Dental trauma has become a significant public health concern in childhood since it is widespread and cases are frequent. Its prevalence, like in most dental cases, varies vastly according to age and population. Within the population and age factors also lies the hand of socioeconomic conditions. In previous decades, much attention has been given to one’s living with regard to problems in oral health. Environmental conditions such as hazards in school, walkways, playgrounds, streets, neighbourhood and most especially one’s home may increase the risk of harm to a child’s oral health through dental trauma.
However, this linkage of traumatic dental injury, or TDI, to socioeconomic status does not come without controversy and debate. Most studies that try to establish an association between the two usually base their outcome on employment status, the level of education attained by the parents, family income and such indices. Individual characteristics that are normally associated with TDI, wherein males usually attain more tooth injuries than females and children who have an increased overjet are more exposed to the risk of TDI, also suggest that the area of infrastructure where the children reside in is possibly another factor that influences TDI cases among children. Studies have also shown an association between TDI prevalence and environment as well as social capital factors. It was reported that lesser prevalence was observed among boys who live in higher-level areas of the social capital, but the studies for girls have been found inconsistent.
Health condition differences may be given light to by environmental hazards and such findings may help craft appropriate health policies. It is, therefore, clamorous to conduct an in-depth analysis of family incomes, neighbourhood infrastructure, residential property values, government social support, location and type of school, general physical environment, family composition, as well as the family’s access to sanitation services, education, work and healthcare. Assessment of TDI cases is based on factors of a wide variety such as anatomy, pathology, treatment and aetiology, depending on various existing criteria such as the World Health Organization’s, Ellis’, Andreasen’s and the like.
Since each population has its own distinct attributes, the prevalence of TDI cases varies. A Brazilian study showed that permanent tooth injury cases range from 10% to 58% of a total sample population of schoolchildren. In other European countries, studies of prevalence showed 17.4% in Spain, 44.2% in the United Kingdom and 34.4% in England. Canada garnered the lowest percentage at 11.4% while Thailand resulted in 35% prevalence. A more specific part of Brazil, Belo Horizonte, showed that TDI cases on permanent teeth increased from 8% at nine years old to about 16% at 14 years old.
Aside from the differences in age and location, variation in prevalence results may also be based on the diagnostic criteria of TDI studies. A supplement study in Brazil shows that 11.44 out 1000 TDI cases involved permanent incisors. The study also states that children who have previously suffered from TDI are at a 4.85% greater risk of suffering from another episode. In general, more males experience TDI as compared to females.
TDI causes are not as hypothetical as a lot of other dental concerns, in fact, the causes are quite known. Main reported causes of TDI are collisions with inanimate objects or people and falls, violence, sports and traffic incidents. Other factors that affect permanent tooth injury include increased incisal tooth overjet and insufficient lip coverage. Another significant factor in TDI cases is child behaviour. A strong hypothesis as to why TDI cases are more prevalent in males than females is attributed to the fact that boys tend to engage in more dangerous activities, therefore marking behaviour as a strong influencer in the gender-based classification.
The various associations of risk factor components make some indicators even more complex, on the other hand enabling the target population’s socioeconomic status to appear more realistic and accurate. Individual components have differences in socioeconomic indicators that act as determinants of complexity and quality. This fact alone prevents comparison between various studies due to the heterogenic nature of TDI criteria variation.
Among studies of traumatic dental injury, only a handful correlates socioeconomic indicators and the prevalence of TDI. While general results point to a higher prevalence in lower socioeconomic groups, there has been, to date, no solid conclusion regarding the association of the two, often resulting in the conflicting and unclear outcome. TDI prevalence among young British people was reported to be greater in lower socioeconomic groups as compared to upper and middle socioeconomic groups. Inconsistently, a Brazil study reports a greater prevalence in higher socioeconomic groups. Interestingly, on the other hand, the study finds that this seems to be the case because of the higher percentage of access to swimming pools, ownership of bicycles, skateboards, rollerblades and the like, as well engaging in activities such as horseback riding, as compared to those who hail from lower socioeconomic groups. Additionally, the study shows that even affluent family-born children in developing countries instinctively tend to play in environments with moderate to high risk of danger due to natural curiosity. Children in developed countries who are born into affluent families otherwise tend to be isolated in a safer environment.
A recent study reported that environments which practice proper adult supervision such as safety protocols included in school curriculums, community activities, the involvement of parents in school matters, as well as lower incidences of absenteeism, punishment and violence lower the risk of permanent teeth injury. It has been found, however, that the physical environment has less significant effect as compared to the social environment with regard to permanent teeth injuries, which may be a result of a sufficiently good physical environment in the schools that were included in the study. It is therefore encouraged to adopt policies for health and safety policies and physical environment protocols, as these will have a positive effect on the prevalence of dental trauma.
To reiterate, several studies have suggested that TDI occurrences are a result of various environmental and physical characteristics, individual indicators of socioeconomic status and sanitary conditions. It may be essential to standardise classification methodologies when studying the association of dental trauma and socioeconomic factors in order to obtain results that are more accurate of the reality of the general population.