J Bagh College Dentistry Vol. 33(2), June 2021 Traumatic dental injuries 10 Traumatic dental injuries in relation to quality of life among school children in Baghdad /Iraq Shahad Jamal (1), Nada Jafer MH Radhi(2) https://doi.org/10.26477/jbcd.v33i2.2933 ABSTRACT Background: One of the significant public health problems is the traumatic dental injury to the anterior teeth, it has a great impact on children’s daily. Physical and psychological disturbance, pain and other negative impacts, such as tendency to avoid laughing or smiling may be associated with traumatic dental injuries, that may affect the social relationships. To determine the occurrence of traumatic dental injuries in relation to quality of life, this study was established among children of primary schools. Material and Methods: A cross-sectional study was conducted among private (574) and governmental (1026) primary school children in Baghdad city. Dental trauma was assessed according to Ellis and Davey classification in1970 and quality of life concerning a child Perceptions Questionnaire (CPQ) was used which consisted according to Jokovic et al.in 2006. Statistical analysis was done using IBMSPASS version (21). Results: Among the permanent anterior dentitions; the most widespread injured teeth were the maxillary central incisors. The boys were more affected with traumatic teeth than girls, as well as a higher percentage noticed in governmental schools than in private schools. Among all quality of life questionnaire, a higher percentage were observed in boys rather than in girls, as well as in governmental schools a higher percentage were listed more than in private schools, all differences were statistically highly significant. Conclusion: A higher association was noticed between traumatic anterior teeth and quality of life for children. Keywords Traumatic dental injuries, quality of life and oral condition. (Received: 27/2/2021, Accepted: 8/4/2021) INTRODUCTION Traumatic dental injuries to the permanent incisors are remarkably common among children and often result in partial or total loss of dental hard tissues along with the underlying esthetic, physical, social, psychological , functional and therapeutic adverse effects on the individual’s quality of life (1,2). It is accepted that the appearance and the position of the anterior teeth have both psychological and social impacts on children by which the appearance of the face plays an important psychosocial role in human life and relationships (3). Maxillary central incisors are the most common injured teeth of the permanent dentitions (4,5). Quality of life is the general well-being of individuals and societies, outlining negative and positive features of life. It observes life satisfaction, including everything from oral symptoms, functional limitations, emotional well- being, and social well-being, and the environment. (1) assistant lecturer , Pedodontics and Preventive Dentistry Department, College of Dentistry, University of Al-Farahidi. (2) Assistant prof., Pedodontics and Preventive Dentistry Department, College of Dentistry, University of Baghdad. Corresponding email, shahad.j.alfalahi@gmail.com Quality of life (QOL) measures are not a substitute of measuring outcomes associated with the disease, but are adjunct to them (6). Many Iraqi studies had been done concerning the trauma to the anterior teeth (7-11) however, this study was conducted in Baghdad city to estimate the occurrence of traumatic dental injuries in relation to quality of life in elementary schoolchildren, this study is considered the first one in Iraq to search association of quality of life and traumatic dental injuries. The null hypotheses was that there is no relation between traumatic dental injuries and quality of life MATERIAL AND METHODS This cross-sectional