Research Article ISSN 2639-9490

Research Article Oral Health & Dental Science

Impact of Malocclusion, Dental Trauma and Developmental Defects of

Enamel in Quality of Life Among Children of 3 to 5 Years Old in Salvador,
Bahia, Brazil, 2018
Maria Cristina Teixeira Cangussu1*, Tatiana Frederico de Almeida1, Jéssica Linday Leal Lima2, Lucilian
Viveiros da Silva2, Maria Beatriz Barreto de Sousa Cabral1, Mércia Santos Sacramento3 and Maria
Isabel Pereira Vianna1
1
Professor in School of Dentistry/ UFBA, Rua Araújo Pinho, 6th
floor, 62 Canela. Salvador- BA. Correspondence:
*

Maria Cristina Teixeira Cangussu, Professor in School of Dentistry/

2
Graduate student in School of Dentistry/ UFBA, Rua Araújo UFBA. Rua Araújo Pinho, 6th floor, 62 Canela, Salvador- Zip code:
Pinho, 6th floor, 62 Canela. Salvador- BA. 41110-150, Brazil.
Doctorade student in Dental Health in Federal University of
3
Received: 28 January 2020; Accepted: 27 February 2020
Bahia, School of Dentistry/ UFBA, Rua Araújo Pinho, 6th floor, 62
Canela. Salvador- BA.

Citation: Maria Cristina TC, Tatiana F de A, Jéssica Linday LL, et al. Impact of Malocclusion, Dental Trauma and Developmental Defects
of Enamel in Quality of Life Among Children of 3 to 5 Years Old in Salvador, Bahia, Brazil, 2018. Oral Health Dental Sci. 2020; 4(1); 1-8.

ABSTRACT
Objectives: To describe malocclusions, dental trauma and dental enamel changes in children aged 3 to 5 years-
old in the city of Salvador-BA, and to investigate the impact of these problems on their OHRQoL, considering the
influence of sociodemographic variables.

Methodology: A study was conducted with 1591 children aged 36 to 71 months attending randomly drawn health
units and municipal day care centers in Salvador, Bahia, Brazil. The clinical examination was performed, and a
questionnaire was administered to those responsible for identifying sociodemographic and behavioral aspects and
OHRQoL using Early Childhood Oral Health Impact Scale (B-ECOHIS). Descriptive, univariate and multivariate
results using robust Poisson regression was performed, with a significance level of 5%.

Results: Of the total, 16.28% of children had mild malocclusion and 23.82% had moderate or severe malocclusion,
and the most prevalent was open bite. 22.31% of the children had at least one type of dental trauma, with limited
fracture in the enamel was the most prevalent. 9.24% presented enamel alteration, with hypoplasia being the
predominant one (65.24%). Regarding OHRQoL, a significant association was found with the child's age >55
months (adjusted PR = 1.62; 1.35-1.93 95% CI), five or more persons in the household (adjusted PR = 1.50; 1.26-
1.79 95% CI) and enamel changes (adjusted PR = 1.31; 1.03-1.68 95% CI).

Conclusion: There was a high prevalence of oral diseases investigated and the older age, higher family density and
enamel changes had a negative impact on the OHRQoL of children and their families.

Keywords well-being [1].

