Original Research

Pediatric Dentistry

Prevalence of and factors associated

with enamel fracture and other traumas
in Brazilian children 8–10 years old

Fernanda Bartolomeo FREIRE-MAIA(a) Abstract: The aim of this study was to assess the prevalence and
Sheyla Márcia AUAD(a) discriminate the associated factors between enamel fractures and other
Mauro Henrique Nogueira
Guimarães de ABREU(b) trauma/trauma sequelae in 8 to 10-year-old Brazilian schoolchildren.
Fernanda SARDENBERG(a) A representative sample of 1,201 children from public and private
Milene Torres MARTINS(c) schools were enrolled in this cross-sectional study. Questionnaires
Saul Martins PAIVA(a)
Isabela Almeida PORDEUS(a) about sociodemographic characteristics were answered by parents. The
Miriam Pimenta VALE(a) outcome variable (traumatic dental injury, TDI) was multi-categorized.
Independent individual variables were sex, age, number of residents in
Universidade Federal de Minas Gerais –
(a) household, parents/caregivers’ level of education, family income, dental
UFMG, School of Dentistry, Department of caries, and overjet. Type of school was considered an independent
Paediatric Dentistry and Orthodontics, Belo
Horizonte, MG, Brazil. contextual variable. Multilevel analysis, bivariate, and multivariate
multinomial logistic regression models were performed. The prevalence
Universidade Federal de Minas Gerais –
(b)

UFMG, School of Dentistry, Department of of TDI was 14.0% (2.8% with other trauma/trauma sequelae). The
Community and Preventive Dentistry, Belo multilevel analysis revealed no significant difference between the type
Horizonte, MG, Brazil. of school and TDI. The multinomial logistic regression showed that
Universidade Estadual de Montes
(c) boys (OR = 2.3; 95%CI: 1.1–4.8), older children (OR = 1.8; 95%CI: 1.1–3.0)
Claros – Unimontes, School of Dentistry, and individuals with an overjet > 3 mm (OR = 2.5; 95%CI: 1.0–6.2) were
Department of Paediatric Dentistry, Montes
Claros, MG, Brazil.
more likely to present other trauma/trauma sequelae. Enamel fracture
was not significantly associated with any variables. The prevalence of
TDI in 8 to 10-year-old schoolchildren was 14% but only 2.8% of other
trauma/trauma sequelae. Differences regarding the associated factors
Declaration of Interests: The authors
of TDI involving enamel fracture or other trauma/trauma sequelae
certify that they have no commercial or
associative interest that represents a conflict were detected, suggesting that the different TDI classification cannot be
of interest in connection with the manuscript. evaluated as a single category. 

Keywords: Tooth Injuries; Child; Dentition, Permanent.

Corresponding Author:
Fernanda Bartolomeo Freire-Maia
E-mail: fernandabartolomeo@gmail.com
Introduction

Traumatic dental injury (TDI) can be an irreversible oral condition

https://doi.org/10.1590/1807-3107bor-2018.vol32.0089
characterized by life-long debilitating effects, such as pain and aesthetic,
psychological, social, therapeutical, and financial problems.1 In addition,
TDI might also impact on the oral health-related quality of life (OHRQoL)
of young patients and their families.2,3 TDI in permanent teeth is a
common oral disorder, and according to a recent meta-analysis, is
Submitted: June 08, 2017
estimated to affect around 20% of children,4 being most frequent in 8
Accepted for publication: July 04, 2018
Last revision: July 18, 2018 to 10-year-old individuals.5,6 TDI can vary from a small concussion or
enamel fracture, to complicated crown fractures or large displacements,

