INTRODUCTION

Traumatic injuries not only pose a health risk worldwide, but are also regarded among serious social problems. One important category is dental trauma, accounting for a major part of health problems in children, adolescents¹ and even adults.² Traumatic dental injury (TDI) is described as a lesion of variable extension, intensity, and severity caused by forces acting on teeth due to falls, fights, traffic accidents, collision against objects or people, and parafunction and/or as a result of an assault.³ It has a great impact on the quality of life, affecting children, adolescents and adults physically, aesthetically, and psychologically.^2,4  

Oral injuries are most frequent during the first 10 years of life, decreasing gradually with age, and are rare after the age of 30 years. On the contrary, non-oral injuries are most frequently seen in adolescents and young adults and are common throughout life.^4,5 Although the oral region comprises an approximate area of 1% of the total body, it accounts for about 5% of all injuries for which patients seek treatment.⁴

In the permanent dentition, the most accident-prone age has been discovered to be between 8 and 12 years.⁶ Studies conducted in different countries report various prevalence rates for traumatic dental injury among children, adolescents and adults.^2,7-10 Demographic evaluations indicate a higher prevalence of trauma in males compared to females.^11-14 Falls, fight, sports, accidents, and hitting items or people are among the most common aetiologic factors.^15-18 Home, school and street are places with the highest frequency of dental traumatic injuries, which most importantly include enamel fracture and enamel and dentin fracture without pulp exposure.^19-24

Dental injuries usually affect one or more teeth and the maxillary central incisors that are important both functionally and aesthetically²⁵ are the most frequently involved. Kahabuka et al.²⁶ reported that the upper incisors are the most frequently affected teeth (78%) while the canines, premolars and molars were least affected. This study aims to determine the prevalence of TDI among patients presenting at a secondary healthcare facility in Southern-Nigeria.

MATERIAL AND METHOD

This was a retrospective study of patients that presented at the Dental department, Central Hospital, Oleh, Delta state over five years (January 2015 – December 2019). Oleh is the headquarter of Isoko South Local Government Area, one of the two administrative units in the Isoko region of Delta State, southern Nigeria.²⁷ Case records for all the patients within the study period were identified, and the variables of interest extracted from the records included age, gender, marital status, TDI environment, aetiology of TDI, categories/primary diagnoses of TDI, number of traumatised teeth and tooth type.

Classification of trauma to the dentition (primary and permanent) was done using Ellis and Davey classification.²⁸ [Table 1] Meanwhile, trauma to the mandible was classified according to the site of injury, and trauma to the maxilla using the Le fort classification.²⁹

Table 1: Ellis and Davey classification.

Cases with incomplete information were excluded from data analysis. Ethical clearance was sought and obtained from the ethical committee of the Delta State Hospitals Management Board. Statistical analysis was carried out using the IBM^® SPSS^® Statistics version 25 software. For analysis, the age of the patients was categorised into childhood (0 – 17 years), adulthood (18 – 64 years) and elderly (≥ 65 years), to help highlight the clinical implications of the study. The significance tests were the Pearson’s Chi-square and Fishers exact, α was set at 0.05.

RESULTS

A total of 857 cases containing the variables of interest were retrieved from the hospital records. The mean age of patients was 39.04 years, with a median of 37.00 years; a majority of patients were from the adults’ age category, 478 (55.8%) patients were female, with a mean age of 37.87 years meanwhile, 379 (44.2%) were male with a mean age of 39.97 years. Male and female patients were significantly different in their age category and TDI distribution [Table 2].

The majority of patients were TDI free n = 635 (74.1%) giving a TDI prevalence of 25.9%. Furthermore, a prevalence of 30.6% was recorded among males and 22.2% among females and the male: female ratio for TDI was 1.1:1 [Table 2]. The mean age of 43.49  was identified in TDI. The home environment was the most common environment for TDI in 151 (68%) followed by the street environment in 44 (19.8%) of patients. Biting on something hard during chewing n = 103 (46.4%) was the most commonly reported aetiology of TDI among patients, and was more frequently seen in females, married patients, adults and in the home environment.

Males were 2.48 times more likely to have TDIs at school than their female counterparts (OR (Odds ratio) = 2.481 (CI = 0.105 – 58.779) p > 0.574), likewise, males were also more likely (16%) to have TDIs at home (OR = 1.156 (CI = 0.067 – 19.967) p > 0.921). Conversely, females were more likely (about 14% and 2.8 times) to have TDIs on the road (OR = 1.137 (CI = 0.63 – 20.833) p > 0.930) and in ‘not aware’ situations (OR = 2.762 (CI = 0.105 – 71.428) p > 0.541).

Other notable aetiologies were fight, n = 25 (11.3%) and motorcycle accident in 25 (11.3%) of patients. Married patients (n = 136) were more frequently seen with TDI than other marital affiliations. Aetiology of TDI was significantly different across sexes (p< 0.005), age categories (p< 0.001), TDI environments (p< 0.001) and marital statuses (p< 0.001) [Table 3]. According to categories or primary diagnoses of TDI among patients, Ellis class III fracture was the most common diagnosis; n = 102 (45.9%) other notable diagnoses were Ellis class VII and Ellis class IV in 30 (13.5%) and 20 (9.0%) each of patients respectively. Ellis class III fracture among patients was mostly as a result of biting on something hard during chewing, Ellis class VII fractures were commonly seen in motorcycle accidents and falls. There was a statistically significant relationship between the categories of TDI and the aetiology of TDI (p < 0.001) [Table 4]. 