Epidemiology, Malloclusion, Dental trauma, Developmental
defects of enamel, Oral health, Preschoolers, Quality of life. In dentistry, only oral clinical characteristics would not represent
the impact of quality of life on the physical, social and mental
Introduction well-being of individuals. This fact led to the development of
Quality of life is a subjective concept that considers the individual's the multidisciplinary concept of oral health-related quality of
perception of their position in life, taking into account the cultural life (OHRQoL), which involves physical, psychological, family,
context in which they live, their values and expectations, as well as among others, and has been studied in different countries [2].
aspects of their physical health associated with mental and social In Brazil, the Questionnaire Quality of Life Related to the Oral
Oral Health Dental Sci, 2020 Volume 4 | Issue 1 | 1 of 8
Health of Preschool Children (B-ECOHIS) has allowed to increase guardians. Children who participated in the pilot study were not
the knowledge about the conditions that affect the quality of life included in the main study.
of children [3-5].
The sample of the study, obtained in multiple stages, was
The oral health conditions of Brazilian preschoolers are characterized calculated considering 10% of event prevalence, standard error of
by the marked presence of oral diseases, such as: malocclusion, 2.9%. A 95% confidence interval was used and the prevalence of
dental trauma and enamel structure injuries, in addition to early the impact of oral conditions on the OHRQoL of children and their
dental caries. In a national study, the prevalence of malocclusion families determined in the pilot study (30%) was used to calculate
among Brazilian preschoolers revealed that 22.01% of 5-year-old the sample size, estimated at 1031 children. The correction factor
had mild malocclusion (especially mild giro-version, crowding of 1.5 was used to increase accuracy. The minimum sample size
and spacing) and 14.45% had moderate or severe malocclusion to meet the required criteria were 1412 individuals. However, the
(open bite or cross-bite) [6]. In Salvador, a significant occurrence sample was increased by 15% to compensate for possible losses,
of this condition was also observed in children of the same age: totaling 1623 children.
about 24.9% of them had mild malocclusion and 12.7% moderate
or severe malocclusion [7]. The prevalence of dental trauma in The sample distribution was proportional to the total number of
Brazil varies from 10 to 60%, according to recent investigations children enrolled in municipal public daycare centers in each health
[4,8-10]. In childhood, dental trauma may have consequences that district. Nurseries and health facilities were randomly selected in
directly affect the quality of life of preschoolers such as painful each area. At the time of oral exams all children between 36 and 71
symptoms, aesthetic changes and malocclusion [9]. months present were evaluated.

Dental enamel is a tissue that has no remodeling capacity, so during The collection team consisted of three teachers of oral public health
its formation enamel changes may occur, such as hypoplasia, from the School of Dentistry of Federal University of Bahia and
which is a deficiency in the amount of issue. Other changes that eight students from the same course, all calibrated. The theoretical-
can be observed are deficiencies in mineralization, known as practical training took place from the discussion of epidemiological
enamel opacities. They may be demarcated or diffuse. The diffuse indicators and they use slides with images of the oral alterations
opacity can be seen linearly or in plaques and may be called dental investigated to discuss the doubts. The inter-examiner calibration
fluorosis [11]. The prevalence of enamel changes in primary took place in a public daycare center, when 30 children from 3 to
dentition ranges from 23.9% to 77.3%. The literature reports that 5 years old were examined. The intra-examiner calibration was
enamel disorders may predispose to tooth decay, tooth sensitivity, measured during the data collection, when 10% of the exams were
malocclusion and aesthetic problems in preschoolers [12]. repeated seven days after the first exam. Cohen´s Kappa value
and the agreement index were used (inter and intra-examiner
Oral disorders can negatively affect the quality of life of children agreement indices equal to or greater than 90% and Kappa equal
and their families, causing pain, difficulty of sleeping, function to or greater than 0.77 for all oral conditions evaluated).
loss, feeding difficulties, which may result in weight loss, and may
also cause psychological problems in children, such as low self- The oral visual inspection of children´s teeth were performed
esteem, introspective, as well as being a causal factor to be more with them sitting, under natural light, with the aid of a mirror,
vulnerable to bullying in school [4]. Dental care in the early years periodontal probe of World Health Organization (WHO) and
of life allows the identification of risk factors for oral diseases, personal protective equipment. The classification proposed by
enabling the planning and execution of preventive and curative Andreasen et al. [14] was used for the diagnosis of dental trauma.
procedures that could reduce the impact of these problems on daily Changes in dental enamel were evaluated based on the criteria
life of these individuals [12]. Thus, the aim of this study was to defined by the International Dental Federation - Commission on
describe malocclusions, dental trauma and dental enamel changes Oral Health, Research and Epidemiology [15]. The presence of
in children aged 3 to 5 years-old in the city of Salvador-BA, and to any trauma related alteration or enamel defects according to the
investigate the impact of these problems on their OHRQoL. criteria above, respectively, were considered presence of trauma or
enamel alteration during data analysis.
Methodology
A cross-sectional epidemiological study was conducted and data The description of malocclusion among children was based
were collected between August and November 2018 in Salvador, on the Foster and Hamilton Index [16], which consists of four
the capital of the State of Bahia, Brazil. The city is geographically measures: canine brace, overjet, overbite and posterior crossbite.
divided into 12 (twelve) administrative and health districts, with The measurement (in millimeters) was performed with the
all approximately 3 million inhabitants residing in urban areas. teeth in occlusion and the probe parallel to the occlusal plane.
The malocclusion Index was also adopted for the evaluation of
A pilot study was first performed at a convenience municipal occlusion. This was established in 1987 by the WHO and is used
public daycare center in March 2018 to test the methodology today for both deciduous and permanent dentition, classifying
and understanding of the instruments. Data collection from the occlusion types as normal and mild and moderate / severe
main study was performed with the children and their mothers or malocclusion. The presence of the disease in the analyzes was
Oral Health Dental Sci, 2020 Volume 4 | Issue 1 | 2 of 8
defined as the presence of mild or moderate/ severe one. race or black (93.34%), and most mothers (81.02%) and parents
(76.68%) of the children were over 8 years of study and they live
The questionnaire was addressed to the mothers or guardians in households with up to 4 people (76.05%) (Table 1).
of the children and was self-administered. It contained child
identification and sociodemographic data - gender (male / female), Variables N %
age (36- 55 months / over 55 months), ethnicity (white / others), Boys 802 50.41
maternal and paternal education (Up to 8 years of schooling / ≥ Gender
Girls 789 49.59
8 years of schooling) and number of people in the household (≤ 36 - 55 785 49.34
4/5 or more). The caregivers were also asked to answer questions Age (in months)
> 55 806 50.66
regarding OHRQoL using B-ECOHIS. The Early Childhood Oral
White 106 6.66
Health Impact Scale (ECOHIS) [17] consists of 13 items that relate Skin color
to two sections: Child Impact and Family Impact. The first has Black/ Brown 1485 93.34