Braz. Oral Res. 2018;32:e89 1

 Prevalence of and factors associated with enamel fracture and other traumas in Brazilian children 8–10 years old

and to tooth loss.7 Although enamel fractures have of Belo Horizonte, from April to October 2010. Belo
minor consequences and may not even be noticed Horizonte is the capital of the state of Minas Gerais,
by the affected individuals and their families,8,9,10,11,12 which is located in the southeastern region of Brazil,
other trauma, considerably more visible and/or and has a population of approximately 2,375,151
severe, may be considered a serious public oral inhabitants distributed across nine administrative
health problem.13 districts.18 Type of school (public and private) was
Despite the different consequences of enamel considered a contextual variable. In Brazil, type of
fracture and other trauma, there are few studies school is indicator of socioeconomic condition where
assessing those differences, especially in children children from higher socioeconomic conditions
aged 8 to 10 years. Most previous studies assessing generally attend private schools and children from
TDI focused on a binary outcome (present or absent) lower socioeconomic conditions mainly attend
including enamel fracture in the same category of public schools.16
other trauma.9,10 There are few published statistical To ensure representativeness, the sample was
models available that evaluate the prevalence of and stratified according to the nine administrative districts.
factors associated with TDI classifying this outcome The first stage was the randomization of public and
in multiple categories of severity.14,15 private schools in each administrative district of
Studies addressing the prevalence and associated the city. In the second and third stages, classes and
factors of oral disorders are vital for the establishment children were randomly chosen from the selected
of preventive and/or educative measures in the public schools (proportionally to the total number of children
healthcare system. Indeed, there has been a need for enrolled in the schools).
the development of evidence-based recommendation
to guide public authorities and oral healthcare policy Sample size calculation
makers. Therefore, the aim of this study was to assess A sample of 1,201 children allowed a power of
the prevalence and discriminate the associated factors 99.9%, and 95% confidence interval (CI), based on
between enamel fracture and other trauma in 8 to a previous Brazilian study on association between
10-year-old children. dental trauma with overjet (overjet < 3mm: 13.1%,
overjet > 3mm: 28.6%). 19
Methodology
Eligibility criteria
Ethical issues The inclusion criteria consisted of children aged
The research project was approved by the Human 8 to 10 years and the presence of upper and lower
Research Ethics Committee of the Universidade permanent incisors. The exclusion criteria were
Federal de Minas Gerais, Belo Horizonte, Brazil children wearing fixed orthodontic appliance and
(Parecer no. 0465.0.203.000-09). Written statements of with cognitive disorders, according to the report of
consent were read and signed by parents/caregivers their teachers.
and children prior to their participation in the study.
The present study was part of a previous cross- Pilot study and calibration
sectional survey in which other outcomes were A pilot study was carried out to test the feasibility
measured, such as dental caries and malocclusion.16,17 of the study, the dental examination, and the
questionnaires; the method proposed was feasible.
Sampling and setting The examination was carried out by two dentists
A cross-sectional study was conducted involving who were previously trained and calibrated for
a representative sample of 1,201 schoolchildren aged each clinical condition. The calibration process
8 to 10 years, randomly selected through a multistage involved theoretical and clinical exercises.16,17
sampling method from an initial population of 97,487 TDI was evaluated through Andreasen criteria.20
children, registered at public and private schools The Dental Aesthetic Index (DAI) criteria were

2 Braz. Oral Res. 2018;32:e89

 Freire-Maia FB, Auad SM, Abreu MHNG, Sardenberg F, Martina MT, Paiva SM et al.

