11

Dental Journal
(Majalah Kedokteran Gigi)

2021 March; 54(1): 1–4

Original article

Epidemiological survey for dental trauma among 12-year-old 
children in Erbil City, Iraq

Mohamed Salim Younus and Karam Ahmed
Faculty of Dentistry, Tishk International University, Erbil, Iraq 

ABSTRACT
Background: Dental injury and trauma are some of the most important public health concerns among school children that may 
require immediate management, as they could result in consequences affecting the child aesthetically, psychologically and socially.              
Purpose: The aim of this study was to determine the prevalence of dental trauma, the type of fracture, the most commonly affected tooth 
and the effect of gender on the occurrence of dental trauma. Methods: The methodology of this study was a cross-sectional survey 
consisting of a questionnaire and an oral examination which was conducted on 12-year-old public primary school children. Schools 
were selected from five different areas of Erbil city in Iraq. Results: The results indicate that 16.3% of the sample were affected with 
dental trauma in both genders. Maxillary central incisor was the most commonly affected tooth, and the majority of dental traumas 
were untreated. The most common type of dental trauma was simple enamel fracture. Conclusions: Child students are at great risk 
regarding dental trauma, which may affect their social activity especially within their school life.

Keywords: dental trauma; prevalence; school students

Correspondence: Mohamed Salim Younus, Faculty of Dentistry, Tishk International University, Erbil, Kurdistan region, Iraq.                  
Email: mohamed.salim@tiu.edu.iq

INTRODUCTION  

Trauma was defined as a physical damage or wound caused 
by an outside force (external) which may cause death or 
permanent disabilities,1 and the term dentoalveolar trauma 
represented alveolar injuries (mandible and maxilla), teeth 
injuries (fractures, avulsions and luxation) and all soft tissue 
wounds (lips, gingiva and tongue), ranging from bruising 
to extreme laceration.2 Damage implies offended, hurt 
or harmed tissue that will stimulate a dystrophic and/or 
provocative response from the affected area.3 Dental injury 
may be a harm to the mouth—including teeth, lips, gingiva 
and tongue—and commonly incorporates a broken or lost 
tooth.1 Tooth wounds were portrayed as a break, luxation or 
separation, in spite of the fact that a combination of wounds 
may happen within the same tooth.4 

Dental injury is a significant and serious health problem, 
as it may lead to many problems including pain and loss 
of function, as well as aesthetic, social and psychological 
issues for the child and their guardians (the entire family). 

Traumatic wounds primarily influence children, with an 
incidence peak of 2–4 years and 8–10 years of age, affecting 
boys more than girls.5,6 Most dental damage was related to 
falls, mainly while using bicycles or skateboards. Others 
were related fundamentally to playing football as well as 
other contact sports, particularly hockey, rugby, judo and 
karate.7–9

The predominance of dental trauma was high throughout 
the world and affected primary and permanent teeth, in spite 
of the fact that the oral cavity comprises as little as 1% of 
the entire body.10 It has been depicted in some studies that 
the predominance of dental and facial wounds within a 
population may reach as high as 35 % of registered cases.7 
Study on Iraqi mothers showed a low level of knowledge 
regarding the methods of management and prevention 
of dental trauma.11 Though the researchers found many 
interesting aspects in this field, the study was planned 
to evaluate the prevalence of dental injuries, the type of 
fracture, the most commonly affected tooth, and the effect 
of gender on the occurrence of dental trauma. 

Dental Journal (Majalah Kedokteran Gigi) p-ISSN: 1978-3728; e-ISSN: 2442-9740. Accredited No. 32a/E/KPT/2017. 
Open access under CC-BY-SA license. Available at https://e-journal.unair.ac.id/MKG/index
DOI: 10.20473/j.djmkg.v54.i1.p1–4

mailto:mohamed.salim@tiu.edu.iq
https://e-journal.unair.ac.id/MKG/index
http://dx.doi.org/10.20473/j.djmkg.v54.i1.p1-4


2 Younus and Ahmed/Dent. J. (Majalah Kedokteran Gigi) 2021 March; 54(1): 1–4

MATERIALS AND METHODS

Before starting the research, written approval was obtained 
from the ethical committee at Tishk International University 
(TIU) (No. 27 on 20/11/2019). The sample chosen for this 
cross-sectional survey consisted of 416 child students (188 
boys and 228 girls), and this sample was selected from 5 
different geographic areas (to cover the entire topography 
of Erbil city) including 10 primary schools randomly 
selected in Erbil city, Iraq. The subjects were all 12-year-
old school students (according to their birth date). The 
purpose and importance of the research were explained 
and discussed with the authorities in the selected schools 
to ensure their full cooperation during the diagnosis of 
the students. Written consent forms were sent to students’ 
parents, explaining the procedure and the reasons for the 
study through the school authority. 

