Document Type : Original Article

Authors

1 Oral and Dental health Research Center, Ilam University of Medical sciences, Ilam, Iran.

2 Department of Dentistry, School of Dentistry, Ilam University of Medical Sciences, Ilam, Iran

3 Department of Anesthesiology, School of Medical Sciences, Ilam University of Medical Sciences.

10.30476/beat.2025.105911.1576

Abstract

Objectives: This study aimed to determine the prevalence of dental trauma (DT) in pediatrics and adolescents
in Ilam.
Methods: This retrospective study was conducted in Ilam (Iran) on a group of pediatric and adolescent patients
with DT between 2017 and 2021. The researchers reviewed patient records from hospital-based specialty clinics
providing DT treatment. Using a predefined checklist, they extracted the relevant data from the patients’
medical files.
Results: In this study, 246 pediatrics and adolescents were examined, including 144 (58.5%) boys and 102
(41.5%) girls. Regarding age distribution, 104 (42.3%) patients were in the pediatric age group (mean age:
7.1±3.2 years) and 142 (57.7%) were adolescents (14.8±5.1 years). A significant relationship was found between
place of occurrence with sex (OR=0.77; 95% CI=0.64-0.93; p=0.008) and age group (OR=0.73; 95% CI=0.6-
0.89; p=0.002). Additionally, the type of trauma showed a significant association with sex (OR=1.24; 95%
CI=1.08-1.43; p=0.002), while the treatment provided was significantly associated with school type (OR=0.79;
95% CI=0.65-0.96; p=0.02). In addition, there was no significant relationship between the demographic
variables and dental injury-related factors (p>0.05).
Conclusion: The present study found a higher prevalence of DT in boys than in girls. However, this trend
reversed in the adolescent age group. In addition, public schools had a higher rate of DT, which influenced the
types of treatments provided. 

Keywords

Introduction

 

The health of children and adolescents, as future builders of society, affects both individual and societal well-being and enhances a nation’s future. On the other hand, children are considered one of the vulnerable groups of society, facing various life-threatening injuries and health risks [1].

Childhood and adolescence represent one of the most critical periods of human development, marked by numerous life changes. These changes include personal, social, physiological, and behavioral transformations, each significantly affects children’s and adolescents’ lives [2, 3].

Trauma is one of the leading causes of illness and hospital admission. It can affect various body parts, such as the head, extremities, thorax, spinal system, and teeth [4-6]. Dental trauma (DT) is one of the most important types of trauma, typically occurring suddenly, unexpectedly, and accidentally. Compared to other traumas, DT requires more time and financial resources for treatment, imposing a considerable physiological burden on individuals. On the other hand, DT management varies significantly, presenting different challenges for individuals and families in different age groups [7-9].

Unlike other body tissues, traumatized teeth cannot undergo physiological self-repair and require dental intervention. When DT occurs, physiological changes will occur in the patient’s body, including changes in blood pressure, pulse, and other physiological indicators [10, 11].

Children are more susceptible to DT due to natural physical activity and mobility, which can result in partial or complete tooth loss, creating aesthetic, physiological, social, and treatment-related challenges for patients. Indeed, DT impacts oral health function and quality of life, leading to financial burdens, social consequences, physiological effects, and school absenteeism among children and adolescents [12-14].

Various factors contribute to DT in children and adolescents, including sports injuries, falls, and fights, with maxillary incisors being most frequently affected. To prevent further complications and achieve pain relief, functional improvement, and aesthetic restoration, prompt diagnosis and treatment of DT must be essential [15-17].

Considering the importance of comprehensive health data for children and adolescents, this study aimed to determine the prevalence of DT among this population in Ilam.

 

Materials and Methods

 

This retrospective study examined pediatric and adolescent DT cases in Ilam between 2017 and 2021. The inclusion criteria for the study included documented DT in patient records matching our checklist criteria, age between 2-12 years (pediatric) and 12-21 years (adolescents). Files with incomplete clinical data were excluded. The sample size was determined based on previous studies [18-20], ultimately including 246 patients.

