 4036 school children aged 7-15 years from 12
schools of Coorg district. The study sample was selected using stratified random
sampling method. The selected children were screened using WHO criteria for oral
examination and those found with clinical traumatic injury were further examined for
the type of traumatic injuries using Garcia-Godoy’s classification and over-jet was
recorded. After examination questions regarding time, place and cause of trauma was
asked.
Results
The statistical analysis of the results was done using chi-square test. The
results showed that out of 4036 children, 128 (3.17%) had suffered traumatic injuries.
Males were 2.76 fold more prone to trauma than females. The common causes for
ix
trauma were play (64.1%), accidents (33.6%) and peer-fighting (2.3%). The common
places of occurrence of traumatic dental injuries were home (63.3%), classroom
(15.6%), playground (14.8%) and road (6.3%). The age group of 10-12 years
experienced 53.1% injuries, while 7-9 years 39.8% and 13-15 years 7.0 %
respectively. Enamel-dentin fracture without pulpal involvement was the commonest
type of trauma and the teeth mostly involved were maxillary central incisors. 55.3%
patients had over-jet less than 3.5 mm, 33.5% between 3.6-5.5 mm, 10.1% between
5.6-8.5 mm and 1.1% had over-jet between 8.6-11.5 mm
Interpretation and conclusion
The prevalence of traumatic injuries in 7-15 years school children of Coorg
district was 3.17%. Males were more commonly injured than females. Play was the
commonest cause and home was the most common place of traumatic injuries.
Enamel-dentin fracture without pulp involvement was the most common type and
maxillary central incisors were the most common teeth having traumatic injuries.
The data derived from this study can be employed in an organized municipal
effort to educate parents, teachers and schoolchildren about the immediate
management and prevention of dental trauma.
Key words: Traumatic injuries; anterior teeth; prevalence; Coorg district; place;
cause; over-jet.
x
TABLE OF CONTENTS
Sl. Page
No. No.
1. INTRODUCTION 1
2 OBJECTIVES 3
3. REVIEW OF LITERATURE 4
4. METHODOLOGY 24
5. RESULTS 32
6. DISCUSSION 46
7. CONCLUSION 52
8. SUMMARY 54
9. BIBLIOGRAPHY 55
10. ANNEXURES 62
xi
LIST OF TABLES
Table Page
No. No.
1 Descriptive statistics showing the prevalence of trauma in 38

both males and females
2 Descriptive statistics showing the comparison of cause with 38

the prevalence of trauma in both males and females
3 Descriptive statistics showing the comparison of place of 39

trauma with the prevalence of trauma in both males and
females
4 Descriptive statistics showing the age wise comparison of 39

prevalence of trauma in both males and female
5 Descriptive statistics showing the comparison of different 40

types of trauma with the tooth types
6 Descriptive statistics showing the comparison of amount of 41

over-jet in an affected tooth with the tooth type
7 Frequency distribution of trauma within the arch 42
xii
LIST OF FIGURES
Figure Page
No. No.
1 Armamentarium used for study. 28
2 Examination and recording of traumatic dental injuries in 28

Children.
3 Subject with clinical presentation of class 0 traumatic dental 29

injury i.r.t. 11
4 Subject with clinical presentation of class 1 traumatic dental 29

injury i.r.t. 21
5 Subject with clinical presentation of class 2 traumatic 30

dental injuries i.r.t. 11 and 21

dental injury i.r.t. 31 and class 1 i.r.t. 41.


