Prevalence and risk factors associated with traumatic dental injuries among adolescent school children: epidemiological survey findings from Sri Lanka

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TDIs involving anterior teeth pose functional concerns and have aesthetic and psychological implications. A variety of physical, sociodemographic and socioeconomic factors influence traumatic injuries. This study aims to determine the TDI prevalence, its perceived impact and associated risk factors among adolescents in the school setting in Ratnapura district, Sri Lanka. Methods A descriptive cross-sectional study was conducted among 585 government school children aged 15 years in the Ratnapura Education division. The children were selected using a two-stage cluster sampling technique with probability proportionate to size. A self-administered questionnaire was used to ascertain information on factors related to TDI, followed by a clinical oral examination to assess dental trauma and malocclusion status. For children who had TDI, the Adolescent Oro Dental Trauma Impact Index (AODTII) was used to assess the impact of TDI on oral health-related quality of life. Statistical analysis was conducted using SPSS version 23. Descriptive analysis, chi-square test, Fisher's exact test and multiple logistic regression were applied for statistical analysis. The significance level was set at p < 0.05. Results Dental trauma was experienced by 14.9% of the study sample of 585, with a female predominance. Most TDIs occurred at home (46%), while falling (51.7%) was the primary etiology for TDIs. Bivariate analysis revealed that TDI was significantly associated with sex, mother’s education, mother’s occupation, engagement in sports activity, presence of malocclusion, degree of overjet and lip coverage. Multiple logistic regression analysis indicated that sex, mother’s occupation and degree of overjet were significant predictors of TDI. AODTII showed that out of those who had TDI, the greatest impact on quality of life was social factors (42.5%) followed by physical factors (39.1%). Conclusions This study revealed a substantial prevalence of TDI among 15-year-old school children in the Ratnapura Education Division, and it was significantly influenced by sex, mother’s occupation and degree of overjet. TDI had a more negative impact on children's quality of life. Traumatic dental injuries school children malocclusion Adolescent Oro Dental Trauma Impact Index Introduction Out of all the oral diseases, traumatic dental injuries (TDIs) are the most common condition after dental caries [ 1 ] . Dental trauma is an abruptly occurring impact injury to the teeth and other tissues in the oral cavity. Emergency interventions are often needed for this condition [ 2 ] . Dental trauma occurs in both primary and permanent dentition. Children and adolescents are highly susceptible to dental trauma, ranking it among one of the most common injuries during these periods [ 2 ] . Health literature has indicated that the TDI prevalence in permanent teeth ranges from 10.5 to 58.6% [ 1 , 3 ] . Although world TDI prevalence is unknown, if it were included in the Global Burden of Disease study, 2015, it would rank fifth in the list of the main chronic diseases and injuries [ 4 ] . Various demographic, socioeconomic, environmental and personal factors influence TDIs. The demographic assessment indicated that males outnumbered females who were experiencing TDIs. This could be due to males' tendency towards violent and risky behaviours and their propensity to contact sports [ 5 , 3 ] . TDI has various risk factors at the individual level, spanning a broader socioeconomic and environmental context. Individuals with prominent maxillary overjet and insufficient lip closure are at increased risk for TDIs [ 6 , 7 ] . Anterior teeth, mainly the maxillary central incisors, are highly susceptible to trauma in primary and permanent dentition [ 8 ] . While the home has been identified as the most common place where TDI occurs, followed by school, falls are the principal cause of TDI [ 2 , 9 ] . Engaging in contact sports increases the risk of oro-dental trauma among adolescents [ 10 ] . The TDI was found to be associated with low socioeconomic status [ 3 ] . Trauma to teeth and supporting structures can occur to varying degrees, and the management can be challenging at times [ 11 ] . The classification of TDI is based on the severity of the injury. Injuries to teeth with no pulpal tissue involvement and with no dislocations are considered uncomplicated TDIs [ 12 ] . Injuries involving the dental pulp, periodontal ligament, alveolar bone, root and cementum are classified as complicated TDIs. Lateral luxation, intrusion, extrusion and avulsion are also considered as complicated TDIs. The resulting complications may vary depending on the severity and the time duration of care [ 13 ] . The management of TDI and its complications is time-consuming, expensive, long-term, and sometimes fraught with failure [ 11 ] . Because of these factors, most dental traumatic conditions end up in sub-optimal management. Thus, it is important to identify the factors imposing risk for dental trauma to take preventive measures. Dental trauma has several implications for quality of life. When TDI affects mainly the anterior teeth, it leads to impaired aesthetics, restricted bite, avoidance of smile and speech and impacts personality and quality of life [ 14 ] . Oral health-related quality of life (OHRQoL) can be described as a multidimensional concept reflecting oral health-related functional, social and psychological well-being, and it significantly contributes to general health [ 15 , 16 ] . TDI has a significant negative impact on OHRQoL among children and adolescents, as it may result in pain, sensitivity, a reduction in social relationships, the erosion of self-confidence and school absenteeism [ 17 ] . Various tools have been created to evaluate the impact of the TDI on OHRQoL across different age groups. These include Early Childhood Oral Health Impact Scale (ECOHIS), Child Performance Questionnaire (CPQ), Oral Impact on Daily Performance (OIDP) and Oral Health Impact Profile (OHIP). Once these instruments are adapted and validated across cultures, they are utilized in numerous countries to assess the impact of dental trauma on OHRQoL [ 10 , 16 , 17 ] . In this particular study, OHRQoL was assessed via the Adolescent Oro Dental Trauma Impact Index (AODTII), which was developed and validated for application among adolescents residing in Sri Lanka [ 10 ] . The prevalence and associated factors of dental trauma play a significant role in the implementation of preventive measures. Moreover, understanding the level of impact of TDI on adolescents’ quality of life is important. The results of the current epidemiological survey shed light on the unexplored area of dental trauma in 15-year-old school children in Ratnapura District, Sri Lanka. Thus, the current study serves as a baseline for future research, and the findings can be used for comparisons with local and regional studies. Most importantly, the reliable updated data on TDI burden provide a better understanding of the context for oral healthcare teams to implement effective preventive strategies and deliver person-centered care for adolescents. Methods This school-based descriptive cross-sectional study was conducted in the Ratnapura Education Division in Sabaragamuwa Province of Sri Lanka. The study population comprised 15-year-old adolescents enrolled in secondary government schools within the division. The Ratnapura Education Division has 25 functioning schools. Using the Lawanga and Lemeshow formula for sample size calculation (n = z 2 x (p) x (1-p) / d 2 ) [ 18 ] , the minimum sample size was obtained as 354. The design effect of 1.5 and 10% non-responsive rate resulted in a final sample size of 585. The study sample was ascertained via a two-stage cluster sampling technique combined with the probability proportionate to size (PPS) method. The cluster size was 30, and 20 clusters with students who completed their 15th birthday but yet to complete their 16th birthday at the time of data collection were recruited. Adolescents who were currently undergoing orthodontic treatments and those who had lost their upper anterior tooth/teeth due to caries or reasons other than dental trauma were excluded from the study. The Ethics Review Committee, Postgraduate Institute of Medicine, University of Colombo verified research ethics. Information sheets regarding the study were provided to the children and their parents/guardians. After providing essential ethical details, including confidentiality, anonymity, and the right to withdraw, written informed consent was obtained from parents/guardians for their children to take part in the study, and assent was obtained from the children. Data were collected on the school premises via a pretested self-administered questionnaire and a clinical oral examination form. The self-administered questionnaire included questions about socioeconomic and demographic data, experience and characteristics of dental trauma, and components related to its impact on OHRQoL. The entire sample underwent clinical oral examination. It was conducted in a separate classroom under natural light while the subjects were seated on an ordinary chair. The investigator used appropriate sterile equipment and protective wear to mitigate the potential for cross-infections. The presence of dental trauma, type of dental trauma in the crown component, type of malocclusion, degree of overjet and lip coverage were recorded on the clinical examination form. Dental trauma was classified according to the WHO classification of tooth fracture (enamel fracture, enamel and dentine fracture, enamel and dentine fracture with pulp involvement, luxation injuries, extrusion and intrusion and avulsion) [ 19 ] . Fractures beyond the cementoenamel junction and root fractures were excluded because a radiological assessment was not performed. Angle’s classification was used to document the type of malocclusion (Class I, Class II Division I, Class II Division II and Class III), while Burden’s criteria were used to evaluate the lip coverage [ 6 ] . The overjet was measured and graded into four groups ( = 9mm). The impact of the TDI was assessed by the Adolescent Oro Dental Trauma Impact Index, which was developed and validated to determine the TDI-related impact on adolescents [ 10 ] . The index consisted of 12 variables, and the component correlation matrix was assessed for suitability for generalising to the target study population. The AODTII was evaluated in terms of less significant, significant, and highly significant impacts according to the composite value obtained with the responses on a five-point Likert scale. Several measures were taken at the design stage of the study instruments, at the time of data collection, data entry, and analysis stage to ensure the validity and reliability of data. A self-administered questionnaire was assessed for face, content and consensual validity. An expert in Restorative Dentistry and Community Dentistry calibrated the principal investigator. Intra-examiner variability was thoroughly monitored during the process of data collection. The questionnaire was pretested on a group of fifteen adolescents who were 15 years of age attending government school in the Kuruwita