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Urban-rural differences in oral and maxillofacial trauma

Abstract

The aim of this research was to assess oral and maxillofacial trauma in urban and rural populations of the same region. The data collected included age, gender, year and month of trauma occurrence, origin (rural and urban), cause of injury, and the type of oral and maxillofacial trauma. Records from 1121 patients with 790 instances of oral and maxillofacial trauma were evaluated. Statistical analysis was performed with the Statistical Package for Social Sciences (SPSS) version 17.0 software and involved descriptive statistics and Pearson's chi-squared test. Male patients were more prone to maxillofacial trauma (n = 537; 68%), and the patients were mostly from urban areas (n = 534; 67.6%). The male-to-female ratio was found to be 2.12:1 (urban zone, 1.72:1; rural zone, 3.49:1). The average age was 25.7 years (SD = 14.1). A traffic accident was the most common cause of oral and maxillofacial trauma (27%). The jaw (18%) was the most commonly fractured bone in the facial skeleton, followed by the zygoma (12.9%). Avulsion (8.5%) was the most common dental trauma. A significant statistical relationship was found between place of origin and gender (p < 0.001). Accidents involving animals were more frequent in rural areas (P < 0.001). Zygomatic fractures (p < 0.001), contusion (p = 0.003), and abrasion (p = 0.051) were the most common injuries among individuals from rural areas. Nasal fracture (p = 0.011) was the most frequent type of trauma in individuals from urban areas. According to these data, it seems reasonable to assume that specific preventive public policy for urban and rural areas must respect the differences of each region.

Facial Injuries; Traumatology; Maxillofacial Injuries; Urban Population; Rural Population


ORAL AND MAXILLOFACIAL TRAUMA

Urban-rural differences in oral and maxillofacial trauma

Anne Margareth BatistaI; Leandro Silva MarquesII; Aline Elizabeth BatistaIII; Saulo Gabriel Moreira FalciI; Maria Letícia Ramos-JorgeIV

ISchool of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil

IIDepartment of Orthodontics, School of Dentistry, Vale do Rio Verde University, Três Corações, MG, Brazil

IIIPrivate clinic, Hospital Imaculada Conceição, Guanhães, MG, Brazil

IVDepartment of Pediatric Dentistry, School of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil

Corresponding author Corresponding author: Anne Margareth Batista E-mail: annemargb@hotmail.com

ABSTRACT

The aim of this research was to assess oral and maxillofacial trauma in urban and rural populations of the same region. The data collected included age, gender, year and month of trauma occurrence, origin (rural and urban), cause of injury, and the type of oral and maxillofacial trauma. Records from 1121 patients with 790 instances of oral and maxillofacial trauma were evaluated. Statistical analysis was performed with the Statistical Package for Social Sciences (SPSS) version 17.0 software and involved descriptive statistics and Pearson's chi-squared test. Male patients were more prone to maxillofacial trauma (n = 537; 68%), and the patients were mostly from urban areas (n = 534; 67.6%). The male-to-female ratio was found to be 2.12:1 (urban zone, 1.72:1; rural zone, 3.49:1). The average age was 25.7 years (SD = 14.1). A traffic accident was the most common cause of oral and maxillofacial trauma (27%). The jaw (18%) was the most commonly fractured bone in the facial skeleton, followed by the zygoma (12.9%). Avulsion (8.5%) was the most common dental trauma. A significant statistical relationship was found between place of origin and gender (p < 0.001). Accidents involving animals were more frequent in rural areas (P < 0.001). Zygomatic fractures (p < 0.001), contusion (p = 0.003), and abrasion (p = 0.051) were the most common injuries among individuals from rural areas. Nasal fracture (p = 0.011) was the most frequent type of trauma in individuals from urban areas. According to these data, it seems reasonable to assume that specific preventive public policy for urban and rural areas must respect the differences of each region.

Descriptors: Facial Injuries; Traumatology; Maxillofacial Injuries; Urban Population; Rural Population.

Introduction

The epidemiology of maxillofacial trauma has been studied worldwide.1-6 The etiology varies, depending on the age of the patient in question, as well as cultural and socio-economic factors.1,2,7,8 Among the most common causes are:

  • a traffic accident involving a car, motorbike, or bicycle;

    1,2,4,7-13

  • day-to-day activities and sports;

    5

  • as well as a fall from a height.