dental injury i.r.t. to 11
xiii
Introduction
INTRODUCTION
Traumatic dental injury in children is a common feature other than dental
caries1. Traumatic dental injuries are often associated with facial fractures in road
traffic accidents whereas exclusive dental injuries are often due to minor accidents
such as fall or contact with blunt objects while playing. The latter is seen more
frequently in the children during developmental period1. Children with injuries to
their anterior teeth and concerned parents present a challenge to dentist. Trauma to a
tooth is followed by pulpal hyperemia, congestion and alteration in the blood flow in
the pulp which is sufficient to initiate irreversible degenerative changes, and over time
can cause pulpal necrosis. In addition the apical vessels might be severed or damaged
enough to interfere with reparative process. Thus the prognosis of such tooth depends
on the rapidity with which it is treated2. A prevalent study of trauma to anterior teeth
and its confounding factors would help the clinicians to recommend preventive
measures to traumatic injuries, such as early reduction of excessive protrusion, use of
car safety belts and to wear mouth guards during high-risk unsupervised athletic
activities.
Dental injuries can occur at any age starting from one year of life which tends
to increase as child starts to crawl, stand or walk with peak incidence being school age
.The review for trauma in different age groups has reported two prevalent age groups
of 2-5 years and 8-12 years. In 2-5 years during developmental period when child is
learning to walk and run as they have tendency to fall due to lack of properly
developed co-ordination and judgment3,4,5. In the age group of 8 to 12 years as a result
of increased outdoor activities and participation in sports as children go into the
higher classes in the schools 6,7,8.
1
Introduction
The common reported cause of trauma in children is fall and sports activity.
Apart from that accidents and peer fighting have also been reported. As children
spend their majority of time at home, the most common place for occurrence of
traumatic injuries is reported to be at home followed by school and other places9,10,11.
The prevalence of the damage exceeds to the percentage of those seeking
treatment leading to high unmet treatment need12. Difficult therapeutic problem raised
by traumatic loss of the anterior teeth and the socio-economic considerations will
stress the need for collecting valuable data dealing with the causes and types of teeth
injuries. It is also of paramount importance that educational programs for lay people
about the importance of early treatment for dental trauma, ways of preventing these
traumas and procedures for appropriate emergency management be instituted. These
educational programs for the lay public in a country should preferably be preceded by
an investigation of background information on the occurrence of oro-dental injuries in
the community13.
This initiated our present study to evaluate the prevalence of the traumatic
injuries to the anterior teeth in school going children of Coorg district and to correlate
the prevalence of the injury to the cause and place of trauma with the age of the child
and incisal over-jet of the traumatized teeth.
2
OBJECTIVES
• To determine the prevalence of trauma to permanent anterior teeth in school
going children of Coorg district.
• To correlate the prevalence of trauma to the cause and place of trauma.
• To determine the prevalence of trauma among different age groups.
• To evaluate the over-jet of traumatized teeth.
3
Review of Literature
REVIEW OF LITERATURE
Traumatic dental injuries have always been a neglected oral condition despite
availability of a sound knowledge about its prevalence causative factors, treatment
and significant impact on individuals1. However in developed and developing
countries14 there is renewed focus on studying dental trauma which is an irreversible
pathology15.
In the early nineties, Andreasen1 hypothesized that dental trauma in the
foreseeable future will probably exceed dental caries and periodontal diseases. An
oral traumatic injury can frequently lead to tooth lesions, affecting both supporting
dental structures and hard tissues. Children and adolescents in general are more
susceptible to these problems than adults. In 1990 it was stated that at least half of all
schoolchildren had a chance of suffering traumatic dental injuries before leaving
school1.
Incisor teeth play a critical role in aesthetics, phonetics and functional
activities. Unfortunately, the morphology and location of these teeth make them
susceptible to a range of traumatic injuries16. The prevalence of incisor injury has
been reported to range from 1.8% to 49%. This great variation in prevalence has been
related to different factors such as the type of the study, trauma classification, limited
age groups, over-jet, cause, place, geographical and behavioral differences between
study locations and countries17. Accordingly, several authors recommended
educational programs for lay people about the importance of early treatment for dental
4
trauma, ways of preventing these traumas and procedures for appropriate emergency
management of avulsed teeth.
A review of literature indicates that there are numerous studies done on
traumatic injuries to teeth around the globe. Following are the studies, conducted to
find the prevalence of traumatic dental injuries in the anterior permanent teeth in
different countries and age groups along with the determination of the various factors
for the occurrence of trauma:
A prevalence study in South India assessed the frequency and distribution of
the traumatic injuries to anterior teeth among 4500 school children in the age group of
3 to 16 years from South Kanara District of Karnataka. The classification used to
record type of trauma was Ellis and Davey’s classification. Random sampling method
was used and examination was done under natural day light by visual and digital
examination in school settings. Information concerning sex, age, cause of trauma,
number of injured teeth, type of the teeth, lip competence, terminal plane relationship
and the molar relationship were recorded. A total of 238 cases (5.29%) had incisor
and canine fractures, which was more prevalent among the boys (72.27%) than the
girls (27.73%). The leading cause of injury was undefined falls and the maxillary
central incisors were commonly affected in both the primary and the permanent
dentition. Enamel fracture was the most common form of injury noted18.
In a South Indian prevalence study of traumatic injuries in the age group of 8-
14 years amongst 2100 school children, the prevalence of traumatic injuries to incisor
teeth was found to be 13.8%. Hargreaves and Craig’s classification was used. Its
5
association with various factors such as age group, sex, place of injury and the
dentition was studied and it was reported that most common age group involved in
trauma was 11-14 years (60.74%). Males (66.81%) were more affected than females
(33.19%). Most common place of occurrence was home (68.76%). The relation
between incidence of overjet and prevalence of fractured incisors was found to be
statistically insignificant19.
A prevalence study determined the traumatic injuries to the anterior teeth and
evaluated the role of anatomic risk factors in the occurrence of such injuries in a
group of 370 males of age group of 14-16 years enrolled in the National Cadet Corps
(NCC) in India. Risk factors such as the socio-economic status of parents, lip
coverage, incisor over-jet, the cause and nature of trauma to anterior teeth were
recorded. A prevalence of 14.9% of traumatic injuries to anterior teeth was found with
sports activities being the most common cause. Permanent maxillary central incisors
involving enamel and dentin were observed most frequently. Increased over-jet and
inadequate lip coverage were significantly associated with the occurrence of trauma20.
In a retrospective study the prevalence of the traumatic injuries to permanent
incisors and canines has been observed to be of 18.1%. The classification used to
record type of trauma was Garcia-Godoy classification. Sample was selected by
random sampling and examination was done under day light in school. It was found
that girls suffered more concussions than the boys. The most frequent place of
occurrence of trauma, in both the sexes, was at home. The teeth most commonly
injured were the maxillary central incisors (63.9%)21.
6
In a prevalence study reported in Calcutta, it has been found that the fracture
to anterior tooth was only 0.73% among children of different ages. It was also
observed that the boys were affected 2.5 times more than the girls and maximum
number of tooth fracture took place in the mixed dentition period22.
The prevalence of the traumatic injuries using Garcia-Godoy classification to
the permanent incisors of children from Dominican private schools was 10.0%. The
largest numbers of injuries were found in 5-6 year old children, followed by the 7 to 8
year olds. The most common cause of injury in both the sexes was falls against an
object and girls suffered more injuries with the ratio of boys to girls being 0.91 to 123.
A retrospective prevalent study of the school children from the city of Santo
Domingo, found traumatic injuries to the permanent incisors and canines was 12.2%.
in 1200 school children of age 6-17 years in 8 public and private schools. The
classification used to record type of trauma was Garcia-Godoy classification. More
boys were injured than the girls with a ratio of 1.1:1. The most common type of injury
in both the sexes was enamel-dentin fracture followed by enamel fracture24.
A retrospective study done in 1,200 children of age 7-16 years in Santo
Domingo in Dominican Republic, found that the prevalence of injuries in private
schools were 21.3% and in public schools were 16.3%. Garcia-Godoy classification
was used for recording trauma. The sample was taken from one private and one public
school from each of the six districts of Santo Domingo. Examination was done under
day light with mouth mirror and probe. The most common type of injury was enamel
fracture followed by enamel dentin fracture without pulp exposure25.
7
In one of the longitudinal study with a 14 year follow-up, the frequency of the
traumatic injuries to the permanent teeth in a Swiss population sample consisting of
262 children of age group 6-18 years was estimated. The prevalence of injury was
10.81% and the boys were found to be between the ages of 9 and 10 years. The teeth
most commonly injured were the maxillary central incisors (80 %), and the most
frequent type of injury was an enamel-dentin fracture without pulp exposure (53 %).
The recall evaluations showed that the prognosis was extremely favorable for enamel
fractures only26.
In an epidemiological survey of two secondary school children in Benin city,
Nigeria, a very high prevalence (19.06%) of traumatic injury to the anterior teeth was
observed. The male to female ratio was 1.6:1. The most frequent injury was loss of
enamel followed by the loss of enamel and dentine. The injury was more common in
the maxilla than in the mandible27.
In a prevalence study from an urban community in a Swiss population, the
traumatic injuries to the permanent and deciduous dentitions were 30%. Boys had a
higher trauma frequency than the girls, the ratio being 1.2:1 in the deciduous dentition
and 1.6:1 in the permanent dentition. 30% of the injured deciduous teeth required
some kind of treatment and that for permanent dentition was 46% 28.
A 6 year retrospective follow-up study was conducted to analyze the records
of 106 patients with sports related dental trauma treated in public oral surgery unit in
Helsinki, Finland. Male to female ratio was found to be 3:1 and the mean age affected
8
was 11.8 years. Most of the injuries had arisen from ice hockey or skating and 80%
were uncomplicated crown fractures followed by concussions or sub-luxations29.
In a retrospective study, conducted to know the frequency of traumatic injuries
to permanent incisors in a sample of 1614 children in age group of 6-16 years from
the Southern Finland, the prevalence of injuries were found to be highest among the
boys than girls and the most frequent type of injury was an uncomplicated crown
fracture (90.5%). Most commonly injured teeth were the upper central incisors.
(81.7%) 30.
In a Mexican retrospective study among the group of boys from private
schools in Monterrey, Mexico, the prevalence of injuries was found to be 28.4%. The
sample selected was 1010 boys of age 3-13 years enrolled in 4 private school in the
city. Garcia-Godoy classification was used for recording trauma. 72.2% of the 4 year
olds presented signs of traumatic dental injuries making this age group more prone to
traumatic injuries. The most common type of injury in the primary and the permanent
dentitions were enamel fractures with 58.5% and 69.6% respectively31.
In a retrospective study it was found that there is a definite relationship
between traumatic injuries to upper permanent incisors and incisal overjet. The
prevalence of the injuries were highest among extreme overjet groups and about 50%
of the girls and 70% of the boys were affected before the age of 10 years32.
A study explained the relationships between traumatic injuries to upper
incisors and incisal overjet in a sample of orthodontically untreated children aged 7 to
9
16 years. It was found that the frequency and severity of the injuries were greater in
children with extreme overjet than in children with over-jet ranging from 0-3 mm12.
A prevalent study was done from 968 photographic records for the accidental
damage to maxillary incisor teeth in 11-12 years old South Wales school children.
The prevalence was estimated to be 15.3% and maxillary central incisors were the
most commonly affected. The percentage of trauma increased significantly with
increasing overjet, but lip incompetence did not affect the prevalence of accidental
damage. Only 14.8% of traumatized teeth had received treatment33.
A 12 month survey from pediatric dental services of the child National
Medical Center in 159 males and 68 females showed leading cause for traumatic
injuries was due to fall (46%) with soft tissue injuries in 132 children, permanent
dentition injuries in 61 teeth of 44 children and primary dentition injuries in 36 teeth
of 31 children34.
A survey in a young Israeli population reported occurrence and causes of oral
and dental injuries during childhood and adolescence as well as participants’
awareness of using protective devices, such as mouth guards, during sporting
activities in 427 young adults, aged 18–21 years. The total number of dental and oral
injuries was 133, affecting 31.1% of the participants, in which 72 (16.9%) suffered
dental injuries, mostly because of falls (64%), followed by sporting activities (23.2%),
street-fights (7.2%), and car accidents (5.6%). Injuries occurred at school in 36.5% of
cases and at home in 23.8% of cases. The most frequently reported injury was
laceration (47.3%) followed by tooth fracture (41.9%). Of the 427 participants, 239
10
(56%) were active in at least one type of sport. Only 22.6% were aware of protective
devices, e.g. mouth guards, and only 2.8% actually used these devices. These results
show the high risk of potential dental and oral injury during childhood and
adolescence, a lack of knowledge regarding the benefits of mouth guards and their
limited use35.
An epidemiological study was conducted to know the etiological and
predisposing factors related to traumatic injuries to permanent teeth in 1610 children.
It reported 286 traumatic injuries to permanent teeth. The most common causes for
injuries were falls and blows followed by traffic accidents. An over-jet exceeding 4
mm, short upper lip, incompetent lip and mouth breathing increased susceptibility to
traumatic injuries. Dental injuries sustained during participation in sports were twice
as common in the boys (18.2%) than in the girls (8.2%)36.
A cross sectional epidemiological study of traumatic injuries was carried out
among the Swedish school children living in a rural area in the age group of 7 - 17
years. The variables examined were age, sex, etiology, organized sports activity, type
of injury, treatment, number of dental visits and time utilized for dental visits. Dental
injuries were recorded in 11.7% of children and prevalence was highest in the 8-12
year old age group for boys (75%) and the 7-9 year old age group for girls (63%). The
most frequent etiological factors were collision during play and falling over. Simple
enamel fracture of maxillary incisors was most common type of injuries. It was
concluded that the frequency of traumatic dental injuries in a rural area was lower
than in urban areas37.
11
In a retrospective study from 227 patient’s records in 2 to 21 years old the
cause of the injury, location of the injury, history of previous trauma, type of the
injury, the number of injured teeth and how patients sought treatment was evaluated
at the children’s Dental traumatology service in Valparaiso, Chile. According to
them, 10 to 12 year old children had the highest number of injuries (83%). Falling
was the most common cause of injury in both males and females followed by
striking against objects and bicycle accidents. The location of trauma in primary
tooth was home and in permanent tooth at school. Uncomplicated crown fractures
(34%) followed by complicated crown fractures (21%) were the main trauma types
in the permanent teeth. Single tooth injury was found in 54% cases, two teeth in
35% and three or more teeth in 11% of children38.
A prevalence study determined the dental injuries in 2020 school children
aged 6-15 years by random sampling from 85 state and private schools of Rennes,
France. Ellis and Davey’s classification was used. Mean prevalence of the dental
injuries were 13.6%. Boys showed a higher prevalence than the girls (17% and
10.2% respectively). Simple enamel fracture of maxillary central incisors was the
common type of injury (59.4%)39.
In a Nigerian study 1016, 12 year old children were examined to assess the
prevalence of traumatic injuries of the anterior teeth in relation to incisor overjet
and lip competence. The prevalence of the dental injury was 10.9%. Boys sustained
more injuries to their anterior teeth than girls. Of the 111 children with traumatic
dental injuries, 721 (64.0%) had increased incisor over-jet (> 3 mm) compared to
257 (28.4%) in the non-trauma group. Similarly, 72 (64.9%) of the trauma group
12
had inadequate lip coverage compared to 224 (24.8%) in the non-trauma group.
These differences were statistically significant. It was concluded that incisor overjet
of more than 3 mm and incompetent lips were significant predisposing factors to
anterior dental injury40.
A report identified 36 Singapore school children, aged 7-18 years, from a
clinic population of 11,179, who had suffered dental trauma while playing contact
or collision sports, The control group of 36 children, matched for age, sex, race and
sporting activities, who had not suffered trauma, was selected from the same clinic
population. Both the groups were examined and the nature of injuries received were
determined. The mean over-jet for the trauma group was 3.42 ±1.45 and for the
injured group was 3.42 ±1.33 mm which was statistically non-significant41.
A prospective longitudinal study was conducted in 470 injured teeth of 370
patients who attended the dental clinic for treatment between 1981-1993 at Ege
university, Izmir. The classification used was Andreasen’s classification. The study
showed that more boys suffered traumatic injuries (64.8%) than the girls (35.2%).
Patient aged 11-15 years exhibited the highest number of injuries (37.4%). The
leading cause of injury was undefined falls and the common type of trauma was
non-complicated crown fractures of maxillary central incisors42.
A prevalence study of traumatic injuries in a sample of 824 school children
of age 6-11 year in Rome (Italy) evaluated relationship between injuries and
predisposing factors to traumatic injuries. Prevalence value of the study-population
was 20.26%. The highest prevalence was found among 9-year-old boys (33.69%)
13
and the male to female ratio was 1.64:1. 62% of the involved teeth were permanent
upper central incisors, 11 % were primary upper central incisors and permanent
upper lateral incisors. 64.39% of all injuries were enamel fractures followed by
enamel-dentin fractures (19.89%)) and concussions (8.90%). Serious injuries such
as root fractures, fractures with pulp exposure, intrusions or extrusions were
uncommon. The main dental injury causes were plays including indoor and outdoor
plays (60%), followed by sports including impact (8.37%) and fall favouring
(7.32%) sports. Traffic accidents were uncommon43.
A study in Alachua County, Florida examined risk factors associated with
incisor injury in 3396 third and fourth grade school children to assess severity of