four sub-scales: symptoms, functions, psychological and social Maternal years of >8 1289 81.02
interaction. The family impact section has two subscales: stress schooling ≤8 302 23.72
and family function. The Brazilian version of Early Childhood >8 1220 76.68
Oral Health Impact Scale (B-ECOHIS) has been culturally adapted Paternal years of schooling
and validated [5]. ≤8 371 23.32

Numbers of persons in the ≤4 1210 76.05

The overall impact on OHRQoL was considered present during data house >5 381 23.95
analysis when there was at least one positive response (frequency Absent 1371 86.17
equal to or greater than 'sometimes') for any of the items in this Open Bite
Present 220 13.83
instrument. Similarly, Child and Family Impact on OHRQoL
Normal 953 59.90
were considered when there was at least one positive response to
Malocllusion Mild 259 16.28
the items in each of these B-ECOHIS sections, respectively. The
Moderate/ Severe 379 23.82
General, Child and Family Impact on OHRQoL were the three
dependent variables considered in the exploratory (univariate) and Class I 1418 89.13
Occlusion position of
multivariate analyzes performed. Sociodemographic conditions, Canines
Class II 89 5.59
such as age of the child, gender, maternal and paternal education Class III 84 5.28
and number of people in the child's home, as well as the prevalence Normal 1259 79.13
of oral diseases malocclusion, trauma and enamel alteration, Severe 140 8.80
Overjet
separately, were evaluated as independent variables. Edge- to- edge 107 6.73
Anterior crossbite 85 5.84
Data were entered into EXCEL [18] and analyzed at STATA 14
Normal 1147 72.09
[19]. Descriptive analyzes of the sociodemographic conditions and
Underbite 50 3.14
oral diseases investigated were performed. Pearson's chi-square test Overbite
Open 220 13.83
was used for exploratory analyzes of potential factors associated
with impact on OHRQoL, observing a significance level of 5%. Deep 174 10.94

