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Muasya, MK.  2014.  Traumatic dental injuries to the primary dentition. . The KNH and UON Oral Health Symposium. , Kenya


Muasya, MK, et al.  2013.  Capacity of Kenyan Health Facilities for Decentralized Dental Training. . 101st FDI Scientific conference. , Turkey


Muasya, MK, Ng'ang'a PM, Opinya GN, Macigo FG.  2012.  Malocclusion and orthodontic treatment need among 12-15-year-old children in nairobi. East African Medical Journal. 89(2):39-44.


Muasya, MK, Ng'ang'a PM, Opinya GN, Macigo FG.  2011.  Traumatic dental injuries to permanent anterior teeth in 12 - 15 year old children in Nairobi. East African Medical Journal. 88(7):238-243.


Muasya, MK.  2009.  Malocclusion and traumatic dental injuries in relation to over-jet and lip posture in 12-15 year old in Nairobi. Abstract

Aim: To determine the prevalence and pattern of occurrence of malocclusion and
traumatic injuries to permanent anterior teeth and establish any association
between traumatic injuries, over-jet and lip posture.
Design: This was a descriptive cross-sectional survey.
Setting: The study was carried out in public primary schools in the City of
Nairobi, Kenya over a period of three months.
Subjects and methods: A sample of 1382 boys and girls aged 12-15 years was
obtained by multi-stage random sampling of children in 8 divisions, then 16
zones, then schools were interviewed. Registration for malocclusion was done
using the Dental Aesthetic Index (DAI) and tae variables sought included missing
teeth, crowding, over-jet and antero-posterior molar relations. Two hundred and
twenty two children with history of traumatic dental injuries were identified. A
structured questionnaire was used to obtain information on the trauma,
symptoms associated, cause, site of trauma and if any treatment was sought.
The data was collected by clinical examination of permanent anterior teeth of the
children based on a modification of the WHO criteria with some variables sought
including: number of teeth injured, type of teeth injured, classification of the
trauma and type of treatment if any. Data was analysed aided by computer using
the Statistical Package for Social Sciences (SPSS) programme. Chi-square and
odds ratios statistical tests were done to determine the differences in
malocclusion and trauma experience between males and females and the
difference in trauma experience by different overjet groupings and lip posture.
Student's t-test was used to determine difference in mean overjet between
children who had sustained traumatic dental injuries and those who had not. A p
value of less than 0.05 was considered significant.
Results: Seven hundred and thirty two (53.0%) of the children examined had
either no abnormality or only minor malocclusion, 318(23%) had definite
malocclusion, 176(12.7%) and 156(11.3%) had severe malocclusion and very
severe or handicapping malocclusion respectively. The mean OAI was 26.6.
Prevalence and severity of malocclusion for male and female children did not
differ significantly (p=0.139). The prevalence of TOls was 16.1%. Males had
experienced a significantly higher prevalence of trauma (18.8%) than females
(13.5%) p=0.008. Amongst the male children, falls were the leading cause of
TOls (37.3%). Approximately half (44.8%) of the females did not remember the

cause of injury while 31(36.5%) had sustained TOls due to falls. One hundred
and seventy two (77.5%) children who had experienced TOls had no symptoms
associated with the traumatized teeth. Ninety six (43.2%) of the children were
injured while in the home environment. The maxillary central incisors were the
most commonly traumatized teeth accounting for 220(73.5%) out of 299 injured
teeth. The most frequently observed type of dental trauma was enamel fracture
206(68.9%) followed by enamel-dentin fracture 71(23.8%). Two hundred (90%)
children had not sought treatment for TOls. When frequency of TOls in the
children was related to overjet, it was found that out of the 886 children with
overjet of 0-3 mm 104(11.8%) had experienced TOls. Out of the 502 children with
overjet greater than 3 mm, 118 (23.5%) were found to have TOI. The prevalence
of TOls in children with overjet greater than 3 mm was significantly higher than
that in children with overjet of 3 mm and less (p=O.OOO).A significantly higher
prevalence of TOls was found when children with incompetent lips 124(55.9%)
were compared to those with competent lips 98(44.1%), (p=O.OOO).
Conclusion: There was an overall high prevalence of malocclusion among the
children with no significant gender difference for most of the traits. The OAI
criteria produced a mean OAI score of 26.6, with 11.3% of subjects exhibiting
handicapping malocclusion. Overall traumatized permanent incisors were found
to occur fairly frequently with 68.9% of the injured teeth having sustained enamel
injuries. A very high proportion of traumatized teeth were untreated. Male
gender, overjet greater than 3 mm and incompetent lips were found to be
statistically significant risk factors for traumatic dental injuries.
Recommendation: Facilities and personnel should be put in place so that
children with very severe or handicapping malocclusion can benefit from
subsidized orthodontic therapy by specialists. There is need to improve oral
health policies in Kenya so as to incorporate periodic checks ups in order to
promptly diagnose and give advice on treatment of TOIs. The high proportion of
untreated dental trauma among the children calls for improvement in children,
parents and teacher education.

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