Dental trauma in New Zealand adults: a secondary analysis of national survey and ACC data

Abstract

Background

Dental trauma is described by the World Health Organization as a worldwide major public health problem. However, little is known in New Zealand (NZ) and worldwide about the dental trauma experience of adults. Most studies of dental trauma prevalence, incidence and aetiology in NZ and overseas have been carried out using convenience samples, such as people attending a hospital dental clinic. The literature shows that a considerable amount of trauma to permanent teeth occurs at a young age. Since most damage to permanent teeth is not self-healing, injuries to permanent teeth and sequelae of the trauma can be carried into adulthood. Dental trauma is therefore a life-long burden for the individual adult and society. While there have been three National Oral Health Surveys in NZ, the 2009 survey was the first to collect information about dental trauma in the interview and examination. In NZ, visits to a dentist for dental trauma and subsequent treatment is recorded with the Accident Compensation Corporation (ACC), a compulsory social insurance scheme. To date, dental injury data recorded with the ACC have not been analysed with respect to outcomes.

Purpose The objective of this study was to assess the prevalence, risk associations and impact of dental trauma of New Zealanders over 18 years old.

Methods Information about dental trauma in a representative sample of NZ adults was collected as part of the 2009 NZOHS. This included self-reported information and a clinical examination of the six maxillary anterior teeth. Data were weighted and analysed using Stata.

Data from a separate sample of NZ adults who had sustained dental trauma in 2008 and had the injury registered with the ACC were analysed using SPSS.

Results Analysis of the 2009 NZOHS data showed that of the approximately 40% who reported previous orofacial trauma, 70% (that is, 28% overall) reported that this included a dental injury. More males than females had experienced orofacial trauma (51% and 31% respectively; P<0.05) but there was no sex difference in self-reported dental trauma. The most common injury was a “chipped or broken tooth” (67%). Almost three-quarters had sought treatment for their dental injury. Clinical examination revealed an overall trauma prevalence of 23%, with more males than females affected (27% and 20% respectively). Almost 15% had one injured tooth; 7% had two injured teeth and 2% had three or more. The central incisors were the most frequently affected. The most common clinical dental trauma observation was evidence of “treatment” or an “untreated enamel fracture”, more common among males and those aged 35-44.

Analysis of dental information from the ACC revealed that 32,110 adults and children sought treatment for orofacial trauma during 2008. Dental injuries to permanent teeth most commonly involved the central and lateral maxillary incisors. Some 1,325 adults who sustained dental trauma during June 2008 were followed for the subsequent 5 years. Generally, more severe injuries required more treatment.

Conclusion Prevalence estimates for and characteristics of dental trauma in NZ adults are similar to international findings. There were socio-demographic disparities in the occurrence and treatment of dental trauma in the NZ adult population. The findings confirmed that traumatic dental injuries in the New Zealand adult population constitute an important public health issue, given that many will need life-long follow-up and treatment.