DOI: 10.1111/ipd.12135
Prevalence of traumatic dental injuries and its association with binge drinking among 12-year-olds: a population-based study PAULA C. P. PAIVA1, HAROLDO N. PAIVA2, PAULO M. OLIVEIRA FILHO3, JOEL ^ A. LAMOUNIER1, RAQUEL C. FERREIRA4, EFIGENIA F. FERREIRA4 & PATRICIA M. ZARZAR5 1
Department of Child and Adolescent Health, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil, 2Department of Dentistry, School of Dentistry, Federal University of the Jequitinonha and Mucuri Valleys, Diamantina, Brazil, 3Department of Basic Sciences, Federal University of the Jequitinonha and Mucuri Valleys, Diamantina, Brazil, 4Department of Public Oral Health, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil, and 5Department of Paediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
International Journal of Paediatric Dentistry 2015; 25: 239–247 Objective. To determine the prevalence of trau-
matic dental injuries and its association with binge drinking among 12-year-old schoolchildren. Methods. A cross-sectional study was carried out involving 588 students from a medium-sized city in Brazil. Data were collected through a clinical examination and self-administered questionnaires. Andreasen’s classification was used for the determination of traumatic dental injuries. The consumption of alcoholic beverages and binge drinking were evaluated using the Alcohol Use Disorders Identification Test – Consumption. Socio-economic status, overjet, and inadequate lip seal were also analysed. Associations were tested using the multivariate logistic regression analysis.
Introduction
Traumatic dental injuries (TDIs) are considered a serious public health problem among children and adolescents due to the high prevalence rates, psychosocial impact, and treatment costs1. The prevalence of TDI in population-based studies ranges from 6 to 58.6%2,3. In Brazil, the prevalence in the permanent dentition is reported to range from 10.7% to 58.6% among 12-year-olds3,4. Predisposing biological factors, such as accentuated overjet5–8, inadequate lip protection9, obesity4,10, and socio-economic status4,7,10,11, Correspondence to: Paula C. P. Paiva, Pracßa Doutor Prado 31, Diamantina, MG 39100-000, Brazil. E-mail: [email protected]
Results. The prevalence rates of traumatic dental injuries, alcohol consumption in one’s lifetime, and binge drinking were 29.9%, 45.6%, and 23.1%, respectively. The prevalence of traumatic dental injuries was significantly higher among those who engaged in binge drinking (PR = 1.410; 95% CI: 1.133–1.754) and even higher among those with inadequate lip protection and accentuated overjet (PR = 3.288; 95% CI: 2.391– 4.522 and PR = 1.838; 95% CI: 1.470–2.298, respectively). Conclusions. A higher prevalence rate of traumatic dental injuries was found among 12-yearolds who engaged in binge drinking. The high rate of alcohol intake among adolescents is worrisome considering the vulnerability of this population due to the intense transformations that occur in the transition from childhood to adulthood.
are reported to contribute to the prevalence of TDI. Adolescence is the period of human development between 10 and 19 years of age in which considerable biological and psychosocial transformations occur12. Binge drinking among adolescents is an important social and public health problem. The high prevalence rates and initiation at increasingly younger ages is a growing concern in many countries13. Alcohol lowers one’s inhibitions and self-control, leading to an increase in risk behaviour. Hazardous consumption is a major cause of injury, violence, and premature death13,14. There is no pattern for the amount of alcohol that can be considered indicative of low risk among adolescents, as even low intake in this population group is associated
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
239
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P. C. P. Paiva et al.
