SCIENTIFIC ARTICLE

Australian Dental Journal 2002;47:(2):142-146

A survey of dental and oral trauma in south-east

Queensland during 1998
EB Wood,* TJ Freer*

Abstract
Background: This project investigated the aetiology
of dental and oral trauma in a population in southeast Queensland. The literature shows there is a lack
of dental trauma studies which are representative of
the general Australian population.
Method: Twelve suburbs in the south-east district of
Queensland were randomly selected according to
population density in these suburbs for each 25th
percentile. All dental clinics in these suburbs were
eligible to participate. Patients presenting with
dental and oral trauma were eligible to participate.
Results: A total of 197 patients presented with
dental/oral trauma over a 12 month period. The age
of patients ranged from 1-64 years whilst the most
frequently presenting age group was 6-10 years. There
was a total of 363 injured teeth with an average of
1.8 injured teeth per patient. Males significantly
outnumbered females in the incidence of trauma.
Conclusions: The highest frequency of trauma
occurred in the 6-10 year age group. Most injuries in
this group occurred while playing or riding bicycles.
In the next most prevalent trauma group, 16-20 years,
trauma occurred as a result of fighting and playing
sport. Overall, males significantly outnumbered
females by approximately 1.8:1.0. The majority of
injuries in the deciduous dentition were to periodontal
tissues. In the secondary dentition most injuries were
to hard dental tissue and pulp.
Key words: Trauma, aetiology, epidemiology.
(Accepted for publication 18 January 2001.)

INTRODUCTION
The majority of dental trauma studies, particularly in
Australia, have specifically focused on patients
presenting to school dental services, casualty
departments of hospitals or after hour clinics.1-4 These
sub-populations represent a small portion of the
general Australian population. Davis and Knott5 in
1984 studied patients presenting with dental trauma to
members of the Australian Society of Endodontology,
Australia-wide. They found that the group most at risk
of dental trauma was the 6-12 year olds and this was in
agreement with other international studies.6,7
*School of Dentistry, The University of Queensland.
142

Stockwell established a rate of 1.7 per cent per

year in a population of 66 500 children aged 6-12 years
presenting to a school dental clinic with dental
trauma. However, only injuries to anterior permanent
teeth were recorded.1 Another Australian study by
Burton et al.2 found a prevalence rate of 6 per cent
of dental trauma in 12 287 secondary school students.
A contrasting study in England, by Hamilton8
established a 34 per cent prevalence rate of dental
trauma in 2022 secondary school students. This large
difference between the Australian and English studies
may be attributed, in part, to the different injuries and
teeth included in each study and the relatively low
response rate of 52 per cent in the Australian study.
The literature shows that there is a lack of dental
trauma studies which are representative of the general
Australian population. This survey studied the aetiology,
gender and age distribution of dental/oral trauma in a
diverse south-east Queensland population. Subjects
were recruited from inner city suburbs and rural areas
of south-east Queensland presenting to a sample of
public and private dental clinics.
M AT E R I A L S A N D M E T H O D S
Twelve suburbs in the south-east district of
Queensland were randomly selected according to
population density three suburbs from each 25th
percentile. All dental clinics listed in the Yellow Pages
in these suburbs were eligible to participate in the study.
Patients who presented with trauma to any dental or
supporting structure of the mouth were eligible to
participate. They were asked to complete one section of
a two part self-administered questionnaire which
elicited demographic information as well as information
about the nature of the accident or mishap which
caused the injury. The second section contained
questions about the nature and severity of the dental
and oral injuries and was completed by the treating
dentist or therapist.
Parents or guardians completed the questionnaire for
their children and this was noted on the consent form.
Information about pre-existing dental trauma as a
result of previous accidents was also collected in this
survey.
Australian Dental Journal 2002;47:2.