incisor injury in relation to gender, age, race, skeletal relationships, morphologic
malocclusion, incisor exposure, inter-labial gap, TMJ sounds, chin trauma, and
history of lower facial trauma. One in five (19.2%) exhibited some degree of incisor
injury. Incisor injury was limited to a single tooth (73.1%) with predominated
enamel injury (89.4%). The majority of the injuries (75.4%) were localized in the
maxillary arch, with central incisors frequently traumatized. Results indicated risk
of incisor injury was greater for children who had a prognathic maxilla, had a
history of trauma, were older in age, were male, and had greater over-jet and
mandibular anterior spacing14.
In a retrospective study of Northern Sweden, 3007 dental records from the
public dental health service was studied in age group 1-16 years and was found that
35% of the children on once or more occasions had sustained injury to their primary
or permanent dentition. Andreasen’s classification was used to classify traumatic
14
injuries. The boys had sustained trauma to their teeth most frequently when they
were 4 years and between 8 to 11 years, whereas in the girls it was 4 and 9 years.
Majority of the dental injuries had affected maxillary incisors and their supporting
tissues44.
A review on the risk of traumatic dental injury due to over-jet using several
published papers and performing a meta-analysis on the results reported the effect
of confounders (i.e. age, gender), which could bias the relationship between over-jet
and dental injury was taken into account. From the results, it was concluded that
children with an over-jet larger than 3 mm are approximately twice as much at risk
of injury to anterior teeth than children with an over-jet smaller than 3 mm. The
effect of over-jet on the risk of dental injury is less for boys than for girls in the
same over-jet group. In addition, risk of injury of anterior teeth tends to increase
with increasing over-jet size45.
A cross-sectional survey for the assessment of epidemiological data
concerning dental injuries to the permanent incisors of children included 1087
children aged 9-12 years, of both the sexes from public and private school in
Damasdcus, Syria. The prevalence of traumatic injuries to the permanent incisors
rose from 5.2% at the age of 9 years to 11.7% at the age of 12 years. There was a
tendency for children with an incisal over jet greater than 5 mm to have experienced
dental injuries. The most common reported cause of injuries to the permanent
incisors was violence (42.5%), followed by traffic accidents (24.1%), collisions
with the people or inanimate objects (16.0%) and falls(9.1%)46.
15
A review describing the aetiology of dental trauma from national and
international studies using the different classifications reported that males tend to
experience more dental trauma in the permanent dentition than females. Accidents
within and around the home were the major sources of injury to the primary
dentition, while accidents at home and school accounted for most of the injuries to
the permanent dentition. The most frequent type of injury was a simple crown
fracture of the maxillary central incisors in the permanent dentition while injuries to
the periodontal tissues were more common in the primary dentition. It also
discussed the possible preventive measures to reduce the increasing frequency of
dental trauma47.
The prevalence of traumatic injuries to permanent incisors and their
distribution according to type and some clinical factors, were analyzed in a total
population of 2798 patients, aged 6–21 years over a 5-year period in the Dental
Clinic of the University of Verona, Italy. Detailed case histories and radiographs
were also recorded. Boys to girls ratio was found to be 2.7:1. Andreasen’s
classification was used. The prevalence of injuries was 7.3%. A very large number
of dental injuries occurred to children aged between 6 and 13 years. Most frequent
causes of injuries were falls and traffic accidents. About 80% of the teeth were
maxillary central incisors. The most common type of injury was non complicated
crown fracture48.
In a study evidence of traumatized permanent incisors was recorded as part
of a national oral health survey of school children in Malaysia. Children were
selected by cluster sampling with the school as primary sampling unit and
16
individual classes as secondary sampling unit. A total of 4085 schoolchildren aged
16 years were examined. The prevalence of injury was 4.1% and it was significantly
higher in males than females, with a ratio of 2:1. Almost 75% of the subjects had
one tooth affected. Out of a total of 200 fractured teeth, 78.0% involved the
maxillary central incisors. A high level of untreated traumatized teeth (89%) was
noted49.
A systematic review of the literature was undertaken to evaluate the criteria
used for the diagnostic classification of traumatic dental injuries from an
epidemiological standpoint. The methodology used was that suggested by the
Cochrane Collaboration and the National Health Service. A total of 12 electronic
bibliographical databases and the World Wide Web were searched. The final study
collection consisted of 164 articles, from 1936 to 2003, and the population sample
ranged from 38 to 210 500 patients. 54 distinct classification systems were
identified. According to the literature, the most frequently used classification
system was that of Andreasen (32%); as regards the type of injury, the
uncomplicated crown fracture was the most mentioned lesion (88.5%). Evidence
supports the fact that there is no suitable system for establishing the diagnosis of the
studied injuries that could be applied to epidemiological surveys50.
A cross-sectional survey was done to assess the prevalence, etiology, place
of occurrence and rate of treatment of traumatic dental injuries (TDI) in 12-year-old
school children of Herval D’Oeste, Brazil. Examinations were performed under day
light with mouth mirrors and CPITN probes. The prevalence of TDI was 17.3% and
the most common type of injury found was enamel fracture alone. The majority of
17
the cases of TDI occurred at home (17.8%) and school (17.8%). Collisions (24.5%),
mainly with doors, and physical leisure activities (20.0%) such as cycling and
playing soccer were the main activities related to TDI etiology. Children who had
an incisal overjet size >5 mm were 3.5 times more likely to have TDI than children
who had an incisal over-jet of <5 mm51.
An epidemiological study of dental and facial trauma from the patients
reporting to University of Otago School of Dentistry during the period 2000–2004
reported the highest number of injuries occurred in the 16–25 year group with a
male to female ratio of 2.01:1. There were 653 deciduous tooth (18.8%) injuries
having male to female ratio 1.58:1 with the greatest number of injuries occurring in
the first 5 years of age. Concussion (51%), sub-luxation (27%) and uncomplicated
crown fractures (11%) were the most common injuries. There were 2039 permanent
teeth injured with a male to female ratio of 1.9:1, and the highest injury occurrence
in the 16–25 year group. The upper permanent incisors with uncomplicated crown
fractures were the most commonly injured. In both primary and permanent teeth the
most common cause was fall and place of injury was home. There were 230 cases
with bone fractures to the facial skeleton with the majority of bone fractures
occurring in the 16–25 year group and a male to female ratio of 4:1 was found52.
A prevalence study of trauma to anterior permanent teeth and its
associations with independent variables in 453, 5th and 6th grade school children of
Eastern Jerusalem reported 33.8% of dental trauma to anterior permanent teeth.
Prevalence of severe trauma (involving dentine) was 12.6%. Severe trauma was
more prevalent among boys, children with lip incompetence and those with an
18
overjet of 4mm or more. The main reported causes for dental trauma were falling
(29.1%), sports (16.4%), violence (20%) and playing (20%)53.
A population-based, matched case comparison study in 30 schools of two
Ontario communities reports on the etiology and environment where dental injuries
occurred and assessed the relationship between dental trauma, socioeconomic status
and dental caries experience. Dental hygienists calibrated the Dental Trauma Index
(DTI) and screened 2422 children aged 12 - 14 years using DTI and DMFT indices.
Prevalence of dental injury was 11.4%, mostly minor injuries 63.7% (enamel
fracture not involving dentin) affecting one upper central incisor (70.4%). The mean
age at the time of dental injuries was 9.5 years. Dental trauma most often occurred
among boys at school because of falls or while playing sports. Authors reported that
there is no significant co-relation between dental injuries and socio-economic status.
However a statistically significant direct relationship was shown between increased
caries experience and dental injuries54.
The aim of this study was to determine the pattern of traumatic dental
injuries in children seeking care at the Dental Hospital, University of Peradeniya,
Sri Lanka. The data was collected by means of an interviewer administered
questionnaires to parent and clinical examination of the children. A total of 197
children aged between 2 and 17 years had sought treatment for 304 traumatized
teeth. The most frequent cause for dental trauma was a fall (89%). Maxillary central
incisors were the most affected teeth. Type of trauma was categorized according to
Who classification. 49% permanent teeth had sustained uncomplicated fractures
involving only the enamel and dentine55.
19
A cross-sectional survey was carried out on 3702 boys and girls aged 9–14
years, attending public and private primary schools in Belo Horizonte, Brazil. A
multi-stage sampling technique using an equal probability scheme was adopted to
select the children. The prevalence of dental injuries increased from 8% at the age of
9 years to 13.6% at 12 and 16.1% at 14 years. Boys were 1.7 times more likely to
have dental injuries than girls. Children with an overjet size greater than 5.0 mm were
1.37 times more likely to have a dental injury than children with an overjet size equal
or lower than 5.0 mm56.
A prevalence study of untreated dental trauma in children of age 4–15 years in
Dar es Salaam, Tanzania from a sample of 4524 children of different socio-economic
status reported a high percentage of untreated dental trauma in 4 and 15 years of age.
Higher percentage of untreated dental trauma was observed among the children of
high socio-economic status. The most frequently observed type of dental trauma was
enamel fracture (67%) followed by enamel-dentin fracture (26%)13.
A cross-sectional survey of dental trauma to upper and lower permanent
incisors in 12-year-old school children in Florianopolis, Brazil reported prevalence of
dental injury was 18.9%. A multi stage sampling procedure was performed. The
prevalence of dental injuries was 895 with boys experiencing more dental injuries
than girls. The most common cause, place and the activity involved with trauma was
fall, home and at leisure respectively57.
A cross-sectional study comprising 1039 students, with 47% being males and
53% females and from teeth examined for physical evidence of traumatic dental
20
injuries the prevalence of incisal fracture was 2.4% with no significant gender
difference. The male to female prevalence ratio was 1.45 to 1.0. The maxillary
incisors accounted for 96% of fractured teeth. Among children with traumatized
incisors 86% had one tooth affected, while 14% had two traumatized teeth. The
prevalence of incisors trauma was significantly higher among the children of low
socio-economic status58.
In a cross-sectional survey of 13-year-old adolescents enrolled in private and
public schools of urban areas in Cianorte, Brazil, the prevalence of traumatic injuries
to the permanent incisors was 20.4%. Survey was done in school settings with the
mouth mirror and CPITN probe. The most common reported cause of injuries to the
permanent incisors was fall (24.1%) followed by collisions with people or inanimate
objects (15%), traffic accidents (10.5%), misuse of the teeth (6%), sports (2.3%) and
violence (1.5%). Unknown causes accounted for 40.6%59.
A study conducted in Canoas, Brazil to evaluate the prevalence of children
with crown fractures in permanent anterior teeth between the ages of 8-10 years
reported the prevalence of 17% with no significant difference between boys and girls.
The most affected tooth was the maxillary central incisor, and a majority of the
children showed only one affected tooth (88.6%). The types of fracture most
commonly found were oblique and horizontal. The portions of dental structures most
affected were only enamel and enamel and dentin60.
A cross-sectional study was conducted to ascertain the prevalence and the risk
factors associated to traumatic crown fractures from 470 school children of age 10
21
years, in Spain. The variables surveyed were overbite, overweight, number of teeth,
cause, type of injury and restoration. Prevalence of traumatic crown fractures to
permanent incisors was 17.4%. Falls were the most frequent cause of dental trauma
(43.9%). Children with over bite more than 5 mm had 1.81 fold higher risk of
suffering from crown fractures. Over weight was statistically insignificant with
traumatic injuries61.
A study in Recife, Brazil investigated the risk factors associated with the
occurrence of dental trauma in permanent anterior teeth of 1046 boys and girls aged
12 attending both public and private schools. Data were collected through clinical
examinations and interviews, after examiner calibration. Dental trauma was classified
according to Andreasen criteria. Overjet was considered a risk factor when it
presented values higher than 5 mm. The prevalence of dental injuries was 10.5%.
Boys experienced more injuries than girls, 12.2% and 8.8%, respectively. Children
attending public schools presented more traumatic injuries than those from private
schools, 11.4% and 9.5%, respectively with statistically insignificance. There was a
statistically significant difference between traumatic dental injuries and over-jet62.
A Turkish study to determine the distribution and etiology of the crown
fractures of permanent anterior teeth in children aged 7–9 and 11– 13 years used study
population of 2570 students from randomly selected 10 primary schools. This study
was based on self reports of the children. The permanent maxillary and mandibular
incisors were examined for evidence of fracture and information was obtained
regarding the age, gender, severity of incisor injury, frequency and type of sports
participation for each child. The prevalence of dental trauma was 7.43%. The
22
proportion of fractured incisors was significantly higher in males than in females
among older children (P < 0.01). Most commonly involved teeth were maxillary
central incisors (84%). Bicycling caused significantly higher rates of crown fractures
than other types of sports. The percentage of incisal fractures caused by sports-related
accidents was 14.14%63.
A recent 6 year study assessed the frequency, associated factors and applied
treatments for dental trauma among children aged 1–15 years from Eastern Anatolia,
Turkey. The total frequency of trauma was 4.9%. The males were found to have more
traumatic injury than females. The permanent teeth were more vulnerable to dental
trauma than the primary teeth. The highest frequency of traumas in the primary teeth
was observed at the age of 5, whereas for the permanent teeth it was 10 years. The
teeth mostly influenced by the traumas were the upper central incisors in both primary
and permanent teeth. The most frequent cause of trauma was fall in males and females
as well as in primary and permanent dentition. The most common type of trauma in
the primary teeth was lateral luxation, while it was enamel-dentin crown fracture in
the permanent teeth64.
23
Methodology
METHODOLOGY
The present study was undertaken by the Dept of Pedodontics and Preventive
Dentistry, Coorg Institute of Dental Sciences, Virajpet. The present study consisted of
4036 primary and high school going children aged between 7-15 years, from both
Government and private schools of three taluks namely, Madikeri, Somwarpet and
Virajpet of Coorg district.
Armamentarium
List of armamentarium for screening: (Fig 1)
• Sterile kidney tray
• Sterile mouth mirror
• Sterile CPITN probes
• Sterile gloves
• Sterile cotton rolls
• Disposable mouth masks
• Gluteraldehyde solution (Cidex®, Johnson and Johnson, Mumbai)
• Hot water sterilizer
• Cheek retractor
• Torch
• Hand washing soap
• Towel
Methodology
4036 school going children aged between 7-15 years were selected by using
stratified random sampling method, from both Government and private schools of
24
Methodology
three taluks namely Madikeri, Somwarpet and Virajpet of Coorg district. Each taluk
was divided into four zones namely North, South, East and West. From each zone one
school was selected, thus comprising of 12 schools from three taluk. Before the
commencement of survey, informed consent (Annexure-II) was taken from the
concerned school authorities.
Inclusion criteria
1. Children aged between 7-15 years irrespective of sex, race or socioeconomic
status.
2. Children who were cooperative.
3. Schools with a minimum student population of 50.
Exclusion criteria
1. Children with any communicable or systemic diseases.
Examination of children
Children were examined clinically for any signs of traumatic dental injury in
the permanent anterior teeth in their respective schools. Examination was performed
in the school settings under natural day light with the child sitting on the bench, by
four examiners trained in using WHO criteria65 for oral and dental examination
(Fig 2). Infection control measures as per WHO recommendations were adopted65.
The examiners used disposable gloves, mouth mirrors, CPITN periodontal probes and
gauze pads which were sterilized (Fig 1). Those cases, which showed clinical
evidence of traumatic dental injuries (Fig 3-8), were further evaluated. A single
examiner evaluated these children and the type of trauma was categorized using a
modified version of the original Garcia- Godoy’s classification.
25
Methodology
Garcia- Godoy’s classification21
CLASS 0 - ENAMEL CRACK
CLASS 1 - ENAMEL FRACTURE
CLASS 2- ENAMEL-DENTIN FRACTURE
CLASS 3- CROWN FRACTURE WITH PULP EXPOSURE
CLASS 4- ENAMEL-DENTIN-CEMENTUM FRACTURE
WITHOUT PULP EXPOSURE
CLASS 5- ENAMEL-DENTIN-CEMENTUM FRACTURE WITH
PULP EXPOSURE
CLASS 7- CONCUSSION
CLASS 8- LUXATION
CLASS 9- LATERAL DISPLACEMENT
CLASS 10- INTRUSION
CLASS 11- EXTRUSION
CLASS 12- AVULSION
CLASS 13- NON-VITAL (Modified category)
Since root fractures (class-6) were not considered in the present study (due to
the lack of any radiographic investigation) it was excluded. Non-vital teeth were
considered under ‘class-13’.
All cases with positive findings of dental trauma were further evaluated using
structured questionnaires regarding the time, place and cause of traumatic injuries by
a single examiner. The choice of answers to the questions was fixed (close-ended).
The interviewer read the questions and the relevant options exactly as they appeared
in the questionnaire format. The children were asked to select a relevant option and
that option was marked by the examiner in the Questionnaires format (Annexure-I).
26
Methodology
Further, in children who experienced traumatic injuries, over-jet was recorded
following WHO criteria65: Measurements to be made with the teeth in the centric
relation. The distance from the labial-incisal edge of the most prominent upper incisor
to the labial surface of the corresponding lower incisor was measured with a CPITN
probe parallel to the occlusal plane. The largest maxillary over-jet was recorded to the
nearest whole millimeter. For the measurement of overjet, calibrations on the CPITN
probe were used i.e. 3.5mm, 5.5mm, 8.5mm and 11.5mm. In cases where over-jet
measurement was found between two calibrations, the nearest marking was taken as
the final reading. In cases where the over-jet measurement was just at the halfway
mark between the two markings the mean value was taken as final reading i.e. if
measured over-jet value on the probe was at the center of 3.5 and 5.5 mm, then 4.5
mm was taken as final reading.
An analysis of the data was made by using descriptive statistics (frequency
distribution and cross-tabulation). Statistical significance for the association between
the occurrence of dental injuries and sex, age, cause, place and incisal over-jet were
tested using Chi-square (χ2) test.
χ2 df = Σ (O-E) 2/ E
df = Degree of freedom
O = Observed frequency
E = Expected frequency
27
Methodology
Fig 1: Armamentarium used for study
Fig 2: Examination and recording of traumatic dental injuries in children
28
Methodology
Fig 3: Subject with clinical presentation of class 0 traumatic dental injury i.r.t. 11
Fig 4: Subject with clinical presentation of class 1 traumatic dental injury i.r.t. 21
29
Methodology
Fig 5: Subject with clinical presentation of class 2 traumatic