The questionnaires included information about where, 
when, and how many times tooth trauma occurred, to 
supplement the visual examination of traumatic tooth or 
teeth recording. Only the children who submitted duly 
signed forms were included in the study (all the students had 
the choice as to whether or not they wanted to participate 
in the research). The ethical statement of this research will 
include: Approval from the directorate of education was 
taken before starting the diagnosis. 

The following instruments were used for diagnosis: 
disposable dental mirrors, disposable dental probes, 
disposable tweezers, gloves and masks. The examined 
students were seated on their chair in their classes, and the 
examiner was standing in front of the chair for diagnosis. 
The criteria of García-Godoy was used for assessing the 
dental trauma.12

Visual and tactile examinations were used for 
determining the type of dental injuries. No radiographs 
were taken so the fracture root was not recorded. Anterior 
teeth with restorations were excluded if the cause of the 
restoration was not confirmed to be due to trauma. We chose 
this index because it is simple and has been widely used in 

most of the previous studies. Furthermore, this classification 
was appropriate for retrospective studies. 

The inclusion criterion in this study was that the 12-
year-old students (their parents) agreed to participate in 
the survey. The exclusion criteria were students younger 
or older than 12 years old, parents or children that refused 
to participate in the research or cases with incomplete 
documentation, and students under orthodontic treatment. 
Statistical Package for the Social Sciences software (SPSS), 
version 20 (IBM, New York, USA), was used for data 
analysis and processing. The collected data was grouped and 
placed in tables and a Chi-square test was used to compare 
the results (χ2). All the values were considered statistically 
significant at p<0.05.

RESULTS

The sample consisted of 416 primary school students from 
ten different public schools in Erbil governorate. 188 of the 
sample subjects were male (45.2%) and 228 were female, 
(54.8%) all with an age of 12 years. The distribution of 
students according to gender is summarised in Table 1. 
The prevalence of dental trauma was shown to be 16.3% 
in the total sample and girls showed a higher prevalence of 
dental trauma (18.4%) in contrast with the boys (13.9%). 
However, this difference in prevalence was statistically 
non-significant (p>0.05), as shown in Table 2.

Table 3 shows that from 68 students who experienced 
trauma, the most prevalent kind was enamel fracture, while 
the least common was enamel dentine pulp fracture with 
high significant differences at p<0.001. The result showed 
that the teeth most commonly affected by trauma were 
upper centrals, while the least affected teeth were lower 
canines with high significant differences at p<0.001, as 
shown in Table 4.

Table 5 shows that from the 68 students who had trauma, 
the dental trauma occurred mainly at home, followed by 
school. The least common places were in the street and park, 

Table 1. Distribution of sample according to gender

Gender No. Percentage (%) 

Boys 188 45.2 

Girls 228 54.8 

Total 416 100 

Table 2. Prevalence of dental trauma among male and female 
students

Dental trauma
Boys Girls Total

No. % No. % No. %

No 162 86.1 186 81.6 348 83.7
Yes 26 13.9 42 18.4 68 16.3
Total 188 100 228 100 416 100

(χ2=0.67, p=0.238)

Table 3. The types of dental trauma

Types of trauma Percentage (%)
E. fracture 91.2
D. fracture 5.9
E.D.P fracture 2.9

(χ2=210.67, p<0.008)

Table 4. The teeth affected with trauma

Tooth Percentage (%)
Upper central 67.6
Upper lateral 8.8
Upper canine 5.9
Lower central 2.9
Lower lateral 5.9
Lower canine 2.9

(χ2=121.35, p<0.001)

Dental Journal (Majalah Kedokteran Gigi) p-ISSN: 1978-3728; e-ISSN: 2442-9740. Accredited No. 32a/E/KPT/2017. 
Open access under CC-BY-SA license. Available at https://e-journal.unair.ac.id/MKG/index
DOI: 10.20473/j.djmkg.v54.i1.p1–4

https://e-journal.unair.ac.id/MKG/index
http://dx.doi.org/10.20473/j.djmkg.v54.i1.p1-4


3Younus and Ahmed/Dent. J. (Majalah Kedokteran Gigi) 2021 March; 54(1): 1–4

with a statistically significant difference (p<0.05). From 
the total number of traumatised students, falling down and 
being struck by an object were the most prevalent reasons 
for the dental trauma in both genders, followed by the 
other causes with high significant differences at p<0.001, 
as shown in Table 6. The number of students visiting the 
dentist for dental treatments was only 20% (23% female 
and 15% male), while the number of students not visiting 
the dentist was 79.4% (77% female and 85% male) with 
statistically non-significant differences (p>0.05), as seen 
in Table 7.

