Saudi Journal of Sports Medicine

: 2014  |  Volume : 14  |  Issue : 2  |  Page : 65--68

Dental trauma and its relation with problem behavior amongst 12-15-year old children

Amandeep Chopra, Manav Lakhanpal, NC Rao, Nidhi Gupta, Shelja Vashisth 
 Department of Public Health Dentistry, Swami Devi Dyal Hospital and Dental College, Panchkula, Haryana, India

Correspondence Address:
Amandeep Chopra
Department of Public Health Dentistry, Swami Devi Dyal Hospital and Dental College, Golpura, Barwala, Panchkula, Haryana - 134 009


Aim : The aim of this study was to assess the relationship between problem behavior and traumatic dental injury amongst children aged 12-15 years. Further, it also aimed to analyze by age and sex, a) the prevalence of traumatic injuries to permanent incisors and canines, and b) their distribution according to type of fracture. Materials and Methods: A cross-sectional study was conducted among 200 children aged 12-15 years in Panchkula, India. Data was collected through clinical examinations and interviews. A hospital based matched (age and sex) case-control design was adopted. A questionnaire was answered by either the children themselves through interview or by any one of their parents. Results: In case study, it was revealed that 16.4% subjects had more than 5 mm overjet and 20.4% subjects had inadequate lip coverage. The largest number of injuries were presented by 15 year old children (43.90%) followed by 14 and 13 years old children. In specification, boys had more injured teeth compared to girls. Conclusion: Problem behavior plays an important role in the occurrence of traumatic dental injury.

How to cite this article:
Chopra A, Lakhanpal M, Rao N C, Gupta N, Vashisth S. Dental trauma and its relation with problem behavior amongst 12-15-year old children .Saudi J Sports Med 2014;14:65-68

How to cite this URL:
Chopra A, Lakhanpal M, Rao N C, Gupta N, Vashisth S. Dental trauma and its relation with problem behavior amongst 12-15-year old children . Saudi J Sports Med [serial online] 2014 [cited 2021 Jul 26 ];14:65-68
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Dental trauma due to sport is devastating to any athlete but is made worse when the athlete is young and still growing. Orofacial trauma is relatively common in the pediatric population and can have significant management problems. Continued maxillary and alveolar growth, development, and maturation of individual teeth, as well as behavioral considerations create unique challenges in the management of this population. Children and youths have increased risk factors for dental trauma due to sports, including untreated malocclusions, an increase in risk-taking behavior, and undeveloped coordination and skill levels. [1]

The decline in the prevalence and severity of dental caries amongst children in many countries may have made traumatic dental injuries, a more serious dental public health problem among the young. [2],[3] The dental literature contains many reports of injuries to primary and permanent teeth in children, most of them treated at dental hospital. The main causes of traumatic dental injuries reported in the literature are falls and collisions, sporting activities and traffic accidents. [4]

It is also well known that increased incisal overjet of the teeth and inadequate lip coverage significantly increase the chances of having a dental injury when people have an accident. [4] Problem behavior has been defined as "behavior that is socially defined as a problem, a source of concerned or as undesired by norms of conventional society and its occurrence usually elicits some kind of social response." [5] Problem behavior has never been studied before as a determinant of traumatic dental injuries.

Behavior and social environmental risk factors for dental injury have been over looked. Socioeconomic status was rarely measured, if measured the results were conflicting. Two studies used area-based measures of deprivation and showed a positive relationship. [6],[7] Conversely, another study that used parents' years of schooling as a measure of socioeconomic status demonstrated that children from parents with higher levels of education had more dental injury than from parents with lower level of education. [8] Andreasen [9] suggested that the different types of dental injuries vary according to the place where the study is conducted. He found that within a hospital environment, luxation and bone injuries are the most predominant.

The present study was conducted to test whether traumatic dental injuries are related to problem behavior, to confirm the relationship between traumatic dental injuries and size of overjet and type of lip coverage and to analyze the prevalence and type of traumatic injuries to permanent incisors and canines and their distribution according to age and gender, in a population sample of 12-15 years old school children of district Panchkula, Haryana.


A cross-sectional study was conducted among 200 school children, aged between 12-15 years belonging to the schools adopted by the dental institution.

Data was collected from January-March 2013 through clinical examinations and interviews.The students were chosen from each classroom by convenience sampling. Examinations of children were done under natural light with the help of probe and mouth mirror (type-III examination). Ethical clearance was obtained from ethical committee of the dental college. Before starting the study, prior permission was taken from the school authority. Out of 200 children, 100 children had traumatic dental injury matched by age and sex with other 100 children who did not have traumatic dental injury.

Traumatic injuries were recorded according to Garcia-Godoy's classification. [10] The informant-rated version of the strengths and difficulties questionnaire (SDQ) [11] was used to identify problems behavior. Pre-test of questionnaire was done before starting the study.

