| Abstract|| |
Aim: The aim of this study was to evaluate demographic and clinical factors involved in the immediate seeking of care after traumatic dental injury (TDI) in Brazilian children. Materials and Methods: Records from 74 patients, age ranged 1–11 years, who sought treatment at the School of Dentistry of Ribeirão Preto at University of São Paulo, Brazil, were collected. Data was analyzed using the Epi Info 7.0 software by t-test, odds ratio calculation, Chi-square, or Fisher's exact tests. Results: Twenty-three (31.1%) sought dental treatment immediately and 51 (68.9%) did not seek dental treatment immediately. The most common type of trauma was lateral luxation (44.6%). In primary teeth, 31 cases (60.78%) involved the soft tissue and 16 (39.2%) involved hard tissue injuries. While in permanent teeth, 20 cases (40%) involved soft tissue and 24 (60%) involved hard tissue injuries had more traumas in the hard tissue (P = 0.04). The type of injury and dentition was not associated with the time that the guardians sought dental treatment (P > 0.05). None of the factors were involved in immediately seeking care after TDI. Conclusion: Moreover, the majority of parents/caregivers did not immediately seek dental treatment after TDI, regardless of the type of injury.
Keywords: Attitude, traumatic dental injuries, traumatized teeth
|How to cite this article:|
Longo DL, Oliveira SS, Küchler EC, Paula-Silva FW, Lucisano MP, Nelson-Filho P, de Queiroz AM, Bezerra Silva RA. Factors involved in the treatment sought immediately after traumatic dental injuries in Brazilian children. Indian J Dent Res 2020;31:109-12
|How to cite this URL:|
Longo DL, Oliveira SS, Küchler EC, Paula-Silva FW, Lucisano MP, Nelson-Filho P, de Queiroz AM, Bezerra Silva RA. Factors involved in the treatment sought immediately after traumatic dental injuries in Brazilian children. Indian J Dent Res [serial online] 2020 [cited 2021 May 11];31:109-12. Available from: https://www.ijdr.in/text.asp?2020/31/1/109/281800
| Introduction|| |
Traumatic dental injuries (TDIs) are an impact injury to the teeth and/or other hard and soft tissues within and around the vicinity of the mouth and oral cavity. TDI commonly affects children and teenagers. The highest incidence of dental trauma in primary teeth occurs between 2 and 3 years of age. The prevalence of dental TDI among children younger than 6 years of age has been reported to vary from 11% to 30%.,
Many factors are involved in TDI etiology, in which falls are the most common cause in preschool children., On the other hand, in school-age children, sports and other games are the main causes of TDI., In adolescents and young adults, violence and traffic accidents are the most common etiological factors.,,, In general, boys experienced TDI more than girls.,,
Many variables are involved in the prognosis of TDI, such as the severity of injury, the correct diagnosis, and the extra alveolar time passed from the injury to seeking of treatment by parents and guardians. Therefore, the aim of this study was to evaluate demographic and clinical factors in the seeking for care after TDI in Brazilian children.
| Methods|| |
The study was approved by the Ethics Committee at the school of dentistry (Process 55304816.2.0000.5419).
Seventy-four records from children, age ranged between 1 and 11 years, who sought treatment at the school of dentistry between 2007 and 2015 were evaluated in this study.
Only the first clinical appointment of patients was considered. Screening and data abstraction (clinical and demographic variables) from the dental records were performed by the same examiner (S. S. O). Data regarding the treatment sought, the time frame after injury, gender, area of residence, type of trauma, dental arch involved, numbers of affected teeth associated with the time that the guardians sought dental treatment, and etiological factors related to dental trauma were extracted from the records. The type of TDI was defined according to the guidelines for the evaluation and management of TDIs from International Association of Dental Traumatology.,,
Statistical analyses were performed to evaluate the factors involved in the immediately seeking for care in TDI, such as gender, area of residence, type of injury, dental arch involved, and number of affected teeth. The patients were dichotomized in 2 groups: the group that “sought for dental treatment immediately” (in <6 h) and the “group that did not seek for dental treatment immediately” (more than 7 h).
Data were analyzed using the Epi Info 7.0 software (Atlanta, GA, USA). The t-test was used to compare mean number of teeth difference between the groups. Chi-square or Fisher's exact tests were used to determine different frequencies of the gender, sought dental care immediately, area of residence, dental arch, teeth tissue injuries, tooth supporting structure injuries, soft tissue injuries, etiology of the dental trauma, type of dentition, and type of injury. Odds ratio (OR) calculation was also performed. The level of statistical significance was set at 5%.
| Results|| |
All 74 children were included in the study. The mean age was 5.14 (±3.25) years. [Table 1] describes the distribution of the children according to their gender, timeframe of seeking treatment following injury, area of residence, type of trauma, dental arch involved, and etiological factors related to dental trauma.