with a high risk of accidents15. Binge drinking (defined as having five or more drinks on a single occasion) is common among adolescents and could further encourage individuals to display risk behaviour16. The few studies in the literature on the association between the consumption of alcoholic beverages and maxillofacial or dentoalveolar trauma report conflicting results6,7,17. Fewer studies have addressed the association between alcohol intake and TDI, with one investigation reporting a greater chance of TDI among adolescents with hazardous alcohol use6, whereas another study found no such association9. This study is important because it investigates the association between alcohol intake and binge drinking, and TDI. The determination of such an association is important to the planning of adequate intervention policies that address both biological and behavioural factors that can serve as mediators of this public health problem. The aim of this study was to investigate the prevalence of TDI and its association with the binge drinking among 12-year-old students in the urban area of a medium-sized city in Brazil. Material and methods
prevalence ratio of 1.51 and 95% confidence interval (CI). A list of the names, addresses of the schools, and total number of 12-year-old students was obtained from the offices of the Secretary of Education. Data acquisition was carried out at the schools on previously scheduled days. Ethical considerations This study received approval from the Ethics Committee of the Federal University of Minas Gerais (Brazil) under process number 317/11 in accordance with the recommendations of the Declaration of Helsinki. Authorisation was obtained from the schools. The participants and their parents/guardians signed statements of informed consent. The participants were assured anonymity and confidentiality in their answers. Pilot study A pilot study was first conducted in a nearby region to test the methods. This pilot study involved a convenience sample of 101 students who were not included in the main study. The findings demonstrated no need to alter the proposed methods.
Study design A cross-sectional epidemiological study was carried out with 12-year-old students from all 13 public and private schools in urban areas of the city of Diamantina (south-east of Brazil), a city with approximately 46,372 inhabitants. The study was performed between February and April 2013. Among the population studied, the power of (b) ranged from 73.2% to 99.9%. For association between TDI and binge drinking, was 91%. For lip protection and overjet, b was 99.9%; however, b was 73.2% for sex. The power of for association between TDI and binge drinking was determined by considering the following estimates: TDI ratio among non-exposed – no binge drinking (121): TDI ratio among exposed – binge drinking (55): 2.2; the prevalence of TDI in non-exposed groups, no binge drinking, was 26.8%, with a
Measures Clinical oral examination. The dependent variable was TDI, which was classified based on the method proposed by Andreasen et al.18 (loss of dental structure, crown discoloration, intrusion, extrusion, lateral luxation, or avulsion). Each traumatised tooth was compared with its corresponding contralateral tooth. For the examination, the teeth were cleaned and dried with gauze and the crowns were examined with the aid of a mouth mirror under artificial light (Petzl Zoom head lampâ, Petzl America, Clearfield, UT, USA) with the patient in the supine position. The examiner recorded the type of injuries sustained and any treatment carried out, as well as the treatment needed. A plain front-surface mouth mirror and a blunt probe (WHO 621)
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Prevalence of dental trauma among schoolchildren
were used to identify the presence and extent of restorations or to remove debris. Evidence of tooth injury and treatment received, including a positive history of injury obtained from the subject, was recorded, in accordance with the study by Marcenes et al. 20014, Artun, and Al-Azemi 200910. Evidence of tooth injury and treatment received was also recorded from self-reported information from adolescents of positive history of teeth injuries. The examiner (PCPP) had previously undergone a training and calibration exercise and used appropriate individual protection equipment. Training was carried out with colour slides of each type of injury (Andreassen’s criteria18) in the permanent dentition, with two images of each injury. The calibration exercise was then performed by clinical examinations of 12-yearold students who did not participate in the main study. These clinical examinations were performed by two dentists. The results of the examinations were compared with the decisions of a dentist with experience in traumatology (gold standard). Intra- and interexaminer agreement was determined using the kappa index. The intervals between both examinations were 15 days. During the oral examination, other clinical variables of interest were investigated. Overjet was measured with the aid of a wooden tongue depressor with a straight tip. The bite was placed in centric occlusion, and overjet was measured from the vestibular face of the lower incisor to the incisal vestibular face of the most prominent upper incisor, with a mark made on the tongue depressor in graphite. The distance from the edge of the tongue depressor to the mark was measured using a digital calliper. A distance >5 mm was recorded as accentuated overjet. Lip protection was evaluated using the method proposed by O’Mullane9 and was considered adequate when the lips covered the upper incisors in the resting position. Assessment of alcohol intake, binge drinking, and socio-economic status The main independent variable was binge drinking and was evaluated using the Alco-
241
