April 2007 - Volume 1, Issue 2

CORONAL FRACTURE OF ANTERIOR TEETH AMONG SCHOOL CHILDREN AGED 10-12 YEARS OLD IN THE CITY OF ZARKA, JORDAN

	AL-Hazaimeh Nawaf BDS, Mdent Sci (Restorative) UK Ayesh Al-Dwairy BDS, MSc . UK
	AL-Hazaimeh Nawaf* BDS, Mdent Sci (Restorative) UK Royal Medical Services, Amman 11814 PO Box 142510 Jordan hazaimehn@yahoo.com

ABSTRACT Objectives: To find the prevalence of coronal fracture for the anterior teeth and the percentage of treatment of those fractured among schoolchildren 10-12 years of age, and to determine if there is any difference between males and females in both fractured and treated anterior teeth. Methods: This study involved 2719 schoolchildren 10-12 years of age attending 6 public schools in Zarka-Jordan. A total of 1370 males and 1349 females were examined at school by a single examiner. Traumatic injuries affecting the coronal part of the teeth were clinically recorded and classified according to the amount of tooth structure being lost. Results: The overall prevalence of fractured anterior teeth was 13.8 %, with males having higher prevalence 19.5 % than females 8 %. About 97.4% of fractured teeth among males were untreated. Whilst the prevalence of untreated fractured anterior teeth in females was 92.6%. No difference between left and right side fractures in males were founded, it was 51.1% of the fractured teeth were on the right while 48.9.% were on the left. However, in females left side fractures show higher percentage than right side with 64.3% and 35.7 respectively. Conclusion: Fractured anterior teeth were more common among males than females, the prevalence of enamel fracture only showed higher percentage than enamel and dentine fracture. The percentage of treated fractured anterior teeth in females were much higher than in males taking into consideration that females had less prevalence in fracture anterior teeth than males

Key words: prevalence; coronal fractured; permanent anterior teeth; school children; treatment. INTRODUCTION

Traumatic injuries to the permanent incisors are very common among children, and may result in a partial or total loss of dental hard tissue (1), most of the trauma cases occur in the maxillary incisor teeth, creating not only physical, but also esthetic and psychological effect on children and their parents (2). The nature of incisal trauma, its substantial impact on quality of life and the availability of knowledge on its etiology and treatment, makes incisal trauma a potential dental public health problem (3).

Sports and accidents that happen at home or school are common etiological factors(4), therefore it is essential that the dental team should educate parents, teachers and patients to the correct emergency care after trauma. In this study only crown fractures were looked at since root fractures can't be detected without a radiograph.

Socioeconomic class was not significant in the traumatic injuries to the permanent anterior teeth among schoolchildren in Jordan (5). Even though, all the students examined were from the same city and the same area.

Parents don't send their children who suffer from fractured crowns, especially those involved enamel and dentin for immediate restoration, unless for esthetic purposes. On the other hand, the prognosis of the traumatized teeth depends on accurate diagnosis and treatment procedures, since the rapid development of the adhesive material needs the dentist's awareness of this and the new material coming onto the market.

In Jordan, there is a lack of information regarding the epidemiology of dental trauma in children. Few studies have been carried out to find the prevalence of traumatized permanent incisors. (5,6,7)

The aim of this study was to determine the prevalence of fractured anterior teeth (treated and untreated) among schoolchildren 10, 12 years of age and to find out if there is any gender difference associated with fractured anterior teeth among the study population. METHODS

The target population in this study was 10- 12 years old schoolchildren studying in 6 government schools in the same part of Zarka city, Jordan to avoid the socio-economic class differences if there iare any, each school has all age groups needed for the study, after examining the anterior teeth of all students whohad been categorized according to the age and the amount of tooth structure lost.

A total of 2719 students (1370 males and 1349 females ) were examined on site by the same examiner using mirror and probe under daylight. Fracture of the crowns of teeth ranging from chipped enamel, to fractured crown involving the pulp was observed. Trauma history was recorded for all students especially for those with restoration, to differentiate the reason behind the restoration, whether it was caries or trauma, even though, at this age it is difficult to have an incisal restoration due to caries.

Fractures affecting the anterior teeth were clinically recorded based on clinical signs according to the following classification:

Class 1: Fracture involving the enamel only,
Class 2: Fracture of enamel and dentine, without pulp involvement.
Class 3: Fracture of enamel and dentine with pulp involvement.
Class 4: Tooth restored with composite or crown following fracture.