used for malocclusion. 21 In this study, however, asked about their children’s dental status. Therefore,
for malocclusion assessment, only overjet was there was no comparison between questionnaires’
considered.22 Inter-examiner kappa ranged from 0.71 data and clinical data.
to 1.00 after examination of 70 children (TDI = 0.71;
malocclusion= 1.00). Intra-examiner kappa values Statistical analyses
were between 0.90 and 1.00 after examination Data were analyzed using the Hierarchical Linear
of 50 children two weeks later (TDI = 0.90; 0.91; and Nonlinear Modeling (HLM for Windows, version
malocclusion= 0.93; 1.00).23 6.06, Scientific Software International Inc., USA) to
perform multilevel analyses and the Statistical Package
Data collection for the Social Sciences (SPSS for Windows, version
Clinical data such as TDI and overjet were collected 19.0, SPSS Inc., Chicago, IL, USA) for descriptive,
by clinical examination carried out in schools. The bivariate, and multivariate multinomial logistic
oral examination was performed in classrooms by regression analyses. This study used “no trauma”
two dentists previously calibrated, using sterile as the reference category. The “enamel fracture” and
clinical mirrors and wooden spatulas, under natural “other trauma/trauma sequelae” categories were
light; radiographs were not taken. The dependent compared with “no trauma”.14
variable of interest (TDI) was categorized in no In the first step, multilevel analyses were used to
trauma, enamel fracture, and other trauma/trauma evaluate the association of contextual and individual
sequelae (which included: enamel-dentin fracture variables with enamel fracture and other trauma/
with or without pulp involvement, lateral luxation, trauma sequelae.24 Following the descriptive analysis,
intrusion, extrusion, avulsion, teeth discoloration bivariate multinomial logistic regression models
and filling of fractured teeth).20 were developed individually to identify explanatory
Parents/caregivers answered a self-administered variables (sex, children’s age, family income, number
structured questionnaire that included demographic of residents in household, parents/caregivers level of
and socioeconomic variables. The sociodemographic education, and overjet) associated with the outcomes.
data included sex, age, family income, number of Variables with p value lower than 0.20 were included
residents in household, and parents/caregivers in the multivariate multinomial logistic regression.
level of education. Family income used the current Independent variables that did not present significant
Brazilian Monthly Minimum Wage in 2010 (BMMW association with the outcome variable were removed
= U$ 258.33). Level of education was measured in from the model one by one, in least significance order.
number of school years (Figure 1). They were not Explanatory variables with p value lower than 0.05

Independent Variables n = 1,201

Sociodemographic characteristics
Age (8, 9, 10 years of age)
Sex (male and female)
Clinical outcomes
Overjet (≥ 3mm and > 3mm)
Socioeconomic indicators

Family income: > 2 minimum wages and ≤ 2 minimum wages (< U$ 516,66)
Number of residents in household: ≤ 4 people and > 4 people
Parents’/caregivers’ level of education: ≤ 8 years of study and > 8 years of study
Types of school: public and private

Figure. Explanatory variables.

Braz. Oral Res. 2018;32:e89 3

 Prevalence of and factors associated with enamel fracture and other traumas in Brazilian children 8–10 years old

were maintained in the final model. Adjusted odds The maxillary central incisors were the teeth
ratios (95%CI) were also calculated.16,23 most frequently affected (68.1%). The most frequent
type of TDI was enamel fracture (81.4%), followed by
Results fractured enamel-dentin (8.3%), complicated crown
fracture (2.6%), discoloration (2.6%), avulsion (1.5%),
Out of the 1,201 schoolchildren, 44.6% were and 7.8% children had restorative treatment on the
boys. The mean age was 9.8 years (SD = 0.80). traumatized teeth. The most prevalent other trauma/
Table 1 shows information about distribution of trauma sequelae was enamel-dentin fracture without
dependent and independent variables among pulp involvement (44.7%).
participants. The prevalence of children with TDI Table 2 shows the analyses of the final estimation
was 14%: 11.2% with enamel trauma (n = 135) and of variance components of the “null model” in the
2.8% with other trauma/trauma sequelae (n = 34). multilevel approach, which revealed no significant
Two hundred and four permanent teeth (204) were difference between type of school (public or private)
involved. Most of the children with TDI had only and enamel fracture and other trauma/trauma
one affected tooth (139; 82.2%); 27 (16.0%) had two sequelae in permanent teeth (p > 0.05). Therefore,
teeth affected, and three children (1.8%) had three type of school was not included in the bivariate and
teeth affected. multivariate multinomial logistic regression analyses.