study was carried out in Baghdad city among the private ( boys 310 and girls 264) and public (boys 580 and girls 446) primary schools, aged 11- 12 years old.as the sample size was measured by specific statistical equation. Depending on the basic method of oral health surveys of the World Health Organization the oral examination was conducted under integrated situation (12) dental mirrors and probes were used. Traumatic dental injury was assessed according to Ellis and Davey classification (13). The child Perceptions Questionnaire (CPQ) consisted of 16 questionnaire that measure quality https://doi.org/10.26477/jbcd.v33i2.2933 J Bagh College Dentistry Vol. 33(2), June 2021 Traumatic dental injuries 11 of life (QoL) (1), a number of close-ended questions contain a self-administrated questioner format. A statistical package for social sciences (SPSS version 21 for windows) was used for both statistical analysis and data entry. Chi-square was used to conduct the association between the dependent variable with independent variables. A level of p-value equal to or less than 0.05 was considered as a significant value. RESULTS The total sample in the present study were consist of 1600 schoolchildren from boys and girls, aged 11- 12 years old. They were 574 from private schools and 1026 from governmental schools (table1). Table (2) shows the distribution of schoolchildren with traumatic teeth injuries according to the type of schools and gender. The high percentage of schoolchildren with traumatized teeth was found in governmental schools than private schools. Regarding gender, boys were affected by dental trauma more than girls. The mean value of traumatic dental injuries were higher among schoolchildren in private schools than in governmental schools, however, this was statistically not significant as it shown in Table(3). Table (1): Distribution of t he sample by gender and school type. Type of schools Gender Total boys girls No. % No. % No. % private 310 54.01 264 45.99 574 100 public 580 56.53 446 43.47 1026 100 Table (2): Distribution of children with traumatic dental injuries by gender and school type. Traumatic injuries of teeth School type Private Governmental boys girls Total boys girls Total No % No % No. % No % No % No. % Present 27 4.70 9 1.57 36 6.27 89 8.67 47 4.58 136 13.25 Table (3): The mean values and standard error of teeth with traumatic dental injuries among private and public schoolchildren. School type No. Mean SE t-test p-value Private 36 2.25 0.24 -1.39 0.19 Governmental 136 1.89 0.10 Tables (4a), (4b), (4c) and (4d) illustrate the association of traumatic dental injuries and quality of life by schools type. Regarding all the associations of traumatic dental injuries and quality of life, among private schools except for “TDI/ Trouble in sleeping, TDI/ Teased or called names and TDI/Not wanted to speak or read loud in class” were statically significant (p<0.05). While concerning all the association of traumatic dental injuries and quality of life in governmental schools they were statistically highly significant (p<0.01). In table (4a), the association of traumatic dental injuries and oral symptoms, it was found that the highest percentage of association in private schools was recorded in bad breath. The same picture was observed in governmental schools, while in table (4b), the association between traumatic dental injuries and functional limitation showed the highest percentage of association was recorded in difficulty in (eating/drinking) hot/cold things in both schools type. Table (4c) shows the association of traumatic dental injuries and emotional well- being, the highest percentage of association in private schools was observed in concerned what people think about your teeth/mouth, while in J Bagh College Dentistry Vol. 