Educational Division. The data were cleaned before analysis with SPSS (Statistical Package for Social Science) version 23. Descriptive statistics of percentages were used to describe the prevalence, sociodemographic factors, and characteristics of dental trauma. Inferential statistics were performed via the chi-square test or Fisher's exact test. The p-value of 0.05 was considered the cut-off for assessing statistical significance. Multiple logistic regression using the backward method was performed with all the variables with p < 0.05, which gradually removed the effects of confounding factors to identify the predictor variables for dental trauma. Results Among the total sample of 585 adolescents aged 15 years, female representation (52.5%) was more predominant than male representation. Approximately 84% of the children belonged to low-income families (monthly income of USD 167). Most fathers and mothers (78.7% and 69.1%, respectively) were educated up to Ordinary Level (11 years of education). Most mothers were housewives (69.3%), whereas 94.9% of fathers engaged in some kind of occupation. Based on the clinical examination, 43.4% of the children had class II division I malocclusion, whereas 41.7% had class I malocclusion. Around 12.3% of children had reverse occlusion, whereas 2.6% had class II division II malocclusion. A substantial number of children (56.8%) had an overjet less than or equal to 3mm, whereas 33.7% had an overjet ranging from 3.1mm to 6mm. A smaller percentage (8.5%) displayed overjet of 6.1mm to 9mm, and only 1% exhibited an overjet exceeding 9mm. The majority of the children (68.5%) had incomplete lip closure. The prevalence of the TDI in the sample was 14.9%. As shown in Table 1 , dental trauma was significantly associated with sex ( p = 0.007), mothers’ education level ( p = 0.03), mothers’ occupation ( p = 0.007), and engagement of sports activities ( p = 0.028). Even though dental trauma was greater among low-income families than among high-income families, the association was not statistically significant. Table 1 Association of dental trauma with to sociodemographic and sport-related factors Variables Dental trauma Total n Chi-square P value Present n (%) Absent n (%) Sex (N = 585)(df = 1) Male 53 (60.9) 225 (45.2) 278 7.356 0.007* Female 34 (39.1) 273 (54.8) 307 Monthly income (N = 581)(df = 1) Low income 76 (88.4) 411 (83) 487 1.542 0.214 High income 10 (11.6) 84 (17) 94 Father’s education level(N = 572)(df = 1) Up to O/L*** 70 (81.4) 380 (78.2) 450 0.448 0.503 Above O/L 16 (18.6) 106 (21.8) 122 Mother’s education level (N = 573)(df = 1) Up to O/L 68 (79.1) 328 (67.4) 396 4.702 0.030* Above O/L 18 (20.9) 159 (32.6) 177 Father’s occupation (N = 569)(df = 1)** Employed 79 (92.1) 461 (95.2) 540 0.795 0.419 Unemployed 6 (7.1) 23 (4.8) 29 Mother’s occupation (N = 566) (df = 1) Employed 37 (43) 137 (28.5) 174 7.184 0.007* Unemployed 49 (57) 343 (71.5) 392 Number of siblings (N = 585)(df = 1) None 12(13.8) 51(10.2) 63 0.972 0.324 One or more than one 75(86.2) 447(89.8) 522 Engagement in sports activity (N = 585)(df = 1) Engaged 57(65.5) 263(52.8) 320 4.825 0.028* Not engaged 30(34.5) 235(47.2) 265 * P < 0.05 (Significantly associated), ** Fisher’s exact test was used Table 2 Association between the TDI and occlusion-related characteristics (n = 585) Variables Dental trauma Total n Chi-square P value Present n (%) Absent n (%) Presence of Malocclusion** (N = 585)(df = 1) Present 26 (29.9) 218 (43.8) 244 5.877 0.015* Not present 61 (70.1) 280 (56.2) 341 Degree of overjet (N = 585)(df = 1) Normal ( = 3.1 mm) 49 (56.3) 204 (41.0) 253 Lip closure (N = 585)(df = 1) Complete closure 19 (21.8) 165 (33.1) 184 4.38 0.036* Incomplete closure 68 (78.2) 333 (66.9) 401 * P < 0.05 (Significantly associated), **Class II division I, Class II division II & Class III were taken as the presence of malocclusion According to the study findings (Table 2 ), the presence of malocclusion was significantly associated with dental trauma (p = 0.015). Furthermore, both overjet and lip closure were significantly associated with dental trauma, with p-values of 0.008 and 0.036, respectively. The multiple logistic regression analysis included all variables associated with dental trauma with p < 0.05. The Omnibus Tests of Model Coefficients demonstrated that the model has a Chi-square value of 26.964 and p < 0.000, which indicates that the model is a significant predictor of the TDI. Nagelkerke R-Square of 0.081 revealed that the predictor variables predicted 84.7% of the variance in the TDI. Table 3 Multivariate analyses: Selected factors associated with dental trauma Variable Adjust OR (95% CI) P value Sex Female 1 < 0.000* Male 2.940 (1.883–4.589) Mother’s education level Up to O/L 1 0.390 Above O/L 0.825 (0.532– 1.280) Mother’s occupation Unemployed 1 < 0.000* Employed 3.297 (2.138–5.084) Engagement in sports activity Not Engaged 1 0.721 Engaged 0.928 (0.614–1.402) Presence of malocclusion Not present 1 0.653 Present 0.872 ( 0.683–1.156) Degree of overjet Normal ( = 3.1 mm) 2.504 (1.433–4.374) Lip closure Complete closure 1 0.402 Incomplete closure 1.338 (0.677–2.645) * P < 0.05 (Significantly associated) Table 3 shows the adjusted associations between sociodemographic factors, sports-related factors and occlusion-related characteristics with dental trauma. When confounding factors were controlled, dental trauma was significantly higher in males than in females (adjusted odds ratio [AOR], 2.940; 95% confidence interval [CI], 1.883–4.589). Children of employed mothers were significantly more likely to have dental trauma experience than their counterparts were (AOR, 3.297; 95% CI, 2.138–5.084). Increased overjet (> 3.1mm) was also a significant predictor of dental trauma (AOR, 2.504; 95% CI, 1.433–4.374). . Table 4 Distribution of the characteristics of dental trauma reported by the study population (N = 87) Characteristics of dental trauma (N = 87) Frequency (%) Frequency of dental traumatic experience Once 70 (80.5) Twice 14 (16.1) More than twice 3 (3.4) Number of affected teeth One 70 (80.5) Two or more 17 (19.5) Place of occurrence Home 40 (46.0) School 10 (11.5) Playground 4 (4.6) Road 8 (9.2) Not aware 25 (28.7) Etiology of dental trauma Fall 45 (51.7) Traffic accident 3 (3.4) Sports activity 7 (8.0) Collision 9 (10.3) Unknown 23 (26.4) Type of dental trauma Uncomplicated 75(86.2) Complicated 12(13.8) Type of teeth affected (n = 111)* Upper central incisor 71 (64.0) Upper lateral incisor 17 (15.3) Other teeth 23 (20.7) * Out of total number of teeth affected The data presented in Table 4 indicate the characteristics of patients with dental trauma. Most of the incidents that led to TDI occurred in the home (46%), followed by the school (11.5%). Falling (51.7%) was the primary etiology of the traumatic dental injuries. The most commonly observed TDI was uncomplicated TDIs (86.2%). Furthermore, teeth predominantly affected by TDI were upper central incisors. The AODTII was assessed for exploratory factor analysis, and the component correlation matrix revealed a positive correlation among the factors of approximately 0.3 but no multicollinearity. KMO and Buttler’s test results were significant (< 0.001), and the total covariance explained by the factors greater than Eigenvalue one was 72.69%. The communalities of the factor matrix are shown in Table 5 . Table 5 Communalities of the factor matrix in AODTII Variable Extraction Uncomfortable while eating 0.539 Problem due to pain 0.941 Problem due to sensitivity 0.903 Injuries to mouth/teeth cause hesitation in smiling 0.816 Get teased by friends due to injuries to mouth/teeth 0.839 Injuries to the mouth and teeth cause nervousness in participating in gatherings 0.893 Feel reluctant to socialize with others due to mouth/teeth injuries 0.907 I can neglect my mouth/teeth injuries 0.466 Stressed for not taking treatments for mouth/teeth injuries 0.838 Poor self-image due to mouth/teeth injuries 0.868 Filling colour is not satisfactory 0.911 Not satisfied with the quality of treatment received 0.917 Table 6 Impact of the TDI on the AODTII among children who experienced dental trauma Level of impact Frequency (%) Less significant impact 7(8.0) Significant impact 65 (74.7) Highly significant impact 15 (17.2) Total 87 (100.0) Table 6 shows that most children were affected by TDI, with nearly 92% of them having either a significant or highly significant impact. The factor with greatest impact on quality of life was social factors (42.5%), followed by physical factors (39.1%). Among the children who had experienced physical repercussions, 10.7% reported difficulties eating certain foods, 58.6% reported experiencing pain, and 49.4% reported feeling sensitivity. Among those affected by dental trauma, 10.3% indicated an impact on smiling, and a similar percentage reported challenges participating in gatherings. Moreover, 69% of the students affected by dental trauma stated that it significantly impacted their lives, mainly because the injury occurred in their mouth. Conversely, approximately 5.7% of the children reported stress-related impacts due to poor accessibility to healthcare services. Discussion Dental trauma is a significant public health concern because of its extensive physical impact combined with psycho-social and economic ramifications [ 3 ] . The current study was conducted among 15-year-old schoolchildren to determine the prevalence and associated factors of dental trauma. In this study, 585 children were selected through a multi-stage cluster sampling method to ensure a robust and representative sample. This relatively large sample size was chosen to enhance the validity and reliability of the findings. Furthermore, a validated tool, meticulously translated into the local language, was employed to improve the accuracy and contextual relevance of the data. Examiner calibration was conducted to reinforce the reliability of the assessments. Despite these methodological strengths, certain limitations must be acknowledged. Notably, the study was confined to a single district, and included only public schools which may introduce the possibility of selection bias and restrict the generalizability of the findings to broader populations. The present study revealed that the prevalence of traumatic dental injury among 15-year-old government school children in the Ratnapura Education Division was 14.9%. This finding aligns with several other regional and global studies. A meta-analysis conducted in 2015 estimated the prevalence of dental trauma among children and adolescents in Asia, the Americas, and Europe as 14.7% (95% CI: 11.3–19.0%), 21.2% (95% CI: 16.6–26.7%), and 19.1% (95% CI: 13.7–24.1%), respectively [ 20 ] . Additionally, a more recent meta-analysis by Petti et al. reported a global prevalence of dental trauma in permanent dentition of 15.2% [ 4 ] . The meta-analysis, which was conducted in 2015, revealed a lower prevalence of dental trauma among Asian populations than among American and European counterparts. This trend is further supported by studies conducted by Kaczmarek et al. [ 21 ] and Kumar et al. [ 22 ] . The prevalence of TDI was 22% and 14%, respectively. The observed regional differences may be attributed to awareness of TDI prevention, availability, and accessibility to oral healthcare facilities, as adolescents in developed countries tend to engage more frequently in extracurricular activities, potentially