Table 1. Frequency of independent variables for the total sample and by types of TDI (n = 1,201), Belo Horizonte, 2010.
Variable Total No trauma Enamel trauma Other trauma/trauma sequelae
Sex
Female 536 (44.6%) 582 (87.5%) 71 (10.7%) 12 (1.8%)
Male 665 (55.4%) 450 (84.0%) 64 (11.9%) 22 (4.1%)
Age (years)
8 338 (28.1%) 300 (88.8%) 32 (09.5%) 6 (1.8%)
9 427 (35.6%) 370 (86.7%) 50 (11.7%) 7 (1.6%)
10 436 (36.3%) 362 (83.0%) 53 (12.2%) 21 (4.8%)
Overjet (mm)
≤3 1105 (92.1%) 951 (86.1%) 127 (11.5%) 27 (2.4%)
>3 95 (7.9%) 81 (85.3%) 7 (7.4%) 7 (7.4%)
Family income (minimun wages)
>2 604 (50.8%) 530 (87.7%) 65 (10.8%) 9 (1.5%)
≤2 585 (49.2%) 490 (83.8%) 70 (12.0%) 25 (4.3%)
Residents in home (persons)
≤4 720 (60.8%) 625 (86.8%) 78 (10.8%) 17 (2.4%)
>4 464 (39.2%) 391 (84.3%) 56 (12.1%) 17 (2.7%)
Parents/caregivers level of education (years of study)
>8 772 (64.5%) 670 (86.8%) 87 (11.3%) 15 (1.9%)
≤8 425 (35.5%) 358 (84.2%) 48 (11.3%) 19 (4.5%)
Type of school
Private 283 (23.6%) 252 (89.0%) 26 (9.2%) 5 (1.8%)
Public 918 (76.4%) 780 (85.0%) 109 (11.9%) 29 (3.2%)

4 Braz. Oral Res. 2018;32:e89

 Freire-Maia FB, Auad SM, Abreu MHNG, Sardenberg F, Martina MT, Paiva SM et al.

The bivariate multinomial logistic regression Table 4 shows the multivariate multinomial
model is shown in Table 3. Enamel fracture was not logistic regression. Sex, age, and overjet maintained
significantly associated to any independent variable. a significant association with other trauma/trauma
Severe trauma was significantly associated with sex, sequelae. Boys, older children, and individuals
age, overjet, family income, and parents/caregivers with an overjet > 3 mm were more likely to have
level of education. Boys, older children, individuals other trauma/trauma sequelae. The association
with an overjet greater than 3 mm, and individuals of family income and level of education and
whose families had a lower income and parents/ other trauma/trauma sequelae was attenuated
caregivers with a lower level of education were more a nd lost st at i st ica l sig n i f ica nce ( p = 0.085;
likely to present other trauma/trauma sequelae. p = 0.444, respectively).

Table 2. Final estimation of variance components in the multilevel analysis (“null-model”).

Standard
Variable Random effect Variance component df Chi-square p-value ICCa
deviation
Enamel fracture INTRCPT1, U0 (0) 0.37681 0.14198 18 1.896.379 0,394 0.04 = 4%
Other trauma/ trauma sequelae INTRCPT1, U0 (1) 0.37834 0.14314 18 1.679.525 > 0,500 0.04 = 4%
a
Intraclass correlation coefficient (ICC): fraction of the total variance that is due to the contextual level.

Table 3. Bivariate multinomial logistic regression model of factors associated with TDI (n = 1,201), Belo Horizonte, 2010.
Other trauma/ X No trauma
Enamel trauma X no trauma
trauma sequelae
Variable
Unadjusted OR Unadjusted OR
p-valor p-valor
(95%CI) (95%CI)
Sex
Female 1.00   1.00  
Male 1.17 (0.81–1.67) 0.403 2.37 (1.16–4.84) 0.018
Age (years)
8        
9        
10 1.16 (0.93–1.46) 0.192 1.92 (1.19–3.10) 0.008
Overjet (mm)
≤3 1.00   1.00  
>3 0.65 (0.29–1.43) 0.647 3.04 (1.29–7.21) 0.011
Family income (minimum wages)
>2 1.00   1.00  
<2 1.17 (0.81–1.67) 0.405 3.01 (1.39–6.50) 0.005

Residents in home (persons)

≤4 1.00   1.00  
>4 1.15 (0.80–1.65) 0.461 1.60 (0.81–3.17) 0.179
Parents/caregivers’ level of education (years of study)
>8 1.00   1.00  
≤8 1.03 (0.71–1.50) 0.867 2.37 (1.19–4.72) 0.014

Braz. Oral Res. 2018;32:e89 5

 Prevalence of and factors associated with enamel fracture and other traumas in Brazilian children 8–10 years old

