Traumatic Dental Injuries Prensenting at the Pediatric Dental Clinic ...

TRAUMATIC DENTAL INJURIES PRENSENTING AT
THE PEDIATRIC DENTAL CLINIC AT PRINCE RASHID
BIN AL-HASSAN HOSPITAL
Othman M. Ajlouni DDS, MSc*, Taghreed F. Jaradat, DDS*, Farouk B. Rihani, DDS**
ABSTRACT
Objectives: To evaluate the frequency of dental injuries in relation to age, gender, etiology, number of
affected teeth, and type of trauma among children referred from Northern provinces of Jordan to the pediatric
dental clinic at Prince Rashid Hospital.
Methods: A total of 3,750 dental records representing children who were referred to pediatric dental clinic
at Prince Rashid Hospital during a 5.5 year period were retrospectively analyzed. Only records for patients
affected by dental trauma to permanent teeth were included in the study. A database for each patient’s record
was constructed to include the age, sex, cause of injury, and number of affected teeth, in addition, to the type
of injury according to Andreasen classification.
Results: Out of the total 3,750 dental records analyzed, there were 371 (9.89%) patients with traumatic
dental injuries, involving a total of 605 teeth (586 permanent teeth). The 8–10 year old age group had the
highest frequency of traumatic injuries (44.74%). Male patients (65.23%) experienced more traumatic dental
injuries than females (34.77%). The main cause of trauma was falls (88.95%). Class 2 (crown fracture
involving enamel and dentine) was the most common type of dental injury in permanent dentition (59.50%).
Maxillary central incisor was the most common tooth affected (84.13%), followed by mandibular central
incisors (6.99%). Approximately 52.29% of the affected children had only one injured tooth.
Conclusion: The results of the study showed that the frequency of dental injuries among children
presenting to the dental clinic at Prince Rashid Hospital was 9.89% and patients between 8-10 years of age
were the most common age group affected by dental injuries. Males were more affected than females and falls
were the most common cause of injury. Majority of patients only had one affected tooth, and the most
commonly injured tooth was a maxillary central incisor. Fracture involving enamel, and dentine without pulp
exposure was the most common type of dental injury.
Key words: Dental trauma, Gender, Type, Retrospective study
Introduction
Traumatic dental injuries are widespread in the
population and are a serious public health problem
JRMS February 2010; 17(Supp 1): 10-15
among children, so they are of interest to dental
educators, clinicians, and coordinators of emergency
health care services. Trauma to the child dentition is
an important issue, since fracture of one or more
From the Department of Dentistry, Division of Pediatric Dentistry
*King Hussein Medical Center, (KHMC), Amman-Jordan
**Prince Rashid Ben Al- Hassan Hospital, Irbid-Jordan
Correspondence should be addressed to Dr. O. M. Al-Ajlouni, P. O. Box: 31 Al-Sareeh 21156, Irbid-Jordan, Email: othmanajlouni@yahoo.com
Manuscript received December 21, 2005. Accepted May 6, 2006
10
JOURNAL OF THE ROYAL MEDICAL SERVICES
Vol. 17 Supp No. 1 February 2010

teeth, especially the anterior, may result in pain, loss
of function, poor aesthetics and psychological
trauma. (1)
Dental trauma is an injury associated to external
factors, such as violence, accidents and falls, among
other reasons and the extension, intensity and
gravity of which may reach both the dental element
and its supporting structures. In periodontally
injured teeth, often seen late complications are pulp
necrosis, pulp canal obliteration, root resorption and
loss of marginal alveolar bone. (2) Traumatic dental
injuries constitute a true dental emergency and
require immediate assessment and management.
There are few reports available on the
epidemiology of injuries to the teeth of children
when compared to epidemiological data on dental
caries and periodontal diseases. There are limited
amounts of epidemiological data in the field of
dental and oral trauma in Jordan. A study by Al-
Khateeb et al. in 2005 (3) found a prevalence of 11%
of coronal fracture with female to male ratio of 1:1.