Table 1. Age distribution of dental injury patients

Age of patient (years)

Number of males (%)

1-5
6-10
11-15
16-20
21-25
26-30
31-35
36-40
41-45
46-50
51-55
56-60
61-65
Totals

22
33
24
30
7
4
1
2
1
1

Number of females (%)

(17.5)
(26.2)
(19)
(23.8)
(5.6)
(3.2)
(0.8)
(1.6)
(0.8)
(0.8)

18
22
11
9
3

1
3
1

71

1 (0.8)
126 (64)

The types of injuries were classified in accordance

with the three tier classification of Andreasen:9 (1)
injury to hard dental tissues and pulp; (2) injury to the
periodontal tissues; and (3) alveolar fractures. Injuries
in each of the three groups were further classified into
six categories. Group 1: (a) uncomplicated enamel
fracture; (b) uncomplicated enamel and dentine
fracture; (c) crown fracture (pulp exposed); (d) crown
and root fracture; (e) crown and root fracture (pulp
exposed); and (f) root fracture. Group 2: (a) concussion;
(b) subluxation (loosening but not displaced); (c)
extrusion; (d) lateral luxation; (e) intrusive luxation;
and (f) avulsion. Group 3: (a) comminution of the
alveolar socket; (b) fracture of the alveolar socket wall;
(c) fracture of the alveolar process with and; (d)
without involvement of the tooth socket; (e) fractures
of the mandible or maxilla with and; (f) without
involvement of the tooth socket. All 18 injury
classifications were also represented by a diagrammatic
illustration of the type of injury in the questionnaire to
avoid confusion. Injuries to the total dentition were
recorded including injuries to both primary and
permanent teeth.
Recruitment of patients was over a 12-month period.
A total of 197 patients from 49 clinics provided a
completed questionnaire and were included in the
analyses. One patient presented to the same dentist on
two separate occasions with dental injuries arising from
two independent accidents and was treated as two
cases. Whilst the dentist at the clinic was responsible
for recording all patients presenting with dental trauma
it was uncertain how accurately the data were recorded.

Total number (%)

(25.4)
(31).4
(15.5)
(12.7)
(4.2)

40
55
35
39
10
4
2
5
2
1
3

(1.4)
(4.2)
(1.4)
(4.2)

(20.3)
(27.9)
(17.8)
(19.8)
(5.1)1
(2)
(1)1.
(2.5)
(1)1.
(0.5)
(1.5)

1 (0.5)
197 (100)1.

(36)

Chi-square tests were used to determine if any

significant differences existed between the proportions
of patients in each variable category investigated.10
R E S U LT S
Data were collected for those patients who presented
with dental or oral trauma and whose ages ranged from
1-64 years. The most frequently presenting age group
was in the 6-10 year range for both males and females
(Table 1).
There was a total of 363 injured teeth, with an
average of 1.8 injured teeth per patient. Most patients
injured one or two teeth per accident 37.6 per cent
and 37.1 per cent respectively. Three or four teeth per
patient were injured in 7.1 per cent of accidents, while
five teeth per patient were injured in 2 per cent of
accidents. Six teeth per patient were injured in three
patients and only one patient injured seven teeth in an
accident (Table 2).
The most common activity at the time of the accident
for both males and females was playing, 23.8 per cent
and 21.1 per cent respectively. Males and females
generally differed in their activities at the time of the
dental injury. There were more injuries sustained
during walking and running activities for females,
compared with injuries sustained through playing
sports in males (Table 3).
Males significantly outnumbered females in incidence
of trauma by a factor of 1.8 (126 males, 71 females,
p<0.001). This trend was reflected in all types of
trauma, except for trauma as a result of a car collision,
swimming and drinking/eating. The proportions for

Table 2. Sex distribution of patients with dental injuries to the primary and secondary dentition
*Primary dentition
Number of teeth
1
2
3
4
5
6
7

11
13
1
4

Male
(%)

Female
(%)

(35.5)1
(41.94)
(3.2)1
(12.9)

7 (43.8)
9 (22)1.

