Gender differences in patients who underwent root canal treatment in anterior teeth after trauma

Reshmi B1, Bhagyalakshmi T*2, Arvind S3 1Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India 2Department of pedodontics and preventive dentistry, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India 3Department of orthodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India


INTRODUCTION
Traumatic injury is a challenging public health problem which has been seriously neglected (Craddock, 2009). The majority of dental injuries involve the anterior teeth, especially the maxillary incisors because of their exposed position in the dental arch and dental trauma in most cases causes damage to the crown. Traumatic dental injuries are prevalent in clinical practice, and their management is a challenge for the clinician, who, depending on the type of injury, will have to choose among several possibilities to approach the problem (Jeevanandan, 2017). Traumatic injury that involves a permanent tooth can sometimes create a dif icult situation for the child, the parents, and the dentist, who may opt for treatment that aims to save the original traumatized tooth (Christabel, 2015). Complicated traumatized anterior teeth require quick functional and esthetic repair (Govindaraju et al., 2017a). Such traumatized teeth can be saved primarily by an endodontic therapy followed by composite buildup, cast post, prefabricated post, and veneering and full coverage crowns for functional and esthetic pur-poses. The incidence of dental trauma among the primary school is an emerging dental health problem (Packiri, 2017). Several studies indicate that traumatic dental injury has increased over the last few decades (Somasundaram, 2015). Dental trauma can result in fracture or loss of a tooth (Jeevanandan and Govindaraju, 2018). The consequences of TDI include alteration in physical appearance, speech defects and emotional impacts and thus affecting a child's quality of life (Panchal et al., 2019;Subramanyam, 2018). Preschool children are more prone to TDI due to their poor stability, passive re lexes, and inde inite movements (Govindaraju et al., 2017b;Mahesh et al., 2018).
There are many cases of anterior dental trauma. At the age of 1 or 2, it's mainly caused by falling when learning to walk (Gurunathan and Shanmugaavel, 2016). At preschool age, 2-6 falls during lack of attention during playing and sports activity. After road traf ic accidents and physical ights, sporting injury is one of the main causes of TDI (Subramanyam, 2018).
Anterior dental trauma is often caused by accidents. It can also cause limb fracture or life-threatening injuries (Gurunathan and Shanmugaavel, 2016). As a result, it often becomes impossible to provide appropriate treatment that would allow the affected teeth to be treated (Govindaraju, 2017). Preservation of an intact permanent tooth which, unlike deciduous teeth, will not be naturally replaced by the body (Ravikumar et al., 2017). It's extremely important for further physiological problems to be treated for the affected person. These problems can lead to both exclusions by peers because of visible laws, which can lead to social deprivation and a feeling of embarrassment when laughing and leading to avoid peers (Nair, 2018).
The present study aims to evaluate the gender differences in patients who underwent root canal treatment in anterior teeth after trauma.

MATERIALS AND METHODS
This was a retrospective study for which patients who attended saveetha dental college for the past one year were included. They were between the age group of 2-7 years and 14-18, including male and female children. Informed consent obtained from children's parents and was explained completely. Ethical approval was obtained from the scienti ic review board of saveetha university. The inclusion criteria included patients who were willing to study, and exclusion criteria were, patients with systemic conditions. The data were collected from dental information archiving software {DIAS} which included age, gender tooth that had trauma followed by root canal treatment. A record of 60 patients was selected randomly. Photographs were also used for recon irmation of the treatment done. The collected data were further segregated based on age, gender and added in excel sheets.

Statistical Analysis
The data was segregated according to age and entered in an excel sheet. The data were analyzed in SPSS software. The independent variable included age, gender and caries and the dependent variable included root canal treatment and behavioural management.

RESULTS AND DISCUSSION
The result showed that males have high incidence when compared to female children. Fifteen male children had an incidence of fracture in 51 and 8 of them in 52, and other anterior teeth involving a total of 40 male children. 7 Female children had an incidence of fracture in 61 and 4 of them with an incidence of fracture in 52,62 and other anterior teeth involving a total of 29.  Figure 1 shows the study had a female population of56.52% and the male population of 43.48%. Figure 2 shows patients belonging to the age group of 2 to 4 were 49.28%, age group of 5 to 7 were 27.54%, Age group of 14 to 17 were 13.0%, and age group of 18 to 20 were 10.14% . Figure 3 shows results based on the fractured tooth and age of the population, the age group of 2 to 4 had a high incidence of fracture of the maxillary left primary central incisor (61) with a percentage of 20.9%. The age group of 5 to 7 had 20.29 % fracture in 52. The age group of 14 to 17     Figure 4 shows results based on the gender and fracture, females had a high incidence of 15.94% fracture in 61, 13.04% fracture in 52 and 7.2% fracture in 22 and 5.80% fracture in 11. 26.09% of males had a high incidence of fracture in 52, 7.25% fracture in 61 and 4.35% fracture in 51, 2.90% fracture in 11, and 1.45% of fracture in 21 and 22 Our study revealed age group of 2 to 4 showed 49.3% male instances for fractures. In a study by Mitra Hegde it all 53.9% had anterior tooth fracture of the age group 15 to 30 followed by 20.2% in the age group less than 15 (Govindaraju et al., 2017a;Hegde and Sajnani, 2015). In our study revealed, high prevalence of mail involving the tooth 51 with 21.6%, 52 of 11.6%, and 61 Of 13.0%. In a study by Tarritani et al., there was high prevalence in maxillary central incisors of74.6% (Petti and Tarsitani, 1996). In our study, females had a high incidence of 42.0% and mails had 58.0 people with no signi icant value. In a study by Alaa Gamaleldin Sulaiman Atal, the prevalence of 45% in boys and 55 % in girls (Sulieman and Awooda, 2018).
In our study, the incidence of maxillary lateral incisors were 37.7% and left maxillary central incisors were 29.0%. In a study by Sulaiman, right maxillary central incisors were 35.1% and left maxillary central incisors were 19.8%. In our study, 51 had a high signi icance of 29.0% fracture. In a study by Swati Sharma, 75% of the maxillary central incisor is highly prone for fractures (Brüllmann et al., 2011). In our study, the incidence of fracture of age group 5 to 17 was 40.6% while in a study by Dan Bullman, it ranged from 6.7% to 37.9% fractures (Brandt, 1995;Brüllmann et al., 2011). The prevention of trauma and the need for the treatment following traumatic dental injuries are very important to avoid possible unfavourable consequences that may precipitate. The fracture of the anterior tooth is taken lightly which leads to loss of the natural integrity of the tooth-limitation of the study, less population and con ined to a single college in the city. Adding up on a few important information and sample size would yield better understanding.

CONCLUSIONS
This study reveals that males were highly prone to anterior tooth fracture when compared to females. Among the most fractured teeth, the right primary maxillary lateral incisor [52] was higher. Both the age groups of 2-4 and 5-7 years were highly prone to anterior fractures. This might be because of their interests in sports and other physical activities. Educating parents, teachers and students the importance of teeth, that the teeth are as important as the other parts of the body is paramount. This can be achieved by conducting seminars and other related programmes in school levels, to create awareness among the parents, teachers and students.
Sulieman, A. G., Awooda, E. M. 2018. Prevalence of Anterior Dental Trauma and Its Associated Factors among Preschool Children Aged 3-5 Years in Khartoum City, Sudan. International Journal of Dentistry, pages 1-5.