Table 4. Multivariate multinomial logistic regression of factors associated with TDI (n = 1,201), Belo Horizonte, Brazil, 2010.
Other trauma/ X No trauma
Enamel trauma X No trauma
trauma sequelae
Variables
Adjusted OR Adjusted OR
p-valor p-valor
(95%CI) (95 CI)
Sex
Female 1.00   1.00  
Male 1.19 (0.83–1.71) 0.344 2.34 (1.13–4.84) 0.021
Age (years)
8        
9        
10 1.20 (0.95–1.51) 0.134 1.81 (1.11–2.96) 0.018
Overjet (mm)        
≤3 1.00   1.00  
>3 0.62 (0.28–1.38) 0.241 2.55 (1.05–6.20) 0.040
OR: odds ratio; 95%CI: Confidence Interval at 95%; adjusted by multinomial logistic regression method for all the variables listed in the table.
For this analysis, the reference group was child without trauma.

Differences regarding the associated factors of TDI

Discussion involving enamel fracture or other trauma/trauma
sequelae were also detected in the present study. While
Since TDI in permanent teeth is most frequent in other trauma/trauma sequelae showed a significant
8 to 10-year-old individuals,1,5,6 representing a special association with sex, age, and overjet, enamel fracture
risk group, this study was limited to this age group. was not associated with any of those variables. One could
Furthermore, they have distinct clinical characteristics argue that minor occurrences on enamel could happen
as they have mixed dentition. The present study showed at any time regardless the aforementioned variables.
that children of 10 years of age also presented more For instance, enamel fractures may be associated with
trauma/trauma sequelae. As TDI is an accumulative more simple factors, such as misuse of teeth with pencils
event, a higher prevalence is expected in older children. and bottle caps or an accidental bite on hard food.30,31
This finding may also be explained by the longer As such, studies that include enamel fracture and
exposure of teeth to reckless activities in this age other trauma/trauma sequelae as a single category of
group, increasing the liability to injuries.1,12,25,26 TDI and evaluate its consequences, such as treatment
The results show a relatively high prevalence of seeking,10 impact on OHRQoL,9,32,33,34 or even the
TDI, when considering enamel fractures and other relationship with associated factors,27 may not find a
trauma/trauma sequelae in a single category. Among the significant association between those variables and TDI.
observed TDI, the majority of cases was limited to enamel, This may happen because enamel fracture is an outcome
corroborating the findings of previous epidemiological of higher prevalence compared to other trauma/trauma
studies conducted in schools.27,28 This shows that the sequelae,14,35 and has a minor impact on the lives of the
prevalence of TDI in the permanent dentition is higher affected individuals and their families.8,9,10,11,12
when enamel fractures are included. Other trauma/ This study confirms that boys are more likely to
trauma sequelae, more visible and/or severe, are not be affected by TDI. This finding may be related to the
only related to physical inabilities, such as pain and fact that boys are more involved in acts of violence and
functional limitations, but it may also have psychosocial engaged in sports and leisure activities.29,36 However,
consequences and a negative impact on OHRQoL. some authors emphasized that this difference has
Therefore, individuals affected by other trauma/trauma been reduced by the increased participation of girls
sequelae seek dental treatment more frequently.2,11,29 in risky outdoor activities.4,5

6 Braz. Oral Res. 2018;32:e89

 Freire-Maia FB, Auad SM, Abreu MHNG, Sardenberg F, Martina MT, Paiva SM et al.