In this study, the researchers reviewed patient records from Imam Khomeini Hospital in Ilam, examining files of patients who visited specialty clinics for DT treatment. Using an established checklist, they extracted relevant data from clinical files and dental radiographs. To complete data collection, a researcher-made demographic profile form and checklist were designed and compiled in collaboration with experts and based on published literature [21, 22]. Researchers utilized this checklist (Attachment 1) to complete data collection.

The demographic form collected data on sex, age group, school type, location, and mean age. The checklist comprised four dimensions, including cause of trauma, place of occurrence, type of trauma, and treatments provided (see attachment).

Patient confidentiality was strictly maintained throughout file review, data reporting, and clinical record preservation. The data related to DT were analyzed using SPSS software (version 16), employing both descriptive statistics, such as frequency and percentages, and analytical statistics, including regression analysis. All study data showed normal distribution, with statistical significance set at p<0.05. For regression analysis, binary logistic regression was specifically applied.

 

Results

 

This study examined 246 pediatric and adolescent patients, comprising 144 (58.5%) boys and 102 (41.5%) girls. By age group, 104 participants (42.3%) were pediatrics (mean age=7.1±3.2 years) and 142 (57.7%) were adolescents (mean age=14.8±5.1 years) (Table 1).

 

Table 1. Demographic characteristics of pediatrics and adolescents

Total

n (%)

Sex

n (%)

Variable

246 (100)

Girl

n=102 (41.5)

Boy

n=144 (58.5)

104 (42.3)

29 (27.9)

75 (72.1)

Pediatrics (2-12 years)

Age group

142 (57.7)

73 (51.4)

69 (48.6)

Adolescents (13-21 years)

207 (84.1)

93 (45)

114 (55)

Public

School type

39 (15.9)

9 (23)

30 (77)

Private

142 (57.7)

54 (38)

88 (62)

Urban

Location

104 (42.3)

48 (46.2)

56 (53.8)

Rural

 

The most common causes of DT were assaults, with a rate of 29.2% in boys, and traffic accidents, with a rate of 37.3% in girls. Regarding the injury locations, 27.8% of boys experienced DT in parks, while 25.5% of the girls experienced it on streets (Table 2).

 

Table 2. Comparison of the cause of trauma and place of occurrence by sex

Total

n (%)

 

Sex

n (%)

Variable

Girl

Boy

35 (14.2)

22 (21.6)

13 (9)

Falls (domestic)

Cause of Trauma

29 (11.8)

9 (8.8)

20 (13.9)

Falls (outdoors)

47 (19.1)

5 (4.9)

42 (29.2)

Assaults

35 (14.2)

9 (8.8)

26 (18.1)

Recreation accident

39 (15.9)

18 (17.6)

21 (14.6)

Sport accident

47 (19.1)

38 (37.3)

 9 (6.3)

Traffic accident

14 (5.7)

 1(1)

13 (9)

Other cause

26 (10.6)

14 (13.7)

12 (8.3)

Home

Place of occurrence

57 (23.2)

26 (25.5)

31 (21.5)

Street

56 (22.8)

29 (28.4)

27 (18.8)

School

60 (24.4)

20 (19.6)

40 (27.8)

Parks

30 (12.2)

8 (7.8)

22 (15.3)

Clubs

17 (6.9)

5 (4.9)

12 (8.3)

Other places

 

Enamel-dentin fractures were the most frequent DT type, occurring in 26.4% of boys and 19.6% of girls. For treatments, sutures were performed in 18.8% of boys, while antibiotics were prescribed for 31.4% of girls (Table 3).

