Online First

2021 : Volume 1, Issue 1

Clinical and Médico-Legal Aspect of Traumatism Bucco-Dental Injuries in Yaounde-Cameroon

Author(s) : Nokam Abena Marie Elvire 1 , Nseme Etoukey Eric 2 , Bate Chloran Louise 1 , Takougang Innocent 3 and Bengondo Messanga Charles 1

1 Department of Oral surgery , Medicine and Biomedical Sciences of University of Yaounde , Cameroon

2 Départment of Legal Medicine , Medicine and Biomedical Sciences of University of Yaounde , Cameroon

3 Department of Public Health , Medicine and Biomedical Sciences of University of Yaounde , Cameroon

Int J Dent Oral Care

Article Type : Research Article

Abstract

The Main Objective: of the study was to describe the socio-demographic, clinical, medico-legal, therapeutic and prognostic characteristics of traumatic oral lesions in patients presenting to health facilities in Yaoundé.
Methods: We conducted a descriptive, prospective, cross-sectional study for 7 months during 2021, in consenting patients, with traumatic dental lesions in four secondary and tertiary health facilities in Yaoundé. The data was collected, processed, and analyzed using IBM SPSS version 23.0 software® for Windows®. 
Results: Of the 129 patients included, 70.54% were male. The median age was 29.57±14.73 years. Single people accounted for 67.44%. People working in the private sector and those with a secondary education represented 48.84% and 44.96% respectively. The emergency department of the selected hospitals received 51.00% of the patients with traumatic oral injuries. Clinically, patients with head and neck injuries and those with isolated oral trauma had 72.09% and 22.48% respectively. Of 183 traumatized teeth, 79.24% were incisors. About 56.59% of the patients were hospitalised, while 75.20% underwent radiological examination. In total, 73.64% had undergone a surgical procedure. About 54.26% of the cases were victims of road traffic accidents (MVA). From a medico-legal point of view, 75.97% of the patients suffered an involuntary trauma. The average total temporary disability was 21.97 days ± 17.47 days (0-45 days). The 5-level pain scale was used and 37.21% of our population had a pain grade of 5. Only 16.28% (21) of the cases received a documented forensic assessment. Of the participants, 13.18% (17) expressed their intention to seek legal compensation for the trauma they suffered. Almost 76.74% (99) of the cases had a combination of functional impotence and cosmetic damage as a result of the traumatic injury. A total of 68.97% (60) of the cases had received a TIW≥30 days for involuntary trauma while, 68.00% (17) received a TIW<8 days for voluntary trauma
Conclusion: The oral trauma profile in Yaoundé is similar to many studies worldwide. Documented forensic assessment of damage to the orofacial sphere is not systematic and is mostly done at the request of the patients.

Introduction

Traumatic bucco-dental injuries (TDI) are quite frequent, though certainly under-reported worldwide [1]. In order to promote oral health, experts have identified the need to properly treat the most common oral diseases, and oral trauma is listed alongside six other conditions including dental caries, periodontal disease and the oral manifestations of HIV and AIDS [1]. Oral dental trauma (ODT) is quite common, although certainly under-reported worldwide. Petti et al in 2018, in their meta-analysis on the world prevalence and incidence of ODT, reported that oral trauma injuries account for 5% of all body injuries, in all age groups, although the oral region accounts for only 1% of the total body surface. They also stated that TBD patients account for a remarkable 85% of all those with maxillofacial trauma injuries [2]. Similarly, Figueiredoa et al in 2019 stated that dental injuries and fractures are among the most common orofacial injuries, with orofacial injuries being the 5th most common traumatic injury worldwide [3]. In our context, Agbor et al in 2012 reported a prevalence rate of 37.1% for dento-facial injuries in athletes practicing contact sports in Yaoundé [4]. Mossus et al recently reported in 2021 a prevalence rate of 14.74% for dento-maxillary trauma in combat sports in Yaoundé [5]. Bengondo et al reported a prevalence rate of 38.2% for traumatic injuries of the alveolar complex and soft tissues in patients aged 1-14 years and a prevalence of 0.5% for mandibular fractures [6]. However, none of these studies examined the medico-legal aspects of the patients' injuries and lesions. The considerable and obvious variations in the incidence and prevalence of traumatic oral injuries around the world may explain why they were not reported among the 310 most important acute and chronic diseases in the Global Burden of Disease Study [7]. Among the reasons identified so far for this global variability are social, economic and cultural diversity [8] and a clear lack of standardised recording and classification of TBI in the currently available literature [9]. From a clinical perspective, evidence-based dental trauma remains a distant wish due to the potentially unethical feat of requiring patients to consent to randomise controlled trials in the acute phase of injury. However, since 2001, the International Dental Trauma Association has been developing and revising guidelines for clinical management in emergencies [10]. In contrast to clinical management, where there is some degree of consensus on what to do with various injuries, the forensic assessment of these injuries appears to be a major problem worldwide [10], including in our context. In order to contribute to the scientific landscape of this very important subject, the aim of this study was to characterise the clinical and especially the medico-legal aspects of oral trauma injuries in patients treated in Cameroon.

