RESEARCH
Dental injuries reported in a dental school:
A 2 year Preliminary study
Kamala BK,1 Swati Tripati2
ABSTRACT
This epidemiologic survey is aimed at assessing the prevalence of
traumatic dental injuries in children seen at the Department of
Pedodontics and Preventive children dentistry, Institute of dental
sciences, Bareilly, India. The records of a total of 458 children (aged
0 to 18 years) seen from 2008 to 2010 were analyzed in the dental
trauma clinic were surveyed, comprising a total of 49 traumatized
primary and permanent teeth. Data pertaining to the child and to
the trauma such as age, gender, etiology, teeth involved, type of
traumatic injury, time elapsed between the trauma and seeking
care, and the presence and kind of clinical and radiographic
sequelae in the first visit were collected from the dental records. All
variables studied were assessed by means of frequency analysis
and the Chi-square test (p < 0.05). A higher prevalence of trauma
was observed in boys (81.7%) and in the age group from 0-3 years
(18.3%). The most affected teeth were the central incisors (88.7%)
and the most common trauma etiology was a fall from the child's
own height (66.8%). The supporting tissues were the most affected.
Within the limits of this study, it can be concluded that traumatic
dental injuries occur more frequently in young male individuals,
due to falls and bicycle accidents.
Key words- trauma, age group, teeth, sequelae
Introduction
As an institution, it is important for dental colleges to
collect data on accidental injuries to recognize potential
problems, develop the quality of care of patients, and
educate students and future practitioners about risk
management. Our data reveal important trends
concerning such injuries. These data were compiled
over a two-year period (2008–10) from the dental
injuries reported to the Department of Pedodontics and
Preventive children dentistry, Institute of dental
sciences, Bareilly, India.
Injuries in our dental college come due to many
reasons. Most of the dental injuries occur due to a fall,
collision, bump, repetitive motion, or broken objects.
The incidence of dental trauma due to falls, sports,
automobile accidents and violence has increased IJCD • MARCH, 2011 • 2(2)
significantly in recent decades, affecting children’s
© 2011 Int.and
Journal of Contemporary Dentistry
teenagers’ anterior teeth. It has a physical, aesthetic
automobile accidents and violence has increased
significantly in recent decades, affecting children’s and
teenagers’ anterior teeth. It has a physical, aesthetic
and psychological impact; not only on the child but also
on his/her parents1 .No agreement exists on the
prevalence of traumatic dental injuries, as this has
differed from study to study and from country to
country. Studies report frequencies ranging from 10.2
to 69.2%.1, 2, 3, 4, 5
The most common age group in which primary tooth
injury occurs is 1 to 3 years6 .Nonetheless, Osuji et al.7
(1996) states that children aged 4 to 5 years are the
most likely to suffer trauma. However, the current
literature is unanimous in that trauma occurs as a result
of psychomotor underdevelopment and poor motor
skills, which do not allow the child to perform precise
and safe movements8, 9, 10.
Unfortunately, people in general are not well informed
about the risks of trauma in the deciduous and
permanent dentitions and what can be done to avoid
them1.
There are several studies in the literature that evaluate
the prevalence of dental trauma in the primary and
permanent dentitions,1,5,11,12,13,14 .So we have conducted
similar study to assess the prevalence of traumatic
injuries in children aged 0-18 years and to create an
awareness among parents and children about traumatic
dental injuries.
Methodology
A Preliminary, observational survey was carried out
among children aged 0 to 18 years seen in the period
from 2008 to 2010 at Department of Pedodontics,
institute of dental sciences, Bareilly. The study was
approved by the college ethical committee. All the
dentoalveolar trauma cases were later treated and
subsequent follow up was done in our department. The
sample comprised a total of 458 children. Clinical and
radiographic records of 458 children having 491
traumatized teeth were examined.
110
 RESEARCH
The following information pertaining to the child and to
the trauma were collected from the dental records:
gender and age at the time of trauma, etiology (fall
from own height, accidents, collision and others), type
of dentition, teeth involved, type of traumatic injuries
(fractures and luxations), time elapsed between the
trauma and seeking care, presence and kind of clinical
and radiographic sequelae observed at the first visit.
