*Maja Lipiec1, Zuzanna Lipiec-Rzepecka2, Sara Shamsa-Nieckula1, Dorota Olczak-Kowalczyk1
Determinants of dental trauma in 5-year-old children – a questionnaire study in the Polish population
Determinanty urazowych uszkodzeń zębów u dzieci 5-letnich – badania ankietowe populacji polskiej
1Department of Paediatric Dentistry, Medical University of Warsaw
Head of Department: Professor Dorota Olczak-Kowalczyk, MD, PhD
2Multidisciplinary Provincial Hospital in Gorzów Wielkopolski
Hospital Director: Jerzy Ostrouch
Streszczenie
Wstęp. Urazy zębów są rozpowszechnionym zjawiskiem w Polsce i na świecie. Postępowanie związane z urazami zębów mlecznych stanowi wyzwanie diagnostyczne oraz lecznicze. Urazom zębów mogą towarzyszyć liczne powikłania. Dotychczas nie były prowadzone epidemiologiczne badania stomatologiczne, które oceniłyby częstość oraz czynniki determinujące występowanie urazów zębów mlecznych w populacji polskiej.
Cel pracy. Określenie częstości, rodzaju i przyczyn urazów zębów mlecznych oraz sposobu postępowania leczniczego, a także wyodrębnienie czynników korelujących z wyżej wymienionymi parametrami u dzieci w pierwszych 5 latach życia w Polsce.
Materiał i metody. Badania ankietowe przeprowadzono w 15 województwach w ramach programu pt. „Monitorowanie stanu zdrowia jamy ustnej populacji polskiej w latach 2016-2020”. Do badania włączono rodziców dzieci w wieku 5 lat. Kwestionariusz badań zawierał pytania dotyczące czynników socjoekonomicznych, sprawdzające wiedzę rodziców i ich zachowania zdrowotne w odniesieniu do zdrowia jamy ustnej dzieci oraz urazów zębów. Wyniki poddano analizie statystycznej przy poziomie istotności p < 0,05.
Wyniki. Do analizy włączono 1044 prawidłowo wypełnione kwestionariusze. Urazu zęba mlecznego doznało około 10% dzieci, najczęściej w 3. roku życia. Na skutek urazu przeważnie dochodziło do złamania korony oraz zwichnięć zębów. Większość rodziców dzieci, które doznały urazu zęba, zgłosiła brak potrzeby leczenia. Najczęściej stosowaną metodą leczniczą była jednak ekstrakcja.
Wnioski. Skutkiem urazu zęba może być występowanie powikłań, a w konsekwencji pogorszenie jakości życia dziecka. Tylko wczesne zaopatrzenie i leczenie urazów może temu zapobiec.
Summary
Introduction. Tooth injuries are a widespread phenomenon in Poland and worldwide. The management of primary tooth injuries is a diagnostic and therapeutic challenge. Tooth injuries can be accompanied by many complications. No epidemiological studies have been conducted that would assess the frequency and factors determining the prevalence of primary tooth injuries in the Polish population.
Aim. Determining the incidence, type and causes of primary dentition injuries and treatment methods, as well as identification of factors correlating with the above-mentioned parameters in 5-year-olds in Poland.
Material and methods. Questionnaire surveys were conducted in 15 voivodeships as part of the programme entitled “Oral health monitoring of the Polish population in years 2016-2020”. Parents of 5-year-old children were included in the study. The questionnaire included questions on socioeconomic factors, parental knowledge and health behaviours in relation to children’s oral health and dental trauma. The results were analysed statistically.
Results. A total of 1,044 correctly completed questionnaires were included in the analysis. About 10% of children had a history of primary tooth trauma, usually in the third year of life. The most common injuries were crown fractures and tooth luxations. Most of the parents of children who have sustained a tooth injury reported no need for treatment. Extraction was the most common treatment method.
Conclusions. Tooth injury may lead to complications and, consequently, reduced life quality in the child. Only early care and treatment of dental trauma can prevent them.