(6.5)

Secondary dentition
Male
(%)
38
30
8
6
3

(44.2)
(34.9)
(9.3)
(7)1.
(3.5)

1 (1.2)

Female
(%)

Male total
(%)

18 (36)
21 (42)
5 (10)
4 (8)
1 (2)
1 (2)

49
43
9
10
3
2
1

(38.9)
(34.1)
(7.1)
(7.9)1
(2.4)1
(1.6)1
(0.8)1

Female total
(%)
25
30
5
4
1
1

(35.2)
(42.3)
(7)1.
(5.6)
(1.4)
(1.4)

Total
(%)
74 (37.6)
73 (37.1)
14 (7.1)1
14 (7.1)1
4 (2)1.
3 (1.5)1.
1 (0.5)1.

*Primary dentition includes patients injuring only primary dentition and patients injuring both primary and secondary dentitions in one accident.
Australian Dental Journal 2002;47:2.

143

Table 3. What patients were doing at the time of the injuries

Activity
Playing
Bicycle/skateboard/rollerblading
Sport
Walking/running
Fighting
Up/down stairs
Driving/passenger
Working
Water activities
Drinking/eating
Other
Totals

Males (%)
30
20
24
17
9

(23.8)
(15.9)
(19)1.
(13.5)
(7.1)1.

5 (4)1.
7 (5.6)
4 (3.2)

10 (7.9)1
126

these latter activities were more equally divided

between the sexes or were too small to analyse.
No significant difference in frequency of trauma was
observed for different days of the week. However, there
were significantly more dental trauma incidents
reported in the months July through October compared
with the rest of the year (P<0.001). The largest number
of accidents (34.5 per cent) occurred between noon and
4pm (p<0.001). Most accidents occurred outdoors,
(65.5 per cent), (p<0.001), reflecting the patients
activities at the time of the accident. The time of the
injury tended to reflect the nature of the accident. For
example, 60 per cent of the accidents that resulted from
fights occurred in the hours between midnight and 4am
whilst 50 per cent of the bicycle accidents occurred in
the hours between 4pm and 8pm (after school hours).
Most accidents occurred at home (28.4 per cent) or on
the road/footpath or in the pool or at the beach (14.2
per cent each). Sportsgrounds were also a very common
location for injury amongst the male population (16.7
per cent) (Table 4).
Five of the seven patients who were either driving or
passengers in cars were wearing seatbelts at the time of
the accident. Only 53.6 per cent of the dental trauma
patients who were either riding a bike, skateboard or
rollerblades at the time of the accident were
wearing helmets and only 6 per cent of patients who
were injured whilst playing sport were wearing a
protective mouthguard. The types of sports involved in
these dental injuries included tennis, cricket, rugby
league and rugby union, AFL football, soccer and
basketball.

Females (%)
15
8
9
12
1
3
2

3
4
14
71

(21.1)
(11.3)
(12.7)
(16.9)
(1.4)
(4.2)
(2.8)
(4.2)
(5.6)
(19.7)

Total (%)
45
28
33
29
10
3
7
7
7
4
24
197

(22.8)
(14.2)
(16.8)
(14.7)
(5.1)1
(1.5)1
(3.6)1
(3.6)1
(3.6)1
(2)1
(12.2)

Of the 32 patients who were classified as working,

17 required time off work due to their injuries, while 45
of the 116 patients who were students required time off
school for their injuries. A further 13 per cent of injured
children required a family member to take time off
work to care for them. However, it was difficult to
establish whether the lost time from work and school
was a direct reflection of the dental and facial injuries
only, or whether it was due to other bodily injuries
sustained in the same incident.
Trauma patients most frequently injured their
maxillary central incisors in both primary and
secondary dentitions (72 per cent and 63.7 per cent
respectively), while maxillary lateral incisors were
affected in 16 per cent of patients (9.8 per cent in the
primary dentition and 17.8 per cent in the secondary
dentition) (Table 5).
The most common type of injury in both the primary
and secondary dentitions was uncomplicated enamel
and dentine fracture. Concussion and subluxation were
equally the second most common dental injuries in the
secondary dentition whilst subluxation was the next
most common injury in the primary dentition. There
were proportionally more injuries to the hard dental
tissue and pulp in the secondary dentition compared
with the primary dentition (Table 6).
DISCUSSION
This study provides an overview of the aetiology of
dental/oral trauma in a diverse south-east Queensland
population. Prospective studies are more advantageous
than their retrospective counterpart studies as they