DISCUSSION

The most common dental injury could be a broken or 
displaced tooth. The study showed that (16.3%) of the 
sample had a dental trauma, which was in agreement with 
other studies that found the prevalence to be 15.1%, 14.4%, 
14.5%, 18.5% and 16.3% respectively; this study was higher 
than that founded by others which found dental trauma 
prevalence to be 10.2%, 5.68% and 6.3%.13–19 Within the 
present study, the high prevalence of dental injury requires 
proficient planning and intervention to prevent and decrease 
its rate. Girls were found to have more dental injuries in 
comparison with boys, similar to the result found by Rajab 
et al.,20 while other studies showed different results. 21,22 
This finding may be because of a higher number of girls 
than boys in our sample.

Enamel fracture (91.5%) was most prevalent in the 
school children followed by enamel-dentin fractures 
(5.9%), which was comparable to the result found by other 

studies.22–24 The tooth that was most highly affected with 
dental trauma was the maxillary central incisor (67.6%), 
followed by upper laterals, (8.8%) which confirms by 
Bendo et al. and Prasad et al.25,26 This finding could be 
attributed to the early eruption and the protrusive position 
of these teeth.

Home was the most common place for an injury to 
happen, followed by school. This finding was comparable 
to other studies. 27,28 This result may be due to the fact 
that the students spend most of their time at home instead 
of at school or other places. From the whole number of 
traumatised students, falling down and being struck by an 
object were the most common reasons for dental injury 
in both genders, which was comparable to results found 
by other studies.17,18,23,24 The rate of children that visit 
the dental practitioner for dental treatment was (20.6%), 
which was comparable to research by Prasad et al.,26 which 
found that the majority of dental injuries were untreated. 
This result might be related to the fact that most of the 
traumas were enamel-dentin fractures which are not seen 
as situations that need urgent treatment. 

Dental trauma is a critical public dental health issue 
among school children which needs prompt treatment. 
Dental injury can result in aesthetic, psychological, social 
and therapeutic problems. It can be concluded from this 
study that dental trauma was highly prevalent among the 
sample of students. Moreover, dental trauma was more 
common among girls than boys, simple enamel fractures 
were discovered to be the most widely recognised type of 
dental trauma, and the maxillary central incisors were the 
most influenced tooth by dental injury. The most widely 
recognised cause of dental trauma was falling, followed by 
being struck by an object, and dental trauma most frequently 
occurred at home followed by school. Finally, high levels 
of untreated traumatised teeth were found in this study.

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Table 5. The students’ distribution according to the place of trauma

Dental trauma Home School Street Park Total
Male 14 10 2 0 26
Female 30 10 0 2 42
Total 44 20 2 2 68

(χ2=23.46, p<0.026)

Table 6. The distribution of students according to the cause of trauma

Dental 
trauma

Falling 
down

Struck by 
object

Bicycle 
accident

Violence
During 
playing

Unknown 
cause

RTA Total

Male 10 4 2 0 4 4 2 26
Female 20 16 2 2 0 2 0 42
Total 30 20 4 2 4 6 2 68

(χ2=42.32, p<0.001)

Table 7. The percentage of students visiting the dentist for 
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Gender
Dental visit by percentage (%)
Yes No

Boy 15 85
Girl 23 77
Total 20.6 79.4

(χ2=4.817, p=0.108)

Dental Journal (Majalah Kedokteran Gigi) p-ISSN: 1978-3728; e-ISSN: 2442-9740. Accredited No. 32a/E/KPT/2017. 
Open access under CC-BY-SA license. Available at https://e-journal.unair.ac.id/MKG/index
DOI: 10.20473/j.djmkg.v54.i1.p1–4

https://e-journal.unair.ac.id/MKG/index
http://dx.doi.org/10.20473/j.djmkg.v54.i1.p1-4


4 Younus and Ahmed/Dent. J. (Majalah Kedokteran Gigi) 2021 March; 54(1): 1–4

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Dental Journal (Majalah Kedokteran Gigi) p-ISSN: 1978-3728; e-ISSN: 2442-9740. Accredited No. 32a/E/KPT/2017. 
Open access under CC-BY-SA license. Available at https://e-journal.unair.ac.id/MKG/index
DOI: 10.20473/j.djmkg.v54.i1.p1–4

https://e-journal.unair.ac.id/MKG/index
http://dx.doi.org/10.20473/j.djmkg.v54.i1.p1-4