Environmental and child-level correlates of traumatic dental injuries in preschool children attending childcare centres in Selangor, Malaysia: a multicentre cross-sectional study

Abstract Aim To estimate the prevalence and pattern of traumatic dental injuries (TDI) in children aged 1–6 years attending early childhood care and education (ECCE) centres in Selangor, Malaysia, and to examine whether behavioural and childcare-environment factors are associated with TDI beyond child-level factors. Methods Children were sampled by cluster from 12 registered ECCE centres in three localities. Calibrated examiners recorded TDI using the Andreasen classification; caregivers completed a questionnaire, and a centre-level checklist recorded the environment. Eleven factors were entered into a mixed-effects logistic regression model with a random intercept for centre; generalised estimating equations (GEE) served as a sensitivity analysis. Results Of 372 children enrolled, 367 (98.7%) were analysed. TDI prevalence was 15.5% (95% CI 12.2–19.6%, unadjusted for clustering), higher in boys than girls (20.3% vs 10.3%). TDI prevalence was 29.5% in centres with a hard outdoor play surface and 7.7% in the others. TDI was independently associated with a hard outdoor play surface, a centre-level exposure (aOR 4.41, 95% CI 2.31–8.42; GEE 4.18, 1.84–9.48), ≥ 3 falls in six months (2.72, 1.39–5.33), first-born status (2.84, 1.40–5.76), male sex (1.96, 1.05–3.66) and overjet > 3 mm (2.18, 1.06–4.49). No professional care had been sought for 24 of 57 affected children (42.1%). Conclusions TDI was associated with child-level, behavioural and environmental factors. The hard-surface association rests on only 12 centres and may reflect other centre differences, but it suggests that the childcare environment may be a modifiable prevention target. Prospective and intervention studies are warranted.