Incidência de traumatismo dentário em pré-escolares e fatores de risco: estudo longitudinal prospectivo

Abstract

The aims of the present prospective longitudinal study were to estimate the incidence of traumatic dental injury (TDI) among preschool children and test the hypothesis that children with previous TDI are more prone to new cases of tooth injury. The study was carried out in two phases one with a cross-sectional design and one with a longitudinal design. In the first phase (baseline), a cross-sectional study was conducted with 261 children aged one to four years in the city of Diamantina (Brazil) to estimate the prevalence of TDI and identify associated risk factors. In the second phase (follow up), the children were allocated to two groups based on exposure to TDI. The exposed group was composed of 91 children with a history of TDI and the non-exposed group was composed of 170 children without TDI. The children were reexamined after one year. Oral exams were performed at baseline and follow up for the collection of data on clinical variables. Interviews were parents/caregivers were conducted at baseline for the collection of socio-demographic information (socioeconomic indicators; childs age and sex) and at the follow up evaluation to confirm these data and determine the occurrence of TDI in the previous year. TDI was diagnosed based on the criteria proposed by Andreasen and Andreasen (2007). During the exam, incisor overjet was measured and lip coverage was evaluated. Data analysis involved frequency distributions, McNemars test, Pearsons chi-square test, the linear trend chi-square test and Poisson regression with robust variance using the SPSS program for Windows 20.0. One hundred ninety-four children participated in the incidence study (65 in the exposed group and 129 in the non-exposed group). The incidence of TDI in the overall sample at the one-year follow up was 55.7% (n = 108): 64.6% in the exposed group and 51.2% in the non-exposed group. Episodes of TDI were more frequent among children with a previous TDI (p < 0.001), inadequate lip coverage (p < 0.001) and overjet > 3 mm (p < 0.001). In the adjusted Poisson regression model, the risk of a new episode of TDI was significantly higher among children with a history of TDI (RR:1.30; 95%CI: 1.01 to 1.67), independently of the other variables (age upon the second exam, lip coverage and overjet). In conclusion, the incidence of TDI was high and that children with previous TDI had a higher risk of a new traumatic injuries.