increasing their risk of dental trauma. However, a study conducted in a tertiary hospital setting in Sri Lanka reported a higher prevalence of dental trauma among adolescents of 17.7% [ 23 ] . This discrepancy may be attributed to differences in study settings, as the present study was conducted in a school environment, whereas the aforementioned study was conducted in a hospital setting, where cases of trauma may be more frequently reported. The initial analysis of this study revealed that TDIs were significantly associated with sex, maternal education level, maternal occupation, and adolescent engagement in sports activities. Multiple logistic regression analysis confirmed that sex and maternal occupation were significant predictors of TDI. The literature indicates that the prevalence of dental trauma is commonly linked to socioeconomic and demographic characteristics [ 24 , 25 , 26 ] . Among these factors, gender is a well-established predictor of TDI, [ 26 ] because males exhibit greater engagement in risky behaviors and physical interactions. Additionally, maternal education level and occupation have been consistently associated with TDI [ 27 ] . This may be attributed to the protective role mothers typically play in their children’s well-being. However, working mothers may have limited time to supervise and care for their children, potentially increasing the risk of dental trauma. Malocclusion, excessive overjet, and inadequate lip coverage have been widely recognized as significant risk factors for dental trauma, as consistently documented in the literature [ 26 , 28 , 29 , 2 , 7 ] . Consistent with these findings, the present study also revealed a higher prevalence of dental trauma among adolescents with malocclusions. This association underscores the importance of early orthodontic assessment and intervention in reducing the risk of traumatic dental injuries. These findings provide valuable evidence for program managers and policymakers, emphasizing the need to integrate preventive strategies—such as school-based screening programs, public awareness campaigns, and improved access to orthodontic care—into oral health policies to minimize the burden of dental trauma among vulnerable populations. Consistent with global, regional, and local evidence, the present study also revealed that the most common setting for traumatic dental injuries was the home, followed by the school, with falls being the leading cause of injury [ 30 , 23 , 2 , 31 , 9 ] . Furthermore, consistent with the findings of the present study, the literature also indicates that enamel fractures are the most common type of uncomplicated crown fractures, followed by enamel-dentine fractures [ 25 , 26 , 32 , 33 , 34 ] . The findings of the present study indicate that dental trauma significantly impacts the physical, functional, and psychological aspects of oral health-related quality of life (OHRQoL). These findings suggest that dental trauma primarily disrupts daily oral functions, such as chewing and speaking, while also leading to emotional distress and self-consciousness. A recent study conducted among adolescents in the Colombo district of Sri Lanka using the same tool, AODTII, reported that dental trauma negatively affected 58.4% of participants. Within this group, 52.4% experienced the greatest impact in the psychological domain, whereas 47.8% reported significant effects in the physical domain [ 10 ] . The variation in findings compared with the present study may be due to differences in the study populations, as the Colombo study focused solely on adolescents engaged in contact sports, a group more prone to high-impact injuries that may lead to different patterns of trauma-related distress. Various researchers have used different measurement tools to assess the impact of dental trauma on OHRQoL. For example, a study by Silva-Oliveira et al. reported that 53.1% of participants experienced a negative impact when the short version of the Child Perception Questionnaire (CPQ) was used for children aged 11 to 14 years [ 3 ] . Similarly, Adeyemo et al. reported that an even greater percentage (84.7%) of adolescents experiencing a negative impact on OHRQoL, also used the CPQ for 11 to 14 years [ 9 ] . El-Kalla et al., utilizing the same assessment tool, concluded that untreated dental trauma significantly impaired OHRQoL [ 30 ] . These findings collectively reinforce the importance of early diagnosis, treatment, and preventive strategies to mitigate the adverse consequences of dental trauma on children’s overall well-being. Given these findings, targeted interventions are essential to mitigate the risk and impact of TDI among adolescents. Strengthening mothers’ health literacy should be prioritized, as well-informed mothers are more likely to adopt preventive practices, recognize early signs of trauma, and seek timely treatment. Educational programs focusing on dental trauma prevention, oral health maintenance, and emergency response should be integrated into maternal and child health services. School-based oral health promotion programs can be expanded to educate students, teachers, and parents about TDI risk factors and preventive strategies. Schools should implement protective measures, such as promoting the use of mouthguards in high-risk sports and enforcing safety guidelines to minimize accidents. School dental therapists can be effectively utilized as a cost-efficient strategy to implement preventive interventions for traumatic dental injuries, ensuring early detection, timely management, referrals, follow up, and improved oral health outcomes among students. Strengthening collaborative efforts between dental professionals, educators, and sports authorities can help in developing structured preventive programs. Establishing dental trauma management protocols in schools ensures that injured children receive timely and appropriate care. Building on the findings of this study, further research is recommended to develop a more generalizable and comprehensive understanding of the factors influencing TDI. Future studies should prioritize longitudinal research to evaluate the long-term effects of TDI on adolescents’ oral health, psychological well-being, and academic performance. Additionally, investigating the economic burden of untreated TDI could offer crucial insights for policymakers, enabling them to allocate resources more effectively for preventive measures and treatment services. Strengthening school-based dental programs and integrating oral health education into school curricula could serve as cost-effective strategies to mitigate the impact of dental trauma in adolescents. Conclusion The current study revealed that the prevalence of TDI among 15-year-old government school children in the Ratnapura Education Division was 14.9%. Furthermore, the gender of the child and the mother's occupation were significant predictors of TDI. It was concluded that TDI had a more negative impact on the children's quality of life. Abbreviations AODTII: Adolescent Oro Dental Trauma Impact Index CI: Confidence interval CPQ: Child Performance Questionnaire ECOHIS: Early Childhood Oral Health Impact Scale OHIP: Oral Health Impact Profile OHRQoL: Oral Health-related Quality of Life OIDP: Oral Impact on Daily Performance O/L-Ordinary Level (11 years of education) OR: Odds Ratio PPS: probability proportionate to size SPSS: Statistical Package for Social Science TDI: Traumatic Dental Injuriy WHO: World Health Organization Declarations Ethics Approval and Consent to Participate Research ethics were obtained from the Ethical Review Committee, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka (Ethical approval number: ERC/PGIM/2022/085). Necessary permission and approval were obtained from the relevant authorities. All the procedures of the study involving participants were conducted in accordance with the Declaration of Helsinki. Written informed consent and assent were obtained from the parents/ guardians of the each participant and the participants respectively before their participation in the study. Consent for publication Not applicable Availability of data and materials The data set that supports the findings of this study is not publicly available due to institutional policy. However, the data are available through the authors upon reasonable request and with the permission of the Post Graduate Institute of Medicine, University of Colombo, Sri Lanka. Competing interest The authors declare that they have no competing interests. Funding Not applicable Author Information Authors and affiliations Sulochana Ranasinghe Directorate of Health Services, Ministry of Health, Sri Lanka Prasanna Jayasekara Ministry of Health, Sri Lanka Iresha Udayamalee Ministry of Health, Sri Lanka Manori Dhanapriyanka Ministry of Health, Sri Lanka Nethma Kalani Jayasekara Army Hospital, Colombo 05 Authors’ contributions SR – data collection, analysis and interpretation of data and manuscript writing. PJ – supervision, supported during study designing and interpretation of data. IU – Statistical analysis, data interpretation, editing and reviewing the manuscript, MD – Statistical analysis, writing the discussion section of the manuscript and editing of the manuscript, NKJ - Editing and reviewing the manuscript. Corresponding Author Correspondence to Prasanna Jayasekara Acknowledgment We would like to express our sincere gratitude to the Ministry of Education, Sri Lanka, Sabaragamuwa Provincial Department of Education, principals, teachers and all participants for their contributions to this study. References Andersson L. Epidemiology of traumatic dental injuries. J Endod. 2013 Mar;39(3 Suppl):S2-5. doi:10.1016/j.joen.2012.11.021. PMID: 23439040. Lam R. Epidemiology and outcomes of traumatic dental injuries: A review of the literature. Aust Dent J. 2016;61(Suppl1): 4-20. doi: 10.1111/adj.12395. PMID: 26923445. Silva-Oliveira F, Goursand D, Ferreira RC, Paiva PCP, Paiva HN, Ferreira EF, et al. Traumatic dental injuries in Brazilian children and oral health-related quality of life. Dent Traumatol. 2018 Feb;34(1):28-35. doi: 10.1111/adj.12395. PMID: 26923445. Petti S, Glendor U, Andersson L. 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Aldrigui JM, Abanto J, Carvalho TS, Mendes FM, Wanderley MT, Bönecker M, et al. Impact of traumatic dental injuries and malocclusions on quality of life of young children. Health Qual Life Outcomes. 2011 Sep 24;9:78. doi: 10.1186/1477-7525-9-78. PMID: 21943368; PMCID: PMC3186738. Kallel I, Douki N, Amaidi S, Ben Amor F. The Incidence of Complications of Dental Trauma and Associated Factors: A Retrospective Study. Int J Dent. 2020;2020:2968174. doi: 10.1155/2020/2968174. PMID: 32256593; PMCID: PMC7086444. Sharva V, Reddy V, Bhambal A, Agrawal R, Gupta M. Traumatic dental injuries to the anterior teeth among 12-year and 15-year-old schoolchildren of urban and rural areas of Bhopal District, Central India: A prevalence study. CHRISMED J Health Res. 2017;4(1):38. doi: 10.4103/2348-3334.196065. World Health Organization. Oral Health Surveys. 2013: Retrieved February 16, 2025 from http://www.who.int/oral_health/publications/9789241548649/en/ Locker D, Allen F. What do measures of 'oral health-related quality of life' measure. Community Dent Oral Epidemiol. 