Pattern of traumatised anterior teeth among adult Nigerians and complications from late presentation

Nigeria, according to World Bank country classification is a low income developing
country, besieged with diverse developmental problems. In Nigeria, the high spate
of violence, increased participation in sporting activities and road traffic crashes
have contributed immensely to traumatic dental injuries (TDI), thus making it an important
oral health problem. Trauma to anterior teeth can cause several aesthetic and functional
alterations, such as fractures, tooth discolouration, tooth mobility, toothache and
tooth loss 1]. Such alterations may have a considerable impact on the quality of life of affected
individuals 2]. It has been proven that trauma to anterior teeth can lead to social and psychological
limitations, which may manifest as feeling embarrassed to smile, having difficulty
with social relationships, inability to maintain a balanced emotional state, which
in turn, provokes a state of irritation, dietary restrictions and difficulty in cleaning
the teeth 3].

Traumatized anterior teeth are a common presentation in clinical dental practice.
The magnitude of this problem has been reported in different parts of the world based
on the prevalence of dental trauma during childhood and adolescence with the causes
of TDI varying with age group. It has been reported that during childhood the main
causes of TDI are falls 4]. Among adolescents, trauma to anterior teeth is mainly due to sports related accidents
5], while at the end of adolescence and beginning of adulthood, car accidents are the
most prevalent causes 6].Trauma related to violence has also been reported in 9–12 year olds 7].

The most frequently traumatized teeth are the maxillary central incisors 8], 9]. Traumatic injuries to teeth and their supporting structures vary in severity ranging
from enamel infraction to avulsions. The most frequent type of injury is uncomplicated
crown fractures 10], 11]. These fractures may involve a single tooth or multiple teeth at the same time, the
pattern of the fracture lines being a function of the direction and impact of the
causative factor 8]. Root fracture is a combined injury of pulp, dentine, cementum and periodontal ligament
and is considered a relatively uncommon type of dental injury 5]. The fracture line may be located at the coronal, middle or apical third of the root.
Traumatized anterior teeth are often neglected and left untreated 12]. When left untreated, they tend to develop complications which may include one or
a combination of the following: pulp necrosis, pulp canal obliteration, tooth discolouration,
ankylosis, resorption, apical periodontitis, dento-alveolar abscess, apical granuloma
or cyst 7], 13].

There are however, few reports 14] on traumatized anterior teeth in adults, especially from the developing world. Kaste
et al. 14] provided estimates of the prevalence of injuries to permanent teeth in an adult representative
sample of the United States (US) population. In subjects aged 21–50 years, 28.1 %
showed clinical evidence of damage to the anterior dentition, with enamel fracture
being the commonest injury observed. It was therefore the aim of the present study
to determine the prevalence and pattern of traumatized anterior teeth among adults
presenting in a tertiary health facility in Nigeria, the time interval between injury
and presentation in the hospital, the reasons for seeking treatment, and the complications
arising due to late presentation.