hol Use Disorders Identification Test – Consumption (AUDIT-C). AUDIT and AUDIT-C have been validated for use in Brazil19,20 to identify the frequency of alcohol intake and binge drinking. This questionnaire is considered adequate for use on adolescents and is both fast and easy to administer21. AUDIT focuses on current habits and considers users who exhibit initial problems with alcohol. The questionnaire is made up of ten items on recent alcohol use, symptoms of dependence, and alcohol-associated problems. As this study involved 12-year-olds, the shortversion AUDIT-C was administered, which is made up of three questions on the frequency and amount of alcohol consumption22: (1) How often did you have a drink containing alcohol in the past year? (response options: never, monthly or less, 2–4 times a month, 2–3 times a week, or four or more times a week); (2) How many drinks did you have on a typical day when you were drinking in the past year? (response options: none, 1 or 2, 3 or 4, 5 or 6, 7 to 9, or 10 or more); and (3) How often did you have five or more drinks on a single occasion in the past year? (response options: never, less than monthly, monthly, weekly, daily, or almost daily). Alcohol intake was derived from Question 1 and dichotomised as 0 (never) or 1 (monthly to 4 or more times a week). Binge drinking was derived from Question 3 and defined as five or more drinks on a single occasion16. Age at initiation regarding the consumption of alcoholic beverages was determined by the following question: How old were you when you first had an alcoholic beverage23? Privacy and confidentiality were ensured. The students self-administrated the questionnaire in the classroom in the absence of the teacher. To guard against bias due to variability in reading proficiency, the researcher read each question aloud and the students marked their responses simultaneously6,7. The questionnaire included items on sex, socio-economic status, and the location and aetiology of TDI. The following socio-economic indicators were employed: monthly household income, mother’s schooling, and type of school (public
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
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P. C. P. Paiva et al.
or private)24. Household income was determined based on the sum of all salaries received by economically active residents in the home and categorised based on the current Brazilian minimum salary; the threshold was the median response. Mother’s schooling was defined as the number of years of study, with seven years used as the cut-off point; the threshold was the median response. The monthly household income and mother’s schooling were chosen as indicators of individual socio-economic status due to their association with dental trauma24 and binge drinking in adolescents6, respectively. These socio-economic variables were collected by a form completed by parents/guardians along with a signed letter of free and informed consent. Type of school was also used as a socioeconomic indicator7. Although this variable only allows a crude assessment, most Brazilian public schools are known to have less educational resources than private schools. Therefore, wealthier adolescents in Brazil are enrolled in private schools24. Statistical analysis Data analysis was performed using the Statistical Package for Social Sciences (SPSS for Windows, version 19.0, SPSS Inc, Chicago, IL, USA) and includes frequency distribution and association tests. Statistical significance for the association between TDI and the independent variables [binge drinking, alcohol consumption, sex, socio-economic status (household income, mother’s schooling, and type of school), lip protection, and overjet] in the bivariate analysis was determined using the chi-square test (P < 0.05). To adjust the final model and determine the independent effect of alcohol intake on the prevalence of TDI, the main independent variable (binge drinking) was first incorporated into the logistic regression analysis. The criterion for the inclusion of independent variables in each model was a P-value < 0.20 in the bivariate analysis. Results
The participation rate was 92.9% (588 of 633 students). A total of 302 (51.4%) of the par-
ticipants were female. The loss of 4.6% (n = 28) was due to refusal to participate on the part of either parents/guardians or the students themselves. The loss of 2.5% (n = 17) was due to non-responses or incoherent data. The majority (n = 542; 92.2%) was enrolled in public schools; 75.2% (n = 442) had a monthly household income of up to three times the Brazilian minimum salary; and 63.9% of the mother’s schooling (n = 376) had more than seven years of schooling. The prevalence of TDI in the permanent incisors was 29.9% (n = 176) [95% CI: 26.2– 33.6], with a total of 219 fractured teeth. Table 1 reports the frequency distribution of the 219 TDI among the 176 schoolchildren. The majority (77.02%) had only one affected tooth. The upper central incisors were the most affected (187 teeth; 85.39%). The prevalence rates of alcohol consumption in life and binge drinking were 45.6% (n = 268) [95% CI: 41.4–49.3] and 23.1% (n = 136) [95% CI: 20.2–27.0], respectively. The mean age reported regarding the consumption of an alcoholic beverage for the first time was 10.76 years (95% confidence interval [CI]: 10.65 – 10.87); however, 31 adolescents (7.6%) reported consuming alcoholic beverages for the first time between eight and nine years of age. In the bivariate analysis, the prevalence of TDI was greater among students who reported the consumption of alcoholic beverages (P = 0.030) and those who reported engaging in binge drinking (P = 0.002) (Table 2). Sex, overjet, and lip Table 1. Frequency distribution of type of injury among 176 12-year-old schoolchildren in city of Diamantina, Brazil.