2007 Dec;35(6):401-11. doi: 10.1111/j.1600-0528.2007.00418.x. PMID: 18039281. Das P, Mishra L, Jena D, Govind S, Panda S, Lapinska B. Oral Health-Related Quality of Life in Children and Adolescents with a Traumatic Injury of Permanent Teeth and the Impact on Their Families: A Systematic Review. Int J Environ Res Public Health. 2022 Mar 6;19(5):3087. doi: 10.3390/ijerph19053087. PMID: 35270779; PMCID: PMC8910580. Lawanga SK, Lemeshow S. Sample size Determination in Health Studies: A Practical Manual. Geneva: World Health Organization. 1991. World Health Organization, editor. Application of the international classification of diseases to dentistry and stomatology. 3 rd ed. Geneva: Macmillan. 1995. Azami-Aghdash S, Ebadifard Azar F, Pournaghi Azar F, Rezapour A, Moradi-Joo M, Moosavi A, Ghertasi Oskouei S. Prevalence, etiology, and types of dental trauma in children and adolescents: systematic review and meta-analysis. Med J Islam Repub Iran. 2015 Jul 10;29(4):234. PMID: 26793672; PMCID: PMC4715389. Kaczmarek U, Gozdowski D, Olczak-Kowalczyk D. Prevalence of traumatic dental injuries in Polish 15-year-olds. Dent Med Probl. 2019;56(4):365-71. doi: 10.17219/dmp/112302. PMID: 31895501. Kumar A, Bansal V, Veeresha KL, Sogi GM. Prevalence of traumatic dental injuries among 12- to 15-year-old schoolchildren in Ambala district, Haryana, India. Oral Health Prev Dent. 2011;9(3):301-5. PMID: 22068187. Abeykoon AMWC, Pathiraja RM, Wettasinghe KA. Causes and prevalence of trauma to permanent teeth. Proceedings of the Peradeniya University Research Sessions; 23 rd October 2003; Sri Lanka. 2003;8:72-72. Kirthiga M, Praveen R, Umesh W. Severity of dental trauma and its associated factors in 11-16 years old school children in Davangere city, India. J Orofac Sci. 2015;7(2):95. doi: 10.4103/0975-8844.169755. Al-Ansari A, Nazir M. Prevalence of Dental Trauma and Receipt of Its Treatment among Male School Children in the Eastern Province of Saudi Arabia. The Scientific World Journal. 2020;2020:1-6. doi: 10.1155/2020/7321873 Abdel Malak C, Chakar C, Romanos A, Rachidi S. Prevalence and Etiological Factors of Dental Trauma among 12- and 15-Year-Old Schoolchildren of Lebanon: A National Study. Scientific World Journal. 2021;2021:5587431. doi: 10.1155/2021/5587431. PMID: 33746633; PMCID: PMC7960040 Hashim R, Alhammadi H, Varma S, Luke A. Traumatic Dental Injuries among 12-Year-Old Schoolchildren in the United Arab Emirates. Int J Environ Res Public Health. 2022 Oct 11;19(20):13032. doi: 10.3390/ijerph192013032. PMID: 36293604; PMCID: PMC9603412. Aikins EA, Onyeaso CO. Prevalence of malocclusion and occlusal traits among adolescents and young adults in Rivers State, Nigeria. Odontostomatol Trop. 2014 Mar;37(145):5-12. PMID: 24979956. Elfseyie M, Hassan MIA, Al-Jaf NMA. Prevalence of malocclusion and occlusal traits of Malay adults (18-23 years) in Shah Alam, Malaysia. Int J Dent Res. 2020;5(2):81–5. El-Kalla IH, Shalan HM, Bakr RA. Impact of Dental Trauma on Quality of Life among 11-14 Years Schoolchildren. Contemp Clin Dent. 2017;8(4):538-44. doi: 10.4103/ccd.ccd_428_17. PMID: 29326503; PMCID: PMC5754973. Rajab LD, Baqain ZH, Ghazaleh SB, Sonbol HN, Hamdan MA. Traumatic dental injuries among 12-year-old schoolchildren in Jordan: prevalence, risk factors and treatment need. Oral Health Prev Dent. 2013;11(2):105-12. doi: 10.3290/j.ohpd.a29362. PMID: 23534038. Ekanayake L, Perera M. Pattern of traumatic dental injuries in children attending the University Dental Hospital, Sri Lanka. Dent Traumatol. 2008 Aug;24(4):471-4. doi: 10.1111/j.1600-9657.2008.00611.x. PMID: 18721351. Zaleckiene V, Peciuliene V, Brukiene V, Drukteinis S. Traumatic dental injuries: etiology, prevalence and possible outcomes. Stomatologija. 2014;16(1):7-14. PMID: 24824054. da Silva RLC, Dias Ribeiro AP, Almeida JCF, Sousa SJL, Garcia FCP. Impact of dental treatment and the severity of traumatic dental injuries on the quality of life of Brazilian schoolchildren. Dent Traumatol. 2021 Aug;37(4):562-7. doi: 10.1111/edt.12660. Epub 2021 January 28. PMID: 33511757. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6234293","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":441262374,"identity":"3db31519-a2c0-4a2d-88d9-797f12897b54","order_by":0,"name":"Sulochana Ranasinghe","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Sulochana","middleName":"","lastName":"Ranasinghe","suffix":""},{"id":441262375,"identity":"21cf308b-3724-4009-bd2c-91e3d9e9b7ae","order_by":1,"name":"Prasanna Jayasekara","email":"data:image/png;base64,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","orcid":"","institution":"Ministry of Health","correspondingAuthor":true,"prefix":"","firstName":"Prasanna","middleName":"","lastName":"Jayasekara","suffix":""},{"id":441262376,"identity":"bff2fcf6-e285-42a1-ad2e-9ec12b7dab64","order_by":2,"name":"Iresha Udayamalee","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Iresha","middleName":"","lastName":"Udayamalee","suffix":""},{"id":441262377,"identity":"8e631e43-aece-4262-a649-6ff2697d352e","order_by":3,"name":"Manori Dhanapriyanka","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Manori","middleName":"","lastName":"Dhanapriyanka","suffix":""},{"id":441262378,"identity":"6b20b082-bdbf-454d-b860-91522805f0d9","order_by":4,"name":"Nethma Kalani Jayasekara","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Nethma","middleName":"Kalani","lastName":"Jayasekara","suffix":""}],"badges":[],"createdAt":"2025-03-15 18:08:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6234293/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6234293/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":80916760,"identity":"84d45577-b26a-4f26-b1b7-62d4dc93d080","added_by":"auto","created_at":"2025-04-18 18:16:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":849380,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6234293/v1/468268f1-8c35-4c7a-80ad-e9ad28c064ca.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and risk factors associated with traumatic dental injuries among adolescent school children: epidemiological survey findings from Sri Lanka","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOut of all the oral diseases, traumatic dental injuries (TDIs) are the most common condition after dental caries \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Dental trauma is an abruptly occurring impact injury to the teeth and other tissues in the oral cavity. Emergency interventions are often needed for this condition \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Dental trauma occurs in both primary and permanent dentition. Children and adolescents are highly susceptible to dental trauma, ranking it among one of the most common injuries during these periods \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHealth literature has indicated that the TDI prevalence in permanent teeth ranges from 10.5 to 58.6% \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Although world TDI prevalence is unknown, if it were included in the Global Burden of Disease study, 2015, it would rank fifth in the list of the main chronic diseases and injuries \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Various demographic, socioeconomic, environmental and personal factors influence TDIs. The demographic assessment indicated that males outnumbered females who were experiencing TDIs. This could be due to males' tendency towards violent and risky behaviours and their propensity to contact sports \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTDI has various risk factors at the individual level, spanning a broader socioeconomic and environmental context. Individuals with prominent maxillary overjet and insufficient lip closure are at increased risk for TDIs \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Anterior teeth, mainly the maxillary central incisors, are highly susceptible to trauma in primary and permanent dentition \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. While the home has been identified as the most common place where TDI occurs, followed by school, falls are the principal cause of TDI \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Engaging in contact sports increases the risk of oro-dental trauma among adolescents \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. The TDI was found to be associated with low socioeconomic status \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTrauma to teeth and supporting structures can occur to varying degrees, and the management can be challenging at times \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. The classification of TDI is based on the severity of the injury. Injuries to teeth with no pulpal tissue involvement and with no dislocations are considered uncomplicated TDIs \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Injuries involving the dental pulp, periodontal ligament, alveolar bone, root and cementum are classified as complicated TDIs. Lateral luxation, intrusion, extrusion and avulsion are also considered as complicated TDIs. The resulting complications may vary depending on the severity and the time duration of care \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. The management of TDI and its complications is time-consuming, expensive, long-term, and sometimes fraught with failure \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Because of these factors, most dental traumatic conditions end up in sub-optimal management. Thus, it is important to identify the factors imposing risk for dental trauma to take preventive measures.\u003c/p\u003e \u003cp\u003eDental trauma has several implications for quality of life. When TDI affects mainly the anterior teeth, it leads to impaired aesthetics, restricted bite, avoidance of smile and speech and impacts personality and quality of life \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Oral health-related quality of life (OHRQoL) can be described as a multidimensional concept reflecting oral health-related functional, social and psychological well-being, and it significantly contributes to general health \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. TDI has a significant negative impact on OHRQoL among children and adolescents, as it may result in pain, sensitivity, a reduction in social relationships, the erosion of self-confidence and school absenteeism \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eVarious tools have been created to evaluate the impact of the TDI on OHRQoL across different age groups. These include Early Childhood Oral Health Impact Scale (ECOHIS), Child Performance Questionnaire (CPQ), Oral Impact on Daily Performance (OIDP) and Oral Health Impact Profile (OHIP). Once these instruments are adapted and validated across cultures, they are utilized in numerous countries to assess the impact of dental trauma on OHRQoL \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. In this particular study, OHRQoL was assessed via the Adolescent Oro Dental Trauma Impact Index (AODTII), which was developed and validated for application among adolescents residing in Sri Lanka \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe prevalence and associated factors of dental trauma play a significant role in the implementation of preventive measures. Moreover, understanding the level of impact of TDI on adolescents\u0026rsquo; quality of life is important. The results of the current epidemiological survey shed light on the unexplored area of dental trauma in 15-year-old school children in Ratnapura District, Sri Lanka. Thus, the current study serves as a baseline for future research, and the findings can be used for comparisons with local and regional studies. Most importantly, the reliable updated data on TDI burden provide a better understanding of the context for oral healthcare teams to implement effective preventive strategies and deliver person-centered care for adolescents.