An increase in the over jet more than 3mm doubled
the incidence of coronal fracture while over jet more
than 6mm increased the incidence fourfold.
In Jordan, a prevalence of 10.5%-19.2% has been
reported for trauma to anterior teeth. (4,5) The
prevalence of traumatic dental injuries worldwide
ranges from 6-37%. (4-9) The most common etiologic
reasons are falls, automobile and bicycle accidents,
collisions and sporting activities. (9-13)
The purpose of the present study was to evaluate
the type and frequency of dental injuries sustained
by children referred from northern cities of Jordan
(Irbid, Jarash, Ramtha, Mafraq, Ajloun, Northern
Aghwar) to the pediatric dental clinic in Prince
Rashid Hospital, Irbid, Jordan, which treats only
military personnel and their families and children.
Methods
A total of 3,750 dental records representing
children who were referred to pediatric dental clinic
at Prince Rashid Hospital during a 5.5 years period
(January 2000 and June 2005) were retrospectively
analyzed. Inclusion requirements for the study were
patients with trauma history that included crown
fractures and crown–root fractures. All other
relevant information was taken from the records.
The following information was collected for each
patient’s record: age, sex, time and cause of injury,
number and location of tooth affected, in addition to
the type of trauma. Andreasen’s classification was
used to identify each trauma (see Table I). (2)
The data were subsequently processed and
analyzed using the SPSS statistical software
program (version 13.00 for windows).
Table I. Andreasen’s classification for tooth trauma
Andreasen’s teeth trauma classification
1. Crown infraction. Incomplete fracture of the enamel
2. Uncomplicated crown fracture. A fracture confined
to the enamel or dentine but not exposing the pulp.
3. Complicated crown fracture. A fracture involving
enamel and dentine, and exposing the pulp.
4. Uncomplicated crown-root fracture. A fracture
involving enamel, dentine, cementum, not exposing
the pulp.
5. Complicated crown-root fracture. A fracture
involving enamel, dentine and cementum and
exposing the pulp.
6. Root fracture. A fracture involving dentine,
cementum, and the pulp.
7. Concussion. Injury without abnormal loosening or
displacement but with marked reaction to
percussion.
8. Subluxation (loosening). Injury with abnormal
loosening but without displacement of the tooth.
9. Intrusive luxation (central dislocation).
10. Extrusive luxation (peripheral dislocation, partiale
avulsion).
11. Lateral luxation.
12. Exarticulation (avulsion).
13. Comminution of alveolar socket.
Results
During the 5.5 year study period, 371 patients
(9.89%) were examined and treated at the pediatric
dental clinic for 586 traumatized permanent teeth
(each tooth had at least one type of trauma). The
mean age of the patients (n=371) at the time of
trauma was 9.54 years (SD=1.51 years) (range=6-14
years). Most dental injuries occurred within the age
group of 8-10 years in which there were 166
(44.74%) injuries and 67% (n=111) of these were
sustained by males. A minority of dental injuries
(n=12, 3.24%) were sustained by children in the age
group above 12 years. Overall, male patients
experienced more traumatic dental injuries than
female patients with a male to female ratio of
1.88:1. Males accounted for 242 (65.23%) of the
JOURNAL OF THE ROYAL MEDICAL SERVICES
Vol. 17 Supp No. 1 February 2010
11

affected children in the study, whereas females
accounted for only 129 (34.77%) (see Table II).
Bivariate correlations among parameters were
computed with the Pearson r. There was a
significant statistically negative relation between sex
and age of the patient (r = -0.113, p

In the studies that investigated the distribution of
dental trauma with respect to fracture types, most
studies reported that the most prevalent fracture type
was crown fracture involving enamel and dentine
(class-2) without pulpal involvement. (9,13-18)
However, some studies showed that enamel fracture
was the most common type of injury in permanent
dentition. (19,20) Our study has showed that maxillary
central incisors are more frequently traumatized than
mandibular teeth by dental trauma; this is generally
supported in the existing literature. (5,9,15-18,21) In this
report, the incidence of these teeth being injured
accounted for 84.13% of all teeth involved by dental
trauma, while Al-Jundi reported an incidence of
79.5%. (21) Our study revealed that the right
maxillary central incisors were slightly more
affected than the left side, contrasts the findings of a
previous study by Al-Jundi (21) .
