Knowledge of dental trauma first aid (DTFA): the example of avulsed incisors in casualty departments and schools in London

What is important to medical students' online learning of dental trauma in medical education

Traumatic dental injury (TDI), a topic not normally offered in the medical curriculum is made available through the medical school as an online learning course. Online learning provides an educational pathway for cross-disciplinary learning without any change to the existing curriculum. This research identified important key features that should be included in the design of an online course to provide a positive online learning experience for medical students. Ten important features were identified for medical educators to consider when they develop an online course to introduce dental trauma. These features are (1) prioritising information to TDI, (2) providing specific facts and information to TDI, (3) information must be easily retrieved, (4) providing career-related information, (5) promoting self-confidence, (6) promoting learning of new knowledge, (7) easy-to-understand content materials, (8) establishing a logical sequence of learning, (9) visual illustrations to complement written text and (10) promoting self-directed learning.

Knowledge and Awareness of School Teachers Regarding Emergency Management of Tooth Avulsion in the Kingdom of Saudi Arabia: A Cross-Sectional Study

Aim:

This study aimed to assess the general knowledge and awareness of school teachers regarding the first aid emergency dental management of tooth avulsion in the kingdom of Saudi Arabia.

Materials and Methods:

A self-administered, anonymous, close-ended structured questionnaire was given to school teachers in Saudi Arabia. It included information regarding gender, knowledge, and awareness [three parts: basic demographic characteristics focusing on the gender (part one), questions regarding knowledge of school teachers toward emergency management of tooth avulsion (part two), and questions regarding awareness of school teachers toward emergency management of tooth avulsion (part three)].

Results:

A total of 615 school teachers (58% males and 42% females) completed the questionnaire. Approximately 54.3% of the school teachers preferred to immediately refer the child to the dentist if trauma affects permanent teeth (p < 0.05), and only 2.1% opined regarding reposition of the tooth in a normal position. Another 22.9% responded that they would scrub the tooth to clean the dirt and rinse with water, while 19.7% reported that they would keep the tooth in a wet handkerchief until they reach the dentist.

Conclusion:

The knowledge and awareness of schoolteachers regarding the management of avulsed teeth are insufficient; thus, education programs on traumatic dental injuries are essential.

School teachers' knowledge and experience about emergency management of traumatic dental injuries: A questionnaire-based online cross-sectional survey

BACKGROUND/AIM

Dental trauma is one of the critical oral health problems in childhood and adolescence that can affect an individual's quality of life. Teachers may witness a dental injury on many occasions, and they are likely to be involved at the site of an accident. Hence, they should be capable of managing prompt and correct emergency treatment at the accident site. The aim of this cross-sectional study was to assess the level of knowledge and experience of Croatian elementary and high school teachers concerning dental trauma.

MATERIALS AND METHODS

A questionnaire-based cross-sectional online survey was conducted to determine knowledge and experience about traumatic dental injuries among 803 full-time working elementary and high school teachers. The inclusion criteria were full-time employment at the time of data collection with at least 1 year of teaching experience. Retirement (teachers aged ≥65 years) and unwillingness to participate in the survey were the exclusion criteria. The Student t test or one-way ANOVA, with Tukey's post hoc was used to evaluate the obtained data. The level of significance was set at p ≤ .05.

RESULTS

The overall mean level of teachers' knowledge regarding emergency management of dental trauma was 6.6 ± 2.5 points, out of a maximum possible score of 14. There were no significant differences in knowledge among teachers from lower elementary, upper elementary, and high school education (6.9 ± 2.5, 6.5 ± 2.4 vs 6.4 ± 2.6 points, respectively; p = .140). Teachers who had personally experienced dental trauma showed better knowledge (7.2 ± 2.6 vs 6.4 ± 2.5 points; p ≤ .001).

CONCLUSION

The knowledge of emergency management of dental trauma among elementary and high school teachers in Croatia is low. Since most of the participants expressed willingness for future education regarding this subject, educational programs are recommended.