According to the number of traumatised teeth per patient, the most common TDI to teeth was trauma to one tooth in n = 147 of cases, trauma to two teeth in n = 42 of cases and three teeth in n = 13 of cases. Based on tooth type, TDI was commoner in permanent maxillary centrals, n = 108 (32.30%) of teeth, others were permanent maxillary laterals, n = 39 (11.70%), permanent mandibular centrals in 36 (10.80%) and permanent maxillary premolars in 36 (10.80%) [Table 5]. A Pearson’s regression was computed, to assess the relationship between age and number of traumatised teeth, a mildly negative correlation between the two variables was discovered (r = -0.22, n = 222, p < 0.002).

Table 2: Number and percentage distribution of TDI according to sex among patients.

*TDIs: Traumatic Dental Injuries.

Table 3: Aetiology of TDI among patients in relation to sex, age category, TDI environment and marital status.

*Cat of TDI: Categories of TDI; TDIs: Traumatic Dental Injuries; A: Biting on something hard during chewing; B: Fight; C: Motorcycle accident; D: Fall; E: Car accident; F: Play; G: Not aware; H: Collision; I: Assault; J: Beating by a spouse or parent(s); K: Using teeth as a bottle opener; L: During toothbrushing; M: Attempted extraction by a quack; N: Bruxism; O: An attempt to create a midline diastema.                                                                            

Table 4: Aetiology of TDI in relation to the categories of TDI among patients.

*TDI: Traumatic Dental Injuries; PSFM: Para-symphyseal fracture of the mandible; SFM: Symphyseal fracture of the mandible; FAM: Fracture of the angle of mandible; FBM: Fracture of the body of mandible; A: Biting on something hard during chewing; B: Fight; C: Motorcycle accident; D: Fall; E: Car accident; F: Play; G: Couldn’t remember; H: Collision against objects or people; I: Assault; J: Beating by a spouse or parent(s); K: Using teeth as a bottle opener; L: During toothbrushing; M: Attempted extraction by a quack; N: Bruxism; O: An attempt to create a midline diastema.

Table 5: Distribution of TDIs to the teeth among different teeth in the patients.

*TDIs: Traumatic Dental Injuries; *1st: First; 2nd: Second; 3rd: Third.

DISCUSSION

This study recorded a prevalence of 25.9%, while the prevalence of other Nigerian studies has ranged from 6.5% – 19.5%,^{3, 30-32} the restriction of those studies to the children population may be a reason for the disparity. This study determined that males were significantly more at risk of TDIs when compared to females, a finding that corresponded with previous studies,^33-34 and may be ascribed to the tendency of males to be more violent and also participate in more challenging endeavours. This study recorded the adults’ age category as the most affected by TDI, a finding that was in agreement to a previous study,² this finding, could be as a result of dental service utilisation being more, among adults in the locality where the studied hospital is located (Oleh). In this study, the most common traumatised teeth were the maxillary centrals, a finding that correlated with some other studies.^34-35

The home environment was the most common TDI environment, this finding, corresponded with previous studies.^32,37 Males were discovered to be more likely of having TDIs at school and home; females, on the other hand, were more likely to have TDIs on the road and at environments, they couldn’t remember. These findings were, however, not statistically significant.

Married patients were more commonly affected by TDI, this finding, was in contrast to that of a previous study.² The greater number of married patients when compared to patients from other marital affiliations in the present study may be the reason for this. The most common number of traumatised teeth involved in TDI among patients was ‘one tooth’ in this study, a finding that agreed with that of a previous study.³⁴ There was a mild decrease in the number of traumatised teeth with increasing age in this study.

TDIs as a result of fights and motorcycle accidents were more common among males, while falls were more common among females. This study also determined that biting on something hard during chewing was the most common aetiology of TDI, this finding could be attributed to the nature of the Nigerian diet. Nigerians show a great preference for hard diets (dried meat, fish, bone etc) over soft ones and as such it’s not strange for the dentist to receive complaints of TDIs as an aftermath of a patient having a meal. This study reported Ellis class III fracture as the most common type of injury and it accounted for 45.9% of the total. This is however, in disharmony with the findings from some other studies.^3,36 The second most common type of injury in this study was Ellis class VII (13.5%), a finding that was previously reported by another study.³⁶

The findings of this study may have been limited by its retrospective nature, which prevented further elaboration of abstracted information.

CONCLUSION

Data from this study revealed that the prevalence of TDI among dental patients presenting at a healthcare facility in Southern Nigeria was 25.9%. Adults were more commonly affected by TDI than children or the elderly, biting on something hard during chewing was a major contributor to the TDI prevalence and therefore, mandates a review and modification of the dietary preferences of the residents at Oleh in particular and Nigeria in general.

 FINANCIAL SUPPORT AND SPONSORSHIP

None.

CONFLICTS OF INTEREST

There are no conflicts of interest.