33(2), June 2021 Traumatic dental injuries 12 governmental schools it was observed in felt irritable/frustrated). Regarding the association of traumatic dental injuries and social well-being the highest percentage of association recorded in Avoided smiling/laughing in both schools type, ( table 4d ). Table (4a): The association of traumatic dental injuries and quality of life regarding oral symptom by school types. Variables Severity Trauma School Private Governmental N. % P[HS] N. % P[HS] pain in teeth/mouth 0 22 61.11 0.000 53 38.97 0.000 1 6 16.67 23 16.91 2 7 19.44 22 16.18 3 0 0.00 27 19.85 4 1 2.78 11 8.09 Bad breath 0 20 55.56 0.000 48 35.29 0.000 1 10 27.78 9 6.62 2 2 5.56 31 22.79 3 3 8.33 30 22.06 4 1 2.78 18 13.24 Mouth sore 0 30 83.33 0.034 73 53.68 0.000 1 3 8.33 29 21.32 2 3 8.33 23 16.91 3 0 0.00 11 8.09 Food catching between teeth 0 25 69.44 0.000 49 36.03 0.000 1 5 13.89 17 12.50 2 4 11.11 28 20.59 3 2 5.56 34 25.00 4 0 0.00 8 5.88 Table (4b): The association of traumatic dental injuries and quality of life regarding functional limitation by school types. Variables Severity Trauma School Private Governmental N. % P[HS] N. % P[HS] Difficulty in (eating/drinking) hot/cold things 0 19 52.78 0.000 59 43.38 0.000 1 4 11.11 10 7.35 2 7 19.44 27 19.85 3 5 13.89 30 22.06 4 1 2.78 10 7.35 Difficulty in eating firm food 0 22 61.11 0.000 70 51.47 0.000 1 3 8.33 15 11.03 2 8 22.22 27 19.85 3 2 5.56 18 13.24 4 1 2.78 6 4.41 Difficulty in saying words 0 28 77.78 0.000 94 69.12 0.000 1 6 16.67 19 13.97 2 1 2.78 16 11.76 3 1 2.78 6 4.41 4 0 0.00 1 0.74 Trouble in sleeping 0 26 72.22 0.126 70 51.47 0.000 1 2 5.56 2 1.47 2 1 2.78 5 3.68 3 3 8.33 20 14.71 J Bagh College Dentistry Vol. 33(2), June 2021 Traumatic dental injuries 13 Table (4c): The association of traumatic dental injuries and quality of life regarding emotional well- being by school types. Variables Severity Trauma School Private Governmental N. % P[HS] N. % P[HS] Upset 0 26 72.22 0.021 56 41.18 0.000 1 5 13.89 25 18.38 2 5 13.89 32 23.53 3 0 0.00 16 11.76 4 0 0.00 7 5.15 Felt irritable/frustrated 0 23 63.89 0.000 51 37.50 0.000 1 4 11.11 11 8.09 2 8 22.22 39 28.68 3 1 2.78 23 16.91 4 0 0.00 12 8.82 Felt shy 0 25 69.44 0.000 101 74.26 0.000 1 7 19.44 11 8.09 2 3 8.33 15 11.03 3 1 2.78 7 5.15 4 0 0.00 2 1.47 Concerned what people think about your teeth/mouth 0 20 55.56 0.000 58 42.65 0.000 1 10 27.78 31 22.79 2 5 13.89 31 22.79 3 1 2.78 16 11.76 Table (4d): The association of traumatic dental injuries and quality of life regarding social well- being by school types. Variables Severity Trauma School Private Governmental N. % P[HS] N. % P[HS] Teased/called names 0 31 86.11 0.126 83 61.03 0.000 1 3 8.33 4 2.94 2 1 2.78 21 15.44 3 1 2.78 24 17.65 4 0 0.00 4 2.94 Avoided smiling/laughing 0 18 50.00 0.000 53 38.97 0.000 1 5 13.89 30 22.06 2 9 25.00 38 27.94 3 4 11.11 15 11.03 Not wanted to speak/read loud in class 0 35 97.22 1.000 104 76.47 0.000 1 1 2.78 12 8.82 2 0 0.00 13 9.56 3 0 0.00 7 5.15 Argued with children/family 0 23 63.89 0.000 66 48.53 0.000 1 4 11.11 11 8.09 2 1 2.78 13 9.56 3 6 16.67 24 17.65 4 2 5.56 22 16.18 J Bagh College Dentistry Vol. 33(2), June 2021 Traumatic dental injuries 14 DISCUSSION A problems in the oral health were recognized as important factors in causing a negative impact on daily performance and QoL (2); the problem in oral the oral health were more in private than in governmental schools. Perhaps trauma is one of the dental disturbances that cause much of distress and psychological adverse effect to both children and their parents. Moreover, the anterior teeth are more susceptible to traumatic dental injuries due to their morphology and location (14). The prevalence of traumatic dental injuries to the permanent anterior teeth in both private and governmental