The results of the present study showed that an overjet root resorptions, pulp necrosis, and pulp calcifications.
greater than 3 mm was a predisposing factor to other In addition, the study has a cross-sectional design and,
trauma/trauma sequelae. Indeed, an increased overjet thus, the data do not support a causality relationship
is related to the proclination of anterior permanent between the associated factors examined and TDI.
teeth, which leads to an inadequate lip coverage.22 The results of the present study may be useful for
In the literature, the association between TDI and practical purposes. Our findings suggest that enamel
socioeconomic indicators is unclear. Our findings fracture should be considered a separate category of other
showed that children whose families earn less than trauma/trauma sequelae, especially when evaluating the
two times the Brazilian minimum wage per month and consequences of the injury and in the identification of
have less than eight years of study were more likely to populations at higher risk of TDI. This strategy should
have other trauma/trauma sequelae in the bivariate be considered in the design and implementation of oral
analysis. Individuals with families with a lower income health public services. The present study demonstrates
and lower level of education usually live in poorer the need for the implementation of preventive and
areas, where leisure facilities are more deteriorated and therapeutic strategies for individuals at risk for TDI as
unsafe, and the social environment is less supportive.26 well as their families. Preventive strategies should also
However, socioeconomic status lost significance in the include the improvement of the environment where
final model, demonstrating that children are subject to those individuals live.
TDI, regardless of socioeconomic status. Further studies using a stronger design, such as
Although no significant difference in the prevalence a case-control and longitudinal assessments will be
of TDI between children of public and private schools required to entirely confirm the associations reported
was found, this issue must be addressed. Children herein. Taking into account that the type of trauma
spend a significant amount of their time in the school may vary according to the place where the study is
and the discussion about healthy environments is conducted, future evaluations should also be carried
thus important. Unsafe and overcrowded places out in reference centers for TDI and emergency
facilitate falls and collisions and, therefore, have been services in hospital settings, where other trauma/
considered a major factor related to TDI. Moreover, trauma sequelae cases are more likely to be notified.
schools should be committed towards a more
favorable social environment. They are considered Conclusion
an appropriate setting for health promotion for
children through the encouragement of healthier The prevalence of TDI in 8 to 10-year-old
habits and friendlier relationships.37 schoolchildren was 14% but only 2.8% were other
The present evaluation has limitations that should trauma/trauma sequelae. Differences regarding the
be acknowledged. The study was conducted in schools associated factors of TDI involving enamel fracture
without the use of radiographs for the diagnosis of TDI. or other trauma/trauma sequelae were detected,
Therefore, the prevalence of this condition may have suggesting that these the two occurrences should
been underestimated due to undiagnosed root fractures, not be evaluated as a single category.

References

1. Patel MC, Sujan SG. The prevalence of traumatic dental 2. Bendo CB, Paiva SM, Abreu MH, Figueiredo LD,
injuries to permanent anterior teeth and its relation Vale MP. Impact of traumatic dental injuries among
with predisposing risk factors among 8-13 years school
adolescents on family’s quality of life: a population-
children of Vadodara city: an epidemiological study. J
Indian Soc Pedod Prev Dent. 2012 Apr-Jun;30(2):151-7. based study. Int J Paediatr Dent. 2014 Sep;24(5):387-96.
https://doi.org/10.4103/0970-4388.99992 https://doi.org/10.1111/ipd.12083

Braz. Oral Res. 2018;32:e89 7

 Prevalence of and factors associated with enamel fracture and other traumas in Brazilian children 8–10 years old