Fig 6 : Subject with clinical presentation of class 3 traumatic

dental injury i.r.t. 31 and class 1 i.r.t. 41.
30
Methodology


dental injury i.r.t. to 11
31
Results
RESULTS
The present study was conducted by the Department of Pedodontics and
Preventive Dentistry, Coorg Institute of Dental sciences, Virajpet to determine the
prevalence of traumatic injuries in 4036 school going children in the age group 7-15
years in 12 schools of Coorg district. The prevalence of traumatic injuries and its
correlation to cause, place of trauma and over-jet was assessed in different age groups
in both the genders.
The results of the present study were tabulated and analyzed under following
headings-
1. Master Chart (Annexure III)- Compilation of collected data regarding the
prevalence of traumatic injuries in 128 children.
2. Table 1 - Descriptive statistics showing the prevalence of trauma in both males
and females.
3. Table 2 and Graph 1- Descriptive statistics showing the cause of traumatic
injuries with the prevalence of trauma in both males and females.
4. Table 3 and Graph 2- Descriptive statistics showing the place of trauma with
the prevalence of traumatic injuries in both males and females.
5. Table 4 and Graph 3- Descriptive statistics showing the prevalence of
traumatic injuries in different age groups of males and females.
6. Table 5 and Graph 4- Descriptive statistics showing the different types of
trauma in the individual maxillary teeth.
7. Table 6 and Graph 5- Descriptive statistics showing the over-jet of the affected
teeth with traumatic injuries.
8. Table 7 and Graph 6- Frequency distribution of trauma within the arch.