children of primary schools; permanent anterior teeth where from (6.27% - 13.25%), while other studies reported it (1.36% - 29.6%) (10; 15-18). Increase the risk for accidents in schoolchildren may be due to frequently engaged in intense/competitive activities which will increase the risk for accidents (19 ,20).The negative impact of Traumatic Dental Injuries on the children’s life includes difficulty in eating, loss appetite, cannot sleep well, losing weight, irritability in their behavior and low self- confidence and decrease in school performance (21). This study showed a significant impact of TDI on QoL among primary schoolchildren. Reduced smiling, laughing, and socializing with others may due to the inconclusive appearance of untreated fractured incisors. This is in agreement with results that suggested that children with fractured teeth were major concerns for esthetics rather than function (22). The present study revealed that there was a high association between traumatic dental injuries and the functional and emotional well-being. Santos et al.(20) also supported these results related to “difficulty in eating” “felt shy” and “caring about what others were thinking of appearance.” Opposite picture was observed in other study (21-24). Good oral health is essential to improve individual overall health and well- being as oral health also affects quality of life in children. The present study recommended an educational program for children regarding information about the importance of dental trauma, ways of how to prevent dental trauma, the advantages of immediate attendance and conservation of avulsed and fractured teeth. This would not only reduce the overall rate of dental injuries, but also minimize the sequelae of traumatic injuries, and it is also recommended that increase knowledge and improvement of quality of life among schoolchildren will enhance their oral health condition. Conflicts of interest The authors has nothing to disclose. REFERENCES 1. Jokovic A, Locker D, Stephens M, Kenny D, Tompson B, Guyatt G. Measuring parental perceptions of child oral-health-related quality of life. J Public Health Dent. 2006;63:67–72. 2. Abanto J, Carvalho TS, Mendes FM, Wanderley MT, Bo¨necker M, Raggio DP. Impact of oral diseases anddisorders on oral health-related quality of life of preschool children. Community Dentistry Oral Epidemiology 2011; 39: 105–114. 3. David J, Strøm ANA, Wang NJ. Factors associated with traumatic dental injuries among 12-year-old schoolchildren in South India. Dental Traumatology 2009; 25:500–505. 4. Al-Obaidi W, Al-Mashadani A. traumatic injuries among 5-30 years in Sheha Village. Iraqi Dent J. 2002; 29:299-304. 5. Hassan F. Farhan. Traumatized anterior teeth among 13-15 year old intermediate school students in Hilla City, Babylon Government/ Iraq. Master thesis submitted to College of Dentistry, University of Baghdad, 2008. 6. Barcaccia, Barbara (4 September 2013). "Quality Of Life: Everyone Wants It, But What Is It?". Forbes/ Education. Retrieved 10 May 2016. 7. Al-Hayali A. traumatized anterior teeth among 4-15 years old in the central region of Iraq. Master thesis submitted to the College of Dentistry, University of Baghdad; 1998. 8. Al-Obaidi WA, Al-Geburi IK. Pattern of traumatic dentalinjuries in a sample formal-Buetha village, Baghdad. Iraqi DentJ 2002;30:207–14. 9. Al-kassab A. Evaluation of primary school student with traumatized anterior permanent incisors in relation to different variables in Mosul city. Master thesis submitted to the College of Dentistry, University of Baghdad; 2005. 10. Noori A. prevalence and pattern of traumatic dental injuries among primary school in Sulaimani city. Master thesis submitted to College of Dentistry, University of Sulaimani; 2007. 