 

Table 3. Comparison of the type of trauma and Treatments provided by sex

Total

n (%)

Sex

n (%)

Variable

Girl

Boy

29 (11.8)

6 (5.9)

23 (16)

Enamel fracture 

Type of trauma

58 (23.6)

20 (19.6)

38 (26.4)

Enamel–dentin fracture (uncomplicated crown fracture)

39 (15.9)

15 (14.7)

24 (16.7)

Complicated crown fracture 

42 (17.1)

19 (18.6)

23 (16)

Root fracture 

32 (13)

17 (16.7)

15 (10.4)

Uncomplicated crown–root fracture

23 (9.3)

12 (11.8)

11 (7.6)

Complicated crown–root fracture 

15 (6.1)

9 (8.8)

6 (4.2)

Concussion and subluxation, and avulsion

8 (3.3)

4 (3.9)

4 (2.8)

Intrusive luxation and extrusive luxation, and lateral luxation

15 (6.1)

6 (5.9)

9 (6.3)

Temporary filling

Treatments provided

42 (17.1)

15 (14.7)

27 (18.8)

Suture

47 (19.1)

23 (22.5)

24 (16.7)

Extraction

18 (7.3)

2 (2)

16 (11.1)

Trepanation

56 (22.8)

32 (31.4)

24 (16.7)

Prescription of antibiotics

38 (15.4)

13 (12.7)

25 (17.4)

Splinting

27 (11)

10 (9.8)

17 (11.8)

Prescription of analgesics

3 (1.2)

1 (1)

2 (1.4)

Other

 

This study found significant associations between place of occurrence with sex (OR=0.77; 95% CI=0.64-0.93; p=0.008) and age group (OR=0.73; 95% CI=0.6-0.89; p=0.002). There was also a significant relationship between the type of trauma and sex (OR=1.24; 95% CI=1.08-1.43; p=0.002). Moreover, a significant relationship was observed between treatments provided and school type (OR=0.79; 95% CI=0.65-0.96; p=0.02). However, no significant relationship was detected between demographic variables and dental injury-related factors (p>0.05) (Table 4).

 

Table 4. Prediction of dental injury based on binary logistic regression.

p value

95% CI

OR

Variable

Upper

Lower

0.07

1.3

0.98

1.13

Sex

Cause of trauma

0.18

1.26

0.95

1.09

Age group

0.23

1.07

0.73

0.89

School type

0.34

1.22

0.93

1.06

Location

0.008

0.93

0.64

0.77

Sex

Place of occurrence

0.002

0.89

0.6

0.73

Age group

0.10

1.57

0.96

1.22

School type

0.36

1.3

0.9

1.08

Location

0.002

1.43

1.08

1.24

Sex

Type of trauma

0.4

1.21

0.92

1.05

Age group

0.98

1.19

0.83

0.99

School type

0.44

1.08

0.83

0.94

Location

0.96

1.15

0.87

1.00

Sex

Treatments provided

1.14

1.31

0.99

0.06

Age group

0.02

0.96

0.65

0.79

School type

0.76

1.17

0.89

1.02

Location

 

Discussion

 

This study aimed to determine the prevalence and associated factors of DT in pediatrics and adolescents. The findings showed a higher prevalence of DT in boys than in girls. In a study by Goettems and colleagues, in the age range of 8-12 years, the prevalence of DT was 14.3% in boys and 11.2% in girls [23]. Damé-Teixeira and colleagues conducted a cross-sectional study of 12-year-old patients, reporting DT prevalence of 40.8% in boys and 28.6% in girls [24]. In the study by Eslamipour and colleagues, using a cross-sectional method and in the age range of 9-14 years, the prevalence of DT was reported as 29.9% in boys and 18.8% in girls [25], which was consistent with the findings of the present study regarding the higher prevalence of DT in boys than girls.

The findings showed that most hospitalized patients attended public schools. Regarding school status, Arheiam et al., reported that 10.3% of patients with traumatic dental injuries attended public schools [26]. Similarly, Malak and colleagues found higher rates of DT in public (12.1%) than in private schools (9.1%) [27]. DT may occur in any school setting, and managing its complications depends on the knowledge and attitudes of students, parents, and teachers [19, 28].