Table 4. Location of accident causing injuries

Location of accident

Males (%)

Home
Road/footpath
Pool/surf
Sportsground
Other private home
School
Workplace
Public bar/nightclub
Shopping centre
Funpark/park
Other
Totals

30
17
16
21
13
8
7
4
2
2
5
125

144

(23.8)
(13.5)
(12.7)
(16.7)
(10.3)
(6.3)
(5.6)
(3.2)
(1.6)
(1.6)
(4)1.

Females (%)
26
11
12
4
3
5
1
2
4

1
69

(36.6)
(15.5)
(16.9)
(5.6)
(4.2)
(7)1.
(1.4)
(2.8)
(5.6)
(1.4)

Total (%)
56
28
28
25
16
13
8
6
6
2
7
195

(28.4)
(14.2)
(14.2)
(12.7)
(8.1)1
(6.6)1
(4.1)1
(3)1
(3)1
(1)1
(3.6)

Australian Dental Journal 2002;47:2.

Table 5. Frequency of tooth specific injuries in primary and secondary dentitions

Injured tooth

Primary dentition

Secondary dentition

Total

59
8
7
7
1

82

179
50
23
16
6
4
2
1
281

238
58
30
23
7
4
2
1
363

Maxillary central incisors

Maxillary lateral incisors
Mandibular central incisors
Mandibular lateral incisors
Maxillary canines
Mandibular canines
Maxillary premolars
Mandibular premolars
Total

allow more accurate information to be gathered at the

time (or close to the time) of the accident occurring.
Retrospective (prevalence) studies will miss those cases
whose signs and/or symptoms have disappeared at the
time of the examination (months or possibly years after
the trauma occurred). However, it must be kept in
mind, that prospective studies may also miss some cases
if patients do not seek treatment for their injuries. Thus
the figures presented in either type of study could be
expected to be lower than the actual rates in the
community.
Given the age range of the patients studied, the
results provide one estimate of expected rates of dental
and oral trauma in the general population. The highest
frequency of trauma occurred in the 6-10 year old age
group and was in agreement with other studies.3,5,6,11
Playing and riding bicycles were the most frequently
associated activities, while in the 16-20 year old group
fighting and sport were the predominant activities.
Assaults or fights were also the second and third most
common cause of dental injury in studies by Davis and
Knott5 and Perez et al.12 respectively.
The predominance of injuries in males (1.8:1.0) was
similar to other Australian and overseas studies which
reported sex ratios between 1.4-2.2:1.0.1,2,5-8,13-16 Two
Australian studies by Martin et al.,3 and Liew and Daly4
established a higher male:female ratio of 2.6:1.0. These
studies examined patients attending after hours clinics
which resulted in a higher incidence for 18-23 year

olds. This age group may also reflect a greater number

of males participating in sports and fights in the
evenings and on weekends compared with females.
The majority of the injuries noted in our study
involved the maxillary central incisors for both the
primary and secondary dentitions, a finding consistent
with the literature on dental trauma. Compared with
other cross-sectional studies in which trauma has been
reported to affect a single tooth in the one individual,
this study found that there were approximately 2.4
injuries per patient. This may be due to the differences
in data collection among different studies. Injuries to all
teeth were recorded in this study compared with other
studies where only injuries to either anterior teeth, or
specifically, injuries to primary or permanent teeth were
recorded. This high number of injuries per patient has
also been reported by Martin et al.3 and Galea13 where
data were collected from casualty and emergency
departments at hospitals. This may once again suggest
that patients experiencing more severe injuries, or
injuries occurring after hours, attend hospitals rather
than public or private dental clinics.
The main difference between the primary and second
dentition observed in this study was the types of
injuries sustained. The majority of injuries to the
primary dentition were injuries to the periodontal
tissue, whilst for the secondary dentition, the majority
of injuries were to the hard dental tissue and pulp.
There were also proportionately more alveolar