Introduction
Tooth injuries are a widespread phenomenon both in Poland and worldwide. The prevalence of deciduous tooth injuries is estimated at about 22.7% in the world and about 14.2% in the European region (1). The management of primary tooth injuries is a diagnostic and therapeutic challenge. Therefore, a greater frequency of dental visits is often needed, which frequently results in absence from school or kindergarten (2). Tooth injuries may be accompanied by multiple complications, most often associated with failure to provide proper assistance at the scene of accident or delayed dental appointment. Research has shown that more than half (67.7%) of respondents (teachers and medical professionals) do not consider it necessary to visit a dentist after traumatic loss of a primary tooth (3). Injuries of primary teeth can lead to complications within the affected teeth, such as loss of a tooth or its vitality. They can also be complicated by damage to permanent teeth, e.g. underdevelopment of the enamel of permanent teeth (4% of cases) or compromised enamel quality (32% of cases) (4). The sequelae of injuries are not only a health problem. They may also be associated with increased treatment expenses and deterioration of child’s quality of life, including worse relationships with peers. So far, no epidemiological dental studies have been conducted in Poland that would assess the incidence of primary tooth injuries in the Polish population and the factors determining their occurrence.
Aim
The aim of the study was to determine the incidence, types and causes of deciduous tooth injuries and the treatment procedure, as well as to identify factors correlating with the above-mentioned parameters in 5-year-olds in Poland.
Material and methods
Questionnaire surveys were conducted in 15 provinces as part of the programme entitled “Oral health monitoring of the Polish population in years 2016-2020”, financed by the Ministry of Health (contract No. 11/1/2019/1210/836, paragraph 3, section 23). Parents of 5-year-old children were included in the study. Stratified sampling was used to select the population sample. Poviats, communes, followed by towns and villages as well as kindergartens in individual towns/villages were randomly selected in each of the voivodships. Parents of children over or under the age of 5 years, those who did not consent to participate in the study, and the authors of incorrectly completed questionnaires, were excluded from the study. The sample size was estimated using the data from the Central Statistical Office (the population of children aged 5 years: 353,516) and data on the incidence of tooth decay as the leading health problem in Poland.
The parental questionnaire included questions about socioeconomic factors, as well as verified parental knowledge and health behaviours in relation to children’s oral health (hygiene, dietary, dental care, oral health-related quality of life) and a history of dental injuries in terms of the number of affected teeth, location of the tooth in the mouth, age at the time of injury, the mechanism of the injury, the scene of injury, and the treatment method used.
The study was approved by the Bioethics Committee of the Medical University of Warsaw (KB 185/2018). The data were analysed statistically. Comparisons of the study groups for quantitative variables were performed using parametric tests, i.e. the t-test for comparing two groups (e.g. gender) or the analysis of variance for more than two groups (e.g. provinces). Categorized variables were analysed using the chi-square test. For the tests performed, the results were presented as p-values, i.e. the observed significance levels (p < 0.05). Spearman correlation analysis was used to assess the relationships between the selected factors. SPSS and Statistica programme were used for analyses.
Results
The analysis included 1,044 correctly completed questionnaires, received from the parents of girls (51%) and boys (49%). The socioeconomic characteristics of respondents are presented in table 1.
Tab. 1. Socio-economic characteristics of the respondents
| | Total number of respondents n (%) |
| Total | 1044 (100%) |
| Gender | male | 512 (49%) |
| female | 532 (51%) |
| Place of residence | urban | 580 (55.6%) |
| rural | 464 (44.4%) |
| Maternal education level | elementary | 1 (0.1%) |
| vocational | 22 (2.1%) |
| secondary | 259 (24.8%) |
| postsecondary college or course | 125 (12%) |
| higher | 637 (61%) |
| Paternal education level | elementary | 7 (0.7%) |
| vocational | 41 (4%) |
| secondary | 374 (35.8%) |
| postsecondary college or course | 98 (9.4%) |
| higher | 524 (50.1%) |
| Self-assessed financial status of the family | unsatisfactory (poor) | 42 (4.02%) |
| average (good) | 68 (39%) |
| very good | 27 (59%) |
| Single parenthood | 84 (8%) |
| Use of dental care (dental appointment) | 670 (64.2%) |
A total of 105 children (10.1%) had a history of primary tooth injury, most often in their third year of life (fig. 1). Usually, 1 tooth was injured (6.23% of injuries), the least frequently > 2 teeth (0.86% of injuries), in the anterior part of the maxilla (8.43% of injuries). Fracture of the tooth crown was the most common trauma (fig. 2). Tooth injury was accompanied by soft tissue damage in 48 children (45.7% of the reported cases of tooth trauma). These were usually lip or gum injuries. Falls (55.2%) and collisions/hitting an object (41.9%) were the main causes of injuries. Home (54.3%), backyard/playground (26.7%), kindergarten (10.5%), and street (8.6%) were the most common injury scenes.
Fig. 1. The incidence of primary tooth trauma in four age groups
Fig. 2. Types of primary tooth trauma reported by parents
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