European Archives of Paediatric Dentistry

, Volume 17, Issue 2, pp 75–80 | Cite as

Risk factors for anterior traumatic dental injury in children and adolescents with autism spectrum disorders: a case–control study

  • R. C. H. Habibe
  • A. O. L. Ortega
  • R. O. Guaré
  • M. B. Diniz
  • M. T. B. R. SantosEmail author
Original Scientific Article



This was to assess and compare risk factors for traumatic dental injury (TDI) among children/adolescents with and without autism spectrum disorders (ASD).


The study consisted of 122 children and adolescents (98 males, 24 females), 61 with ASD (study group) and 61 without ASD (control group, CG). Dental injuries were determined according to Andreasen´ss classification. The cause, location and type of activity at the time of trauma were recorded from patient/carer recollection.


Subjects with ASD presented higher percentages of TDI in routine activities (P = 0.003), falling while walking and episodes of self-harm (P = 0.007) in the individual’s own residence (P = 0.036). TDI prevalence in the ASD group was higher (39.3 %) than in the CG (26.2 %) though not significant, (P = 0.123). Girls with ASD presented a significantly higher TDI percentage (50.0 %) compared with girls from the CG (8.3 %) (P = 0.024). Enamel fracture was the most frequent type of TDI for both groups (P = 0.292). The teeth most commonly affected were #11 and #21 for both groups.


Children and adolescents with ASD exhibit different risk factors for TDI compared with those without ASD, and girls with ASD are more prone than boys.


Autistic disorder Prevalence Epidemiology Tooth injuries 


Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval and Consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Signed informed consent was obtained from all child’s parents/guardians in the study. This research was approved by the Review Board for Human Studies of the University Center of Volta Redonda (UniFOA), Volta Redonda, Rio de Janeiro, Brazil, under protocol no. CAAE 1338.0.000.446-11.