Robust Poisson regression was used to estimate prevalence ratios Absent 1481 93.08
and their respective 95% Confidence Intervals, considering the Posterior crossbite Unilateral 92 5.78
three dependent variables (General, Child and Family Impact on Bilateral 18 1.13
OHRQoL) and the independent variables. In multivariate analysis, Absent 1236 77.69
the stepwise forward method was used to include them in the final Present 355 22.31
adjusted models. Independent variables with a p-value <0.20 for Colour change 106 23.87
each outcome in the univariate analysis were incorporated, and
Enamel crack 38 8.55
those with a p-value <0.05 were maintained in the final models. Traumatic Dental Injury
Enamel fracture 256 57.65
Poisson regression with robust variance was used as multiple
Enamel and Dentine fracture 28 6.30
analysis to determine the potential variables associated in each
model. Pulpar exposition 6 1.35
Tooth avulsion 10 2.28
The study was approved by the Research Ethics Committee of the Absent 1444 90.76
School of Dentistry of the Federal University of Bahia (Brazil) Present 147 9.24
(CAAE 78351317.0.0000.5024). Development defects of
Hypoplasia 92 65.24
enamel
Opacity 40 28.37
Results Fluorosis 9 6.39
In the present study, 1591 preschoolers with a mean age of 56 Table 1: Sociodemographic and oral health conditions distribution in
months were evaluated. Most children were male (50.41%), mixed preschool children from Salvador- BA, 2018. (n=1591).
Oral Health Dental Sci, 2020 Volume 4 | Issue 1 | 3 of 8
In relation to oral disorders, open bite was the most common the child (Table 2).
malocclusion condition (13.83%). Malocclusion classified as
moderate or severe was more prevalent (23.82%), but the majority When it was analyzed the association between independent
of children did not present any alteration (59.90%). Of the children variables and the impact on general quality of life, age, maternal
examined, 10.87% showed changes in the canine key, 8.80% had education, paternal education, number of people in the household
high overjet, and 10.94% deep overbite. The unilateral posterior and enamel changes were associated with the conditions in the
crossbite occurred in 5.78% of the children (Table 1). univariate model (p<0.05). Age, maternal education and the
number of people living at home were associated with the impact
The prevalence of dento- alveolar trauma was 23.31%. Fracture on children's quality of life (p <0.05); and age, the number of people
limited to enamel (56.65%) and changing in dental color (23.87%) living at home, malocclusion and enamel changes were associated
were the most frequent conditions. Regarding enamel changes, with the impact on family quality of life (p <0.05) (Table 3).
9.24% of the children had the pathology, and hypoplasia was the
most frequent (65.24%), followed by opacity (28.37%) (Table 1). In the adjusted multivariate models that considered the impact on
the general and children's quality of life, the variables that were
With regard to OHRQoL assessed through B-ECOHIS, it was positively associated with the outcome- age and the number of
found that 18.60% of children experienced pain sometimes and people in the child's home. With the outcome impact on family
1.95% of them experienced pain frequently. Parents also reported quality of life, age was positively associated (Adjusted PR =
difficulty drinking hot or cold beverages (6.98%) and eating 1.62; 1.35-1.93 95% CI), the number of people in the household
certain foods (10.12%) due to problems with their teeth, mouth or (Adjusted PR = 1.50; 1, 26- 1.79 95% CI) and enamel changes
jaws. It was observed that 9.74% of the mothers or guardians of the (Adjusted PR = 1.31; 1.03-1.68 95% CI) (Table 4).
children were sometimes upset or guilty, due some oral problem of

Never Hardly Ocassionally Often Very often Don´t Know

Impacts
(%) never (%) (%) (%) (%) (%)
Pain in the teeth. mouth or jaws 70.46 7.48 18.60 1.95 0.57 0.94
Difficulty drinking hot or cold beverages 86.24 4.46 6.98 0.94 0.57 0.82
Difficulty eating some foods 83.85 3.96 10.12 1.13 0.63 0.31
Difficulty pronouncing any word 93.02 2.20 2.58 0.44 0.31 1.13