    6,14,15

Knowing the etiology of the maxillofacial trauma provides an understanding of people's behavior in a region and the need for adoption of preventive policies.16

Very little research has been done on the prevalence and etiologic factors of maxillofacial trauma in rural areas.17,18 Studies of the prevalence of tooth injuries in clinical settings other than dental offices, such as hospitals and emergency rooms, are important, since they provide information about the most prevalent types of trauma and the characteristics of the treated population.19 This should help to improve the treatment, prevention, and prognosis of trauma cases, and to minimize the damage. Knowledge about the most commonly found maxillofacial trauma among the rural Brazilian population is scarce, as is knowledge about the causes of these traumas.

This study presents the results of a 35-month survey on the occurrence and characteristics of oral and maxillofacial trauma in patients (both urban and rural dwellers) admitted to a hospital in the region of Guanhães, MG, Brazil.

Methodology

The Oral and Maxillofacial Surgery Unit of the Public Hospital in Guanhães, in the southeast of Brazil, provides maxillofacial trauma treatment for a large number of people from urban and rural areas of the state of Minas Gerais. It is a reference point for 23 Municipalities (urban areas) and various districts and villages (rural areas), in an area with a population of 238,797 inhabitants and an area of 12,745.1 km2. This study was based on the data pertaining to those patients who had suffered a maxillofacial trauma between the 1st of January 2005 and the 30th of November 2007, and who had been attended to in the Public Hospital. Data were collected from the patients' medical files by a single trained researcher.

All patients who had been victims of maxillofacial trauma were included in the sample. Variables related to origin were collected (rural or urban), including:

  • cause of injury:

-(i) vehicles, which included accidents involving automobiles, motorcycles, and bicycles;

-(ii) violence, which included interpersonal violence and the violent use of weapons;

-(iii) falls;

-(iv) sports injuries;

-(v) accidents involving animals; and

-(vi) accidents at work;

  • gender;

  • age;

  • year and month in which the trauma occurred;

  • the type of maxillofacial trauma:

-fractured jaw,

-zygomatic fracture,

-broken nose,

-two or more facial fractures,

-facial abrasion,

-facial laceration,

-facial contusion,

-tooth luxation,

-dental avulsion,

-broken teeth.

Statistical analysis, which was performed with the Statistical Package for Social Sciences (SPSS) version 17.0 software (SPSS Inc., Chicago, USA), involved evaluating the measures of central tendency and variability and calculating proportions. Pearson's chi-squared test was used to compare factors linked to the occurrence of trauma in both rural and urban individuals.

This research was approved by the Research Ethics Committee of the Public Hospital.

Results

Clinical records of 1121 patients who attended the hospital between January 2005 and November 2007 were evaluated. Of these patients, 790 (70.5%) had experienced a maxillofacial trauma. The majority of these were male (n = 537; 68%) and urban dwellers (n = 534; 67.6%). The male-to-female ratio was found to be 2.12:1 (urban zone, 1.72:1; rural zone, 3.49:1). The average age was 25.7 years (SD = 14.1). For both rural and urban patients, the main etiologic factors of trauma were traffic accidents (27%), practicing sports (20.5%), and violence (19%). The most common types of facial fractures were mandibular fracture (18%) and zygomatic fracture (12.9%). The most common dental trauma was avulsion (8.5%) (Table 1).

A statistically significant association was found between place of origin and gender. The lowest incidence levels of trauma were among female rural dwellers (Table 2).

Car accidents (p = 0.040), violence (p = 0.040), and practicing sports (p = 0.030) caused trauma more frequently in urban areas than in rural areas. Accidents involving animals were more common in rural areas (p < 0.001) (Table 3).

Zygomatic fracture (p<0.001), contusion (p = 0.003), and abrasion (p = 0.051) were the most common types of trauma among rural dwellers. A broken nose was the most common injury among urbanites (p = 0.011) (Table 4).

