Abstract
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Background:
Traumatic dental injuries (TDIs) are one of the most common body injuries and
constitute an important public health problem. These injuries are
considerably more common among adolescents, and can lead to pain, physical
impairment, emotional distress and negative impact on the quality of life.
Theories link most types of injuries to individual behaviours within a
complex matrix involving both the physical and social environments. However,
most of the aetiological studies on TDIs focus on proximal risk factors and
overlook the underlying more distal determinants. This PhD thesis aimed to
assess whether certain behavioural and psychosocial determinants were
associated with the prevalence of TDIs among adolescents in Riyadh, Saudi
Arabia, with a particular focus on the role of their risk-taking behaviours
and peer influence. Methods: A stratified two-stage cluster sample of 902
students (461 boys and 441 girls) was randomly selected from adolescents
attending 1st and 2nd years of public and private secondary schools in
Riyadh, using a self-weighting design for both sexes and school types. Data
were collected through clinical examination and questionnaire. TDIs were
clinically diagnosed using a modified version of the WHO classification for
epidemiological studies. The clinical examination also included assessment of
overjet and lip coverage. The questionnaire was based on the WHO Health
Behaviour in School-Aged Children questionnaire and the CDC Youth Risk
Behaviour Surveillance System, assessing exposures risk-taking behaviours and
peer influence, as well as demographics, socio-economic status and physical
activity. The differences in prevalence of TDIs between the different groups
of the covariates and exposures were calculated. Then, Poisson regressions
with a robust error variance were used to estimate adjusted prevalence ratios
(relative risks) of TDIs between the different exposures to provide
sequential adjustment for confounding factors. The models were further
checked for interactions between the main exposure and the peer influence
variables. Results: Overall, 42.6% of adolescents had TDIs to their anterior
teeth (Boys: 59.4%; Girls: 24.9%). After adjusting for age, sex, father's
education, nationality, physical activity and overjet >3mm, smoking was
significantly associated with TDIs among girls (RR 2.50; 95% CI 1.42-4.41),
and the same was the case among boys for fights (RR 1.46; 95% CI 1.19-1.79),
for spending time with friends after school on more than three days a week
(RR 1.25; 95% CI 1.07-1.46) and for having peers who carried weapons (RR
1.19; 95% CI 1.01-1.40), compared to their counterparts. TDIs were also
significantly associated with both boys and girls who carried weapons (RR
1.36; 95% CI 1.12-1.66), had multiple risk-taking behaviours (RR 1.44; 95% CI
1.20-1.72) and had less than three close friends (RR 1.19; 95% CI 1.00-1.42)
compared to their counterparts. The risk of TDIs was intensified among
adolescents who carried weapons and had multiple risk-taking behaviours when
they lacked peer support (RR 2.18; 95% CI 1.05-4.57 and RR 2.18; 95% CI
1.05-4.57, respectively) compared to their counterparts who had supportive
peers (RR 1.28; 95% CI 1.01-1.62 and RR 1.36; 95% CI 1.11-1.68,
respectively). Conclusions: Adolescents in Riyadh, particularly boys, had a
very high prevalence of TDIs. Risk-taking behaviours (smoking, fights and
carrying weapons) and negative peer influence (having peers who carried
weapons) indicated an increased risk of TDIs among those adolescents
independent of their age, socioeconomic status, physical activity and incisor
overjet level. Negative peer influence (lack of peer support) intensified the
association between risk-taking behaviours and TDIs.
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