Type of dental injury Enamel fracture Enamel/dentin fracture Enamel/dentin/pulp exposure Intrusive luxation Lateral luxation Extrusive luxation Avulsion Composite restoration
Absolute frequency n
Relative frequency %
92 89 4 8 1 0 0 25
42 40.64 1.83 3.65 0.46 0 0 11.41
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Prevalence of dental trauma among schoolchildren
protection were also associated with TDI in the bivariate analysis. In the adjusted multivariate logistic regression analysis, the prevalence of TDI was sigTable 2. Distribution of 588 12-year-old schoolchildren according to traumatic dental injuries and independent variables, Brazil, 2014. Traumatic dental injuries Independent variables Binge drinking No Yes Alcohol intake No Yes Lip coverage Adequate Inadequate Overjet ≤5 mm >5 mm Sex Female Male Type of school Public Private Household income Up to 3 times the minimum salary More than 3 times the minimum salary Missing Mother’s schooling 0–7 years 8 years or more Missing
P-value*
Present
Absent
(n) (%) 121 (68.8) 55 (31.3)
(n) (%) 331 (80.3) 81 (19.7)
85 (48.3) 91 (51.7)
239 (58.0) 173 (42.0)
0.030*
41 (23.3) 135 (76.7)
276 (67.0) 136 (33.0)
5 mm Female Male
(1.244–2.773)
0.002
(4.455–10.022)
Prevalence of traumatic dental injuries and its association with binge drinking among 12-year-olds: a population-based study PAULA C. P. PAIVA1, HAROLDO N. PAIVA2, PAULO M. OLIVEIRA FILHO3, JOEL ^ A. LAMOUNIER1, RAQUEL C. FERREIRA4, EFIGENIA F. FERREIRA4 & PATRICIA M. ZARZAR5 1
Department of Child and Adolescent Health, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil, 2Department of Dentistry, School of Dentistry, Federal University of the Jequitinonha and Mucuri Valleys, Diamantina, Brazil, 3Department of Basic Sciences, Federal University of the Jequitinonha and Mucuri Valleys, Diamantina, Brazil, 4Department of Public Oral Health, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil, and 5Department of Paediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
International Journal of Paediatric Dentistry 2015; 25: 239–247 Objective. To determine the prevalence of trau-
matic dental injuries and its association with binge drinking among 12-year-old schoolchildren. Methods. A cross-sectional study was carried out involving 588 students from a medium-sized city in Brazil. Data were collected through a clinical examination and self-administered questionnaires. Andreasen’s classification was used for the determination of traumatic dental injuries. The consumption of alcoholic beverages and binge drinking were evaluated using the Alcohol Use Disorders Identification Test – Consumption. Socio-economic status, overjet, and inadequate lip seal were also analysed. Associations were tested using the multivariate logistic regression analysis.