The location and type of occlusions were limited
in this study because they were not reported in the
patient’s records.
Conclusion
It is extremely difficult to compare the results of
the different investigations of dental injuries, partly
because information is lacking or inaccurate and
partly because the studies are based on specific
groups (age, class, location or comprise trauma
patients exclusively). However, the main reason for
this difficulty is that the investigation of trauma
differs substantially from study to study. It is
desirable to unify recording standards to make
effective use of data that may by compared with
similar studies.
The following information is concluded in this
study:
- Traumatic dental injury is most frequent
between age 8 and 10 years.
- Males suffered dental injury more often than
females.
- Falls accounted for most of injury causes in
children.
- Majority of patients have had only one affected
tooth.
- Crown fracture class-2 involving enamel, and
dentine without pulp exposure is the most
common crown fracture.
- The most injured tooth was maxillary central
incisor.
- Right maxillary central incisor was affected
more than the left side.
References
1. Borssen E, Holm AK. Traumatic dental injuries in
a cohort of 16-year-olds in northern Sweden.
Endod Dent Traumatol 1997; 13(6): 276-80.
2. Andreasen JO, Andreasen FM. Textbook and
color atlas of traumatic Injuries to the teeth, 3rd ed.
Copenhagen: Munksgaard 1994.
3. Al-Khateeb S, Al-Nimri K, Alhaija EA. Factors
affecting coronal fracture of anterior teeth in North
Jordanian children. Dent Traumatol 2005; 21(1):
26-28.
4. Jamani KD, Fayyad MA. Prevalence of
traumatized permanent incisors in Jordanian
children, according to age, sex and socio-economic
class. Odontostomatol Trop 1991; 14(2): 17-20.
5. Hamdan MA, Rock WP. A study comparing the
prevalence and distribution of traumatic dental
injuries among 10-12-year-old children in an urban
and in a rural area of Jordan. Int J Paediatr Dent
1995; 5(4): 237-241.
6. Wilson S, Smith GA, Preisch J, Casamassimo
PS. Epidemiology of dental trauma treated in an
urban pediatric emergency department. Pediatric
Emergency Care 1997; 13(1): 12-15.
7. Sae-Lim V, Hon TH, Wing YK. Traumatic dental
injuries at the Accident and Emergency
Department of Singapore General Hospital. Endod
Dent Traumatol 1995; 11(1): 32-36.
8. Schatz JP, Joho JP. A retrospective study of
dento-alveolar injuries. Endod Dent Traumatol
1994; 10(1): 11-14.
9. Rajab LD. Traumatic dental injuries in children
presenting for treatment at the Department of
Pediatric Dentistry, Faculty of Dentistry,
University of Jordan, 1997-2000. Dent Traumatol
2003; 19(1): 6-11.
10. Gutmann JL, Gutmann MS. Cause, incidence,
and prevention of trauma to teeth. Dent Clin North
Am 1995; 39(1): 1-13.
11. Garcia-Godoy F, Garcia-Godoy F, Garcia-
Godoy FM. Reasons for seeking treatment after
traumatic dental injuries. Endod Dent Traumatol
1989; 5(4): 180-181.
12. Marcenes W, al Beiruti N, Tayfour D, Issa S.
Epidemiology of traumatic injuries to the
permanent incisors of 9-12-year-old schoolchildren
in Damascus, Syria. Endod Dent Traumatol 1999;
15(3): 117-123.
13. Traebert J, Peres MA, Blank V, et al. Prevalence
of traumatic dental injury and associated factors
among 12-year-old school children in
Florianopolis, Brazil. Dent Traumatol 2003; 19(1):
15-18.