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis school-based descriptive cross-sectional study was conducted in the Ratnapura Education Division in Sabaragamuwa Province of Sri Lanka. The study population comprised 15-year-old adolescents enrolled in secondary government schools within the division. The Ratnapura Education Division has 25 functioning schools. Using the Lawanga and Lemeshow formula for sample size calculation (n\u0026thinsp;=\u0026thinsp;z\u003csup\u003e2\u003c/sup\u003e x (p) x (1-p) / d\u003csup\u003e2\u003c/sup\u003e) \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e, the minimum sample size was obtained as 354. The design effect of 1.5 and 10% non-responsive rate resulted in a final sample size of 585. The study sample was ascertained via a two-stage cluster sampling technique combined with the probability proportionate to size (PPS) method. The cluster size was 30, and 20 clusters with students who completed their 15th birthday but yet to complete their 16th birthday at the time of data collection were recruited. Adolescents who were currently undergoing orthodontic treatments and those who had lost their upper anterior tooth/teeth due to caries or reasons other than dental trauma were excluded from the study.\u003c/p\u003e \u003cp\u003e The Ethics Review Committee, Postgraduate Institute of Medicine, University of Colombo verified research ethics. Information sheets regarding the study were provided to the children and their parents/guardians. After providing essential ethical details, including confidentiality, anonymity, and the right to withdraw, written informed consent was obtained from parents/guardians for their children to take part in the study, and assent was obtained from the children.\u003c/p\u003e \u003cp\u003eData were collected on the school premises via a pretested self-administered questionnaire and a clinical oral examination form. The self-administered questionnaire included questions about socioeconomic and demographic data, experience and characteristics of dental trauma, and components related to its impact on OHRQoL.\u003c/p\u003e \u003cp\u003eThe entire sample underwent clinical oral examination. It was conducted in a separate classroom under natural light while the subjects were seated on an ordinary chair. The investigator used appropriate sterile equipment and protective wear to mitigate the potential for cross-infections. The presence of dental trauma, type of dental trauma in the crown component, type of malocclusion, degree of overjet and lip coverage were recorded on the clinical examination form.\u003c/p\u003e \u003cp\u003eDental trauma was classified according to the WHO classification of tooth fracture (enamel fracture, enamel and dentine fracture, enamel and dentine fracture with pulp involvement, luxation injuries, extrusion and intrusion and avulsion) \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Fractures beyond the cementoenamel junction and root fractures were excluded because a radiological assessment was not performed. Angle\u0026rsquo;s classification was used to document the type of malocclusion (Class I, Class II Division I, Class II Division II and Class III), while Burden\u0026rsquo;s criteria were used to evaluate the lip coverage \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. The overjet was measured and graded into four groups (\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;3mm, 3.1- 6mm, 6.1- 9mm and \u0026gt;\u0026thinsp;9mm).\u003c/p\u003e \u003cp\u003eThe impact of the TDI was assessed by the Adolescent Oro Dental Trauma Impact Index, which was developed and validated to determine the TDI-related impact on adolescents \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. The index consisted of 12 variables, and the component correlation matrix was assessed for suitability for generalising to the target study population. The AODTII was evaluated in terms of less significant, significant, and highly significant impacts according to the composite value obtained with the responses on a five-point Likert scale.\u003c/p\u003e \u003cp\u003eSeveral measures were taken at the design stage of the study instruments, at the time of data collection, data entry, and analysis stage to ensure the validity and reliability of data. A self-administered questionnaire was assessed for face, content and consensual validity. An expert in Restorative Dentistry and Community Dentistry calibrated the principal investigator. Intra-examiner variability was thoroughly monitored during the process of data collection. The questionnaire was pretested on a group of fifteen adolescents who were 15 years of age attending government school in the Kuruwita Educational Division.\u003c/p\u003e \u003cp\u003eThe data were cleaned before analysis with SPSS (Statistical Package for Social Science) version 23. Descriptive statistics of percentages were used to describe the prevalence, sociodemographic factors, and characteristics of dental trauma. Inferential statistics were performed via the chi-square test or Fisher's exact test. The p-value of 0.05 was considered the cut-off for assessing statistical significance. Multiple logistic regression using the backward method was performed with all the variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, which gradually removed the effects of confounding factors to identify the predictor variables for dental trauma.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAmong the total sample of 585 adolescents aged 15 years, female representation (52.5%) was more predominant than male representation. Approximately 84% of the children belonged to low-income families (monthly income of \u0026lt;\u0026thinsp;USD 167), whereas 16.2% belonged to high-income families (monthly income of \u0026gt;\u0026thinsp;USD 167). Most fathers and mothers (78.7% and 69.1%, respectively) were educated up to Ordinary Level (11 years of education). Most mothers were housewives (69.3%), whereas 94.9% of fathers engaged in some kind of occupation.\u003c/p\u003e \u003cp\u003eBased on the clinical examination, 43.4% of the children had class II division I malocclusion, whereas 41.7% had class I malocclusion. Around 12.3% of children had reverse occlusion, whereas 2.6% had class II division II malocclusion. A substantial number of children (56.8%) had an overjet less than or equal to 3mm, whereas 33.7% had an overjet ranging from 3.1mm to 6mm. A smaller percentage (8.5%) displayed overjet of 6.1mm to 9mm, and only 1% exhibited an overjet exceeding 9mm. The majority of the children (68.5%) had incomplete lip closure.\u003c/p\u003e \u003cp\u003eThe prevalence of the TDI in the sample was 14.9%. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, dental trauma was significantly associated with sex (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007), mothers\u0026rsquo; education level (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.03), mothers\u0026rsquo; occupation (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007), and engagement of sports activities (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.028). Even though dental trauma was greater among low-income families than among high-income families, the association was not statistically significant.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation of dental trauma with to sociodemographic and sport-related factors\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eDental trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eChi-square\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAbsent\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;585)(df\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (60.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e225 (45.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e7.356\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.007*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (39.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e273 (54.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e307\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMonthly income (N\u0026thinsp;=\u0026thinsp;581)(df\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76 (88.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e411 (83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.542\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (11.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84 (17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFather\u0026rsquo;s education level(N\u0026thinsp;=\u0026thinsp;572)(df\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUp to O/L***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (81.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e380 (78.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e450\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.448\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.503\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbove O/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (18.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106 (21.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMother\u0026rsquo;s education level (N\u0026thinsp;=\u0026thinsp;573)(df\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUp to O/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (79.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e328 (67.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e396\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e4.702\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.030*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbove O/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (20.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e159 (32.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFather\u0026rsquo;s occupation (N\u0026thinsp;=\u0026thinsp;569)(df\u0026thinsp;=\u0026thinsp;1)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79 (92.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e461 (95.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e540\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.795\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.419\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMother\u0026rsquo;s occupation (N\u0026thinsp;=\u0026thinsp;566) (df\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e137 (28.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e7.184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.007*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e343 (71.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e392\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNumber of siblings (N\u0026thinsp;=\u0026thinsp;585)(df\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51(10.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.972\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.324\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOne or more than one\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75(86.