Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 14 nº 4 - Oct/Dec - 2017

Original Article Imprimir 

Páginas 24 a 30

Dental trauma in children and teens inquired at legal medical institute in Feira de Santana-Bahia

Traumas dentales en niños y adolescentes evaluados en el instituto médico legal de Feira de Santana-Bahia

Traumas dentários em crianças e adolescentes periciadas no instituto médico legal de feira de Santana-Bahia

Autores: Mona Lisa Cordeiro Asselta da Silva1; Jamilly de Oliveira Musse2; André Henrique do Vale de Almeida3; Jeidson Antônio Morais Marques4; Maria Conceição Oliveira Costa5

1. Bachelor's Degree in Collective Health by the Graduate Program in Collective Health, State University of Feira de Santana (UEFS). Feira de Santana, BA, Brazil
2. Doctorate in Dental Sciences from the University of São Paulo (USP). Professor of the Department of Health, working in the Public Health Area, State University of Feira de Santana (UEFS). Feira de Santana, BA, Brazil. Expert Odontologist in the Department of Technical Police of Bahia / IML. Salvador, BA, Brazil
3. Doctor in Epidemiology in Public Health from the Department of Epidemiology and Quantitative Methods in Health, National School of Public Health Sergio Arouca (ENSP / Fiocruz). Rio de Janeiro, RJ, Brazil. Master's Degree in Collective Health from the State University of Feira de Santana (UEFS).Feira de Santana, BA, Brazil
4. Postdoctoral degree from the University of Coimbra (UC). Coimbra, Portugal. PhD in Preventive and Social Dentistry, Faculty of Dentistry of Araçatuba, State University of São Paulo "Júlio de Mesquita Filho" (FOA / UNESP). Araçatuba, SP, Brazil. Adjunct Professor of the Department of Health, State University of Feira de Santana (UEFS). Feira de Santana, BA, Brazil
5. Post-doctorate at Université du Québec à Montréal (UQAM). Québec, Canada. Full Professor, Department of Health, State University of Feira de Santana (UEFS). Feira de Santana, BA, Brazil

Mona Lisa Cordeiro Asselta da Silva
Rua Barcelona, nº 136, Residencial Arthur A. Cordeiro, Apt.101
Feira de Santana, BA, Brasil. CEP: 44076-720

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How to cite this article

Keywords: Violence, child health, adolescent health.
Palabra Clave: Violencia, salud del niño, salud del adolescente.
Descritores: Violência, saúde da criança, saúde do adolescente.

OBJECTIVE: Describe the epidemiological profile of children and adolescents who had physical violence as the etiological factor of dental trauma.
METHODS: Case study in children and adolescents victims of violence under consideration of personal injury inquired by forensic dental experts in the IML in Feira de Santana, Bahia, using secondary data, in 01 period January 2010-31 December 2015.
RESULTS: 79 cases of physical abuse in children and adolescents were appreciated with 77.9% of them belonging to the adolescent age group (12-18 years), 85.9% classified as brunette skin and 31.2% had dental injuries. 70.1% of aggressions reached the soft tissue, followed by the tooth (24.7%), the most prevalent clinical manifestations were ecchymosis (22.1%), and dental trauma (17.6). Mouth (38.9%) and teeth (19.0%) were the most affected regions in the body at the time of the assault, and the arm (49.5%) and foot (7.4%) the most prevalent aggression tools.
CONCLUSION: Most physical violence victims that suffered dental trauma were teenager with brunette skin. Victims who had two lesions were the ones that suffered the greatest number of dental trauma and in most cases caused by hands with punches and blows.