Introduction
Traumatic dental injuries (TDIs) are considered a serious public health problem among children and adolescents due to the high prevalence rates, psychosocial impact, and treatment costs1. The prevalence of TDI in population-based studies ranges from 6 to 58.6%2,3. In Brazil, the prevalence in the permanent dentition is reported to range from 10.7% to 58.6% among 12-year-olds3,4. Predisposing biological factors, such as accentuated overjet5–8, inadequate lip protection9, obesity4,10, and socio-economic status4,7,10,11, Correspondence to: Paula C. P. Paiva, Pracßa Doutor Prado 31, Diamantina, MG 39100-000, Brazil. E-mail: [email protected]
Results. The prevalence rates of traumatic dental injuries, alcohol consumption in one’s lifetime, and binge drinking were 29.9%, 45.6%, and 23.1%, respectively. The prevalence of traumatic dental injuries was significantly higher among those who engaged in binge drinking (PR = 1.410; 95% CI: 1.133–1.754) and even higher among those with inadequate lip protection and accentuated overjet (PR = 3.288; 95% CI: 2.391– 4.522 and PR = 1.838; 95% CI: 1.470–2.298, respectively). Conclusions. A higher prevalence rate of traumatic dental injuries was found among 12-yearolds who engaged in binge drinking. The high rate of alcohol intake among adolescents is worrisome considering the vulnerability of this population due to the intense transformations that occur in the transition from childhood to adulthood.
are reported to contribute to the prevalence of TDI. Adolescence is the period of human development between 10 and 19 years of age in which considerable biological and psychosocial transformations occur12. Binge drinking among adolescents is an important social and public health problem. The high prevalence rates and initiation at increasingly younger ages is a growing concern in many countries13. Alcohol lowers one’s inhibitions and self-control, leading to an increase in risk behaviour. Hazardous consumption is a major cause of injury, violence, and premature death13,14. There is no pattern for the amount of alcohol that can be considered indicative of low risk among adolescents, as even low intake in this population group is associated
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
239
240
P. C. P. Paiva et al.
with a high risk of accidents15. Binge drinking (defined as having five or more drinks on a single occasion) is common among adolescents and could further encourage individuals to display risk behaviour16. The few studies in the literature on the association between the consumption of alcoholic beverages and maxillofacial or dentoalveolar trauma report conflicting results6,7,17. Fewer studies have addressed the association between alcohol intake and TDI, with one investigation reporting a greater chance of TDI among adolescents with hazardous alcohol use6, whereas another study found no such association9. This study is important because it investigates the association between alcohol intake and binge drinking, and TDI. The determination of such an association is important to the planning of adequate intervention policies that address both biological and behavioural factors that can serve as mediators of this public health problem. The aim of this study was to investigate the prevalence of TDI and its association with the binge drinking among 12-year-old students in the urban area of a medium-sized city in Brazil. Material and methods
prevalence ratio of 1.51 and 95% confidence interval (CI). A list of the names, addresses of the schools, and total number of 12-year-old students was obtained from the offices of the Secretary of Education. Data acquisition was carried out at the schools on previously scheduled days. Ethical considerations This study received approval from the Ethics Committee of the Federal University of Minas Gerais (Brazil) under process number 317/11 in accordance with the recommendations of the Declaration of Helsinki. Authorisation was obtained from the schools. The participants and their parents/guardians signed statements of informed consent. The participants were assured anonymity and confidentiality in their answers. Pilot study A pilot study was first conducted in a nearby region to test the methods. This pilot study involved a convenience sample of 101 students who were not included in the main study. The findings demonstrated no need to alter the proposed methods.