32
Results
1. Master Chart
The master chart shows the prevalence of traumatic injuries observed in 128
children among the 4036 children surveyed along with the age, gender, place, cause of
injury, as well as with the over-jet and type of trauma of individual tooth types.
2. Observations from Table 1
It shows the distribution of trauma among both males and females. From 128
reported cases of traumatic injuries, 94(73.4%) males and 34(26.6%) females
had traumatic dental injuries which was statistically highly significant
(Chi-square = 14.880; P< 0.001). This meant that males experienced more traumatic
injuries compared to females.
3. Observations from Table 2 and Graph-1
It shows descriptive statistics of the cause of trauma with the prevalence of
traumatic injuries in both males and females. From the 128 cases of traumatic injuries,
82 cases (64.1%) got injured while playing, followed by 43 cases (33.6%) of
accidental injuries and 3 cases (2.3%) of peer fighting. This frequency distribution for
the cause of trauma was found to be statistically highly significant (Chi-square
=102.813; P < 0.000). It means children were more prone for traumatic injuries while
playing compared to accidents and peer-fighting. Within the gender, the distribution
of cause of trauma in males was play (66%) followed by accidents (31.9%) and peer-
fighting (2.1%), whereas in females too the most common cause was play (58.8%),
followed by accidents (38.2%) and peer-fighting (2.9%). The Contingency Coefficient
33
Results
value which showed the pattern of distribution of cause within the gender (i.e. males
and females), was 0.066 which was statistically non-significant (P= 0.754), which
meant that both the genders followed the same pattern for the cause of trauma i.e.
playing > accidents > peer-fighting. So there was no correlation between the different
causes of trauma and the type of gender of the child.
This table shows the place of trauma with the prevalence of traumatic injuries
in both males and females. From 128 cases of traumatic injuries, 81 (63.3%) were
injured at home, followed by 20 (15.6%) in classroom, 19 (14.8%) at playground and
8(6.3%) on road. The distribution for the different places of occurrence of trauma was
statistically highly significant (Chi-square value = 73.141; P<0.001). It meant that
children experienced greater trauma while they were at home, followed by classroom,
playground and least on the road. Within the gender also the distribution of place of
trauma remained the same for both males and females which meant that the most
common place of traumatic injuries in both the genders was at home followed by
classrooms, playground and road. In males 60(63.8%) were injured at home,
14(14.9%) in the classrooms, 15(16.0%) in the playground and 5(5.3%) on road,
while in females 21(61.8%) got injured at home, 6(17.6%) in the classroom, 4(11.8%)
in the playground and 3(8.8%) on road. The Contingency Coefficient value of 0.085
which was statistically non-significant (P= 0.820), which meant that both the gender
followed the same pattern for the place of trauma i.e. Home > Class-room > Play
ground > Road.
34
Results
It shows the prevalence of traumatic injuries in different age groups of males
and female. Among 128 reported cases of trauma 51 children (39.8%) were in the age
group of 7-9 years of which 30 were males and 21 were females. Similarly 68
(53.1%) were in age group of 10-12 years of the age, of which 59 were males and 9
were females. In the age group of 13-15 years from 9 cases (7.0 %), 5 males and 4
females experienced traumatic injuries to their anterior teeth which was found
statistically highly significant (Chi-square = 43.234; P < 0.001). It meant that children
experienced greatest injury to anterior teeth in the age group of 10-12 years, followed
by 7-9 years and least in the age range of 13-15 years. But within the gender, the age
distribution of trauma was not the same for both males and females. Among males
62.8% experienced injury in the age10-12 years followed by 31.9% in the age group
of 7-9 years and 5.3% in the age group of 13-15 years and among females, 61.8%
experienced injury to anterior teeth in 7-9 years followed by 26.5% in 10-12 years and
11.8% in the age group of 13-15 years. The Contingency Coefficient value was 0.306
which was statistically highly significant (P<0.001) which meant that the prevalence
of trauma among males and females was positively correlated to their age groups.
6. Observations from Table 5 and Graph 4
In this table, descriptive statistics shows different types of trauma (according
to Garcia- Godoy classification) with the individual anterior tooth involved. Total
teeth involved in traumatic injuries from 128 individuals were 179 teeth. Among 179
teeth reported, 105 i.e. 58.7% belonged to class 2 (Enamel-Dentin fracture) category,
followed by 56 teeth (31.3%) which belonged to class 1 (Enamel fracture), 13 teeth
(7.3%) which belonged to class 3 (enamel dental fracture with pulp exposure), 2 teeth
35
Results
(1.1%) each belonged to class 12 (avulsion) and class 13 (non-vital) and 1(0.5%) of
class 0 (enamel crack). This distribution of type of trauma was found to be
statistically highly significant (Chi-square = 129.968; P<0.000). Therefore it meant
that maximum number of tooth injury observed was enamel-dentin fracture followed
by enamel fracture. The most commonly involved teeth were maxillary central
incisors followed by maxillary lateral incisors and canines. The Contingency
Coefficient value was 0.343 which was statistically non-significant (P= 0.979), which
meant that there was no significant correlation between the type of trauma and the
individual tooth type involved.
This table shows the over-jet of individual affected teeth with the type of
traumatic injury. Of 179 teeth reported, 99 teeth (55.3%) had over-jet less than 3.5
mm, followed by 60 teeth (i.e. 33.5%) between 3.6-5.5 mm, 18 teeth (10.1%) between
5.6-8.5 mm and finally only 2 teeth (1.1%) that had over-jet between the range of 8.6-
11.5 mm. None of the teeth reported had an over-jet more than 11.5 mm. This
distribution of amount of over-jet was found to be statistically highly significant
(Chi-square = 66.544; P < 0.001). It meant that maximum number of injured teeth had
over-jet value less than 3.5 mm, followed by over-jet of 3.6-5.5 mm, 5.6-8.5 mm and
8.6-11.5 mm. This type of distribution of overjet of the teeth involved in trauma was
statistically highly significant (Chi-square = 286.536; P<0.001) which meant that the
maximum teeth affected with trauma were in the over jet of less than 3.5 mm
followed by 3.6-5.5 mm overjet. The Contingency Coefficient value was 0.287 which
was statistically non-significant (P= 0.885), which meant that there was no significant
correlation between the amount of over-jet and the type of individual tooth involved.
36
Results
This table shows frequency distribution of trauma within the arch. Among 179
traumatically injured teeth, 155 teeth (86.6%) belonged to the maxillary arch and 24
teeth (13.4%) belonged to the mandibular arch. It meant that the maxillary arch was
more prone for injury compared to the mandibular arch. Graph 6 shows this frequency
distribution was found to be statistically highly significant (Chi-square Value =
95.872; P<0.001).
37
Results
Table – 1 : Descriptive statistics showing the

prevalence of trauma in both males and females
Gender
Total
Male Female
128 94 34
% DISTRIBUTION 73.4% 26.6%
Chi-square value = 14.880 ; P < 0.001 (HS)
Table – 2 : Descriptive statistics showing the comparison of cause with the

Sex
Cause Total
Male Female
Play 62(66.0%) 20(58.8%) 82 (64.1%)
Peer-fight 2(2.1%) 1(2.9%) 3(2.3%)
Accident 30 (31.9%) 13(38.2%) 43(33.6%)
Total 94(100.0%) 34(100.0%) 128 (100.0%)
Chi-square (cause)=102.813; P<0.001 (HS)

Contingency Coefficient= 0.066; P= 0.754 (NS)
38
Results
Table – 3 : Descriptive statistics showing the comparison of place

of trauma with the prevalence of trauma in both males and females
Sex
Cause Total
Male Female
Home 60(63.8%) 21(61.8%) 81(63.3%)
Classroom 14(14.9%) 6(17.6%) 20(15.6%)
Play ground 15(16.0%) 4(11.8%) 19(14.8%)
Road 5(5.3%) 3(8.8%) 8(6.3%)
Total 94(100.0%) 34(100.0%) 128(100.0%)
Chi-square (Place)=73.141; P<0.001 (HS)

Contingency Coefficient= 0.085; P= 0.820 (NS)
Table – 4 : Descriptive statistics showing the age wise comparison

of prevalence of trauma in both males and female
Age Group Sex

Total
(years) Male Female
7-9 30(31.9%) 21(61.8%) 51(39.8%)
10-12 59(62.8%) 9(26.5%) 68 ( 53.1%)
13-15 5 (5.3%) 4(11.8%) 9 (7.0%)
Total 94(100.0%) 34(100.0%) 128 (100.0%)
Chi-square (Age group)= 43.234; P<0.001 (HS)

Chi-square (gender)= 14.880; P<0.001 (HS)
Contingency Coefficient = 0.306 ; P<0.001 (HS)
39
Results
Results
Table – 5 : Descriptive statistics showing the comparison of different types of trauma with the tooth types
Trauma Tooth type