Table 6. Types of dental injuries occurring in the primary and secondary dentitions
Primary dentition
Type of injury
Uncomplicated enamel fracture
Uncomplicated enamel and dentine fracture
Complicated crown fracture (pulp exposed)
Uncomplicated crown and root fracture
Complicated crown/root fracture (pulp exposed)
Root fracture
Concussion
Subluxation loosening not displaced
Extrusion
Lateral luxation
Intrusive luxation
Avulsion
Comminution alveolar socket
Fracture alveolar socket wall
Fracture alveolar process, socket involvement
Fracture alveolar process, no socket involvement
Mandible/maxilla fracture, socket involvement
Mandible/maxilla fracture, no socket involvement
Australian Dental Journal 2002;47:2.

Secondary dentition

Male

Female

Male

Female

4
12
6

2
2
9
11
9
10
3
5

3
5
7

4
3
4

4
2

15
51
15
6
6
10
28
29
9
14
8
15
2
4
5

8
2

19
37
13
1

1
16
9
4
6
5
10

11

Total
41
105
41
7
8
13
57
52
26
30
20
32
2
11
5

19
3
145

fractures in the primary dentition compared with the

secondary dentition. It was also interesting to note that
all alveolar fractures occurred only in males for both
the primary and secondary dentitions. Some investigators
have indicated that the supporting structures in the
primary dentition are more resilient than those in the
secondary dentition, thereby favouring dislocations
rather than fractures of the hard dental tissue.17,18
Significantly more accidents occurred in and around
the home and on the road or footpath compared with
other locations. This was also the case in two separate
Australian studies by Stockwell1 and Davis and Knott.5
Galea13 and Onetto14 also found that most injuries
occurred around the home or school and on the street.
It was disturbing to find that only a minority of
patients who were injured whilst playing sport were
wearing a mouthguard and only half of those injured
whilst riding a bicycle, skateboard, or rollerblades were
wearing any protective head or mouth gear.
Mouthguards, particularly custom made mouthguards,
offer significant protection to the teeth and oral
structures and their use should be encouraged to
prevent injuries during sport.19
Time lost from work or school due to dental and oral
injuries is significant. Both groups were unable to carry
on with their normal day-to-day activities for an
average of approximately five days. It should be noted
that this figure may be an underestimate of time lost
since school and public holidays were not included in
time lost from work and school.
CONCLUSIONS
The results of the present study provide an estimate
of the expected rates of dental and oral tissue injuries in
the general population in Queensland although it must
be accepted that the survey outcomes were affected by
the non-participation of some potential respondents
and by the need of some patients to seek out-of-hours
emergency treatment at hospitals and therefore remain
outside the scope of our sampling methodology. This
may indicate that the actual population rates are higher
than reflected by this study.
Some of the most significant causes of injury revealed
by the present study are due to incidents while playing
sport or riding bicycles, skateboards and rollerblades.
Only a small percentage of those injured in these
activities were wearing protection. All of these activities
are susceptible to preventive measures and given the
amount of time lost due to associated injuries, it seems
reasonable to suggest that there is still considerable
scope for the profession to educate the public more
widely of the potential dangers and complications of
dental and oral injuries.
AC K N OW L E D G M E N T S
This study was supported by the Motor Accident
Insurance Commission/Centre of National Research on

146

Disability and Rehabilitation Medicine and the

Australian Research Council.
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Address for correspondence/reprints:

Professor Terry Freer
School of Dentistry
The University of Queensland
200 Turbot Street
Brisbane, Queensland 4000
Email: t.freer@mailbox.uq.edu.au

Australian Dental Journal 2002;47:2.