OBJETIVO: Describir el perfil epidemiológico de niños y adolescentes que presentaron violencia física como factor etiológico del traumatismo dental.
MÉTODOS: Estudio de serie de casos en niños y adolescentes víctimas de violencia sometidos a examen de lesión corporal, evaluados por peritos odontolegales en el Instituto Médico Legal (IML) de Feira de Santana-Bahia, utilizando datos secundarios, en el período de 01 de enero de 2010 a 31 de diciembre de 2015.
RESULTADOS: evaluados 79 casos de violencia física en niños y adolescentes, con 77,9% pertenecientes a la franja etaria adolescente (12 a 18 años), 85,9% clasificada como faioderma y 31,2% presentaron lesiones dentales. El 70,1% de las agresiones alcanzaron el tejido blando, seguido del dental con (24,7%); las manifestaciones clínicas más prevalentes fueron las equimosis (22,1%) y el trauma dental (17,6). La boca (38,9%) y los dientes (19,0%) fueron las regiones en el cuerpo más alcanzadas al momento de la agresión, siendo el brazo (49,5%) y pies (7,4%) los instrumentos de agresión más prevalentes.
CONCLUSIÓN: La mayor parte de los victimados por la violencia física que sufrieron traumatismo dental eran adolescentes y faiodermas. Las víctimas que presentaron dos lesiones fueron las que sufrieron el mayor número de traumatismo dental, siendo en la mayoría de los casos provocados por las madres con golpes y puñetazos.

OBJETIVO: Descrever o perfil epidemiológico de crianças e adolescentes que apresentaram a violência física como fator etiológico do traumatismo dentário.
MÉTODOS: Estudo de série de casos em crianças e adolescentes vítimas de violência submetidas a exame de lesão corporal, periciadas por peritos odontolegal no Instituto Médico Legal (IML) de Feira de Santana-Bahia, utilizando dados secundários, no período de 01 de janeiro de 2010 a 31 de dezembro de 2015.
RESULTADOS: Foram periciados 79 casos de violência física em crianças e adolescentes, com 77,9% pertencentes à faixa etária adolescente (12 a 18 anos), 85,9% classificada como faioderma e 31,2% apresentaram lesões dentárias.70,1% das agressões atingiram o tecido mole, seguido do dentário com (24,7%), as manifestações clínicas mais prevalentes foram as equimoses (22,1%), e o trauma dentário (17,6). A boca (38,9%) e os dentes (19,0%) foram as regiões no corpo mais atingidas no momento da agressão, sendo o braço (49,5%) e pés (7,4%) os instrumentos de agressão mais prevalentes.
CONCLUSÃO: A maior parte dos vitimados pela violência física que sofreram traumatismo dentário eram adolescentes e faiodermas. As vítimas que apresentaram duas lesões foram as que sofreram o maior número de traumatismo dentário, sendo na maioria dos casos provocados pelas mãos com socos e murros.


Traumatic dental injuries are considered a serious health problem, with a high prevalence in children and adolescents1. Researches indicate that currently, dental trauma exceeds the incidence of caries lesions and periodontal disease in this population2. The consequence of oral trauma, independent of the deciduous or permanent teeth, in most cases, is endodontic intervention or even loss of the affected unit, deserving a better attention on the part of the dental surgeon1.

Facial traumatism is the most prevalent among the numerous injuries, resulting from falls, traffic accidents and violence. This is because it is the most exposed and least protected part of the body. Most of the time, facial trauma is associated with trauma to the teeth and young people are more likely to be more active3.

Studies show that children are more susceptible to dental injuries, and the dental elements most affected are the upper central incisors, and in the deciduous dentition, dental trauma causes both loss of the dental element and damage to the permanent dentition4.

The most susceptible dental elements are the upper central incisors, followed by the lower ones. In the case of permanent dentition, the consequences of these injuries are endodontic treatments with posterior prosthetic rehabilitation (crown) and in the worst case, depending on the type of trauma suffered, urgency and quality of the service provided, the extraction of the affected unit becomes necessary5.

It is interesting to note that even when observed patterns of similar dental trauma, the treatment of patients of different ages vary and the treatment plan must take into account the patient, parents and stage of dentition in which the victim is, always remembering that the child is not only a miniature adult, but has its peculiarities that must be respected at the moment of care6.