Total
type 11 12 13 21 22 23 31 32 33 41 42 43
0 1 -- -- -- -- -- -- -- -- -- -- -- 1
(1.6%) (0.5%)
1 26 5 -- 15 3 1 2 -- -- 2 2 -- 56
(40.6%) (50%) (21.7%) (30%) (50%) (22.2%) (20%) (50%) (31.3%)
2 30 4 -- 49 7 1 6 1 -- 5 2 -- 105
(46.9%) (40%) (71.0%) (70%) (50%) (66.7%) (100%) (50%) (50%) (58.7%)
3 5 1 -- 3 -- -- 1 -- -- 3 -- -- 13
(7.8%) (10%) (4.3%) (11.1%) (30%) (7.3%)
4 -- -- -- -- -- -- -- -- -- -- -- -- --
5 -- -- -- -- -- -- -- -- -- -- -- -- --
7 -- -- -- -- -- -- -- -- -- -- -- -- --
8 -- -- -- -- -- -- -- -- -- -- -- -- --
9 -- -- -- -- -- -- -- -- -- -- -- -- --
10 -- -- -- -- -- -- -- -- -- -- -- -- --
11 -- -- -- -- -- -- -- -- -- -- -- -- --
12 1 -- -- 1 -- -- -- -- -- -- -- -- 2
(1.6%) (1.4%) (1.1%)
13 1 -- -- 1 -- -- -- -- -- -- -- -- 2
(1.6%) (1.4%) (1.1%)
Total 64 10 -- 69 10 2 9 1 -- 10 4 -- 179
(100%) (100%) (100%) (100%) (100%) (100%) (100%) (100%) (100%) (100%)
Chi-square (Trauma type) = 129.968; P<0.000 (HS)
Contingency Coefficient = 0.343; P = 0.979 (NS)
40
Results
Results
Table – 6 : Descriptive statistics showing the comparison of amount of over-jet in an affected tooth with the tooth type
Over-jet Tooth type

Total
(mm) 11 12 13 21 22 23 31 32 33 41 42 43
< 3.5 30 9 -- 34 7 1 8 1 -- 6 3 -- 99
(46.9%) (90.0%) (49.3%) (70.0%) (50.0%) (88.9%) (100%) (60.0%) (75.0%) (55.3%)
3.6-5.5 25 1 -- 25 3 1 1 -- -- 3 1 -- 60
(39.1%) (10.0%) (36.2%) (30.0%) (50.0%) (11.1%) (30.0%) (25.0%) (33.5%)
5.6-8.5 8 -- -- 9 -- -- -- -- -- 1 -- -- 18
(12.5%) (13.0%) (10.0%) (10.1%)
8.6-11.5 1 -- -- 1 -- -- -- -- -- -- -- -- 2
(1.6%) (1.4%) (1.1%)
>11.6 -- -- -- -- -- -- -- -- -- -- -- -- --
Total 64 10 -- 69 10 2 9 1 -- 10 4 -- 179
(100%) (100%) (100.0%) (100.0%) (100.0%) (100.0%) (100.0%) (100%) (100%) (100.0%)
Chi-square = 66.544; P<0.000 (HS)
Contingency Coefficient value = 0.287; P=0.885 (NS)
41
Results
Table – 7 : Frequency distribution of trauma within the arch
Arch Frequency Percent
Maxillary arch 155 86.6%
Mandibular arch 24 13.4%
Total 179 100.0%
Chi-square Value = 95.872 ; P<0.001 (HS)
42
Results
Graph –1 : Descriptive statistics showing the cause of traumatic injuries with the
Graph – 2 : Descriptive statistics showing the place of trauma with the

prevalence of traumatic injuries in both males and females
43
Results
Graph – 3 : Descriptive statistics showing the prevalence of traumatic injuries in

different age groups of males and females
Graph – 4 : Descriptive statistics showing the different types of

trauma in the individual anterior teeth
50
45
40
35
30
c las s 0
No. of cases
25 c las s 1
c las s 2
20
c las s 3
15 c las s 12
c las s 13
10
0
11 12 21 22 23 31 32 41 42
Type of tooth
Graph – 5 : Descriptive statistics showing the over-jet of

44
Results
the affected teeth with traumatic injuries
Graph – 6 : Frequency distribution of traumatized teeth

among both the dental arches
45
Discussion
DISCUSSION
Dental trauma is a common form of injury, especially in children. Usually it
represents a serious problem associated with many aspects of the patient’s life.
Several educational programmes have been recommended for lay people about the
importance of early treatment for dental trauma, ways of preventing traumatic injuries
and procedures for appropriate emergency management49. These educational
programmes for the lay public in any country should preferably be preceded by an
investigation of the background information on the occurrence of oro-dental injuries
in that community. The information gathered can be utilized to prepare the contents of
a programme49.
There is a plethora of available studies investigating different parameters of
dental trauma. The most commonly investigated parameters are frequency, aetiology,
appropriate treatment plan and methods for prevention of the dental trauma. Another
factor investigated in the literature is the age wise distribution of trauma. Also,
predisposing factors like increased over-jet, short upper lip, incompetent lips, mouth
breathing and class II malocclusion have also been considered47.
The results from all these studies present a contrasting volume of data that
may be attributed to differences in experimental design among the studies, differences
in the population studied and variation in the age or the size of the sample60.
Coorg district of Karnataka state, falls into a geographical region which
is situated at high altitude and mostly consists of dense forests and scattered
population in small villages and towns. Coorg is known for an extended rainy season
46
Discussion
lasting up to 6 months in a year. Besides limited assigned places for playgrounds;
hockey, traditionally has been a prime sport in this region. All these factors and the
fact that there is no previously published study regarding Coorg population, this
prevalence study was undertaken in Coorg district to create a database of the
distribution of traumatic injuries in school children of age 7-15 years and to correlate
it with other factors such as age, gender, place, cause and overjet.
In the present study, samples were taken from all three taluks of Coorg
districts by mapping and dividing each taluks into four zones (North, South, East and
West). One school from each zone was taken so that the resultant final sample was
representative of the entire Coorg population25.
The classification used to identify the type of trauma was Garcia-Godoy
classification25 which is a deviation of the WHO classification. The reason for using
the former classification, instead of the more widely used WHO classification or Ellis
and Davey’s classification was because of its simplicity and ease of epidemiological
field applicability 47,50. Another reason was that in Garcia-Godoy classification, broad
terms like complicated and uncomplicated fractures (WHO classification) or simple
and extensive fractures were not used, which were not suggested for epidemiological
studies50,59,60.
The present study identified a prevalence of 3.17% of traumatic injuries to the
permanent anterior teeth among 4036 school going children in the age group of 7-15
years in Coorg district. This result corroborates with the earlier studies done where the
prevalence was found to be 5.3%18, 4.1%59 and 4.7%64. There are studies which have
47
Discussion
reported higher prevalence than the present study13,18,19,21,25,40,47. The reason for that
can be attributed to sample selected (age range studied, sample size, socio-
demographic and behavioural indicators, rural/urban population, among others), the
classification used to report the traumatic injuries, the type of study and the
methodology used (Samples collected in the school environment with limited
conditions for clinical examination.)60.
Except for a study carried out in school children in Santo Domingo of
Dominican Republic by Garcia-Godoy25, almost all other studies reported a higher
prevalence of traumatic injuries in males than in females. The author reported that
more girls suffered traumatic injuries than boys, with the gender ratio being 0.9:1 for
girls and boys respectively. However in a later study21 done on the same population
by the same author, gender ratio reversed to 1.3:1 being in favour of males. In the
present study, it was observed that males were affected more than females with the
gender ratio being 2.76:1. This result may be explicable by the fact that males are
more aggressive, venture into more risks and participates more in sports activities53.
Apart from that in the Indian scenario cultural trends also have a role to play in the
lower prevalence of trauma in females19,42.
In this study causes of trauma have been categorised into play, peer-fighting
and accidents. Out of which, play was found to be the most common cause followed
by accidents and peer-fighting in that order, similar to previous studies18,61,60,52,63. The
only difference from the previous studies was that instead of taking play as a separate
entity for the cause of trauma, most of these studies divided course of trauma into falls
and sports activities and considered them separately. Most of the time falls and some
48
Discussion
times sports activities were reported as the most common cause in these
abovementioned studies.
In the present study 63.3% of traumatic injuries occurred at home followed by
class room, play ground and road accordingly. This greater prevalence of trauma at
home has been reported in earlier studies47,52,61. This can also be explained by the fact
that children in Coorg district probably spend more time at home compared to other
places. The attributable geographic reasons include prolonged rains lasting months
together, paucity of playgrounds in this hilly area and cold climatic conditions.
In the present study the age range selected was 7-15 years which was further
divided into 3 groups 7-9 years, 10-12 years and 13-15 years. Among them it was
evident that 10-12 year age group was most prone to injuries followed by 7-9 years
and 13-15 years respectively. This pattern of age distribution of traumatic injuries is
in accordance with few previous studies40,47,64. However one interesting finding on
closely examining the gender wise age distribution was that in males there was an
increase in prevalence from 31.9% in 7 – 9 year age group to 62.8% in the 10 – 12
year age group, while it again reduced to 5.3% in 13 – 15 year age group. Where as in
females, prevalence was maximum in the 7 – 9 age group (61.8%) which reduced to
26.5% in 10 – 12 years age group and was least in 13- 15 years age group (11.8%).
The reason could be that in the traditional Indian society as the girls grow up more
cultural restrictions and house hold responsibilities are imposed on them leading to
reduced exposure to the predisposing factors for trauma such as contact sports, falls,
road accidents etc. Whereas, in case of boys as they grow, they get involve more in
outdoor activities. However reduction in the prevalence of trauma in the 13 – 15 years
49
Discussion
age group among boys could probably be attributed to more maturity, sense of
balance and control over aggression which comes with increasing age.
Fracture of enamel-dentine without pulpal exposure (Garcia-Godoy class 2)
was found to be the most frequent type of injury in this study (58.7%) which was
similar to previous studies61,64.
Increased over-jet has been considered as a predisposing factor for traumatic
injuries. Thus a correlation between overjet and prevalence of trauma was
investigated and it was found to be statistically insignificant. Most of the previous
studies13,51,52 have reported a significant correlation between traumatic injuries and
over-jet, which can be explained by the fact that in these studies over-jet had been
recorded for both children with and without traumatic injuries. However, in the
present study, over-jet was measured only in subjects with traumatic dental injuries
(i.e.128) and not for entire sample of 4036. Similar statistically insignificant
correlations have also been reported in some previous studies19,47,55. The attributable
reason was the smaller sample size. A review of earlier studies45 regarding the
relationship between over-jet size and traumatic dental injuries stated that, because of
their behaviour and/or their involvement in specific types of sports, boys are more
prone to receive trauma regardless of their over-jet. This finding supports the non
correlation of traumatic dental injuries and over-jet found in the present study as
hockey is a popular sport in Coorg district.
In the present study it was found that the prevalence of traumatic injuries was
significantly higher in maxillary arch (86.6%) compared to mandibular arch (13.4%).
50
Discussion
Within the arch, left maxillary permanent central incisors were found to be most
frequently involved (38.5%) followed by the right maxillary central incisors (35.8%),
maxillary lateral incisors (11.2%), mandibular right central incisors (5.6%),
mandibular left central incisors (5.0%), mandibular right lateral incisors (2.2%),
maxillary left canine (1.1%) and mandibular left lateral incisors (0.6%). This is in
accordance with the reports of some previous studies13,18,50,52, 55,59,60,61,63,64. The reason
can be explained by the fact that in the vertical plane, the maxillary arch is located
more anteriorly than the mandibular arch as a result of which the impact of injury
would be more on the maxillary arch. Within the arch, the proclination of central
incisors and their forward placement in the vertical plane also make them more prone
for the injury1.
The present study was a retrospective collection of data on traumatic anterior
teeth injuries. Baston47 stated such a study design has a major disadvantage because
other types of injuries such as alveolar fracture and soft tissue injuries may not always
be evident at the time of the examination if the injuries occurred sometime
beforehand. Other injuries could also be missed if signs and symptoms do not exist at
the time of study examination20. Play was considered as a single cause of trauma
while most earlier studies have considered it as falls and sports activity separately in
order to relate causes more specifically to the traumatic dental injuries. Only a dental
aspect (over-jet) was considered as a predisposing factor in the study over seeing the
skeletal aspect i.e. malocclusion. Another shortcoming of retrospective studies is the
accuracy of a child patient’s ability to recall events associated with the injury if the
accident occurred months or even years before the examination20. However, despite
these shortcomings the findings of the present study will contribute to the database of
the prevalence of traumatic injuries in children that can be used to plan school based
preventive programs in the district under study in the future.
51
Conclusion
CONCLUSION
The following conclusions were drawn from the present study:
• Prevalence of traumatic injury to anterior teeth in school children of Coorg
district was 3.17%.
• Males experienced 2.76 fold greater trauma compared to females.
• The most common cause of trauma was play followed by accidents and peer-
fighting.
• The commonest place of trauma reported was at home followed by classroom,
playground and road.
• Children in the age group of 10-12 years experienced highest trauma, followed
by 7-9 years and 13-15 years age group respectively. On comparing the age
wise group distribution variation in males trauma prevalence was highest in
10-12 years followed by 7-9 years and 13-15 years age groups respectively.
Whereas in females, it was of 7-9 years followed by 10-12 years and 13-15
years age group respectively.
• There was no correlation between over-jet and prevalence of trauma to
anterior teeth.
• The teeth commonly involved with trauma were maxillary central incisors,
followed by maxillary lateral incisors and canines.
The present retrospective study was an unostentatious attempt to determine the
prevalence of traumatic injuries to anterior teeth among school children of Coorg
district, Karnataka in the age group 7-15 years. It is evident that the data gathered
52
Conclusion
from this study stresses upon conducting educational programs directed at parents to
create awareness about the importance of immediate management of traumatic
injuries and encourage parents and children towards prevention of traumatic injuries.
The findings of the present study can be employed in an organized municipal
effort to educate parents, teachers and schoolchildren about the immediate
management and prevention of dental trauma. However further studies are needed on
a larger sample size, focusing on the tribal areas that have limited access to health
care and education facilities for better representation of the native Coorg population
combined with a meticulous evaluation of the more specific confounding factors of
dental trauma.
53
Summary
SUMMARY
The present study was conducted by the Department of Pedodontics and
Preventive Dentistry, Coorg Institute of Dental Sciences, Virajpet.
The aim of the study was to determine the prevalence and distribution of the
traumatic injuries to the permanent anterior teeth in school going children of Coorg
district and to correlate the injury to the cause, place, age and incisal over-jet. 4036
school going children aged between 7-15 years were selected by using stratified
random sampling method, from both Government and private schools of three taluks
namely Madikeri, Somwarpet and Virajpet of Coorg district, Karnataka state. Each
taluk was divided into four zones namely North, South, East and West. From each
zone one school was randomly selected, thus comprising of 12 schools from the three
taluks. The selected children were screened and those found with traumatic injuries
were further examined for the type of trauma using Garcia-Godoy’s classification for
traumatic injuries. The over-jet of patients who experienced dental trauma was
measured. A questionnaire was used to assess the history regarding cause, place and
age at the time of trauma.
The results were tabulated and statistically analyzed.
54
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61
ANNEXURE- I
DEPT. OF PEDODONTICS AND PREVENTIVE DENTISTRY,