Traumatic injuries to the extra oral areas, maxillary and
mandibular primary teeth were recorded according to
the method described by Andreasen15 .
Quantitative analysis of the collected data was
performed by using a statistical program. The relative
frequency (%) of all variables studied was obtained and
the relation between them was assessed by the
nonparametric Chi-square test (p < 0.05).
Results
Quantitative analysis of the collected data was
performed by using nonparametric Chi-square test (p <
0.05).
The sample consisted of 458 children (81.7% boys;
18.3% girls). A total of 491 teeth were traumatized in
458 children and were included in the study. The great
majority was present in the maxillary arch (98.4 %),
being the central incisors (88.7%) the most affected
teeth, followed by the lateral incisors (11.3%). The
majority of the traumas occurred between two age
groups-from 1-3 years of age (23.1%) . Children aged 2
years were the most affected (31.3%) ,secondly
between the age group of 7-14 years(76.9 %).
The most common trauma cause related by the
children's parents or guardians was fall from the child's
own height (66.8 %), followed by accidents (18.2%).
When relating the cause to the child's gender and age, a
higher prevalence was observed in boys (p = 0.04) and
in the age group from 1- 3yearsand 12-18years (p =
0.05). Complementary tests performed for diagnosis
included 478 percussion tests, 220 heat sensitivity tests,
160 cold sensitivity tests, 297 occlusal examinations and
209 mobility assessments. When assessing the influence
of gender on clinical and radiographic sequelae, there
was no statistically significant difference (respectively p
= 0.54 and p = 0.55). Age seemed not to have any
influence on radiographic sequelae (p = 0.41); however,
clinical sequelae were more evident in children aged 11-
14 years (p = 0.03).As regards the time at which
treatment was sought; it was observed that most of the
sample (78.6%) were classified as not immediate (more
than 24 h from the time of dental trauma). The
treatment plans varied according to the type of dental
traumatism.
IJCD • MARCH, 2011 • 2(2)
111 © 2011 Int. Journal of Contemporary Dentistry
Treatment plans reported were root canal therapy
(40%), dental splint therapy (17%), surveillance (14%),
composite resin restoration (10%), tooth repositioning
(7%), tooth extraction (6%) and others (6%). Treatments
actually performed were root canal therapy (6%), dental
splint therapy (15%), surveillance (12%), composite
resin restoration (7%), tooth repositioning (6%), tooth
extraction (6%), intra canal calcium hydroxide dressing
changes (41%), occlusal adjustment (2%), temporary
partial prosthesis (2%) and others (3%).
Discussion
Current Dentistry presents high scientific and
technological standards, and, in most cases, it is capable
of reestablishing esthetics and function to patients.
Nevertheless, traumatic dental injuries are still a great
challenge in as much as they usually injure teeth and
their supporting tissues in a precocious phase and
frequently with an unfavorable prognosis that can lead
to tooth loss.
The great expediency of such a retrospective study is
that it gives an overview of the traumatic dental injuries
with respect to the profile of the most affected
patients, the etiologic factors involved and the most
frequently adopted treatment plans. Putting the
information all together leads to a better knowledge of
the different types of injuries. It also allows the choice
of the most effective and long-lasting therapeutic
procedures16, 17, 18, and 19.
In the present study two age groups were mostly
affected by dentoalveolar injuries. First one is between
1-3 years. This finding is in concurrence with those of
the literature specifically related to the subject as it is
the time when the child acquires independence and
starts to explore its environment, hence the increase in
injuries is natural9 .
The other age group which was commonly affected by
dentoalveolar injuries was 12-18 years male children
and this finding was in tandem to previous studies,14 -25.
During adolescence, most of the traumatic dental
injuries are attributable to accidents in sports activities.
Some authors have described that approximately 1.5%
to 3.5% of all adolescents practicing sports activities
undergo traumatic dental injuries annually. In late
adolescence and early adulthood, these injuries
associated to automotive accidents are prevalent24.
In agreement with the findings of other authors, it was
found that a fall from the child's own height, followed
by other falls, was the most frequent etiologic factor for
the occurrence of dentoalveolar injuries26.
 RESEARCH