Child (How often has your child Missed preschool. day care or school 93.15 2.64 3.52 0.31 0.13 0.25
had...) Difficulty in any daily activity 94.34 2.64 2.58 0.13 0.13 0.19
Had trouble sleeping 91.51 2.89 4.46 0.68 0.25 0.19
Been irritable or frustrated 89.00 3.39 5.66 1.01 0.38 0.57
Avoid Smiling or laughing 94.72 1.89 2.33 0.44 0.38 0.25
Avoid talking 96.35 1.38 1.76 0.06 0.19 0.25
Financial impacts 92.02 2.45 3.71 0.69 0.75 0.38
Family (How often have you or Been upset 83.41 2.89 9.74 2.20 1.51 0.25
another Family member.... because
of your child´s dental problem Felt guilty 83.03 3.58 9.11 1.76 2.26 0.25
Taken time off from work 91.26 3.08 4.15 0.57 0.75 0.19
Tabela 2: B- ECOHIS responses of parentes/ caregivvers of preschool children from Salvador-BA. 2018. (n=1591).

Impact of oral health- overall Child impact Familiar Impact

Variables
% p- value % p-value % p-value
Boys 40.90 35.66 23.75
Gender 0.13 0.12 0.25
Girls 44.61 39.42 26.27
36 a 55 33.25 0.00 27.64 19.11
Age (in months) 0.00 0.00
>55 51.99 47.15 30.76
White 38.68 35.85 20.75
Skin color 0.38 0.71 0.30
Black/ brown 43.03 37.64 25.30
>8 41.19 36.15 24.26
Maternal years of schooling 0.01 0.02 0.16
≤8 49.34 43.38 28.15
>8 41.48 37.21 24.24
Paternal years of schooling 0.06 0.64 0.21
≤8 anos 46.90 38.54 27.49

Numbers of persons in the ≤4 40.66 36.12 22.33

0.00 0.04 0.00
house >4 49.34 41.99 33.51

Oral Health Dental Sci, 2020 Volume 4 | Issue 1 | 4 of 8

 Absent 43.55 37.78 26.47
Malocclusion 0.43 0.80 0.01
Present 41.54 37.15 22.80
Absent 41.91 37.30 24.78
Traumatic dental injury 0.21 0.73 0.70
Present 45.63 38.31 25.78

Development defects of Absent 41.97 37.05 24.15

0.05 0.22 0.01
enamel Present 50.34 42.18 33.33
Table 3: Impacto f sociodemographic variables and oral health problemns on oral health quality of life- general, child impact section, familiar impact
section using B-ECOHIS. Salvador-BA. 2018. (n=1591).

Impact of oral health- overall Child Impact Family impact (Modelo 1) Family impact (Modelo 2)
Variables
PR (CI95%) p-value RP (IC95%) p-value PR (C95%) p-value PR (C95%) p-value
Boys 1.0 1.0 1.0 1.0
Gender 0.07 0.70 - -
Girls 1.11 (0.99 - 1.24) 1.12 (0.99 - 1.27) 1.0 1.0
36 a 55 1.0 1.0 1.0 1.0
Age (in months) 0.00 0.00 0.00 0.52
>55 1.57 (1.38 – 1.75) 1.71 (1.49-1.95) 1.62 (1.35–.93) 1.60 (1.34-.1.91)
Maternal years of >8 1.0 1.0 1.0 1.0
0.10 0.07 0.53 -
schooling ≤8 1.12 (0.98 – 1.29) 1.14 (0.99- 1.32) 1.07 (0.87–.31) 1.06 (0.87-1.31)
Paternal years of >8 1.0 1.0 1.0 1.0
0.47 - - 0.03
schooling ≤8 1.05 (0.92 - 1.99) 1.0 1.0 1.0
Absent 1.0 1.0 1.0 1.0
Malocclusion - - 0.15 -
Present 1.0 1.0 0.88 (0.74-.05) 1.0
Traumatic dental Absent 1.0 1.0 1.0 1.0
- - - -
injury Present 1.0 1.0 1.0 1.0
Development Absent 1.0 1.0 1.0 1.0
0.09 - - 0.00
defect of enamel Present 1.16 (0.98-1.38) 1.0 1.0 1.31 (1.03 1.68)
Table 4: Adjusted prevalece ratios and confidence interval 95% for the association between impacto n oral health quality of life (general, child im-
pact section and familiar impact section) and socidemographic conditions, malocclusion dental trauma injury and development defects in enamel in
preschool children. Salvador-BA. 2018. (n=1591).
PR: Prevalence Ratio from Poisson regression
CI 95%: Confidence Interval 95%
Model 1: Adjusted by age, maternal years of schooling, numbers of persons in the house and malocclusion.
Model 2: Adjusted by age, maternal years of schooling, numbers of persons in the house and development defect of enamel.