Knowledge on Pre-Hospital Emergency Management of Tooth Avulsion among Croatian Students of the Faculty of Education

The purpose of this study was to evaluate the knowledge regarding tooth avulsion and dental first aid response among Croatian students of the Faculty of Education. A cross-sectional study was conducted among students. Participants (N = 235) were female with an average age of 21.9 ± 2.7 years. The questionnaire contained 10 close-ended questions with two to eleven possible answers. Every participant chose one correct answer. Statistical significance was determined using a Chi-square test. Majority of participants had never received any kind of information on management of a knocked-out tooth. Questions in the nature of tooth injuries, a knocked-out tooth, tooth replantation and whether the knocked-out tooth should be placed back were answered confirmatively by 40.43%, 83.40%, 57.02% and 62.55% of participants, respectively. The questionnaire showed that 18.78% of participants were aware that replantation should be performed within 30 min. The appropriate cleaning and transport medium was chosen by 40.85% and 35.31% of participants, respectively. A nearby dentist would be visited by 66.38% of students. Only 8.08% of participants provided a correct answer to all of the knowledge-based questions. The “I do not know” answer was chosen by 18.30% of participants whenever it was offered. This indicates that the majority (89.78%) were not aware of the fact that the procedure they chose would be inappropriate. The current study confirmed that future primary school teachers have a lack of knowledge for immediate response to tooth avulsion, leaving small chances for a successful prognosis of tooth replantation.

Traumatic dental injuries in the Eastern Region of Saudi Arabia: Factors influencing teachers' management practices

BACKGROUND/AIMS

Traumatic dental injuries (TDIs) in children frequently occur in schools where teachers can play an important role in their management. Therefore, the aim of this study was to assess schoolteachers' knowledge and the factors that determine their management of TDIs.

MATERIALS AND METHODS

This cross-sectional study was conducted in the Eastern Province of Saudi Arabia from January to June 2018. Data were collected through an online pre-tested questionnaire. The questionnaire collected demographic data and included questions that assessed participants' knowledge and management practices for TDI. Chi-square test and multivariate logistic regression analysis were performed.

RESULTS

A total of 443 teachers were included in the study, and 72.5% of the participants were females. The prevalence of TDIs was 49% yet only 7.2% of the participants reported managing dental trauma. Fights (22.8%) and falls (21.7%) were the most common causes of dental injuries. Mean TDI knowledge score was 2.75 ± 2.05, but only 47.2% were willing to receive training about TDI management. Regarding supportive environments, 75.8% of teachers reported having safety playgrounds, however 10.6% reported having a nurse in schools. After controlling for other variables, male respondents were 3.85 times more likely to manage TDIs than female respondents (P = .001). Similarly, previous knowledge of dental trauma management (OR = 4.32, P < .001) and having less than 50 students in class (OR = 2.61, P = .021) were significantly associated with TDI management.

CONCLUSION

The teachers demonstrated inadequate knowledge about TDIs which were highly prevalent in primary schools. Male gender, having knowledge of TDI management and teaching less students were associated with increased likelihood of TDI management. There is a crucial need for the reinforcement of policies that support school safety and a supportive environment.

'He was distraught, I was distraught.' Parents' experiences of accessing emergency care following an avulsion injury to their child

Objective To explore how parents access emergency care for their children following avulsion of a permanent tooth.Method Semi-structured qualitative interviews were undertaken with parents of children who had suffered a tooth avulsion injury in the previous two years. The interviews were recorded and transcribed verbatim. Framework analysis was used to analyse the data and interpret the core concepts from the interviews. Results Nine parents participated in the study. None of the children received the appropriate emergency dental care within the timeframe identified by national and international guidelines. The core themes that emerged following the analysis were knowledge, access and emotion.Discussion & Conclusions The parents who were interviewed for this study had poor knowledge of what to do in the event of a tooth avulsion injury. This lack of knowledge directly impaired their ability to navigate emergency dental care for their child. They described their upset and distress following their child's injury, but also feelings of frustration and disappointment in relation to the emergency care their child received. There is a need to develop appropriate support and clinical pathways to enable parents to rapidly access appropriate and timely care for their child following a complex dental trauma.

A questionnaire-based survey for the evaluation of the knowledge level of primary school teachers on first-aid management of traumatic dental injuries in Athens, Greece

BACKGROUND/AIM

School teachers can play an important role in improving the prognosis of traumatized teeth of school children through immediate onsite management or on time referral to healthcare providers. In Greece where the research in the field of dental traumatology is very limited, this issue is of utmost importance. The aim of this study was to evaluate the knowledge level of Greek primary school teachers and their attitude with regard to emergency first-aid management of traumatic dental injuries (TDI) occurring in schools.