Violence with children and adolescents has been studied by different authors in several countries, and even then, it remains a topic that is far from being exhausted. In this context, the dental surgeon has the ethical, legal and social duty to notify and denounce the cases he or she has knowledge of during his or her work, and is also "protected" by his code of ethics on the need to breach professional secrecy.

However, there is a gap in the identification and notification of these cases by health professionals7. Many do not know how to identify the violence, or even knowing how to make this differential diagnosis is not aware of the way to be covered for the notification of the case, which can be attributed to the deficiency of the approach of this subject in graduation or even by ignorance of the legal obligations.

In this context, the objective of the study was to describe the epidemiological profile of children and adolescents who presented physical violence as an etiological factor of dental traumatism.


Epidemiological study of the series of cases, based on secondary data from the records of children and adolescents victims of violence submitted to physical injury examination, performed by odontolegal experts in the IMI of Feira de Santana-Bahia, in the period of January 1, 2010 to 31 December 2015.

With the purpose of analyzing the evolution of the occurrence of dental trauma, it was decided to study the period in question, considering a more current analysis of the phenomenon. The research consolidates a partnership between the State University of Feira de Santana, through the Nucleus of Studies and Research in Childhood and Adolescence, with the Legal Medical Institute. The study subjects were allocated to two groups: children (0-12 years old) and adolescents (12-18 years old).

To analyze the data, we used the descriptive statistical technique that involved absolute and percentage distributions. In the bivariate analysis, the Pearson's Chi-square test and Fischer's exact test were used. The statistical programs Statistical Package for Social Science for Windows 17.0 (SPSS) and the Open Epi were used. This study was submitted and approved by the Human Research Ethics Committee (CEP) of the State University of Feira de Santana/UEFS (CAAE 46251015.2.0000.0053).


In the period from 2010 to 2015, 79 cases of physical violence with children and adolescents, by Odontologist at the Legal Medical Institute (IML) of Feira de Santana-Bahia, were investigated. Of these, 31.2% had dental injuries, all of them caused by a blunt instrument.

Regarding the characteristics of the lesions presented by the victims, it was observed that 70.1% of the aggressions reached the soft tissue, followed by the dental (24.7%). The most prevalent clinical manifestations were ecchymosis (22.1%), dental trauma (17.6%), abrasions (15.4%) and edema (14.0%). The mouth (38.9%) and the teeth (19.0%) were the regions in the body most affected at the time of the aggression (Table 1).

Table 2 shows the socio-demographic characteristics of those who had dental trauma, 62.5% were male, and the majority (66.7%) belonged to the adolescent age group (12 to 18 years). As for skin color, 86.4% were faiodermic (brown), followed by melanodermic (black) with 9.1%. In this group, no variables were significantly associated with the study outcome.

Dental trauma was observed more frequently in victims with more or four lesions (39.1%), followed by two (30.4%), and one lesion (17.4%). As for the instrument used, the arm (42.3%), motorcycle (19.2%) and body (19.2) were the most prevalent. The two variables were statistically significant with dental traumatism (Table 3).


The panorama of violence against children and adolescents in this study revealed part of the reality experienced in Feira de Santana and in the region, since the Medical Legal Institute (IML) is the agency in charge of receiving alleged victims. And the 79 cases analyzed corresponded only to those examined by the odontolegal expert, not including the medical examinations in live and cases that evolved to deaths or even cases in which no physical injury examination requests were made.

According to the results found in the descriptive analysis, 70.1% of the aggressions reached the soft tissue region followed by the dental tissue in 24.7% of the cases. A similar result was found by Cavalcanti8 (2009), where a higher prevalence of soft tissue lesions was observed, especially the lip and mucosal injuries, with the presence of wounds in the labial commissures, tears in the lingual or labial brakes, and lacerations in the tongue9,10.