14. Hennekens CH, Buring JE. Epidemiology in
Medicine. Boston: Little Bronw and Company;
1987.
JOURNAL OF THE ROYAL MEDICAL SERVICES
Vol. 17 Supp No. 1 February 2010
13

15. Saroglu I, Sonmez H. The prevalence of traumatic
injuries treated in the pedodontic clinic of Ankara
University, Turkey, during 18 months. Dental
Traumatology 2002; 18(6): 299-303.
16. Zuhl K, Semra OEM, Huseyin K. Traumatic
injuries of the permanent incisors in children in
southern Turkey: a retrospective study. Dental
Traumatology 2005; 21(1): 20-25.
17. Skaare AB, Jacobson I. Dental injuries in
Norwegians aged 7-18 years. Dental Traumatology
2003; 19(2): 67-71.
18. Oulis CJ, Berdouses ED. Dental injuries of
permanent teeth treated in private practice in
Athens. Endod Dent Traumatol 1996; 12(2): 60-65.
19. Zaragoza AA, Catala M, Colmena ML,
Valdmoro C. Dental trauma in school children
6-12 years of age. J Dent Child 1998; 65(6): 492-
494.
20. Hargreaves JA, Cleaton-Jones PE, Roberts GJ,
et al. Trauma to primary teeth of South Africa preschool
children. Endod Dent Traumatol 1999;
15(2): 73-76.
21. Al-Jundi SH. Dental emergencies presenting to a
dental teaching hospital due to complications from
dental injuries. Dent Traumatol 2002; 18(4): 181-
185.
14
JOURNAL OF THE ROYAL MEDICAL SERVICES
Vol. 17 Supp No. 1 February 2010

Table II. The percentage of different age group with traumatic dental injuries in males, females, and the whole sample
Age Group (yr) Male Female Total
No. % No. % No. %
≤6 3 0.81 2 0.54 5 1.35
>6-≤8 49 13.21 38 10.24 87 23.45
>8-≤10 111 29.92 55 14.82 166 44.74
>10-≤12 71 19.14 30 8.09 101 27.22
>12 8 2.16 4 1.08 12 3.24
Total 242 65.23 129 34.77 371 100
Table III. Distribution of traumatic injuries according to etiology of trauma
Etiology No. of Patients %
Falls 330 88.95
Collisions 22 5.93
Traffic accidents 2 0.54
Sports 15 4.04
Fights 2 0.54
Total 371 100
Table IV. Distribution of traumatic injury cases according to number of injured teeth
No. of Injured Teeth
Male Female Total
No. % No. % No. %
1 121 32.61 73 19.68 194 52.29
2 101 27.22 48 12.94 149 40.16
3 10 2.70 7 1.89 17 4.58
4 7 1.89 1 0.27 8 2.16
≥5 3 0.81 0 0 3 0.81
Table V. The percentage of types of dental injuries according to Andreasen’s classification
Type No. of Teeth %
Class 1 11 1.82
Class 2 360 59.50
Class 3 83 13.72
Class 4 0 0
Class 5 6 0.99
Class 6 13 2.15
Class 7 1 0.17
Class 8 41 6.78
Class 9 13 2.15
Class 10 14 2.31
Class 11 35 5.79
Class 12 27 4.46
Class 13 1 0.17
Total 605 100
Table VI. Tooth-specific distribution of dental trauma cases (586 teeth).
Maxilla
Mandible
Right Left Right Left Total
No. % No. % No. % No. %
Permanent
(n= 586)
Central Incisor 258 44.03 235 40.10 18 3.07 23 3.92 534
Lateral Incisor 24 4.10 16 2.73 6 1.02 3 0.51 49
Canine 1 0.17 1
First Premolar 1 0.17 1
Second Premolar 1 0.17 1
JOURNAL OF THE ROYAL MEDICAL SERVICES
Vol. 17 Supp No. 1 February 2010
15