MATERIAL AND METHODS

A cross-sectional descriptive study among 276 school teachers was undertaken in Athens, Greece. This was done through a two-part questionnaire-based survey including demographic characteristics, attitude, and knowledge of first-aid management of TDI. Data were analyzed using non-parametric tests for differences. Log Poisson regression analysis was used to estimate relative risks of low or high knowledge of first-aid management.

RESULTS

The risk of lower knowledge score was almost double in teachers with <10 years of teaching experience and almost threefold higher in those reporting that they are not interested in being informed about dental trauma. In the case of luxation injury, 69.9% of the participants would not take any immediate action and would refer the child to a dentist. In case of permanent tooth avulsion, 52.2% knew that the tooth can be replanted in the socket, whereas only 17% believed that this should be performed within 30 minutes. Most of the participants would send the child to their own/family dentist, whereas only 4.7% would refer to an Endodontist.

CONCLUSION

The knowledge of primary school teachers in Greece about first-aid management of TDI is limited. However, a clear positive association was found between knowledge of first-aid management and teaching experience. Reliable information about dental trauma may result in improving the knowledge level of Greek primary school teachers.

Elementary school staff knowledge about management of traumatic dental injuries

Aim

This study investigated the knowledge of elementary school staff regarding the management of traumatic dental injuries (TDIs) in children.

Methods

The present cross-sectional study analyzed data collected between September 2016 and April 2017. The sample consisted of 2,027 elementary school staff members in Riyadh, Saudi Arabia. A stratified cluster random sampling technique was used to select the required sample. Those who agreed to participate in the study completed a 4-part self-administered questionnaire comprising questions regarding demographic data, knowledge on management of tooth fracture, and avulsion using photographs of TDI cases.

Results

The majority of the school staff showed inadequate basic knowledge regarding the importance of saving the broken piece of the tooth and identifying the tooth involved in the trauma (67% and 66.3%, respectively), P<0.05. However, they had a significantly high number of correct responses regarding the immediate management of TDIs for the 2 case scenarios presented in the questionnaire (P<0.05), and the majority (41%) reported normal saline as a suitable storage medium (P<0.01).

Conclusion

This study revealed a lack of knowledge in certain aspects of TDIs among elementary school staff.

The association of overjet with traumatic dental injuries: a systematic review protocol

REVIEW QUESTION

The objective of this review of association (etiology) is to identify the relationship between different overjet measurements and developing a traumatic dental injury (TDI) across different dentition stages. Specifically, the review will elucidate the critical level, in millimetres, at which an overjet will place an individual at an increased risk of developing a TDI within each specific dentition stage. The specific review questions are.

Knowledge and Sociodemographic Determinants of Emergency Management of Dental Avulsion among Parents in Kuwait: A Cross-Sectional Study

OBJECTIVES

The aim of this study was to evaluate the knowledge of first aid measures for a permanent tooth avulsion among parents in Kuwait and to assess the effect of different sociodemographic characteristics.

MATERIALS AND METHODS

A cross-sectional study was conducted among 554 parents who visited 5 dental specialty centers in Kuwait. Parent sociodemographic data and responses to avulsion management questions were collected through a self-administered questionnaire. Descriptive and binary logistic regression analyses were used for data analysis.

RESULTS

In the 554 responses from patients, gaps were identified in the following areas: replantation (199, 35.9%), cleaning of the tooth (182, 32.9%), and transport media (84, 15.2%). Most parents demonstrated satisfactory knowledge levels regarding the urgency to seek professional help (391, 70.6%) and the first place of contact after the injury (525, 94.8%). Having previous information on emergency management of dental avulsion was a significant predictor of good knowledge (OR 2.138, 95% CI 1.347-3.395, p = 0.001). Of the 544 parents, 99 (17.8%) had received information on dental avulsion management: 30 (30.3%) from the Internet, 19 (19.2%) from books, 12 (12.1%) from television, 6 (6%) from smart phone applications, 2 (2%) from newspapers, and 30 (30.3%) from other sources.

CONCLUSION

In this study, parents in Kuwait did not have adequate knowledge of emergency management for dental avulsion. Future educational campaigns on dental avulsion are urgently needed to educate parents.

