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On Dental Trauma in Children and Adolescents: Incidence, Risk, Treatment, Time and Costs
Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
2000 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Dental trauma occur in childhood and adolescence with consequences in time and costs for both patient and family. The scientific knowledge of these matters is scarce. For some individuals, dental trauma will result in long, time-consuming and costly treatments in childhood which will continue into adulthood.

Aim: The thesis aimed to increase the knowledge of incidence, risk, treatment, time and costs spent on dental traumas to primary and permanent teeth in children and adolescents.

Material and method: The material for the studies emanated from the county of Västmanland, Sweden, and the municipality of Copenhagen, Denmark, and from a Swedish nation-wide material (Folksam). The material was collected from accident reports, dental files, dental trauma forms, questionnaires and telephone interviews. Descriptive, prospective and analytical methods were used. A classification of uncomplicated and complicated dental traumas was presented.

Results: The incidence of dental trauma to boys was higher, compared to girls, in the county of Västmanland in almost all age groups. For both sexes, the first years in life and the first years in school were the most accident prone periods with incidence twice as high as the average incidence for all children and adolescents in the county. Every third trauma was complicated with injuries to the pulp or periodontal ligaments. Every second patient with a dental trauma to permanent teeth suffered from multiple dental trauma episodes (MDTE) during a period of 12 years. In almost every second patient with MDTE, at least one of the affected teeth had sustained repeated trauma episodes. The risk of sustaining MDTE increased when the first trauma episode occurred in the age interval of 6-10, compared to 11-18 year olds. During a 12-year period, treatment times for complicated traumas were 2.0 and 2.7 times higher for primary and permanent teeth, respectively, compared to corresponding values for uncomplicated traumas. On average, direct time (treatment time) represented 11% and 16% of the total time, while the direct costs (health are service, transport, loss of personal property and medicine) represented 60% and 72% of the total costs of traumas to primary and permanent teeth, respectively, during a 2-year period for cases of a nation-wide material.

Conclusion: Dental traumas are frequent and some individuals are injured several times. Besides treatment time, efforts from the family are substantial in time and costs. Parameters such as degree of severity, access to treatment and place of injury are of major importance to both patient and family and should be considered when calculating time and costs of dental trauma in children and adolescents.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2000. , 52 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 624
Keyword [en]
adolescence, child, time, incidence, costs, permanent dentition, primary dentition, risk, tooth injuries
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-5016ISBN: 91-7219-581-9 (print)OAI: oai:DiVA.org:liu-5016DiVA: diva2:20938
Public defence
2000-04-28, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Supervisors
Available from: 1999-02-27 Created: 1999-02-27 Last updated: 2012-01-24Bibliographically approved
List of papers
1. Incidence of traumatic tooth injuries in children and adolescents in the county of Vastmanland, Sweden
Open this publication in new window or tab >>Incidence of traumatic tooth injuries in children and adolescents in the county of Vastmanland, Sweden
1996 (English)In: Swedish Dental Journal, ISSN 0347-9994, Vol. 20, no 1-2, 15-28 p.Article in journal (Refereed) Published
Abstract [en]

The study reports the total incidence as well as the incidence of different types of traumatic tooth injuries in a Swedish county in the age interval 0-19 years during 1989/90. The incidence of individuals experiencing tooth injuries was 13 per 1000 per year. Boys were more frequently injured in the age-groups 3-4 years and 7-9 years and girls, in the age-group 5-6 years. A method is presented defining uncomplicated and complicated tooth injuries as a basis for estimating the economic consequences of these injuries in the community. Boys more often suffered uncomplicated injuries to permanent teeth and girls, to primary teeth (p < 0.05). The same distribution was found for uncomplicated multiple tooth injuries. Boys sustained more uncomplicated hard tissue injuries and girls, more uncomplicated luxation injuries (p < 0.01). Using a classification according to the most serious tooth injury in each episode, 33% of the episodes had resulted in complicated injuries in which the pulpal tissue and/or periodontal membrane was severely damaged.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13543 (URN)
Available from: 1999-02-27 Created: 1999-02-27 Last updated: 2009-02-12
2. Risk evaluation and type of treatment of multiple dental trauma episodes to permanent teeth
Open this publication in new window or tab >>Risk evaluation and type of treatment of multiple dental trauma episodes to permanent teeth
2000 (English)In: Endodontics & dental traumatology., ISSN 0109-2502, Vol. 16, no 5, 205-210 p.Article in journal (Refereed) Published
Abstract [en]