The questionnaire composed of 25 questions under the heading, conduct problems (e.g. often fights with other children or bullies them) prosocial behavior (e.g. often volunteers to help others such as parents, teachers, other children), hyperactivity/inattention (e.g. restless, over active, cannot stay still for long), peer relationship problem (e.g. picked on or bullied by other children) and emotional symptoms. (e.g. many fears, easily scared).

Each of the above mentioned categories were provided with the options 'not true', 'somewhat true' and 'certainly true'. A score of 0 was assigned to the answer 'not true', a score of 1 to the answer 'somewhat true' and a score of 2 to 'certainly true'.


[Table 1] reveals the frequency distribution of age, gender, father's level of education, mother's level of education, size of overjet and type of lip coverage in the sample. "Case and control" were perfectly matched by age and sex. More boys injured their teeth than the girls. Among these cases, 24.4% of subjects were having inadequate lip coverage. While in the control group, 19.9% subjects were having inadequate lip coverage. Among these cases, 16.4% subjects were having more than 5 mm of overjet.{Table 1}

[Table 2] reveals the prevalence of traumatic injuries to permanent incisors canines was 61.5% (50.83% in boys and 11.2% in girls). Out of 200 injured children, 123 presented traumatized teeth. The largest number of injuries was presented by 15 years old children (43.90%) followed by the 14 and 13 years old.{Table 2}

[Table 3] reveals that boys had more injured teeth than the girls. The most common type of injury in both sexes was the enamel-dentin fracture (71.9%) followed by crown fracture with pulp exposure (11.6%).{Table 3}

[Table 4] reveals that subjects who had conduct problem and peer relationship problems, had more traumatic dental injury when compared to hyperactive and prosocial behavior.{Table 4}


This study was done to reveal the association between problem behavior and traumatic dental injury. The result of this study showed that peer relationship problems were significantly associated with higher levels of traumatic dental injuries. It was expected that hyperactive behavior would increase the chances of having traumatic injury. This suggested that not all types of problem behavior are related to traumatic dental injuries. The results also showed that the type of lip coverage affected the relationship between type of overjet and traumatic dental injury.

Several reports have shown that the prevalence of traumatic dental injuries in the permanent dentition range from 18 to 22%. [12],[13],[14],[15] Lower prevalence has been reported in most of the earlier studies. [16],[17],[18],[19],[20],[21],[22] While in our study, prevalence of traumatic dental injuries in the permanent dentition was 61.5%.

Some studies have found that traumatic injuries to the permanent dentition are most frequent between 9 to 10 years of age [13],[14],[23],[24],[25],[26] while other studies report a range from 7 to 10 years as the peak ages for injuries to the permanent dentition. [27],[28] But in this study it was found that 15 years old children sustained more traumatic dental injuries to the teeth.

Garcia-Goday [29] found concussion as the most predominant injury in the primary dentition and enamel dentin fracture in the permanent dentition in the private pedodontic practice. While in our study, the enamel dentin fracture in the permanent dentition was most predominant. The result also showed that the type of lip coverage affected the relationship between type of overjet and traumatic dental injury. This might be expected as adequate lip coverage that would provide some protection to children with pronounced overjet when they have a harmful event.

Most of studies in the literature show that boys suffer more injuries to the permanent teeth. [13],[14],[22],[23],[26],[27],[30],[31],[32],[33] Garcia-Goday et al. [12] reported that more girls suffered injuries than boys with a ratio of 0.93:1. The present study shows boys to girls ratio of 1.1:1. Boys have more traumatic dental injury than the girls. It has been stated that careful attention should be paid when analyzing the type of injury because this can vary according to the place where the study is conducted. [16],[18],[34],[35]


Traumatic dental injury is the most predominant cause of dental injury among children. The conclusion of the study was that boys comparatively had more traumatized teeth than the girls. To develop an effective health promotion strategy and to prevent traumatic dental injury, it is necessary to find the cause why people fall, fight or injure themselves when they have an accident. The administrators of youth, high school, and college football, lacrosse, and ice hockey have demonstrated that dental and facial injuries can be reduced significantly by introducing mandatory protective equipment.