Discussion prevalence of malocclusion in 6.855 Brazilian preschoolers, using

Oral disorders in preschoolers, such as malocclusion, have a high the database of the last SB Brasil [21], in which it was found
prevalence in Brazil. According to the findings of the national whereas 22.9% of children had Class II or III canine position
oral health survey, SB Brazil 2004 [6], 22.01% of children aged malocclusion, 22.8% high overjet, 3.1% anterior crossbite, 11.1%
0 to 5 years old had mild malocclusion and 14.45% had moderate open overbite, 10.8% deep bite and 12.7% reduced overbite [21].
or severe malocclusion. The prevalence of the problem found in
the present study was even higher (23.82%), which corroborates The literature shows that open bite is the most prevalent
the study by Morais et al. [20], which assessed the occurrence of malocclusion in preschoolers, and the result was similar to
malocclusion in the primary dentition in children aged 0 to 36 the present study. Oliveira et al. [8], in Salvador-BA, found a
months, verifying that about 23.3% of the children had moderate prevalence of 26.3% of anterior open bite in children from 2 to 5
or severe malocclusion. Almeida et al. [7] observed a prevalence years- old, a finding superior to that of this study (13.83%).
of 12.7% of moderate/ severe malocclusion among children of the
same age group in Salvador-BA. Malocclusion can negatively interfere with the child's quality of
life, causing pain, difficulty sleeping, loss of function, feeding
Regarding the criteria of Foster and Hamilton [16], which were also difficulties, resulting in weight loss, and also psychological
used as indicators of malocclusion in this investigation, 10.87% of problems, such as low self-esteem and introspective, as well as
children had malocclusion related to canine braces (Class II or III), being a factor causal for them to be victims of bullying at school,
8.8% high overjet, 6.73% edge-to-edge bite, 5.84% anterior cross with an impact on quality of life [4].
bite, 13.83% open bite, 10.94% deep bite, 3.14% reduced over bite
and 5.78% unilateral posterior cross bite. Some of these findings However, in the present study there was no positive association
are similar to the study by Bauman et al. [13], who evaluated the between malocclusion and negative interference in the general
Oral Health Dental Sci, 2020 Volume 4 | Issue 1 | 5 of 8
quality of life of the child and/ or family, which differs from the These findings differ from the present study, which found no
study by Carvalho et al. [22] in Belo Horizonte-MG, with 1069 association between dental trauma and impact on general,
pre-school children aged between 60 and 71 months. The authors child or family quality of life. It may have occurred due to the
concluded that the impact of malocclusion on OHRQoL was 32.7% higher prevalence of less severe trauma. Borges et al. [29] after
among children and 27.1% among families. Sousa et al. [23] also analyzing ten studies comprising a population of 7.461 children
identified a positive association between malocclusion and child of preschool age, suggested that clinical criteria may overestimate
and family quality of life among children aged 3 to 5 years-old in the occurrence of oral disorders in relation to the perception of
Campina Grande-PB, as well as Sakaryali et al. [24] in a sample of individuals and their families about their own oral conditions.
107 children from 1 to 6 years old in Turkey.
Approximately 9.24% of the children examined had some enamel
The results of this study were similar to those of Abanto et al. [25], alteration-hypoplasia (65.4%), opacity (28.37%) or fluorosis
in a study carried out in São Paulo, with parents of 260 children, (6.39%). A negative impact of enamel changes was observed on
from 2 to 5 years-old with malocclusion did not identify a negative family OHRQoL. The epidemiological study by Faria et al. [30]
impact of malocclusion on the average of the OHRQoL or in each carried out in Diamantina- MG, which examined 209 children aged
domain of the same indicator used here. Carminatti et al. [26] also 3 to 5 years old, found a higher prevalence of this oral problem
did not show a negative impact of malocclusion on OHRQoL in a (29.9%), and registered the following changes: demarcated
sample of 93 children treated at the pediatric clinic at the Federal opacity (16.8%), diffuse opacity (15.7%) and hypoplasia (4.2%)
University of Rio Grande do Sul. as the most relevant changes.