The most prevalent clinical manifestation was ecchymosis (22.1%) followed by dental trauma (17.6%), not corroborating with the study by Cavalcanti8 (2009), which found a higher prevalence of abrasions (42.9%). The mouth and tooth region was most affected at the time of the blow. Similar results were raised by Carvalho11 et al. (2009) and Atwal12 et al. (1998), who demonstrated the high frequency of lesions in the face, skull and neck regions.

Of the victims who suffered violence, 31.2% had dental trauma, corroborating with the study by Oliveira and collaborators9 (2008), where it was found that 40.5% of the victims of aggression were affected in this region. The literature attributes the occurrence of this type of location to the ease of reaching the head and neck, even by the difference of height in relation to the aggressor. It is also observed that they are prominent areas, so they can more easily be reached by the abusers at the time of the aggression13.

Although there was a balance between the sexes, the male presented a higher prevalence among those who suffered dental traumatism (62.5%). It is worth noting that dental injuries accounted for 39.5% of the injuries suffered by male victims. The studies performed by Prata et al13 (2000) and by Xavier et al.14 (2011) corroborate the present study by showing the most prevalent lesions in men, accounting for 62.91% and 74.6%, respectively.

The majority (77.9%) of the victims of physical violence were adolescents (12-18), of whom 26.7% suffered dental injuries. Similar result was found by Cavalcanti 8 who also pointed out a higher prevalence of adolescent victims. The studies by Brito 15 (2005) and Pires 16 (2005) found a higher prevalence of children victims of violence, as well as the study by Prata and collaborators13 (2000) that pointed to the age group between 7 and 11 years of age as the more victimized, not corroborating with the present work. An explanation for this difference in outcome may be in the etiological factors, since the present study only used physical aggressions as a causative factor for dental trauma, while Prata et al.13 used other factors, such as drop (48.4%) and aggression / stroke as the third most prevalent etiological factor (15.89%).

Regarding the skin color of the victims, 85.9% were faiodermic (brown), of these 31.1% suffered dental traumatisms. A study by Guimarães and Vilella17 (2011), Pimenta and collaborators18 (2013) and Martins19 (2009) found that 71.6%, 64.2% and 58.7% respectively of the victims presented faiodermic color. Literature often points to a higher proportion of victims of skin color faiodermic (brown) and melanodermic (black), which deserves greater attention from public policies.

When the number of lesions that the victims presented at the time of the examination was analyzed, this study found a higher prevalence of victims with two and one lesion (25.7% and 19.8%, respectively), followed by those with ≥ four lesions (11,9%). Cavalcanti (2009)8 observed that (66.7%) of the victims had one lesion, followed by two lesions (21.4%).

The arm was the vehicle most used to cause the lesions (49.5%), among which, 23.4% caused dental trauma in the victims, corroborating with the study by Oliveira and collaborators 09 (2008) that found that 58, 2% the form used to provoke dental injuries were the arms and feet. Treating dental trauma, which is the object of study of the present research, punches or punches deferred against children or adolescents can cause this type of lesion with very high frequency.


The analyzes indicated a higher frequency of victimization in the race / skin color faiodermic in adolescents, in the region of the mouth and teeth, with the main manifestation of dental trauma, and as the main instruments used arms and feet.

To know the epidemiological profile of children and adolescents who presented physical violence as an etiological factor of dental trauma, allows the health professional, and especially the dental surgeon, to suspect with greater skill of the cases that come to his care, whether in primary care, private offices, or even hospitals.

In this way, this professional can fulfill his / her legal, ethical and social role in the notification and denunciation of suspected and / or confirmed cases of violence against children and adolescents, allowing a greater confrontation of this serious and persistent world public health problem. It is understood that this study contributes to elucidate some mechanisms that involve the violence perpetrated against children and adolescents who are being interviewed in the IML of Feira de Santana, Bahia. However, further research should further deepen the topic, contributing to its understanding.


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