3. Ramos-Jorge J, Paiva SM, Tataounoff J, Pordeus IA, 15. Freire MC, Vasconcelos DN, Vieira AS, Araújo JA,
Marques LS, Ramos-Jorge ML. Impact of treated/untreated Moreira RS, Nunes MF. Association of traumatic dental
traumatic dental injuries on quality of life among Brazilian injuries with individual-, sociodemographic- and school-
schoolchildren. Dent Traumatol. 2014 Feb;30(1):27-31. related factors among schoolchildren in midwest Brazil.
https://doi.org/10.1111/edt.12048 Int J Environ Res Public Health. 2014 Sep;11(9):9885-96.
4. Aldrigui JM, Jabbar NS, Bonecker M, Braga MM, Wanderley https://doi.org/10.3390/ijerph110909885
MT. Trends and associated factors in prevalence of dental 16. Martins MT, Sardenberg F, Abreu MH, Vale MP, Paiva
trauma in Latin America and Caribbean: a systematic review SM, Pordeus IA. Factors associated with dental caries
and meta-analysis. Community Dent Oral Epidemiol. 2014 in Brazilian children: a multilevel approach. Community
Feb;42(1):30-42. https://doi.org/10.1111/cdoe.12053 Dent Oral Epidemiol. 2014 Aug;42(4):289-99.
5. Oldin A, Lundgren J, Nilsson M, Norén JG, Robertson https://doi.org/10.1111/cdoe.12087
A. Traumatic dental injuries among children aged 17. Sardenberg F, Martins MT, Bendo CB, Pordeus IA, Paiva SM,
0-17 years in the BITA study - a longitudinal Swedish Auad SM et al. Malocclusion and oral health-related quality
multicenter study. Dent Traumatol. 2015 Feb;31(1):9-17. of life in Brazilian school children. Angle Orthod. 2013
https://doi.org/10.1111/edt.12125 Jan;83(1):83-9. https://doi.org/10.2319/010912-20.1
6. Atabek D, Alaçam A, Aydintuğ I, Konakoğlu G. A retrospective 18. Instituto Brasileiro de Geografia e Estatística. Cidades. Rio
study of traumatic dental injuries. Dent Traumatol. 2014 de Janeiro: Instituto Brasileiro de Geografia e Estatística;
Apr;30(2):154-61. https://doi.org/10.1111/edt.12057 2010 [cited 2016 Aug 21]. Available from: http://cod.ibge.
7. Diangelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope gov.br/5N7
M, Sigurdsson A et al.; International Association of Dental 19. Cavalcanti AL, Bezerra PK, Alencar CR, Moura C. Traumatic
Traumatology. International Association of Dental Traumatology anterior dental injuries in 7- to 12-year-old Brazilian
guidelines for the management of traumatic dental injuries: 1. children. Dent Traumatol. 2009 Apr;25(2):198-202.
Fractures and luxations of permanent teeth. Dent Traumatol. 2012 https://doi.org/10.1111/j.1600-9657.2008.00746.x
Feb;28(1):2-12. https://doi.org/10.1111/j.1600-9657.2011.01103.x 20. Andreasen JO, Andreasen FM, Andersson L. Textbook and
8. Fakhruddin KS, Lawrence HP, Kenny DJ, Locker color atlas of traumatic injuries to the teeth. 4th ed. Oxford:
D. Impact of treated and untreated dental injuries Blackwell Munksgaard; 2007.
on the quality of life of Ontario school children. 21. Cons NC, Jenny J, Kohout FJ, Songpaisan Y, Jotikastira
Dent Traumatol. 2008 Jun;24(3):309-13. D. Utility of the dental aesthetic index in industrialized and
https://doi.org/10.1111/j.1600-9657.2007.00547.x developing countries. J Public Health Dent. 1989;49(3):163-6.
9. Piovesan C, Abella C, Ardenghi TM. Child oral health-related https://doi.org/10.1111/j.1752-7325.1989.tb02054.x
quality of life and socioeconomic factors associated with 22. Petti S. Over two hundred million injuries to anterior teeth
traumatic dental injuries in school children. Oral Health Prev attributable to large overjet: a meta-analysis. Dent Traumatol.
Dent. 2011;9(4):405-11. 2015 Feb;31(1):1-8. https://doi.org/10.1111/edt.12126
10. Schuch HS, Goettems ML, Correa MB, Torriani DD, Demarco 23. Kirkwood B, Stern J. Essentials of medical statistics. 2nd ed.
FF. Prevalence and treatment demand after traumatic dental Oxford: Wiley-Blackwell; 2003.
injury in South Brazilian schoolchildren. Dent Traumatol. 2013 24. Andersen RM, Davidson PL. Ethnicity, aging,
Aug;29(4):297-302. https://doi.org/10.1111/edt.12003 and oral health outcomes: a conceptual
11. Bendo CB, Paiva SM, Varni JW, Vale MP. Oral health-related framework. Adv Dent Res. 1997 May;11(2):203-9.
quality of life and traumatic dental injuries in Brazilian https://doi.org/10.1177/08959374970110020201
adolescents. Community Dent Oral Epidemiol. 2014 25. Goettems ML, Torriani DD, Hallal PC, Correa MB,
Jun;42(3):216-23. https://doi.org/10.1111/cdoe.12078 Demarco FF. Dental trauma: prevalence and risk factors
12. Chen Z, Si Y, Gong Y, Wang JG, Liu JX, He Y et al. Traumatic in schoolchildren. Community Dent Oral Epidemiol. 2014
dental injuries among 8- to 12-year-old schoolchildren in Dec;42(6):581-90. https://doi.org/10.1111/cdoe.12113
Pinggu District, Beijing, China, during 2012. Dent Traumatol. 26. Soriano EP, Caldas Junior AF, Carvalho MVD, Amorim
2014 Oct;30(5):385-90. https://doi.org/10.1111/edt.12110 Filho HA. Prevalence and risk factors related to
13. Soriano EP, Caldas AF Jr, Góes PS. Risk factors traumatic dental injuries in Brazilian schoolchildren.
related to traumatic dental injuries in Brazilian Dent Traumatol. 2007 Aug;23(4):232-40.
schoolchildren. Dent Traumatol. 2004 Oct;20(5):246-50. https://doi.org/10.1111/j.1600-9657.2005.00426.x
https://doi.org/10.1111/j.1600-9657.2004.00246.x 27. Marcenes W, Murray S. Social deprivation and traumatic
14. Damé-Teixeira N, Alves LS, Susin C, Maltz M. dental injuries among 14-year-old schoolchildren in
Traumatic dental injury among 12-year-old South Newham, London. Dent Traumatol. 2001 Feb;17(1):17-21.
Brazilian schoolchildren: prevalence, severity, and https://doi.org/10.1034/j.1600-9657.2001.170104.x
risk indicators. Dent Traumatol. 2013 Feb;29(1):52-8. 28. Shulman JD, Peterson J. The association between incisor
https://doi.org/10.1111/j.1600-9657.2012.01124.x trauma and occlusal characteristics in individuals 8-50