COORG INSTITUTE OF DENTAL SCIENCES, VIRAJPET
QUESTIONNAIRE FOR CHILDREN

Name - Sex- Identification No. -
Class - Sec -
School -
1. To which of the following age groups did you belong at the time of injury to
your teeth?
a) 7-9 years b) 10-12 years c) 13-15 years
1. ¤ªÀÄUÉ AiÀiÁªÀ ªÀµÀðzÀ°è ºÀ°èUÉ KlÄ ©¢ÝgÀÄªÀÅzÀÄ?

(J) 7-9 ªÀµÀð (©) 10-12 ªÀµÀð (¹) 13-15 ªÀµÀð
2. Where you were at the time of the injury?

a) Home b) Classroom c) Playground d) Road
2. KlÄ ©zÀÝ ¸ÀªÀÄAiÀÄzÀ°è ¤ÃªÀÅ J°è E¢Ýj?

(J) ªÀÄ£ÉAiÀÄ°è (©) vÀgÀUÀwAiÀÄ°è
(¹) DlzÀ ªÉÄÊzÁ£ÀzÀ°è (r) gÀ¸ÉÛAiÀÄ°è
3. How you get injured?

a) Play in play ground b) Fall in the class room
c) Peer-fighting d) Road accident.
3. ¤ªÀÄUÉ ºÉÃUÉ KlÄ ©¢ÝvÀÄÛÛ?

(J) DlzÀ ªÉÄÊzÁ£ÀzÀ°è DqÀÄwÛgÀÄªÁUÀ (©)
vÀgÀUÀwAiÀÄ°è ©zÀÄÝ
(¹) ªÀÄPÀÌ¼ÉÆA¢UÉ dUÀ¼ÀªÁqÀÄªÀ ¸ÀªÀÄAiÀÄzÀ°è (r) C¦à vÀ¦à
©zÀÝ KlÄ (DPÀ¹äPÀªÁV)
62
ANNEXURE- II
DEPT. OF PEDODONTICS AND PREVENTIVE DENTISTRY,

COORG INSTITUTE OF DENTAL SCIENCES, VIRAJPET
CONSENT FORM
Dear Principal / Head Master,
I, Dr. Punit Bharadwaj, post-graduate student in the Department of
Pedodontics and Preventive Dentistry, Coorg Institute of Dental Sciences, Virajpet,
request your consent in the participation of your school children from classes III to X
for an oral examination programme and interview by questionnaires.
I request your kind written consent to involve your children in the above-
mentioned programme. This is a voluntary participation and children can withdraw
from this programme any time.
From,
Dr. Punit Bharadwaj,
Post-graduate student,
Department of Pedodontics and Preventive Dentistry,
Virajpet.
We are providing /not providing consent for our school children to participate
in the above mentioned programme.
Signature of the Principal /Head Master:
Name of school:
Address:
Date:
63
Master Chart
MASTER CHART
COMPILATION OF COLLECTED DATA REGARDING THE PREVALENCE OF TRAUMATIC INJURIES IN 128 CHILDREN
Questionnaire Gender Trauma Types Over-jet
Sl. Tooth Trauma Over-
Q1 Q2 Q3
No. No. M F 0 1 2 3 4 5 7 8 9 10 11 12 13 Types 1 2 3 4 5 jet
1 2 3 a b c d a b c d
1 21 1 4 4 2 2 2 1 1
2 11 1 1 4 2 1 1 1 1
3 11 1 3 1 1 1 1 1 1
4 11 1 3 1 1 1 1 3 3
21 2 2 4 4
5 11 1 3 1 1 1 1 1 1
12 1 1 1 1
6 11 2 1 1 2 2 2 1 1
7 11 2 3 1 1 2 2 1 1
8 21 2 1 1 1 3 3 2 2
9 21 2 1 1 1 1 1 3 3
10 21 1 4 4 2 1 1 3 3
11 21 3 1 1 2 2 2 1 1
12 31 1 1 1 1 2 2 2 2
13 21 2 1 4 1 2 2 1 1
22 2 2 1 1
23 2 2 1 1
14 11 2 4 4 1 2 2 2 2
21 2 2 2 2
22 2 2 2 2
15 11 3 2 4 2 2 2 1 1
16 11 2 2 1 2 1 1 1 1
21 1 1 1 1
17 11 2 1 1 1 3 3 2 2
12 3 3 1 1
21 2 2 2 2
22 1 1 1 1
18 11 3 1 4 2 1 1 1 1
12 1 1 1 1
21 1 1 1 1
64
Master Chart

Q1 Q2 Q3
No. No. M F 0 1 2 3 4 5 7 8 9 10 11 12 13 Types 1 2 3 4 5 jet
1 2 3 a b c d a b c d
19 11 2 2 1 1 1 1 3 3
20 11 2 1 4 1 1 1 1 1
21 1 1 1 1
21 11 3 1 1 1 1 1 1 1
21 1 1 1 1
22 21 2 2 1 1 2 2 2 2
23 21 2 1 1 1 1 1 1 1
24 11 2 1 4 1 1 1 2 2
21 2 2 1 1
25 11 2 1 4 1 1 1 2 2
41 1 1 2 2
42 2 2 2 2
26 11 1 1 1 1 1 1 1 1
21 2 2 1 1
27 11 2 3 1 1 1 1 1 1
21 2 2 1 1
41 2 2 1 1
28 21 3 2 1 1 2 2 1 1
29 21 2 1 4 1 3 3 1 1
30 41 2 1 4 2 2 2 1 1
31 21 2 2 1 1 1 1 3 3
32 21 1 3 1 1 2 2 2 2
33 11 1 1 1 1 2 2 1 1
41 3 3 1 1
34 11 1 1 4 1 2 2 3 3
35 11 1 1 1 2 1 1 2 2
36 21 1 2 1 2 2 2 1 1
37 22 1 3 1 2 1 1 1 1
38 21 2 4 4 1 2 2 3 3
39 21 1 1 1 1 2 2 2 2
40 11 2 1 1 1 2 2 2 2
65
Master Chart