The gender ratio male-to-female was 1.5:1. Twenty-three (31.1%) sought dental treatment immediately and 51 (68.9%) did not seek dental treatment immediately. The time of care seeking ranged between 20 min and 3 years; 25 (33.78%) guardians sought treatment in the first 24 h after the trauma.
The type of injury was associated with the type of dentition. In primary teeth, 31 cases (60.78%) involved the tooth supporting structures and 16 (39.2%) involved hard tissue injuries. While in permanent teeth, 20 cases (40%) involved the soft tissue and 24 (60%) involved hard tissue (P = 0.04; OR = 2.3, [95% confidence interval, 1.0–5.4]). The type of dentition was not a factor in the time taken to seek dental treatment (P = 0.42).
The area of residence and children's age was also not a factor in the time taken to seek dental treatment (P > 0.05).
Regarding the type of injury, 9 (22.5%) patients with hard tissue injuries sought dental care immediately, while 31 (77.5%) did not seek dental care immediately. Twenty-one (43.7%) patients with soft tissue injuries sought dental care immediately, while 29 (56.2%) did not seek dental care immediately. Two patients (28.6%) with soft tissue injuries sought dental care immediately, while 5 (71.4%) patients did not seek dental care immediately. There was no statistical difference between the type of injury and the time taken to seek dental treatment (P = 0.421).
[Table 2] presents the variables associated with the time taken to seek treatment.
The distribution between the types of dental trauma according to the time that the guardians took to seek treatment is presented in [Table 3]. The majority of the parents/guardians did not seek for immediate dental treatment, regardless of the type of dental trauma.
| Discussion|| |
A high prevalence of TDI is detected in children and adolescents (0–18 years old). This prevalence varies among different geographic regions. According to a published review, the prevalence of dental trauma exhibits a wide range from 6% to 59%. In Brazil, this prevalence is high and also ranges according to the geographical location (9.4%–58.6%).
The present study aimed to evaluate the factors involved in the immediately seeking for care after TDI. We were able to note that almost all parents and guardians did not seek for dental care immediately. Although we were not able to identify any clinical or demographic factor such as gender, area of residence, type of trauma, dental arch involved, and number of affected teeth associated with the time that the guardians seek for dental treatment, our results raise an important concern.
Among the many factors involved in the TDI prognosis, seeking dental treatment within the first 24 hours is a key factor to predict the outcome. However, it is important to highlight that procedures carried out immediately after a traumatic injury such as replantation, splintage, bleeding and pain control, antibiotic therapy, and antitetanus immunization are not the only factors involved in the dental trauma outcome. A long-term follow-up and in some cases, treatment should also be performed. Therefore, our study is a cross-sectional study that analyzes data collected at a specific point in time, which is an obvious limitation. Further study in our population should be performed in a cohort design that allows to evaluate the evolution and complications of the dental trauma.
Some studies attempted to evaluate parents' and guardians' knowledge and attitudes regarding the emergency of TDI.,,,,,, These studies demonstrated the parents' lack of awareness, knowledge, and skills in relation to TDI in children. In fact, although our study did not aim to evaluate the parents' knowledge, our results suggested insufficient information related to TDI emergency management among parents and guardians.
It is important to emphasize that TDI causes physical and psychological impact such as: teeth discolorations, eating difficulty, esthetic alterations, oral pain, and other negative psychological impacts, such as tendency to avoid laughing or smiling, which can affect social relationships., Hence, TDI should be treated promptly and properly to reduce the physical and psychological impact and costs for patients, parents, and health-care providers.
In our studied population, only 31% of the parents/guardians sought immediate dental treatment. This result corroborates with a previous study also performed on Brazilian children. The authors evaluated children enrolled in private and public preschools and they concluded that the frequency of seeking treatment following TDI was low, and a poor perception regarding the TDI might be associated with the failure to seek dental treatment.
Although TDI requires treatment or clinical follow-up, parents/caregivers are often ill-informed about the risks and consequences of not seeking care, and the demand for treatment is dependent on parental perception and awareness of the oral health of the child.
Parents/guardians or caregivers should be constantly alert because some injuries occur in a caregiver's absence and mild injuries sometimes cannot be identified. Failure to seek dental care following TDI is quite worrisome because it reveals a lack of awareness among the population regarding the importance of TDI consequences.
Briefly, our results demonstrated that awareness campaigns for parents and caregivers about the possible consequences of TDI and the required follow-up. Our results should be taken into account in programs and clinical interventions/orientations.
| Conclusion|| |
In the present study, none of the factors were involved in the immediately sought for care after TDI. Moreover, the majority of parents/caregivers did not immediately seek dental treatment after TDI, regardless of the type of injury.
Financial support and sponsorship
This study was supported by Grants from CAPES (PROEX fellowship to DLL).
Conflicts of interest
There are no conflicts of interest.
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Daniele Lucca Longo
Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Avenida do Café s/n, Monte Alegre, 14040-904, Ribeirão Preto, SP
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3]