1Cornwell H. Dental trauma due to sport in the pediatric patient. J Calif Dent Assoc. 2005;33:457-61.
2Andreasen JO, Andreasen FM. Dental trauma: Quo vadis. Tandlaegebladet 1989;93:381-4.
3Marcenes W. Al Beiruti N, Tayfour D, Issa S. Epidemiology of traumatic injuries to the permanent incisors of 9-12 year old school children in Damascus Syria. Endod Dent Traumatol 1999;15:117-23.
4Andreasen JO, Andreasen FM. Textbook and colour atlas of traumatic injuries to the teeth. 3 rd ed. Co-penhagen: Munksgaard; 1994.
5Jessor R, Jessor SL. Problem behaviour and psycholsocial development. New York: Academic Press; 1977.
6Hamilton FA, Hill FJ, Holloway PJ. An investigation of dento-alveolar trauma and its treatment in an adolescent population. Part 1: The prevalence and incidence of injuries and the extent and adequacy of treatment received. Br Dent J 1997;182:91-5.
7Marcenes W, Murray S. Social deprivation and dental injuries among 14-year old school children in Newham, London. Endod Dent Traumatol 2000;16:1-4.
8Cortes MI, Marcenes W, Sheiham A. Prevalence and correlates of traumatic injuries to the permanent teeth of schoolchildren aged 9-14 years in Belo Horizonte, Brazil. Endod Dent Traumatol 2001;17:22-6.
9Andreasen JO. Etiology and pathogenesis of traumatic dental injuries. A Clinical study of 1,298 cases. Scand J dent Res 1970;78:329-42.
10Garcia-Goday F. A classification for traumatic injuries to primary and permanent teeth J Pedod 1981;5:295-7.
11Goodman R. The strengths and difficulties questionnaire: A research note. J Child Psychol Psychiatry 1997;38:581-6.
12Garcia-Godoy F, Sanchez R, Sanchez JR Traumatic dental injuries in a sample of Dominican schoolchildren. Community Dent Oral Epidemiol 1981;9:193-7.
13Andreasen JO, Ravn JJ. Epidemiology of traumatic dental injuries to primary and permanent teeth in a danish population sample. Int J Oral Surg 1972;1:235-9.
14Jarvinen S. Fractured and avulsed permanent incisor in Finnish children. A retrospective study. Acta Odontol Scand 1979;37:47-50.
15Ravn JJ. Dental injuries in Copenhagen schoolchildren, school years 1967-1972. Community Dent Oral Epidemiol 1974;7:231-45.
16Mcewen JD, Mchugh WD. Predisposing factors associated with fractured incisor teeth. Rep Congr Eur Orthod Soc 1969;343-51.
17Garcia-Goday F, Morban F. Prevalencia de traumatismos en dientes anteriores de 502 ninos escolares dominicanos. venez odontol 1954;18:47-51.
18Ellis RJ. The classification and treatment of injuries to the teeth of children chicago: Years Book Medical Publishers; 1979.
19Gauba ML. A Correlation of fractural anterior teeth to their Proclination. J Indian Dent Assoc 1967;39:105-12.
20Grundy JR. The incidence of fractured incisors. Br Dent J 1959;106:312-4.
21Schotzmannsky G. Unfallverletzungen an jugendlichen zahnen. Dtsch Stomatol 1963;13:919-27.
22Zadik D, Chosack A, Eidelman E. A survey of traumatized incisors in Jerusalem school children. ASDC J Dent Child 1972;39:185-8.
23Gutz DP. Fractural permanent incisors in a clinic population. ASDC J Dent Child 1971;38:94-5 passim.
24Hedegaard B. Stalhave J. A study of traumatized permanent teeth in children aged 7-15 years Part II. Swed Dent J 1973;66:431-50.
25Magnusson B, Holm AK. Traumatized permanent teeth in children: A follow-up I. Pulpal complications and root resorption. Sven Tandlaek Tidskr 1969;62:61-70.
26Ravn JJ, Rossen L. Hyppighed og fordeling of traumatiske beskadigelser of taenderne hoskoben-havnske Skoleborn 1967-69. Tandlaege bladet 1969;71:1-9.
27Haavikko K, Rantanen L. A follow-up study of injuries to permanent and primary teeth in children. Proc Finn Dent Soc 1976;72:152-62.
28O'Mullane DM. Injured permanent incisor teeth: An epidemiological study. J Ir Dent Assoc 1972;18:160-73.
29Garcia-Goday F, Garciá-Godoy F, Olivo M. Injuries to primary and permanent teeth treated in a private paedodontic practice. J Can Dent Assoc 1979;45:281-4.
30Gelbier S. Injured anterior teeth in children. A preliminary discussion. Br Dent J 1967;123:331-5.
31Macko DJ, Grasso JE, Powell EA, Doherty NJ. A study of fractured teeth in a school population. ASDC J Dent Child 1979;46:130-3.
32Schreiber CK. The effect of trauma on the anterior deciduous teeth. Br Dent J 1959;106:340-3.
33Sundvall HI. Olycksfallsskador pa. taender och prodontium under barnaaren. Nord Klin Odontol 1964:1-4.
34Garcia-Godoy F, Morban-Laucer F, Corominas LR, Franjul RA, Noyola M. Traumatic dental injuries in preschoolchildren from Santo Domingo. Community Dent Oral Epidemiol 1983;11:127-30.
35Sanchez JR, Sanchez R, Garcia-Godoy F. Traumatic injuries of the anterior teeth in preschool children. Acta Odontol Pediat 1981;2:17-23.