Traumatic dental injuries : Prevalence, severity and risk factors along the life course - a study among 16-year-old pupils in Hordaland, Western Norway

Abstract

Purpose/Aim: To assess prevalence, severity and risk factors for traumatic dental injuries (TDI), in a life course perspective, among Norwegian adolescents.

Materials and Methods: A prevalence study, including prospective clinical data, was conducted among 16- year-old high school students in the county of Hordaland, Western Norway. All first-grade students at public high schools, registered in the census as born in 1997, were invited to participate (n = 5 184). Recruitment was by electronically administered invitation (e-mail and SMS), with an attached closed-ended electronic questionnaire (SurveyXact). The questionnaire covered such topics as TDI and life course events, categorized as socioeconomic, biological, psychosocial and behavioural indicators. Consent was given to access the participants’ dental records, held by the county Public Dental Service: information about TDI (diagnosis and treatment) and radiographs were interpreted and transferred to the database. Only TDI to anterior teeth was recorded (canine to canine in maxilla and mandible).

Results: A total of 2 055 students agreed to participate (response rate 40 per cent). The prevalence of TDI involving at least one anterior tooth was 16.4 per cent (338 pupils). Boys were more prone to injury than girls (p < 0.05). Severity of TDI was categorised as mild, moderate or severe, with the following distribution: mild = 563 (88.4 per cent), moderate = 39 (6.1 per cent) and severe = 35 (5.5 per cent). The peak age for TDI was 8-10 years (50.9 per cent). Hierarchical logistic regression analyses were used to assess risk factors for TDI. Using experience of TDI (Yes/No) as the dependent variable, 12 variables with a significant bivariate effect (p < 0.05) on the dependent variable were tested (Stata for Mac ver. 15.0). TDI was more frequent among adolescents reporting a mother with high level of education, among boys, among those reporting a low level of conscientiousness, those answering yes to the question “I like being the way I am”, those with no plans for after high school, or who do not see the point in planning for the future, and those reporting a high frequency of sporting activities. Using severity of TDI as the dependent variable, participants reporting religion/beliefs as unimportant in their personal life, those active in wrestling and those who failed to attend four or more dental appointments are at significantly increased risk of severe TDI. Using multiple versus single episodes of TDI as the dependent variable, multiple episodes were more frequent among participants reporting lack of love and affection from mother/female guardian, those participating in sporting activities and those with moderate/severe TDI. The prevalence of pulpal necrosis with infection was 7.53 per cent. Moderate and severe TDI was associated with a higher frequency of pulpal necrosis with infection. Of teeth with TDI, pulp canal obliteration and root resorption were found in 2.80 and 2.28 per cent respectively. Hard tissue injuries were more prone to development of pulpal necrosis with infection than luxation injuries and combination injuries. The relationship between the stage of root development and development of pulpal necrosis with infection was not statistically significant.

Conclusions: The prevalence of TDI was 16.4 per cent. TDI is more frequent among boys, among adolescents of higher socioeconomic status and among those with adverse scores for psychosocial and behavioural parameters. Moderate and severe TDI is more frequent among adolescents with adverse scores for psychosocial and behavioural parameters and among those who participate in the sport of wrestling. Multiple episodes of TDI are more frequent among adolescents with adverse scores for psychosocial and behavioural parameters and those who participate in sporting activities. Pulpal sequelae in teeth with TDI are infrequent. The risk is greater in moderate and severe TDI. The risk of pulpal necrosis with infection is higher in cases involving hard tissue injuries.