The main causes of DT in the studied population were assaults, traffic accidents, and sports incidents. Thelen and colleagues reported the following causes of DT among urban adolescents: traffic accidents(4.7%), collisions (27.5%), falls (13.4%), fights/violence (4%), swimming/diving (9.1%), cycling (6.9%), biting hard food (8%), unknown causes (10.5%), and missing data (1.8%) [29]. Ain and colleagues conducted a study which involved 1,600 school children, and identified falls (42.2%) as the most common cause, followed by sports (22.81%), unknown causes (16%), accidents (10.06%), collisions (4.69%), violence (2.01%), and biting (2.01%) [30]. Similarly, Soriano et al., found sports (8.2%), road accidents (2.7%), leisure activities (9.1%), violence (6.4%), falls (27.3%), collisions (18.2%), and unspecified accidents (22.7%) as DT causes [31].

The findings indicated that antibiotic prescription was the most common treatment provided. Al-Ansari and colleagues conducted a cross-sectional study on individuals with an average age of 14.29 years and found that 7.2% of patients used self-care/self-medication for DT treatment, 1.1% visited hospital emergency departments, 3.6% attended public dental clinics, and 7.2% visited private dental clinics [32]. Additionally, Chopra and colleagues found that only 3.5% of children aged 2-15, who had experienced DT trauma, sought treatment. The most common treatments included adhesively luted restorations, acid-etched restorations, and crowns [33]. The differences between the findings of this study and other studies could be attributed to the lack of an appropriate guideline for antibiotic prescription [34, 35] and differences in study methodology. While this study employed a retrospective review of hospitalized patients’ medical records, the compared studies used cross-sectional descriptive methods.

The findings showed that parks were the most common location for trauma in boys (27.8%), and schools were the most frequent for girls (28.4%). Schuch et al., found that among 8-12-year-olds, trauma incidents occurred at home (55%), school (18%), on streets (15%), and other locations (12%) [36]. Similarly, Teixeira et al., reported trauma occurrences at home (22.32%), school (8.52%), and other locations (15.5%) [37]. These studies collectively indicated that schools and homes were among the most significant places for trauma incidents.

This study represented the first investigation of children’s DT during the COVID-19 pandemic in Iran. Given that parks, schools, and streets, particularly in Ilam, are important places for DT occurrence, it is essential to enhance safety measures in these environments and provide children and adolescents with proper trauma prevention education. However, the same as other studies, this research had limitations inherent to its retrospective design. The potential for human error in medical records and incomplete data must be acknowledged. We recommend future cross-sectional or prospective studies to address these limitations. Importantly, while this study was conducted during the COVID-19 pandemic, when routine oral health services were reduced (especially during lockdown periods), potentially affecting our sample size, multiple studies unanimously reported that the pandemic did not significantly alter DT incidence rates [38, 39].

According to the findings of the present study, it is recommended to implement preventive measures against DT and conduct further research to enhance knowledge and attitudes regarding DT among students and teachers. This study revealed that the rate of DT in boys was higher than in girls. However, this trend reversed in adolescence. In addition, public schools had a higher rate of DT, which could affect treatment approaches. 

 

Declaration

 

Ethics approval and consent to participate: The study was approved by the Ethics Committee of Ilam University of Medical Sciences (IR.MEDILAM.REC.1404.010)

 

Consent for publication: All authors expressed their consent to the publication of this study.

 

Conflict of Interest: The authors declared that there was no conflict of interest.

 

Funding: There was no funding support for this study.

 

Authors’ Contribution: All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed, and a draft of the manuscript was written, based on previous versions of the manuscript. All authors read and approved the final manuscript.

 

Acknowledgment: Not applicable.

 

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