Discussion

This research was carried out between January 2005 and November 2007 in a region of Minas Gerais, in the southeast of Brazil, covering a population of about 238,797 inhabitants. This region includes both rural and urban areas, with 70% of the population younger than 30 years of age. The results of epidemiological investigations vary depending on the demographics of the population studied. Factors such as geographic region, socio-economic status, and temporal factors such as the period of the year and area can influence the causes, types, and frequency of injuries. These factors must be considered when data are compared.20

Analysis of the demographic data on maxillofacial trauma in this region indicated that it was most prevalent among men (2.1:1) in both urban (1.72:1) and rural areas (3.49:1). These results agree with data from others regions of the world9,14 and also within Brazil.7,11 It is interesting to note that the cultural and socio-economic characteristics of the studied population may influence the rates of facial fractures in women. In regions where women participate directly in social activities and consequently are more susceptible to traffic accidents and urban violence, the ratio of men:women incurring maxillofacial trauma is generally low.5,11 In rural regions, where few women drive and do outdoor work, the ratio of men:women tends to be higher.21

In this research, traffic accidents were the most common cause of maxillofacial trauma. Within the category of traffic accidents, bicycle and motorcycle accidents deserve special attention, since they are prominent in maxillofacial trauma etiology.22 Traffic accidents are important causes of maxillofacial injuries in both developing1,2,4,11,23 and developed countries.9,24 Bicycles and motorcycles are important means of transportation in both urban and rural areas. In rural areas, traveling on horseback is still common, which explains the higher levels of maxillofacial trauma attributed to accidents involving animals.

In this research, we can see that maxillofacial trauma due to violence or practicing sports is more common in urban areas than in rural areas. Research carried out in urban areas of developed countries confirms that practicing sports is the second most common cause of maxillofacial injuries,25 while, in developing countries, interpersonal violence is the second most common cause of facial traumas.22 Educational campaigns should be promoted in both urban and rural areas with the aim of recommending the use of mouthguards, helmets, and knee-pads and/or elbow pads while practicing sports. Recently, in terms of violence, assault has been found to be the most common etiology of facial trauma in many urban centers in developed countries. Some previous studies26,27 demonstrated that developed countries have a higher level of interpersonal violence, and this is the leading cause of facial injuries. With the ease of acquiring weapons and increasingly aggressive behavior in urban centers, violence has replaced road accidents as the leading cause of maxillofacial trauma in these regions.11 Because of legislative changes and preventive measures involving the use of seat belts and air bags, as well as the reduction in driving while under the influence of alcohol, motor vehicle accidents related to facial injuries have tended to decrease in some countries, while interpersonal violence has emerged as the predominant cause of facial trauma. Alcohol and unemployment are also contributing factors.7,28,29

The lower jaw was the most prevalent facial bone fractured, followed by the zygomatic complex and the nose. Similar results were found in other research projects carried out in Brazil 7,11,30 and in other countries, such as Turkey,4 India,2 Japan,9 and the UAE.10 The lower jaw is one of the most frequent targets in fights and is also a frequently fractured bone in motor vehicle accidents.7 Zygomatic fracture, contusion, and abrasion were the most common types of trauma among rural dwellers. A broken nose was the most common injury among urbanites. Further studies should be carried out to link each type of injury with the type of accident. It is believed that this difference between rural and urban areas is due to the large number of accidents involving animals in rural areas. Reports with high numbers of traffic accidents tend to contain many jaw injuries, particularly condylar fractures. In studies of significant interpersonal violence, mandibular fractures and zygomatic complex fractures appear to be the most prevalent fracture location.9 However, no research of this type has been carried out in Brazil as yet.

This research supports the idea that regular epidemiologic evaluations of maxillofacial fractures provide important support for care facilities and research priorities, since factors associated with maxillofacial traumas can be identified. According to these data, it seems reasonable to assume that specific preventive public policy for urban and rural areas must respect the differences of each region.

Conclusion

The prevalence of maxillofacial trauma was high. The male-to-female ratio was higher in rural areas than in urban areas. The most common type of trauma was a fractured lower jaw, followed by a zygomatic fracture. The cause of injury differed greatly between rural and urban areas, with car accidents, violence, and sports accidents being the most common cause in urban areas and accidents involving animals causing most injuries in rural areas. Zygomatic fracture, contusion, and abrasion were the most common types of trauma among rural dwellers. A broken nose was the most common injury among urbanites.

Acknowledgements

We thank UFVJM and CAPES for the master's scholarship.

Received for publication on Sep 25, 2011

Accepted for publication on Jan 18, 2012

Declaration of Interests: The authors certify that they have no commercial or associative interest that represents a conflict of interest in connection with the manuscript.

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  • Corresponding author:
    Anne Margareth Batista
    E-mail:
  • Publication Dates

    • Publication in this collection
      10 Apr 2012
    • Date of issue
      Apr 2012

    History

    • Received
      25 Sept 2011
    • Accepted
      18 Jan 2012
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