Study design A cross-sectional epidemiological study was carried out with 12-year-old students from all 13 public and private schools in urban areas of the city of Diamantina (south-east of Brazil), a city with approximately 46,372 inhabitants. The study was performed between February and April 2013. Among the population studied, the power of (b) ranged from 73.2% to 99.9%. For association between TDI and binge drinking, was 91%. For lip protection and overjet, b was 99.9%; however, b was 73.2% for sex. The power of for association between TDI and binge drinking was determined by considering the following estimates: TDI ratio among non-exposed – no binge drinking (121): TDI ratio among exposed – binge drinking (55): 2.2; the prevalence of TDI in non-exposed groups, no binge drinking, was 26.8%, with a
Measures Clinical oral examination. The dependent variable was TDI, which was classified based on the method proposed by Andreasen et al.18 (loss of dental structure, crown discoloration, intrusion, extrusion, lateral luxation, or avulsion). Each traumatised tooth was compared with its corresponding contralateral tooth. For the examination, the teeth were cleaned and dried with gauze and the crowns were examined with the aid of a mouth mirror under artificial light (Petzl Zoom head lampâ, Petzl America, Clearfield, UT, USA) with the patient in the supine position. The examiner recorded the type of injuries sustained and any treatment carried out, as well as the treatment needed. A plain front-surface mouth mirror and a blunt probe (WHO 621)
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Prevalence of dental trauma among schoolchildren
were used to identify the presence and extent of restorations or to remove debris. Evidence of tooth injury and treatment received, including a positive history of injury obtained from the subject, was recorded, in accordance with the study by Marcenes et al. 20014, Artun, and Al-Azemi 200910. Evidence of tooth injury and treatment received was also recorded from self-reported information from adolescents of positive history of teeth injuries. The examiner (PCPP) had previously undergone a training and calibration exercise and used appropriate individual protection equipment. Training was carried out with colour slides of each type of injury (Andreassen’s criteria18) in the permanent dentition, with two images of each injury. The calibration exercise was then performed by clinical examinations of 12-yearold students who did not participate in the main study. These clinical examinations were performed by two dentists. The results of the examinations were compared with the decisions of a dentist with experience in traumatology (gold standard). Intra- and interexaminer agreement was determined using the kappa index. The intervals between both examinations were 15 days. During the oral examination, other clinical variables of interest were investigated. Overjet was measured with the aid of a wooden tongue depressor with a straight tip. The bite was placed in centric occlusion, and overjet was measured from the vestibular face of the lower incisor to the incisal vestibular face of the most prominent upper incisor, with a mark made on the tongue depressor in graphite. The distance from the edge of the tongue depressor to the mark was measured using a digital calliper. A distance >5 mm was recorded as accentuated overjet. Lip protection was evaluated using the method proposed by O’Mullane9 and was considered adequate when the lips covered the upper incisors in the resting position. Assessment of alcohol intake, binge drinking, and socio-economic status The main independent variable was binge drinking and was evaluated using the Alco-
241
hol Use Disorders Identification Test – Consumption (AUDIT-C). AUDIT and AUDIT-C have been validated for use in Brazil19,20 to identify the frequency of alcohol intake and binge drinking. This questionnaire is considered adequate for use on adolescents and is both fast and easy to administer21. AUDIT focuses on current habits and considers users who exhibit initial problems with alcohol. The questionnaire is made up of ten items on recent alcohol use, symptoms of dependence, and alcohol-associated problems. As this study involved 12-year-olds, the shortversion AUDIT-C was administered, which is made up of three questions on the frequency and amount of alcohol consumption22: (1) How often did you have a drink containing alcohol in the past year? (response options: never, monthly or less, 2–4 times a month, 2–3 times a week, or four or more times a week); (2) How many drinks did you have on a typical day when you were drinking in the past year? (response options: none, 1 or 2, 3 or 4, 5 or 6, 7 to 9, or 10 or more); and (3) How often did you have five or more drinks on a single occasion in the past year? (response options: never, less than monthly, monthly, weekly, daily, or almost daily). Alcohol intake was derived from Question 1 and dichotomised as 0 (never) or 1 (monthly to 4 or more times a week). Binge drinking was derived from Question 3 and defined as five or more drinks on a single occasion16. Age at initiation regarding the consumption of alcoholic beverages was determined by the following question: How old were you when you first had an alcoholic beverage23? Privacy and confidentiality were ensured. The students self-administrated the questionnaire in the classroom in the absence of the teacher. To guard against bias due to variability in reading proficiency, the researcher read each question aloud and the students marked their responses simultaneously6,7. The questionnaire included items on sex, socio-economic status, and the location and aetiology of TDI. The following socio-economic indicators were employed: monthly household income, mother’s schooling, and type of school (public