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e447(89.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e522\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEngagement in sports activity (N\u0026thinsp;=\u0026thinsp;585)(df\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEngaged\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57(65.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e263(52.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e320\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e4.825\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.028*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot engaged\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30(34.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e235(47.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e265\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003cp\u003e* P \u003c 0.05 (Significantly associated), ** Fisher’s exact test was used\u003c/p\u003e\n\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between the TDI and occlusion-related characteristics (n\u0026thinsp;=\u0026thinsp;585)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eDental trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eChi-square\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAbsent\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePresence of Malocclusion**\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(N\u0026thinsp;=\u0026thinsp;585)(df\u0026thinsp;=\u0026thinsp;1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (29.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e218 (43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e5.877\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.015*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot present\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (70.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e280 (56.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e341\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDegree of overjet\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(N\u0026thinsp;=\u0026thinsp;585)(df\u0026thinsp;=\u0026thinsp;1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal (\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;3 mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (43.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e294 (59.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e7.117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.008*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased (\u0026gt;\u0026thinsp;3.1 mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e204 (41.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e253\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eLip closure (N\u0026thinsp;=\u0026thinsp;585)(df\u0026thinsp;=\u0026thinsp;1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComplete closure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (21.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e165 (33.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e4.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.036*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncomplete closure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (78.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e333 (66.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e401\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003e* P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 (Significantly associated), **Class II division I, Class II division II \u0026amp; Class III were taken as the presence of malocclusion\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAccording to the study findings (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), the presence of malocclusion was significantly associated with dental trauma (p\u0026thinsp;=\u0026thinsp;0.015). Furthermore, both overjet and lip closure were significantly associated with dental trauma, with p-values of 0.008 and 0.036, respectively.\u003c/p\u003e \u003cp\u003eThe multiple logistic regression analysis included all variables associated with dental trauma with \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05. The Omnibus Tests of Model Coefficients demonstrated that the model has a Chi-square value of 26.964 and p\u0026thinsp;\u0026lt;\u0026thinsp;0.000, which indicates that the model is a significant predictor of the TDI. Nagelkerke R-Square of 0.081 revealed that the predictor variables predicted 84.7% of the variance in the TDI.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate analyses: Selected factors associated with dental trauma\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdjust OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.940 (1.883\u0026ndash;4.589)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMother\u0026rsquo;s education level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUp to O/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.390\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbove O/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.825 (0.532\u0026ndash; 1.280)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMother\u0026rsquo;s occupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.297 (2.138\u0026ndash;5.084)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEngagement in sports activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot Engaged\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.721\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEngaged\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.928 (0.614\u0026ndash;1.402)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePresence of malocclusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot present\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.653\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.872 ( 0.683\u0026ndash;1.156)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDegree of overjet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal (\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;3 mm )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased (\u0026gt;\u0026thinsp;3.1 mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.504 (1.433\u0026ndash;4.374)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLip closure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComplete closure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.402\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncomplete closure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.338 (0.677\u0026ndash;2.645)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003cp\u003e* P \u003c 0.05 (Significantly associated)\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the adjusted associations between sociodemographic factors, sports-related factors and occlusion-related characteristics with dental trauma. When confounding factors were controlled, dental trauma was significantly higher in males than in females (adjusted odds ratio [AOR], 2.940; 95% confidence interval [CI], 1.883\u0026ndash;4.589). Children of employed mothers were significantly more likely to have dental trauma experience than their counterparts were (AOR, 3.297; 95% CI, 2.138\u0026ndash;5.084). Increased overjet (\u0026gt;\u0026thinsp;3.1mm) was also a significant predictor of dental trauma (AOR, 2.504; 95% CI, 1.433\u0026ndash;4.374).\u003c/p\u003e \u003cp\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of the characteristics of dental trauma reported by the study population (N\u0026thinsp;=\u0026thinsp;87)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristics of dental trauma (N\u0026thinsp;=\u0026thinsp;87)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eFrequency of dental traumatic experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnce\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70 (80.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTwice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (16.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMore than twice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (3.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eNumber of affected teeth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOne\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70 (80.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTwo or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (19.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003ePlace of occurrence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40 (46.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSchool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (11.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePlayground\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (4.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRoad\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (9.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot aware\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (28.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eEtiology of dental trauma\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45 (51.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTraffic accident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (3.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSports activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (8.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (10.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23 (26.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eType of dental trauma\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUncomplicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75(86.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComplicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12(13.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eType of teeth affected (n\u0026thinsp;=\u0026thinsp;111)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper central incisor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71 (64.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper lateral incisor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (15.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23 (20.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e* \u003cem\u003eOut of total number of teeth affected\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe data presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e indicate the characteristics of patients with dental trauma. Most of the incidents that led to TDI occurred in the home (46%), followed by the school (11.5%). Falling (51.7%) was the primary etiology of the traumatic dental injuries. The most commonly observed TDI was uncomplicated TDIs (86.2%). Furthermore, teeth predominantly affected by TDI were upper central incisors.