  1. Aiello TP, Whitaker-Azmitia PM. Sexual differentiation and the neuroendocrine hypothesis of autism. Anat Rec (Hoboken). 2011;294:1663–70.CrossRefGoogle Scholar
  2. Altun C, Guven G, Akgun OM, Acikel C. Dental injuries and attention-deficit/hyperactivity disorder in children. Spec Care Dentist. 2012;32:184–9.CrossRefPubMedGoogle Scholar
  3. Altun C, Guven G, Yorbik O, Acikel C. Dental injuries in autistic patients. Pediatr Dent. 2010;32:343–6.PubMedGoogle Scholar
  4. Andreasen JO, Andreasen FM, Skeie A, Hjørting-Hansen E, Schwartz O. Effect of treatment delay upon pulp and period ontal healing of traumatic dental injuries–a review article. Dent Traumatol. 2002;18:116–28.CrossRefPubMedGoogle Scholar
  5. Andreasen JO, Andreasen FM, Andersson L. Textbook and color atlas of traumatic injuries to the teeth. 4th ed. Copenhagen: Wiley; 2007.Google Scholar
  6. Ankola AV, Hebbal M, Sharma R, Nayak SS. Traumatic dental injuries in primary school children of South India–a report from district-wide oral health survey. Dent Traumatol. 2013;29:134–8.CrossRefPubMedGoogle Scholar
  7. Barry S, O’Sullivan EA, Toumba KJ. Barriers to dental care for children with autism spectrum disorder. Eur Arch Paediatr Dent. 2014;15:127–34.CrossRefPubMedGoogle Scholar
  8. Bhat N, Agrawal A, Nagrajappa R, Sen Roy S, Singh K, Chaudhary H, Asawa K. Teeth fracture among visually impaired and sighted children of 12 and 15 years age groups of Udaipur city, India–a comparative study. Dent Traumatol. 2011;27:389–92.CrossRefPubMedGoogle Scholar
  9. Choi SC, Park JH, Pae A, Kim JR. Retrospective study on traumatic dental injuries in preschool children at Kyung Hee Dental Hospital, Seoul, South Korea. Dent Traumatol. 2010;26:70–5.CrossRefPubMedGoogle Scholar
  10. Damé-Teixeira N, Alves LS, Susin C, Maltz M. Traumatic dental injury among 12-year-old South Brazilian schoolchildren: prevalence, severity, and risk indicators. Dent Traumatol. 2013;29:52–8.CrossRefPubMedGoogle Scholar
  11. Developmental Disabilities Monitoring Network Surveillance Year 2010 Principal Investigators; Centers for Disease Control and Prevention (CDC). Prevalence of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites, United States, 2010. MMWR Surveill Summ. 2014;63:1–21.Google Scholar
  12. Díaz JA, Bustos L, Brandt A, Fernández BE. Dental injuries among children and adolescents aged 1–15 years attending to public hospital in Temuco, Chile. Dent Traumatol. 2010;26:254–61.CrossRefPubMedGoogle Scholar
  13. dos Santos MT, Souza CBC. Traumatic dental injuries in individuals with cerebral palsy. Dent Traumatol. 2009;25:290–4.CrossRefPubMedGoogle Scholar
  14. Du RY, Yiu CK, King NM, Wong VC, McGrath CP. Oral health among preschool children with autism spectrum disorders: a case-control study. Autism. 2015;19:746–51.CrossRefPubMedGoogle Scholar
  15. Duerden EG, Oatley HK, Mak-Fan KM, et al. Risk factors associated with self-injurious behaviors in children and adolescents with autism spectrum disorders. J Autism Dev Disord. 2012;42:2460–70.CrossRefPubMedGoogle Scholar
  16. Faus-Damiá M, Alegre-Domingo T, Faus-Matoses I, et al. Traumatic dental injuries among schoolchildren in Valencia, Spain. Med Oral Patol Oral Cir Bucal. 2011;16:e292–5.CrossRefPubMedGoogle Scholar
  17. Feldens CA, Kramer PF, Feldens EG, Pacheco LM, Vítolo MR. Socioeconomic, behavioral, and anthropometric risk factors for traumatic dental injuries in childhood: a cohort study. Int J Paediatr Dent. 2014;24:234–43.CrossRefPubMedGoogle Scholar
  18. Ferreira MC, Guare RO, Prokopowitsch I, Santos MT. Prevalence of dental trauma in individuals with special needs. Dent Traumatol. 2011;27:113–6.CrossRefPubMedGoogle Scholar
  19. Fombonne E. Epidemiological surveys of autism and other pervasive developmental disorders: an update. J Autism Dev Disord. 2003;33:365–82.CrossRefPubMedGoogle Scholar
  20. Goettems ML, Torriani DD, Hallal PC, Correa MB, Demarco FF. Dental trauma: prevalence and risk factors in schoolchildren. Community Dent Oral Epidemiol. 2014;42:581–90.CrossRefPubMedGoogle Scholar
  21. Hasan AA, Qudeimat MA, Andersson L. Prevalence of traumatic dental injuries in preschool children in Kuwait—a screening study. Dent Traumatol. 2010;26:346–50.CrossRefPubMedGoogle Scholar
  22. Hergüner A, Erdur AE, Başçiftçi FA, Herguner S. Attention-deficit/hyperactivity disorder symptoms in children with traumatic dental injuries. Dent Traumatol. 2015;31:140–3.CrossRefPubMedGoogle Scholar
  23. IBGE. Demographic census 2000: population and household chracteristics. Rio de Janeiro: The Brazilian Institute of Geography and Statistics; 2000. Accessed 3 Dec 2014.
  24. Jalihal S, Nagarajappa R, Sharda A, Asawa K, Tak M. Assessment of dental trauma among cerebral palsy individuals in Udaipur city. Dent Traumatol. 2012;28:448–51.CrossRefPubMedGoogle Scholar
  25. Livny A, Sgan-Cohen HD, Junadi S, Marcenes W. Traumatic dental injuries and related factors among sixth grade schoolchildren in four Palestinian towns. Dent Traumatol. 2010;26:422–6.CrossRefPubMedGoogle Scholar
  26. Murthy AK, Mallaiah P, Sanga R. Prevalence and associated factors of traumatic dental injuries among 5- to 16-year-old schoolchildren in Bangalore City, India. Oral Health Prev Dent. 2014;12:37–43.PubMedGoogle Scholar
  27. National Survey of Oral Health 2010, SB Brazil (SB 2010): survey on the oral health conditions of the Brazilian population 2010. Main results. Ministry of Health, Brazil. Accessed 31 Aug 2015.
  28. Navabazam A, Farahani SS. Prevalence of traumatic injuries to maxillary permanent teeth in 9 to 14-year-old school children in Yazd, Iran. Dent Traumatol. 2010;26:154–7.CrossRefPubMedGoogle Scholar
  29. Pocock SJ. Clinical trials. A practical approach. New York: Wiley; 1983.Google Scholar
  30. Ritwik P, Massey C, Hagan J. Epidemiology and outcomes of dental trauma cases from an urban pediatric emergency department. Dent Traumatol. 2015;31:97–102.CrossRefPubMedGoogle Scholar
  31. STROBE statement–checklist of items that should be included in reports of observational studies (STROBE initiative). Int J Public Health. 2008;53:3–4.Google Scholar
  32. Surabian SR. Dentistry’s intrinsic link to provision of services for persons with disabilities. J Calif Dent Assoc. 2013;41(677–83):686–8.Google Scholar
  33. Tagelsir A, Khogli AE, Nurelhuda NM. Oral health of visually impaired schoolchildren in Khartoum State, Sudan. BMC Oral Health. 2013;13:33. doi: 10.1186/1472-6831-13-33.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Taiwo OO, Jalo HP. Dental injuries in 12-year old Nigerian students. Dent Traumatol. 2011;27:230–4.CrossRefPubMedGoogle Scholar
  35. World Health Organization. The ICD-10 classification of mental and behavioral disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 1992.Google Scholar
  36. Zengin AZ, Celenk P, Sumer AP, Cankaya S. Evaluation of traumatic dental injuries in a group of Turkish population. Niger J Clin Pract. 2015;18:86–9.PubMedGoogle Scholar

Copyright information

© European Academy of Paediatric Dentistry 2015

Authors and Affiliations

  • R. C. H. Habibe
    • 1
  • A. O. L. Ortega
    • 2
  • R. O. Guaré
    • 2
  • M. B. Diniz
    • 3
  • M. T. B. R. Santos
    • 2
    • 4
    Email author
  1. 1.Coordinator School of Dentistry University Center of Volta Redonda (UniFOA)Campus Olezio Galotti—Três PoçosVolta RedondaBrazil
  2. 2.Persons with Disabilities Division, Institute of DentistryCruzeiro do Sul UniversitySão PauloBrazil
  3. 3.Paediatric Dentistry, Institute of DentistryCruzeiro do Sul UniversitySão PauloBrazil
  4. 4.Individuals with Special NeedsCruzeiro do Sul UniversitySão PauloBrazil

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