The chi square test was used for testing the statistical differences between males and females according to the prevalence of fractured anterior teeth compared to non-fractured teeth in both age groups (10-12 years).

Because of the small sample size of the treated teeth in both males and females, Fisher Exact test was used to determine if there were any statistical differences in the prevalence of the treated teeth among the different age groups (10-12) in males and females. RESULTS

The percentage of males to females in the sample was 50.4%:49.6%. The overall prevalence of anterior teeth fracture for both males and females was 13.8%, with males having higher prevalence 19.5% than female 8%, which was statistically significant (Table 1). However, the prevalence of treated fractures among females was 7.4% and in males 2.6%, the difference was statistically significant (Table 1).

The age group 12-year-old males had the highest fracture percentage of 20% with 4.6% receiving treatment followed by the age 10 years males with 18.6 % fractured percentage and the lowest treatment percentage 0%. Meanwhile the female age group 12 had the lowest fracture percentage 7% with the highest treatment percentage 9.6%, followed by the female age 10 group with 9.3% fractures and 5.4% treatment.

The percentage of fractured anterior teeth according to the amount of tooth structure loss classification in different age groups in males and females are presented in Table 2.

Enamel fracture only (class 1) in both males and females showed the highest percentage 46.8% and 63.9% respectively, among the other types of fracture. Meanwhile, class 3 showed the lowest percentage in both males and females, 17.2 and 7.4 respectively.

There was not any difference between left and right side fractures in males; 50.6% of the fractured teeth were on the right while 49.4% were on the left. However, in females, left side fractures showed a higher percentage than right side with 61.6% and 38.4 respectively. DISCUSSION

The present study represents the population of children enrolled at schools in one city in Jordan which is Zarka.

Traumatic injuries to the anterior teeth occur fairly frequently and they are usually accidental in nature rather than due to contact sport (8,9,10). These injuries may result in teeth fracture or in soft tissue injuries, which may heal without leaving any signs of the injury. Predisposing factors were suggested as socio-economic class and increase in incisal overjet. However, Hamdan and Rajab (5) 2003 found no significant differences between different socioeconomic classes regarding traumatic injuries to the anterior teeth among 12-year-old schoolchildren in Jordan but children with incisal overjet of greater than 5 mm had more tendency toward fracture.

Most of the fractured anterior teeth involved the maxillary central incisors due to the prominent position of the teeth in the arch (11) with no any difference in prevalence of injuries between left and right (12). In this study, females' left side fractures showed higher percentage than right side with 63.3% and 36.7 respectively with no difference in males.

The comparison of one dental trauma study with another is a difficult task, as few epidemiological surveys are similar. They may have different methodologies, different populations and different diagnostic criteria.

The prevalence of dental trauma to the anterior teeth in this study was 19.5% for males, and 8% for females. The prevalence of fractured anterior teeth in 10 and 12 years old males were 18.6 % and 20 % respectively which is lower than the study of O'Brien in the UK(14) who found a prevalence of 25% for 12-year-old-males. On the other hand, the result of other studies (10,14), Todd & Dodd in UK and Al-Majed et al in Saudi Arabia was much higher than this study. They found the prevalence of 29% for 12 years old males in the 1983 UK national survey and 34% in Saudi Arabia.

This study has confirmed the major finding of previous epidemiological studies namely that traumatic injury is more common among males than females (9,13), whereas the prevalence of enamel fracture was much higher than the enamel and dentine fracture (Table 2) which agreed with the results of other studies (6, 10,13-16).

The proportion of fractured anterior teeth that required treatment in this study was 97.4% in males and 92.6% in females, which were almost the same findings in the studies carried out in Malaysia by Nik-Hussein (11) and by Esa & Razak (17) especially in male's results.

These results were really disappointing; one of the possible reasons could be due to the low occurrence of problems that arise as a result of traumatized teeth.

Finally, one can say that the results of this study were almost the same as the results of many studies carried out in different countries all over the world with few differences in parts of it.

CONCLUSION

Fractured anterior teeth were more common among males than females, and the prevalence of enamel fracture only showed higher percentage than enamel and dentine fracture. The percentage of treated fractured anterior teeth in females was much higher than in males, taking into consideration that females had less prevalence in fractured anterior teeth than males.

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