Supervisors info:
Αγουρόπουλος Ανδρέας, Επίκουρος Καθηγητής, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Γκιζάνη Σωτηρία, Αναπληρώτρια Καθηγήτρια, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Βαδιάκας Γεώργιος, Επίκουρος Καθηγητής, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Summary:
Traumatic dental injuries (TDI) are a public health problem and one of the main reasons for dental emergencies. Trauma studies in different regions are useful to identify groups and individuals at risk and contribute to the development of health strategies. The aim of this study was to assess the prevalence of TDIs and its association with socio-demographic and personal/behavioral risk indicators, in a national representative sample of 5,12- and15-year-old Greek children and adolescents.
Materials and methods
The sample was selected according to the guidelines proposed for pathfinder surveys by the World Health Organization using stratified cluster sampling. The sampling was performed exclusively on children and adolescents in three age groups 5, 12, 15 years old according to the following inclusion criteria: 1) Written parental consent, 2) Greek
citizenship, 3) healthy. The study population included samples from urban and rural areas. Collection of the sample was carried out by random selection of public schools in the proposed sampling locations.
Demographic data were collected from questionnaires answered by the parents/ legal guardians, while adolescents in the 12 and 15yo groups, answered a separate
questionnaire on their dental history and personal habits like alcohol consumption, smoking and mouth piercing and perception about their oral health. All children with informed consent were examined in classrooms with artificial light, a mirror and a WHO periodontal probe. All participants were examined by 10 calibrated dentists and recorded dental trauma as: a) enamel fracture, b) enamel-dentin fracture c) crown fracture with pulp involvement, d) crown discoloration, e) fistula, f) composite resin build-up. All teeth in the dentition were examined. Overjet was recorded during maximum intercuspation using the periodontal probe in all children and in the 12& 15 yo age groups the permanent molar relationship was recorded according to Angle classification. Presence of piercing intraorally or on the lips was also recorded. Furthermore, weight and height were recorded for the children living in Attica only and the BMI was calculated for each child. Children were classified as underweight, normal, overweight, obese using the nationalreference growth curves.
Descriptive statistics (frequency, mean, and standard deviation, valid percents) took place, while multifactorial analysis was performed to study the simultaneous correlation of a number of variables with parameters of oral health using specific statistical models (negative binomial, fraction allogit and ordinal logistic regression models). Statisticalsignificance was set to p<0.05.
Results
The sample consisted of 3.455 children, 1222 children 5 years old, 1102 children 12 years old and 1131 children 15 years old. For the 5yo group the prevalence of dental trauma was 12,5%. The most prevalent TDI was enamel fracture and the most affected teeth were upper central incisors. Statistically significant more upper teeth were traumatized compared to lower ones (p<0.001). Children with increased overjet were 2.08 times more likely to suffer traumatic dental injury compared to counterparts with normal overjet.
Furthermore, mothers’ low educational level was significantly correlated with increased trauma prevalence in young children. For the 12yo and 15 yo groups the prevalence of TDI was 13% and 11,5% respectively, the most prevalent TDI was enamel fractures and upper central incisors were the most affected teeth(p≤ 0,001) in both age groups. Additionally, boys had experienced dental trauma significantly more frequent than girls (12yo: p=0,025, 15yo:p=0,003). In the 15yo teenage group, smokers were 1.85 times more likely to have suffered TDI than non-smoking peers while those with dental trauma were conscious that their oral health condition was worse compared to their counterparts with no TDI(p=0,008).The rest of the demographic and personal data, including the BMI, were not significantly correlated with the presence of TDIs.
Conclusions
Overall, around 1 in 10 children in each age group had suffered a TDI, the upper central incisors were the most frequently traumatized teeth, and enamel fractures was the most frequent type of trauma. Identified risk indicators were male gender, increased overjet, maternal education level and smoking, but were not the same across the three age groups. Interestingly enough, 15yo adolescents seem to be more self-conscious and acknowledge TDI as an oral health problem. The large and country-wide representative sample was a big strength of this study, while a significant weakness was the limitation to identify luxation injuries due to the study design.