Q1 Q2 Q3
No. No. M F 0 1 2 3 4 5 7 8 9 10 11 12 13 Types 1 2 3 4 5 jet
1 2 3 a b c d a b c d
41 11 2 1 4 1 1 1 3 3
42 11 1 1 4 2 1 1 4 4
43 11 2 1 4 1 1 1 2 2
44 11 2 1 1 1 2 2 1 1
45 21 2 1 4 1 2 2 1 1
46 21 1 2 4 1 2 2 2 2
47 21 1 1 1 1 2 2 2 2
11 13 13 2 2
48 12 2 1 1 1 1 1 2 2
49 11 1 1 1 2 2 2 2 2
50 21 2 1 1 1 2 2 3 3
11 2 2 1 1
51 12 2 3 1 1 1 1 1 1
52 41 2 1 1 1 3 3 1 1
53 11 2 1 4 1 3 3 2 2
21 1 1 1 1
54 41 2 1 4 1 1 1 1 1
55 22 1 1 4 1 1 1 1 1
56 31 2 1 4 1 1 1 1 1
57 41 2 3 1 1 2 2 2 2
58 21 2 3 1 1 2 2 1 1
59 21 2 1 1 1 2 2 2 2
60 21 2 1 1 1 2 2 1 1
11 1 1 1 1
61 42 2 1 4 1 1 1 1 1
62 21 2 1 4 1 1 1 2 2
63 21 1 1 1 1 1 1 2 2
64 31 2 1 3 1 2 2 1 1
65 21 2 4 4 1 13 13 1 1
66 21 2 1 4 1 2 2 1 1
11 2 2 3 3
66
Master Chart

Q1 Q2 Q3
No. No. M F 0 1 2 3 4 5 7 8 9 10 11 12 13 Types 1 2 3 4 5 jet
1 2 3 a b c d a b c d
67 21 3 1 1 2 1 1 3 3
11 1 1 2 2
21 2 2 2 2
68 22 1 1 1 2 2 2 2 2
11 2 2 1 1
69 21 1 1 4 1 2 2 1 1
70 21 2 1 1 2 2 2 1 1
11 2 2 2 2
71 21 1 1 1 1 2 2 2 2
11 1 1 1 1
72 22 1 1 1 1 2 2 1 1
73 11 1 1 4 1 2 2 3 3
11 3 3 1 1
74 42 1 2 1 2 2 2 1 1
75 21 2 1 1 1 3 3 2 2
76 11 1 3 1 2 2 2 2 2
77 31 1 3 1 1 1 1 1 1
78 11 2 2 4 2 2 2 1 1
79 21 2 1 1 1 1 1 1 1
31 2 2 1 1
80 32 3 3 4 1 2 2 1 1
81 11 1 1 1 2 2 2 1 1
82 41 2 1 1 2 2 2 1 1
83 31 2 2 1 1 2 2 1 1
84 21 2 1 1 1 2 2 1 1
11 2 2 1 1
85 21 1 2 1 1 2 2 1 1
67
Master Chart

Q1 Q2 Q3
No. No. M F 0 1 2 3 4 5 7 8 9 10 11 12 13 Types 1 2 3 4 5 jet
1 2 3 a b c d a b c d
86 11 1 1 1 1 2 2 1 1
11 1 1 2 2
21 1 1 2 2
22 2 2 2 2
23 1 1 2 2
87 41 2 1 4 1 3 3 2 2
88 22 1 1 1 2 2 2 1 1
89 21 1 3 1 1 2 2 2 2
90 21 1 1 4 1 2 2 1 1
91 11 3 1 1 1 2 2 2 2
92 11 2 2 1 1 2 2 2 2
11 2 2 2 2
93 21 1 1 1 1 2 2 1 1
21 2 2 1 1
94 42 1 2 4 2 1 1 1 1
95 21 2 2 4 1 2 2 1 1
96 11 1 1 1 1 1 1 3 3
97 21 1 1 4 2 2 2 2 2
98 12 1 3 1 2 2 2 1 1
99 11 1 1 4 2 1 1 3 3
11 0 0 1 1
12 2 2 1 1
100 21 2 1 1 1 2 2 2 2
12 2 2 1 1
101 22 2 1 1 1 2 2 1 1
102 11 2 2 4 1 2 2 2 2
103 31 1 4 4 1 2 2 1 1
104 31 1 3 1 1 3 3 1 1
105 11 2 1 1 1 2 2 1 1
12 1 1 1 1
68
Master Chart

Q1 Q2 Q3
No. No. M F 0 1 2 3 4 5 7 8 9 10 11 12 13 Types 1 2 3 4 5 jet
1 2 3 a b c d a b c d
106 21 2 2 1 1 2 2 3 3
107 21 2 1 1 1 2 2 2 2
108 11 2 1 1 1 2 2 2 2
109 21 1 1 4 2 2 2 1 1
11 12 12 2 2
110 21 2 1 3 1 12 12 2 2
11 2 2 2 2
111 21 1 3 1 2 2 2 3 3
112 11 2 4 4 2 1 1 2 2
113 11 1 1 1 1 1 1 1 1
11 1 1 2 2
114 21 1 3 1 1 2 2 1 1
115 12 3 1 1 1 2 2 1 1
116 11 2 4 4 1 2 2 1 1
117 21 2 1 1 2 2 2 2 2
118 11 2 2 1 1 2 2 1 1
119 21 2 1 1 1 2 2 2 2
120 21 2 1 1 1 2 2 2 2
11 3 3 1 1
121 21 1 2 1 1 2 2 1 1
122 21 1 3 1 1 2 2 3 3
123 31 2 1 1 2 2 2 1 1
124 11 1 1 3 2 3 3 2 2
11 2 2 1 1
125 21 1 1 1 2 2 2 1 1
11 2 2 2 2
126 21 2 2 1 1 2 2 2 2
127 21 2 1 4 1 2 2 1 1
128 41 2 1 1 1 2 2 3 3
21 1 1 2 2

69

TM Traumatic Injuries of Anterior Teeth

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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

TRAUMATIC INJURIES OF ANTERIOR TEETH:

Dissertation Submitted to the

Under the guidance of

DEPARTMENT OF PEDODONTICS AND PREVENTIVE DENTISTRY

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation entitled “TRAUMATIC INJURIES OF

ANTERIOR TEETH: A PREVALENT STUDY IN SCHOOL CHILDREN OF

COORG DISTRICT” is a bonafide and genuine research work carried out by me

Pedodontics and Preventive Dentistry, Coorg Institute of Dental Sciences, Virajpet.

Place : Virajpet Dr. PUNIT BHARADWAJ

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “TRAUMATIC INJURIES OF

ANTERIOR TEETH: A PREVALENT STUDY IN SCHOOL CHILDREN OF

COORG DISTRICT” is a bonafide work done by Dr. PUNIT BHARADWAJ in

the specialty of Pedodontics and Preventive Dentistry.

Date : Dr. SHANTHALA B.M.

ENDORSEMENT BY THE HOD, PRINCIPAL/

HEAD OF THE INSTITUTION

This is to certify that the dissertation entitled “TRAUMATIC INJURIES OF

ANTERIOR TEETH: A PREVALENT STUDY IN SCHOOL CHILDREN OF

COORG DISTRICT” is a bonafide research work done by Dr. PUNIT

of the Department, Department of Pedodontics and Preventive Dentistry, Coorg

Institute of Dental Sciences, Virajpet.

Dept of Pedodontics and Coorg Institute of Dental sciences,

Place: Virajpet Place: Virajpet

DECLARATION BY THE CANDIDATE

I hereby declare that the Rajiv Gandhi University of Health Sciences,

thesis in print or electronic format for academic/research purpose.

Place: Virajpet Dr. PUNIT BHARADWAJ

© Rajiv Gandhi University of Health Sciences, Karnataka.

Towards the completion of this dissertation and my course, I would like to

deep gratitude to her for always encouraging me to excel in my work.

and my post-graduate training.

constant support, blessings and guidance during the course of my dissertation.

I thank Dr. Sunil Muddaiah, Managing Trustee, Coorg Institute of Dental

fulfillment of this dissertation.

I am also grateful to Dr. Lancy D’Souza, Professor (Biostatistics and

Department of Pedodontics, with out whose support and personal involvement at

encouragement and support.

of Coorg district for there co-operation during my dissertation.

assistants and the non teaching staff in the department.

Words are not sufficient to convey my gratitude to my loving parent and my

sisters. It is because of their encouragement, love, great sacrifices and innate

CPITN : Community Periodontal Index and Treatment Need

WHO : World Health Organization

Background and Objectives

present a contrasting volume of prevalence data that may be attributed to differences

variation in the age or the size of the sample.

The paucity of available studies on Coorg population initiated us to

trauma, age distribution of trauma and over-jet of the traumatized teeth.

places of occurrence of traumatic dental injuries were home (63.3%), classroom

respectively. Enamel-dentin fracture without pulpal involvement was the commonest

5.6-8.5 mm and 1.1% had over-jet between 8.6-11.5 mm

Interpretation and conclusion

The prevalence of traumatic injuries in 7-15 years school children of Coorg

effort to educate parents, teachers and schoolchildren about the immediate

management and prevention of dental trauma.

1 Descriptive statistics showing the prevalence of trauma in 38

2 Descriptive statistics showing the comparison of cause with 38

3 Descriptive statistics showing the comparison of place of 39

4 Descriptive statistics showing the age wise comparison of 39

5 Descriptive statistics showing the comparison of different 40