Studies have shown that some children and adolescents are effected only once with a dental trauma, while others seem to be accident-prone and suffer from multiple dental trauma episodes (MDTE). Studies have also shown that dental traumas mostly affect upper permanent and medial incisors. Less is known about treatment consequences related to teeth with repeated dental trauma episodes. The aim was therefore to evaluate the risk of MDTE to permanent teeth among children and adolescents by age and gender and to compare types of dental treatment modalities used for patients with one episode and those with MDTE and with single and repeated traumatized teeth. The study was based on a random sample of 83 Danish 6-18-year-old children and adolescents born in 1970 who suffered from dental trauma episodes. All patients were followed during a 12-year period (1976-1988). Forty-one of the patients were registered with MDTE with a range of 2-7 episodes and a mean of 2.9 episodes/patient (SD = 1.1). The mean age at single and MDTE was 11.4 years (SD = 3.6) and 8.6 years (SD = 2.1), respectively. No significant differences were found between age at first episode and the number of MDTE per patient. The number of patients with MDTE was significantly higher among those who suffered their first trauma episode in the age interval 6-10 years than in the age interval 11-18 years (P < 0.001). A survival analysis showed that the risk of sustaining another trauma episode increased by 14.9-30.3% when the first trauma occurred before the age of 11, compared to 0-7.4% after the age of 10. The risk of sustaining multiple injuries was 8.4 times higher when the first trauma episode occurred at 9 years of age, compared with those occurring at age 12. The survival analysis also showed that for every new trauma episode, the interval between them became closer. Forty-five per cent of the MDTE affected teeth had already sustained an injury. With an increased number of trauma episodes per patient followed an increase in the number of follow-ups, filling therapy, information and prosthetics, whereas the rates of endodontics, surgery, and consultations were unchanged or even decreased.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13544 (URN)
Available from: 1999-02-27 Created: 1999-02-27
3. Type of treatment and estimation of time spent on dental trauma--a longitudinal and retrospective study
Open this publication in new window or tab >>Type of treatment and estimation of time spent on dental trauma--a longitudinal and retrospective study
Show others...
1998 (English)In: Swedish Dental Journal, ISSN 0347-9994, Vol. 22, no 1-2, 47-60 p.Article in journal (Refereed) Published
Abstract [en]

The consequences of traumatic tooth injuries (dental trauma) are time-consuming and costly treatment and follow-ups, of which our knowledge is scarce. Consequently the aim of the present study was to measure the total time of treatment of uncomplicated and complicated traumas to primary and permanent teeth. The study was performed in three steps based on a randomly selected sample of Danish children and adolescents living in the municipality of Copenhagen, Denmark: (I) A descriptive analysis of traumas affecting 106 children and adolescents all born in 1970 and randomly chosen among the total number of patients treated. Treatments took place between 1972 and 1988. (II) A study of the time and frequency of different types of emergency and planned treatment estimated by 14 dentists employed by the municipal dental service. (III) Calculation of the total treatment time on the basis of the results from (I) and (II). The most common traumas were luxations of primary teeth and fractures of permanent teeth. The most frequent treatments dealt with were uncomplicated crown fractures and luxations followed by other different diagnoses of complicated traumas. The treatment time for primary teeth for uncomplicated traumas were used mostly for information, while the time for complicated traumas was used for follow-ups. The treatment time for traumas to permanent teeth was dominated by follow-ups, irrespective of the complication status. Only 3% of uncomplicated traumas of permanent teeth resulted in endodontic treatment, compared to 67% with complicated traumas. Uncomplicated traumas to primary teeth required a total of 2.5 visits and 0.8 hrs treatment time, while 4.3 visits and 1.6 hrs per individual were used for complicated traumas. For permanent teeth with uncomplicated traumas 9.2 visits and 3.2 hrs were required, and for complicated traumas 16.4 visits and 8.5 hrs per individual. The respective treatment times for complicated traumas for primary and permanent teeth were 2.0 and 2.7 times higher, compared to the corresponding uncomplicated traumas. There were no gender differences in type of injury and number of visits for injuries to primary and permanent teeth.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13545 (URN)
Available from: 1999-02-27 Created: 1999-02-27 Last updated: 2009-02-12
4. Direct and indirect time spent on care of dental trauma: a 2-year prospective study of children and adolescents
Open this publication in new window or tab >>Direct and indirect time spent on care of dental trauma: a 2-year prospective study of children and adolescents
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2000 (English)In: Endodontics and dental traumatology, ISSN 0109-2502, Vol. 16, no 1, 16-23 p.Article in journal (Refereed) Published
Abstract [en]