\u003c/p\u003e \u003cp\u003eThe AODTII was assessed for exploratory factor analysis, and the component correlation matrix revealed a positive correlation among the factors of approximately 0.3 but no multicollinearity. KMO and Buttler\u0026rsquo;s test results were significant (\u0026lt;\u0026thinsp;0.001), and the total covariance explained by the factors greater than Eigenvalue one was 72.69%. The communalities of the factor matrix are shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCommunalities of the factor matrix in AODTII\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExtraction\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUncomfortable while eating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.539\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProblem due to pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.941\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProblem due to sensitivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.903\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInjuries to mouth/teeth cause hesitation in smiling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.816\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGet teased by friends due to injuries to mouth/teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.839\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInjuries to the mouth and teeth cause nervousness in participating in gatherings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.893\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFeel reluctant to socialize with others due to mouth/teeth injuries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.907\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI can neglect my mouth/teeth injuries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.466\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStressed for not taking treatments for mouth/teeth injuries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.838\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor self-image due to mouth/teeth injuries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.868\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFilling colour is not satisfactory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.911\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot satisfied with the quality of treatment received\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.917\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eImpact of the TDI on the AODTII among children who experienced dental trauma\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel of impact\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess significant impact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7(8.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSignificant impact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65 (74.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHighly significant impact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (17.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87 (100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e shows that most children were affected by TDI, with nearly 92% of them having either a significant or highly significant impact. The factor with greatest impact on quality of life was social factors (42.5%), followed by physical factors (39.1%). Among the children who had experienced physical repercussions, 10.7% reported difficulties eating certain foods, 58.6% reported experiencing pain, and 49.4% reported feeling sensitivity. Among those affected by dental trauma, 10.3% indicated an impact on smiling, and a similar percentage reported challenges participating in gatherings. Moreover, 69% of the students affected by dental trauma stated that it significantly impacted their lives, mainly because the injury occurred in their mouth. Conversely, approximately 5.7% of the children reported stress-related impacts due to poor accessibility to healthcare services.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDental trauma is a significant public health concern because of its extensive physical impact combined with psycho-social and economic ramifications \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. The current study was conducted among 15-year-old schoolchildren to determine the prevalence and associated factors of dental trauma.\u003c/p\u003e \u003cp\u003eIn this study, 585 children were selected through a multi-stage cluster sampling method to ensure a robust and representative sample. This relatively large sample size was chosen to enhance the validity and reliability of the findings. Furthermore, a validated tool, meticulously translated into the local language, was employed to improve the accuracy and contextual relevance of the data. Examiner calibration was conducted to reinforce the reliability of the assessments. Despite these methodological strengths, certain limitations must be acknowledged. Notably, the study was confined to a single district, and included only public schools which may introduce the possibility of selection bias and restrict the generalizability of the findings to broader populations. The present study revealed that the prevalence of traumatic dental injury among 15-year-old government school children in the Ratnapura Education Division was 14.9%. This finding aligns with several other regional and global studies. A meta-analysis conducted in 2015 estimated the prevalence of dental trauma among children and adolescents in Asia, the Americas, and Europe as 14.7% (95% CI: 11.3\u0026ndash;19.0%), 21.2% (95% CI: 16.6\u0026ndash;26.7%), and 19.1% (95% CI: 13.7\u0026ndash;24.1%), respectively \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Additionally, a more recent meta-analysis by Petti et al. reported a global prevalence of dental trauma in permanent dentition of 15.2% \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe meta-analysis, which was conducted in 2015, revealed a lower prevalence of dental trauma among Asian populations than among American and European counterparts. This trend is further supported by studies conducted by Kaczmarek et al. \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e and Kumar et al. \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. The prevalence of TDI was 22% and 14%, respectively. The observed regional differences may be attributed to awareness of TDI prevention, availability, and accessibility to oral healthcare facilities, as adolescents in developed countries tend to engage more frequently in extracurricular activities, potentially increasing their risk of dental trauma.\u003c/p\u003e \u003cp\u003eHowever, a study conducted in a tertiary hospital setting in Sri Lanka reported a higher prevalence of dental trauma among adolescents of 17.7% \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. This discrepancy may be attributed to differences in study settings, as the present study was conducted in a school environment, whereas the aforementioned study was conducted in a hospital setting, where cases of trauma may be more frequently reported.\u003c/p\u003e \u003cp\u003eThe initial analysis of this study revealed that TDIs were significantly associated with sex, maternal education level, maternal occupation, and adolescent engagement in sports activities. Multiple logistic regression analysis confirmed that sex and maternal occupation were significant predictors of TDI.\u003c/p\u003e \u003cp\u003eThe literature indicates that the prevalence of dental trauma is commonly linked to socioeconomic and demographic characteristics \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. Among these factors, gender is a well-established predictor of TDI, \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e because males exhibit greater engagement in risky behaviors and physical interactions. Additionally, maternal education level and occupation have been consistently associated with TDI \u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. This may be attributed to the protective role mothers typically play in their children\u0026rsquo;s well-being. However, working mothers may have limited time to supervise and care for their children, potentially increasing the risk of dental trauma.\u003c/p\u003e \u003cp\u003eMalocclusion, excessive overjet, and inadequate lip coverage have been widely recognized as significant risk factors for dental trauma, as consistently documented in the literature \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Consistent with these findings, the present study also revealed a higher prevalence of dental trauma among adolescents with malocclusions. This association underscores the importance of early orthodontic assessment and intervention in reducing the risk of traumatic dental injuries. These findings provide valuable evidence for program managers and policymakers, emphasizing the need to integrate preventive strategies\u0026mdash;such as school-based screening programs, public awareness campaigns, and improved access to orthodontic care\u0026mdash;into oral health policies to minimize the burden of dental trauma among vulnerable populations.\u003c/p\u003e \u003cp\u003eConsistent with global, regional, and local evidence, the present study also revealed that the most common setting for traumatic dental injuries was the home, followed by the school, with falls being the leading cause of injury \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Furthermore, consistent with the findings of the present study, the literature also indicates that enamel fractures are the most common type of uncomplicated crown fractures, followed by enamel-dentine fractures \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe findings of the present study indicate that dental trauma significantly impacts the physical, functional, and psychological aspects of oral health-related quality of life (OHRQoL). These findings suggest that dental trauma primarily disrupts daily oral functions, such as chewing and speaking, while also leading to emotional distress and self-consciousness. A recent study conducted among adolescents in the Colombo district of Sri Lanka using the same tool, AODTII, reported that dental trauma negatively affected 58.4% of participants. Within this group, 52.4% experienced the greatest impact in the psychological domain, whereas 47.8% reported significant effects in the physical domain \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. The variation in findings compared with the present study may be due to differences in the study populations, as the Colombo study focused solely on adolescents engaged in contact sports, a group more prone to high-impact injuries that may lead to different patterns of trauma-related distress.\u003c/p\u003e \u003cp\u003eVarious researchers have used different measurement tools to assess the impact of dental trauma on OHRQoL. For example, a study by Silva-Oliveira et al. reported that 53.1% of participants experienced a negative impact when the short version of the Child Perception Questionnaire (CPQ) was used for children aged 11 to 14 years \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Similarly, Adeyemo et al. reported that an even greater percentage (84.7%) of adolescents experiencing a negative impact on OHRQoL, also used the CPQ for 11 to 14 years \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. El-Kalla et al., utilizing the same assessment tool, concluded that untreated dental trauma significantly impaired OHRQoL \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. These findings collectively reinforce the importance of early diagnosis, treatment, and preventive strategies to mitigate the adverse consequences of dental trauma on children\u0026rsquo;s overall well-being.