Table -1 Types of extraoral injuries

Injury Site Total

(N=491)

Face lip mentum nose

Laceration 59(12.0%) 38(7.7%) 71(14.4%) 66(13.4%) 234(47.6%)

Abrasion 43(8.7%) 67(13.6%) 45(9.1%) 3(0.6%) 158(32.1%)

Contusion 77(15.6%) 56(11.4%) 28(5.7%) 34(6.9%) 195(39.7%)

No injury 312 330 347 388

No - - - -
answer

Table-2 Prevalence of Dentoalveolar trauma

Type of injuries N Percentage(%)

Fracture involving 53 10.7%

only enamel

Fracture involving 67 13.6%

only enamel and
dentin

Fracture involving 224 45.6%

pulp

Fracture of roots 7 1.4 %

Crown root fracture 5 1.01%

Fracture of alveolar 17 3.4%

process

Lateral luxation 45 9.1 %

Concussion 36 7.3 %
Intrusive luxation 3 0.6%

Extrusive luxation 7 1.4%

Subluxation 4 0.8%
Avulsion 23 4.6%
Total 491

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© 2011 Int. Journal of Contemporary Dentistry
 RESEARCH

Table –3 Prevalence of Dentoavleolar clinical sequelae

Clinical sequelae N Percentage(%)

Coronal discoloration 93 28.0%
Abcess 81 24.4%
Edema 17 5.1%
Absence of clinical 140 42.2%
signs

Total 331

Table –4 Prevalence of Dentoalveolar radiographic sequelae

Radiographic sequelae N Percentage(%)

External resorption 11 3.3%

Thickening of 109 32.9%
periodontal ligament
space
Periapical lesion 112 33.8%
Root fracture 11 3.3%
Alveolar fracture 17 5.1%
Internal resorption 13 3.9%
Pulp Calcification 9 2.7%
Absence of radiographic 14 4.2%
evidence

Root canal obliteration 12 3.6%

Bone loss 23 6.9%

Total 331

Laceration was the most common type of extra oral
injury (47.6%).This is effortlessly explained since most of
the traumas were caused by direct impacts, in which
lips act as a shield15. Intraoral examinations revealed
that gingival and lip laceration were the most common
soft tissue injuries due to tooth dislodgement, mainly in
cases of luxation15.
As related in other studies, 2, 4, 9, 26 the maxillary arch and
the central maxillary incisors were the most affected
arch and teeth. Among the complementary tests,
percussion and thermal sensitivity tests were largely
performed to obtain information regarding damage to
periodontal ligament and pulp tissue, respectively.1, 15, 19
All traumatized teeth should be radio graphed to
investigate the existence of root fracture and/or injuries
IJCD • MARCH, 2011 • 2(2)
113 © 2011 Int. Journal of Contemporary Dentistry
to periodontal structures as well as to assess root
development stage. These are important factors
accounting for the establishment of the treatment
plan15, 27.
Among the complementary tests, percussion and
thermal sensitivity tests were largely performed to
obtain information regarding damage to periodontal
ligament and pulp tissue, respectively15, 27, 28 .Pulp
sensitivity tests require the patient's cooperation, which
is frequently not achieved during first-aid care.
Therefore, the validity of these tests is controversial.
Andreasen28 (1989) postulated that sensitivity
responses may be temporarily reduced, especially in
traumatic luxations. Consequently, sensitivity tests
should be postponed to a subsequent visit.