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
242
P. C. P. Paiva et al.
or private)24. Household income was determined based on the sum of all salaries received by economically active residents in the home and categorised based on the current Brazilian minimum salary; the threshold was the median response. Mother’s schooling was defined as the number of years of study, with seven years used as the cut-off point; the threshold was the median response. The monthly household income and mother’s schooling were chosen as indicators of individual socio-economic status due to their association with dental trauma24 and binge drinking in adolescents6, respectively. These socio-economic variables were collected by a form completed by parents/guardians along with a signed letter of free and informed consent. Type of school was also used as a socioeconomic indicator7. Although this variable only allows a crude assessment, most Brazilian public schools are known to have less educational resources than private schools. Therefore, wealthier adolescents in Brazil are enrolled in private schools24. Statistical analysis Data analysis was performed using the Statistical Package for Social Sciences (SPSS for Windows, version 19.0, SPSS Inc, Chicago, IL, USA) and includes frequency distribution and association tests. Statistical significance for the association between TDI and the independent variables [binge drinking, alcohol consumption, sex, socio-economic status (household income, mother’s schooling, and type of school), lip protection, and overjet] in the bivariate analysis was determined using the chi-square test (P < 0.05). To adjust the final model and determine the independent effect of alcohol intake on the prevalence of TDI, the main independent variable (binge drinking) was first incorporated into the logistic regression analysis. The criterion for the inclusion of independent variables in each model was a P-value < 0.20 in the bivariate analysis. Results
The participation rate was 92.9% (588 of 633 students). A total of 302 (51.4%) of the par-
ticipants were female. The loss of 4.6% (n = 28) was due to refusal to participate on the part of either parents/guardians or the students themselves. The loss of 2.5% (n = 17) was due to non-responses or incoherent data. The majority (n = 542; 92.2%) was enrolled in public schools; 75.2% (n = 442) had a monthly household income of up to three times the Brazilian minimum salary; and 63.9% of the mother’s schooling (n = 376) had more than seven years of schooling. The prevalence of TDI in the permanent incisors was 29.9% (n = 176) [95% CI: 26.2– 33.6], with a total of 219 fractured teeth. Table 1 reports the frequency distribution of the 219 TDI among the 176 schoolchildren. The majority (77.02%) had only one affected tooth. The upper central incisors were the most affected (187 teeth; 85.39%). The prevalence rates of alcohol consumption in life and binge drinking were 45.6% (n = 268) [95% CI: 41.4–49.3] and 23.1% (n = 136) [95% CI: 20.2–27.0], respectively. The mean age reported regarding the consumption of an alcoholic beverage for the first time was 10.76 years (95% confidence interval [CI]: 10.65 – 10.87); however, 31 adolescents (7.6%) reported consuming alcoholic beverages for the first time between eight and nine years of age. In the bivariate analysis, the prevalence of TDI was greater among students who reported the consumption of alcoholic beverages (P = 0.030) and those who reported engaging in binge drinking (P = 0.002) (Table 2). Sex, overjet, and lip Table 1. Frequency distribution of type of injury among 176 12-year-old schoolchildren in city of Diamantina, Brazil.
Type of dental injury Enamel fracture Enamel/dentin fracture Enamel/dentin/pulp exposure Intrusive luxation Lateral luxation Extrusive luxation Avulsion Composite restoration
Absolute frequency n
Relative frequency %
92 89 4 8 1 0 0 25
42 40.64 1.83 3.65 0.46 0 0 11.41
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Prevalence of dental trauma among schoolchildren
protection were also associated with TDI in the bivariate analysis. In the adjusted multivariate logistic regression analysis, the prevalence of TDI was sigTable 2. Distribution of 588 12-year-old schoolchildren according to traumatic dental injuries and independent variables, Brazil, 2014. Traumatic dental injuries Independent variables Binge drinking No Yes Alcohol intake No Yes Lip coverage Adequate Inadequate Overjet ≤5 mm >5 mm Sex Female Male Type of school Public Private Household income Up to 3 times the minimum salary More than 3 times the minimum salary Missing Mother’s schooling 0–7 years 8 years or more Missing
P-value*
Present
Absent
(n) (%) 121 (68.8) 55 (31.3)
(n) (%) 331 (80.3) 81 (19.7)
85 (48.3) 91 (51.7)
239 (58.0) 173 (42.0)
0.030*
41 (23.3) 135 (76.7)
276 (67.0) 136 (33.0)
5 mm Female Male
(1.244–2.773)
0.002
(4.455–10.022)