Methodology

It was a prospective, cross-sectional study for 7 months from December 2020 to May 2021. Our sampling was consecutive including all patients consenting, presenting with traumatic dental injuries in 4 secondary and tertiary health facilities in Yaounde. This study was conducted in Yaounde city, respectively at the Yaoundé Central Hospital (HCY), the Efoulan District Hospital (HDE), the Biyem-Assi District Hospital (HDB) and the Cité Verte District Hospital (HDCV). These hospitals were selected because of their high patient attendance. After obtaining ethical clearance from the Institutional Ethics Committee of the Faculty of Medicine and Biomedical Sciences of the University of Yaounde 1, administrative authorization from the directors of the above-mentioned hospitals was obtained and finally, informed consent was submitted and signed by the patients who agreed to participate in the study. The data was collected, processed, and analyzed using IBM SPSS version 23.0 software® for Windows®.

Results

Out of 2429 cases of body trauma consulted, 129 cases of orofacial trauma were recruited in four health structures in the city of Yaoundé [Table 1], corresponding to a prevalence of 5.60% and a male prevalence of 70.54% (91). The mean age was 29.57±14.73 years with extremes of 1 year and 68 years. Single people were the most represented with 67.44% (87). People working in the private sector were more prone to traumatic oral injuries with 48.84% (63), followed by students with 29.46% (38), then the unemployed with 12.40% (16) and finally civil servants with 9.30% (12). Individuals with secondary education were 44.96% (58), and only 14.73% (19) of the participants had a university degree. About 46.51% (60) of the patients were seen at the Yaounde Central Hospital (HCY) [Table 1]. The emergency department of the selected health facilities received 51% of patients [Figure1]. Regarding oral trauma injuries, 85.27% had dental injuries, followed by 81.40% of traumatic lip injuries [Figure 2]. A total of 183 traumatized teeth were composed of 79.23% canines (145). There were 56.59% (73) of the patients admitted to hospital, 43.41% (56) of the cases had undergone imaging procedures, 26.36% received drug treatment and 73.64% (95) received surgical treatment. These were 31.78% major surgery.

                                                                      

Figure 1: Care setting for patients presenting oral trauma (N=129).

Other services: general surgery, traumatology, neurosurgery, paediatric surgery, ENT, and neurology

Figure2: Distribution of traumatic oral lesions amongst participants (N=129)

[Figure 3] (osteosynthesis with mini-plates, restraints with ligature wires), 31.01% minor surgery [Figure 4] (sutures, splints, root canal treatment, extraction, drainage, debridement, reimplantation) and 10.85% cosmetic procedures (prostheses, implants, root canal treatment, crowns). Concerning polytrauma (multiple lesions), 93 patients had other non-dental, extra-oral lesions on the head and neck (72.09%). According to the mechanism of occurrence of trauma, about 54.26% of the participants were victims of road accidents, while 24.03%(31) reported a physical assault, falls were recorded in 20.15% of cases, and finally, 1.55% of cases were sports accidents.

Variables(N=129) Frequency(n) Percentage(%)
HCY* 60 46.51
HDE* 25 19.38
HDCV* 10 7.75
HDB* 14 26.36

Table 1: Repartition in health facility of patients presenting Traumatic Dental Injuries (N=129), Yaounde Central Hospital; *Effoulan District Hospital; *District Hospital of Green City; *Byemassi District Hospital.

Figure 3: a) Participants presenting oro-facial trauma b) Osteosynthesis of an infra orbital and Nasion fracture c) Management of a maxillo-facial trauma with contention wires.