The aim was to account for the total time spent by professional care-givers (direct time) and by patients and companions engaged as support and help (indirect time) to treat and otherwise attend to children and adolescents with dental trauma to primary and permanent teeth. The study was based on a random sample of 192 children and adolescents with dental traumas reported to an insurance company and prospectively followed up by telephone interviews over a period of 2 years after the trauma episode. On average, direct time represented 16% of total time for all visits for dental trauma to permanent teeth and 11% for trauma to primary teeth. The most extensive type of indirect time was transport time, which took up 30% of the total time spent on injuries to permanent teeth and 36% for injuries to primary teeth. Multiple regression analysis of the impact of dental and demographic injury variables on the time variables showed that complicated trauma was associated with extended time, direct as well as indirect, for permanent and primary teeth injuries. Our estimate of the average relative increase in total time spent by patients and companions in cases of complicated injury to permanent teeth was 117% (95% confidence interval [CI], 52-211) for patients and 112% (95% CI, 42-217) for companions. For transport time a strong predictor was access to a dental clinic near the place of residence. Lack of access could extend the average transport time by 180% (95% CI, 80-335) for patients and 163% (95% CI, 67-317) for their companions in cases of injuries to primary teeth.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13546 (URN)
Available from: 1999-02-27 Created: 1999-02-27 Last updated: 2009-02-12
5. Direct and indirect costs of dental trauma in Sweden: a 2-year prospective study of children and adolescents
Open this publication in new window or tab >>Direct and indirect costs of dental trauma in Sweden: a 2-year prospective study of children and adolescents
2001 (English)In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, Vol. 29, no 2, 150-160 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To study total costs, including direct costs (health care service, loss of personal property, medicine and transport) and indirect costs (loss of production or leisure) of dental trauma to children and adolescents with special reference to predictors.

METHODS: The study was based on a random sample of 192 children and adolescents with a dental trauma reported to an insurance company and prospectively followed up by telephone interviews over a period of 2 years.

RESULTS: On average, health care service costs represented 2,955 SEK (SD=3,818) and total costs 4,569 SEK (SD=3,053) for dental trauma to permanent teeth, and 837 SEK (SD=898) and 1,746 SEK (SD=1,183) for trauma to primary teeth. The most extensive type of indirect cost was loss of production or leisure, which averaged 1,286 SEK (SD=1,830) for injuries to permanent teeth and 699 SEK (SD=1,239) for injuries to primary teeth. Multiple regression analysis of demographic and dental injury variables showed that complicated trauma was of special importance to costs for permanent and primary teeth injuries. The average relative increase in total costs to patients and companions for complicated injury to permanent teeth was 140% (95% confidence interval [CI], 66-248%) for patients and 132% (95% CI, 54-249%) for companions. Lack of access to a dental clinic near the place of residence could increase the average total costs of injuries to permanent teeth by 91% for companions (95% CI, 20-204%) and for primary teeth by 134% (95% CI, 38-296%).

CONCLUSIONS: Dental traumas result in both direct and indirect costs, with a predominance of direct costs. The direct costs primarily depend on degree of severity, while indirect costs are mostly due to compromised access to health care service. Traumas to permanent teeth are especially costly and, due to additional maintenance, the care may continue for several years. This study has drawn attention to the significant implications of dental trauma to patient and companion, a new area where further studies are warranted.

Keyword
adolescence, child, tooth injuries, costs, permanent dentition, primary dentition, regression analysis
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13547 (URN)10.1111/j.1600-0528.2001.290210.x (DOI)
Available from: 1999-02-27 Created: 1999-02-27 Last updated: 2009-05-15

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