According to Soxman et al.29, tooth discoloration is a
common post-traumatism episode. According to Holan,
Fuks 30, these results from pulp hemorrhage, and
coloring can vary from yellow to pink, pink to gray and
gray to black. Tooth discoloration was also important in
the spectrum of clinical sequelae observed in the
present study with 28.0%.
Dental mobility was not observed during the first visit
because its presence immediately after the trauma
would be considered luxation, i.e., it would represent a
feature of the trauma and not a sequelae resulting from
it. We therefore suggest that in future studies this
criterion be used for assessing this sequela, i.e., that
mobility be assessed only in follow-up visits. In our
study the most frequent sequelae were periapical lesion
(33.8%) followed by thickening of periodontal ligament
space (32.9%).
In the present study, the most common type of
sequelae was radiographic in nature (41.4%). This
finding can be explained by the greater number of
patients who seek dental care due to a non-immediate
complaint (more than 24 hours after the trauma) and
because radiographic sequelae take more time to
become apparent than do clinical sequelae.
Additionally, clinical recovery may occur while no
radiographic repair is evident. When analyzing the
radiographic sequelae observed, it was found that
periapical abscess was the most frequent alteration
reported in 33.8% of cases.
With regard to seeking treatment, most of the sample
sought care at a not immediate time (more than 24
hours after the trauma), which could be a critical factor
in determining a post-traumatic prognosis. Delay in
seeking treatment facilitates consolidation and
aggravation of subclinical lesions, which in turn may
eventually lead to a worst prognosis.
The therapeutic approach for traumatic dental injuries
varies according to the dentition affected (primary or
permanent) and to the type of damage for both the
teeth and supporting structures.1,15,18 In this context, it
should be kept in mind that the treatment plan must be
carefully elaborated. This would avoid new traumas that
would worsen the prognosis, which is not so favorable
in many cases.
Regarding treatment, root canal therapy is advised
mainly for luxations (extrusive lateral and intrusive) in
which pulp neurovascular supply is disrupted. This
would avoid pulp necrosis leading to external
inflammatory root resorption15, 24, 27, 28, 31, and 32. Intra-
canal calcium hydroxide dressing placement and
changes are widely employed procedures due to the
well-recognized anti-bacterial and healing properties of
calcium hydroxide.22 It also has the ability of preventing
IJCD • MARCH, 2011 • 2(2)
© 2011 Int. Journal of Contemporary Dentistry
RESEARCH
and/or arresting the process in cases of ongoing
external inflammatory root resorption.32, 33
Occlusal adjustment is another key step of the
treatment plan because tooth repositioning does not
necessarily return it to its original position. Even small
dislodgements may provide premature contacts that
cause undesirable additional traumas15.
The importance of the time elapsed between the
trauma event and initial treatment for the prognosis of
the trauma should be emphasized in educational
practice of primary prevention. Parents should be
aware of the importance of seeking immediate
treatment and of a periodic follow-up by the dentist
with the objective of limiting the damage to the
deciduous and permanent dentitions. Knowledge of the
type of traumatic lesion, its location, clinical and
radiographic extent, and post trauma sequelae is
extremely important to determine the prognosis for the
primary and permanent dentitions.
Follow-up of any type of traumatism is of supreme
importance because it is not possible to know exactly
the extent of damage for both the tooth and the
supporting tissues or predict future consequences15
.However, this is difficult to be achieved since it
depends on the patient's compliance on a long-term
basis.
Conclusion
Within the limits of this study, it can be concluded that
traumatic dental injuries occur more frequently in
young male individuals, due to falls and bicycle
accidents. The importance of the time elapsed between
the trauma event and initial treatment for the prognosis
of the trauma should be emphasized in educational
practice of primary prevention. Parents should be
aware of the importance of seeking immediate
treatment and of a periodic follow-up by the dentist
with the objective of limiting the damage to the
deciduous and permanent dentitions. Kowledge of the
type of traumatic lesion, its location, clinical and
radiographic extent, and post trauma sequelae is
extremely important to determine the prognosis for the
primary and permanent dentitions.
It is therefore suggested that further studies be
conducted over a longer period of time, involving a
follow-up of the development and course of sequelae to
assess the possible importance of the time elapsed after
the trauma in their severity. Such studies should
evaluate the sequelae resulting from dental trauma
both in the primary and permanent dentitions.
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1996;7(1):41-6 Address for Correspondence

Kamala B.K

Reader,
Department of Pedodontics and Preventive Dentistry,
The Oxford Dental College and Hospital, Bangalore,
Karnataka, India.

Email: drkkiran@gmail.com

IJCD • MARCH, 2011 • 2(2) 116

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