\u003c/p\u003e \u003cp\u003eGiven these findings, targeted interventions are essential to mitigate the risk and impact of TDI among adolescents. Strengthening mothers\u0026rsquo; health literacy should be prioritized, as well-informed mothers are more likely to adopt preventive practices, recognize early signs of trauma, and seek timely treatment. Educational programs focusing on dental trauma prevention, oral health maintenance, and emergency response should be integrated into maternal and child health services. School-based oral health promotion programs can be expanded to educate students, teachers, and parents about TDI risk factors and preventive strategies. Schools should implement protective measures, such as promoting the use of mouthguards in high-risk sports and enforcing safety guidelines to minimize accidents. School dental therapists can be effectively utilized as a cost-efficient strategy to implement preventive interventions for traumatic dental injuries, ensuring early detection, timely management, referrals, follow up, and improved oral health outcomes among students. Strengthening collaborative efforts between dental professionals, educators, and sports authorities can help in developing structured preventive programs. Establishing dental trauma management protocols in schools ensures that injured children receive timely and appropriate care.\u003c/p\u003e \u003cp\u003eBuilding on the findings of this study, further research is recommended to develop a more generalizable and comprehensive understanding of the factors influencing TDI. Future studies should prioritize longitudinal research to evaluate the long-term effects of TDI on adolescents\u0026rsquo; oral health, psychological well-being, and academic performance. Additionally, investigating the economic burden of untreated TDI could offer crucial insights for policymakers, enabling them to allocate resources more effectively for preventive measures and treatment services. Strengthening school-based dental programs and integrating oral health education into school curricula could serve as cost-effective strategies to mitigate the impact of dental trauma in adolescents.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe current study revealed that the prevalence of TDI among 15-year-old government school children in the Ratnapura Education Division was 14.9%. Furthermore, the gender of the child and the mother's occupation were significant predictors of TDI. It was concluded that TDI had a more negative impact on the children's quality of life.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAODTII: \u0026nbsp;Adolescent Oro Dental Trauma Impact Index\u003c/p\u003e\n\u003cp\u003eCI: Confidence interval\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCPQ: Child Performance Questionnaire \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eECOHIS: \u0026nbsp;Early Childhood Oral Health Impact Scale\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOHIP: Oral Health Impact Profile\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOHRQoL: Oral Health-related Quality of Life\u003c/p\u003e\n\u003cp\u003eOIDP: Oral Impact on Daily Performance\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eO/L-Ordinary Level (11 years of education)\u003c/p\u003e\n\u003cp\u003eOR: Odds Ratio\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePPS: probability proportionate to size\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSPSS: Statistical Package for Social Science\u003c/p\u003e\n\u003cp\u003eTDI: Traumatic Dental Injuriy\u003c/p\u003e\n\u003cp\u003eWHO: World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cu\u003eEthics Approval and Consent to Participate\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResearch ethics were obtained from the Ethical Review Committee, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka (Ethical approval number: ERC/PGIM/2022/085). Necessary permission and approval were obtained from the relevant authorities. All the procedures of the study involving participants were conducted in accordance with the\u0026nbsp;Declaration of Helsinki. Written informed consent and assent were obtained from the parents/ guardians of the each participant and the participants respectively before their participation in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eConsent for publication\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eAvailability of data and materials\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data set that supports the findings of this study is not publicly available due to institutional policy. However, the data are available through the authors upon reasonable request and with the permission of the Post Graduate Institute of Medicine, University of Colombo, Sri Lanka.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eCompeting interest\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eFunding\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eAuthor Information\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors and affiliations\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eSulochana Ranasinghe\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eDirectorate of Health Services, Ministry of Health, Sri Lanka\u0026nbsp;\u003c/p\u003e\n\u003col start=\"2\"\u003e\n \u003cli\u003ePrasanna Jayasekara\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eMinistry of Health, Sri Lanka\u0026nbsp;\u003c/p\u003e\n\u003col start=\"3\"\u003e\n \u003cli\u003eIresha Udayamalee\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eMinistry of Health, Sri Lanka\u003c/p\u003e\n\u003col start=\"4\"\u003e\n \u003cli\u003eManori Dhanapriyanka\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eMinistry of Health, Sri Lanka\u003c/p\u003e\n\u003col start=\"5\"\u003e\n \u003cli\u003eNethma Kalani Jayasekara\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eArmy Hospital, Colombo 05\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSR – data collection, analysis and interpretation of data and manuscript writing. PJ – supervision, supported during study designing and interpretation of data. IU – Statistical analysis, data interpretation, editing and reviewing the manuscript, MD – Statistical analysis, writing the discussion section of the manuscript and editing of the manuscript, NKJ - Editing and reviewing the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding Author\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to Prasanna Jayasekara\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eAcknowledgment\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our sincere gratitude to the Ministry of Education, Sri Lanka, Sabaragamuwa Provincial Department of Education, principals, teachers and all participants for their contributions to this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAndersson L. Epidemiology of traumatic dental injuries. 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PMID: 29326503; PMCID: PMC5754973.\u003c/li\u003e\n\u003cli\u003eRajab LD, Baqain ZH, Ghazaleh SB, Sonbol HN, Hamdan MA. Traumatic dental injuries among 12-year-old schoolchildren in Jordan: prevalence, risk factors and treatment need. Oral Health Prev Dent. 2013;11(2):105-12. doi: 10.3290/j.ohpd.a29362. PMID: 23534038. \u003c/li\u003e\n\u003cli\u003eEkanayake L, Perera M. Pattern of traumatic dental injuries in children attending the University Dental Hospital, Sri Lanka. Dent Traumatol. 2008 Aug;24(4):471-4. doi: 10.1111/j.1600-9657.2008.00611.x. PMID: 18721351.\u003c/li\u003e\n\u003cli\u003eZaleckiene V, Peciuliene V, Brukiene V, Drukteinis S. Traumatic dental injuries: etiology, prevalence and possible outcomes. Stomatologija. 2014;16(1):7-14. PMID: 24824054.\u003c/li\u003e\n\u003cli\u003eda Silva RLC, Dias Ribeiro AP, Almeida JCF, Sousa SJL, Garcia FCP. Impact of dental treatment and the severity of traumatic dental injuries on the quality of life of Brazilian schoolchildren. Dent Traumatol. 2021 Aug;37(4):562-7. doi: 10.1111/edt.12660. Epub 2021 January 28. PMID: 33511757.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Traumatic dental injuries, school children, malocclusion, Adolescent Oro Dental Trauma Impact Index","lastPublishedDoi":"10.21203/rs.3.rs-6234293/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6234293/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTraumatic dental injuries (TDIs) can occur at any age, in children at a higher susceptibility. TDIs involving anterior teeth pose functional concerns and have aesthetic and psychological implications. A variety of physical, sociodemographic and socioeconomic factors influence traumatic injuries. This study aims to determine the TDI prevalence, its perceived impact and associated risk factors among adolescents in the school setting in Ratnapura district, Sri Lanka.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA descriptive cross-sectional study was conducted among 585 government school children aged 15 years in the Ratnapura Education division. The children were selected using a two-stage cluster sampling technique with probability proportionate to size. A self-administered questionnaire was used to ascertain information on factors related to TDI, followed by a clinical oral examination to assess dental trauma and malocclusion status. For children who had TDI, the Adolescent Oro Dental Trauma Impact Index (AODTII) was used to assess the impact of TDI on oral health-related quality of life. Statistical analysis was conducted using SPSS version 23. Descriptive analysis, chi-square test, Fisher's exact test and multiple logistic regression were applied for statistical analysis. The significance level was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eDental trauma was experienced by 14.9% of the study sample of 585, with a female predominance. Most TDIs occurred at home (46%), while falling (51.7%) was the primary etiology for TDIs. Bivariate analysis revealed that TDI was significantly associated with sex, mother\u0026rsquo;s education, mother\u0026rsquo;s occupation, engagement in sports activity, presence of malocclusion, degree of overjet and lip coverage. Multiple logistic regression analysis indicated that sex, mother\u0026rsquo;s occupation and degree of overjet were significant predictors of TDI. AODTII showed that out of those who had TDI, the greatest impact on quality of life was social factors (42.5%) followed by physical factors (39.1%).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis study revealed a substantial prevalence of TDI among 15-year-old school children in the Ratnapura Education Division, and it was significantly influenced by sex, mother\u0026rsquo;s occupation and degree of overjet. TDI had a more negative impact on children's quality of life.\u003c/p\u003e","manuscriptTitle":"Prevalence and risk factors associated with traumatic dental injuries among adolescent school children: epidemiological survey findings from Sri Lanka","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-17 15:53:14","doi":"10.21203/rs.3.rs-6234293/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3bf64044-ae49-40ee-93e6-daecb927b9be","owner":[],"postedDate":"April 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-18T18:08:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-17 15:53:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6234293","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6234293","identity":"rs-6234293","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}