11. Azhar Ammash Hussien. Traumatic Dental Injuries Among 6 – 13 – Year - Old - School Children in Tikrit City. MDJ 13 (1) 2016. 12. World Health Organization. (1997). Oral health surveys : basic methods, 4th ed. World Health Organization. 13. Shobha Tandon. Text book of Pedodontics. 2nd edition, India: Paras,2009. 14. Soriano EP, Caldas JR AF, Carvalho MVD, AmorimFilho HA. Prevalence and risk factors related to traumatic dental injuries in Brazilian J Bagh College Dentistry Vol. 33(2), June 2021 Traumatic dental injuries 15 schoolchildren. Dental Traumatology 2007; 23:232– 240. 15. Al-Azawi L. Oral health status and treatment needs among Iraq 5 years old kindergarten children and 15 years old student (A national survey). Ph.D. thesis submitted to the College of Dentistry, University of Baghdad, 2000. 16. Baghdady VS et al. Traumatized anterior teeth as related to their causes and place. Community Dent Oral Epidemiol. 1981,9 : 91. 17. El-Samarrai S. Oral health status and treatment need among preschool children in Baghdad. MSc thesis. Baghdad: College of Dentistry, University of Baghdad; 1989. 18. Hassan F. Farhan, Ahlam T. Mohammed. Traumatized Anterior Teeth among 13-15 Years Old Intermediate School Students in Hilla City, Babylon Governorate- Iraq. 2014, IDJ,36 (1). 19. Traebert J,lacerda JTD,Page LAF,Thomson WM,Bortoluzzi MC. Impact of traumatic dental injuries on the quality of life of schoolchildren. Dental Traumatology 2012; 28: 423–428. 20. Santos A, Faria D, Spitz B, Volpe A. Impact of traumatic dental injury on the quality-of-life of children and adolescents: A case-control study. Acta Odontol Scand. 2013. 71:1123–8. 21. Bendo cb, Paiva SM, Torres CS, Oliveira AC, Goursand D, Pordeus IA.. Association between treated / untreated traumatic dental injuries and impact on quality of life of Brazilian schoolchildren. Health Qual Life Outcomes. 2010, 8:114. 22. Traebert J,lacerda JTD,Page LAF,Thomson WM,Bortoluzzi MC. Impact of traumatic dental injuries on the quality of life of schoolchildren. Dental Traumatology 2012; 28: 423–428. 23. Irene Julie Higginson, Alison J Carr. easuring quality of life: Using quality of life measures in the clinical setting, 322(7297):1297-300 · June 2001. 24. Abanto J, Carvalho TS, Mendes FM, Wanderley MT, Bo¨necker M, Raggio DP. Impact of oral diseases anddisorders on oral health-related quality of life of preschool children. Community Dentistry Oral Epidemiology 2011; 39: 105–114. المستخلص حدة من مشاكل الصحة العامة الكبيرة هي إصابة األسنان األمامية لألسنان ، ولها تأثير كبير على حياة األطفال اليومية. االضطرابات واالخلفية: االبتسام قد تترافق مع إصابات األسنان الرضية التي قد تؤثر الجسدية والنفسية واأللم واآلثار السلبية األخرى ، مثل الميل إلى تجنب الضحك أو بين أطفال المد هذه الدراسة إنشاء تم ، الحياة بنوعية يتعلق فيما األسنان الرضية إصابات حدوث مدى لتحديد االجتماعية. ارس على العالقات . االبتدائية ( من تالميذ المدارس االبتدائية في مدينة بغداد. 1026قطاع الخاص والحكومي )( تلميذ من ال574تم إجراء دراسة مقطعية على )المادة والطرق: ( CPQوتم استخدام نوعية الحياة المتعلقة باستبيان تصورات الطفل ) 1970في عام Daveyو Ellisتم تقييم إصابات األسنان وفقًا لتصنيف .IBMSPASS( 21اإلحصائي باستخدام نسخة ) . تم إجراء التحليل Jokovic et al. 2006والذي يتكون وفقًا لـ األسنان صاباتمن خالل األسنان األمامية الدائمة. كانت األسنان األكثر إصابة هي القواطع المركزية العلوية. كان األوالد أكثر تأثراً باالنتائج: جودة الحياة استبيانات جميع بين الخاصة. من في المدارس منها لوحظت في المدارس الحكومية أعلى أن النسبة التي كما ، بالفتيات ، مقارنة نت جميع لوحظت نسبة أعلى في األوالد وليس لدى الفتيات ، وكذلك في المدارس الحكومية تم تسجيل نسبة أعلى منها في المدارس الخاصة ، وكا الفروق ذات داللة إحصائية عالية. . لوحظ ارتباط أعلى بين األسنان األمامية المتعرضة للصدمة ونوعية الحياة لألطفالالخالصة: Articles Published by Journal of Baghdad College of Dentistry is licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/