8 Braz. Oral Res. 2018;32:e89

 Freire-Maia FB, Auad SM, Abreu MHNG, Sardenberg F, Martina MT, Paiva SM et al.

years of age. Dent Traumatol. 2004 Apr;20(2):67-74. 33. Castro RA, Portela MC, Leão AT, Vasconcellos MT.
https://doi.org/10.1111/j.1600-4469.2004.00234.x Oral health-related quality of life of 11- and 12-year-
29. Cortes MI, Marcenes W, Sheiham A. Impact of old public school children in Rio de Janeiro. Community
traumatic injuries to the permanent teeth on the oral Dent Oral Epidemiol. 2011 Aug;39(4):336-44.
health-related quality of life in 12-14-year-old children. https://doi.org/10.1111/j.1600-0528.2010.00601.x
Community Dent Oral Epidemiol. 2002 Jun;30(3):193-8. 34. Feldens CA, Day P, Borges TS, Feldens EG, Kramer PF. Enamel
https://doi.org/10.1034/j.1600-0528.2002.300305.x fracture in the primary dentition has no impact on children’s quality
30. Nicolau B, Marcenes W, Sheiham A. Prevalence, causes of life: implications for clinicians and researchers. Dent Traumatol.
and correlates of traumatic dental injuries among 13-year- 2016 Apr;32(2):103-9. https://doi.org/10.1111/edt.12222
olds in Brazil. Dent Traumatol. 2001 Oct;17(5):213-7. 35. Tovo MF, Santos PR, Kramer PF, Feldens CA, Sari GT.
https://doi.org/10.1034/j.1600-9657.2001.170505.x Prevalence of crown fractures in 8-10 years old schoolchildren
31. Malikaew P, Watt RG, Sheiham A. Prevalence and factors in Canoas, Brazil. Dent Traumatol. 2004 Oct;20(5):251-4.
associated with traumatic dental injuries (TDI) to anterior teeth https://doi.org/10.1111/j.1600-9657.2004.00253.x
of 11-13 year old Thai children. Community Dent Health. 36. Glendor U. Epidemiology of traumatic dental injuries: 12 year
2006 Dec;23(4):222-7. review of the literature. Dent Traumatol. 2008 Dec;24(6):603-11.
32. Piovesan C, Antunes JL, Guedes RS, Ardenghi TM. https://doi.org/10.1111/j.1600-9657.2008.00696.x
Impact of socioeconomic and clinical factors on 37. Moysés ST, Moysés SJ, Watt RG, Sheiham A. Associations
child oral health-related quality of life (COHRQoL). between health promoting schools’ policies and indicators of
Qual Life Res. 2010 Nov;19(9):1359-66. oral health in Brazil. Health Promot Int. 2003 Sep;18(3):209-18.
https://doi.org/10.1007/s11136-010-9692-7 https://doi.org/10.1093/heapro/dag016

Braz. Oral Res. 2018;32:e89 9