Dental trauma injury is a public health problem in Brazil and affects Scarpelli et al. [31] also investigated the impact of malocclusion,
a significant part of the population. In the present study, 22.31% dental trauma and enamel defects on children's and family
of preschoolers had some type of dental trauma, and the most OHRQoL and did not find any negative influence of these problems
common trauma found were the enamel-limited fracture (57.65%), on the quality of life of children or their families, the same results
followed by color change (23.87%). This data is corroborated by as Corrêa- Faria et al. [32] in a sample of 646 children in the city
the study by Oliveira et al. 8 whose, in a sample of 472 children of Diamantina- MG.
from Salvador-BA, verified a greater presence of dental trauma
(16.3%) in children under 42 months. In this study, children with the most unfavorable socioeconomic
conditions had a greater negative impact on OHRQoL. Other
Similar to what occurred with malocclusion, the presence of previous studies have reported that socio-economic aspects
dental trauma also had no negative influence on the OHRQoL of influence the OHRQoL of preschoolers and schoolchildren
children and their families. Gonçalves et al. 4 evaluated a sample [27,28,31,33-35] It is valid to clarify that the clinical findings of
of 192 children in Florianópolis – Brazil and results corroborate oral problems and OHRQoL is mediated by social, psychological
the present study- the prevalence of dental trauma found by these and environmental factors in general. Understanding the mediation
authors was 62.5%, significantly higher than that observed in the of these factors and the regional variations that can happen in
current study. Díaz et al. [27] also found no association between Brazil is fundamental due to social inequalities.
the presence of dental trauma and OHRQoL among children aged
1 to 5 years- old in Cartagena, Colombia. This study described oral conditions and analyzed OHRQoL in
preschoolers through a representative and random sample from
Also, Siqueira et al. [9] evaluated 814 children aged between three the city of Salvador-BA, which represents an advantage in relation
and five years, in the city of Campina Grande - Brazil, and verified to most of the investigations already carried out. In addition,
the prevalence of 34.6% of dental trauma in the sample, with the oral diseases were investigated based on well-defined criteria in
upper incisors (88.4%) the teeth more affected, followed by the the literature, with multivariate analyzes that take into account
lateral incisors (8.9%). Among the injuries found, it was found sociodemographic characteristics. Its limitations are inherents
that enamel fracture was the most common type (17.0%), followed to those of cross-sectional studies, which limit the investigation
by tooth discoloration (11.2%), and no positive relationship was of causal relationships between the variables studied at the time
found between the presence of malocclusion and dental trauma of data collection. Studies with a longitudinal outline can better
with the quality of life of children and their families, results similar clarify these relationships.
to those seen in the present study.
Conclusion
However, other authors had investigated and showed that the Of the total, 23.82% of the children had moderate or severe
presence of dental trauma among preschoolers was associated with malocclusion, and the most prevalent was open bite (13.83%).
OHRQoL [3,24,25,28]. For example, Gomes et al. [10] evaluated Trauma was identified in 22.31% of the population, with fractures
a sample of 832 pre-school children in Campina Grande - PB, limited to the enamel the most prevalent one. The enamel
and observed 34.1% of children with dental trauma. Regarding alteration happened in 9.24% of the children, with hypoplasia
the parents' feeling of guilt, there was an association with the being the predominant one (65.24%). With regard to OHRQoL, a
occurrence of tooth avulsion/ dislocation and tooth discoloration. significant association was found with the child's age (Adjusted PR
Oral Health Dental Sci, 2020 Volume 4 | Issue 1 | 6 of 8
= 1.62; 1.35-1.9395% CI), the number of people in the household 15. A review of the developmental defects of enamel index
(Adjusted PR = 1.50; 1.26- 1.7995% CI) and enamel changes (DDE Index). Commission on Oral Health, Research &
(Adjusted PR = 1.31; 1.03-1.68 95% CI). Epidemiology. Report of an FDI Working Group. Int Dent J.
1992; 42: 411–426.
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