The Emergency Treatment of Traumatised Permanent Anterior Teeth in Children and Adolescents

This article aims to provide a practical clinician's guide to assessing and diagnosing dental trauma involving permanent teeth in children and young people, and for carrying out appropriate, guideline supported acute management. Timely referral to specialist paediatric dental services is crucial in more complex trauma presentations and will lead to improved outcomes for the dentition. Appropriate acute management by the primary clinician optimises the prognosis of any traumatised tooth and this article will focus on the emergency treatment of the traumatised permanent tooth.

Massachusetts emergency departments' resources and physicians' knowledge of management of traumatic dental injuries

BACKGROUND

Hospital emergency departments (ED) are confronted with triaging and managing dental emergencies of both traumatic and non-traumatic origin. However, the literature suggests that there exists inadequate knowledge of the management of traumatic dental injuries (TDI) among medical professionals who must be knowledgeable and have the appropriate resources needed to triage or treat patients presenting with TDI.

AIM

The aims of this study were to (i) evaluate the resources of Massachusetts emergency departments (MEDs) for TDI, (ii) determine the knowledge of management of TDI among MED physicians, and (iii) investigate potential factors that affect their knowledge.

MATERIALS AND METHODS

Surveys were mailed to MED directors and their physicians. The director survey contained questions regarding institutional information for each emergency department (ED). The physician survey contained questions about physician characteristics and tested their knowledge of managing dental trauma.

RESULTS

A total of 72 surveys (16 MED directors and 56 physicians) were returned and included in the analysis. Only 50% of the MEDs had on-site dental coverage, 43.8% had 24-h off-site dental coverage, and none had a formal written dental trauma protocol. MED physician's knowledge of the appropriate management of luxations and avulsions was generally good, but poor for dental fractures. The MED physician's knowledge for the emergent nature of the various injuries was generally good with that of avulsions being the best. Physicians were more likely to have a better knowledge of managing dental trauma if they were specialists in pediatric emergency medicine (P = 0.001) or their hospitals had an academic affiliation (P = 0.05).

CONCLUSIONS

Based on the findings from this study, educational campaigns must be undertaken to improve both the resources available to the ED, and the knowledge of physicians regarding emergency management of TDI. In addition, efforts should be made by local dental organizations to provide ED with lists of dentists who are knowledgeable and willing to be available 24 h day⁻¹ to consult with and, if necessary, treat TDI. These efforts would enhance the long-term outcomes for patients sustaining dental trauma who present to hospital ED.

Dentine sialoprotein expression in gingival crevicular fluid during trauma-induced root resorption

AIM

To detect and quantify dentine sialoprotein (DSP) in the gingival crevicular fluid (GCF) of luxated teeth.

METHODOLOGY

Eighteen subjects were enroled and distributed as follows. Group I (n = 6, positive control): subjects with primary second molar teeth undergoing physiological root resorption. Group II (n = 6, negative control): subjects with permanent mature maxillary central incisors. Subjects with a recent history (<1 week) of luxation injury were included in group III (n = 6, test group) and standardized digital radiographs with a superimposed mesh gauge were exposed at various time intervals. Percentage of radiographic root resorption (%RRR) was calculated. GCF was collected using microcapillary pipettes. DSP in the GCF was quantified using enzyme-linked immunosorbant assay. Group III was subjected to Spearman's rank test to establish the correlation between the concentration of DSP and %RRR at 6 weeks, 3 and 6 months.

RESULTS

Quantifiable amounts of DSP were released in the GCF of subjects in Group I and III. However, the protein was not detected in Group II. Detectable quantities of DSP were observed in the GCF of luxated teeth before any radiographic evidence of root resorption (base line radiograph). A positive correlation was established at 6 weeks (r = 0.795), 3 (r = 0.755) and 6 month (r = 0.837) between the release of DSP and %RRR (P < 0.05).

CONCLUSION

Dentine sialoprotein was released in the GCF of luxated teeth and its concentration correlated with the active and remission phases of this pathological process. Further investigation is required to establish a potentially noninvasive aid for diagnosing and monitoring root resorption.

Education on and prevention of dental trauma: it's time to act!

Dental trauma is, unfortunately, not uncommon and may be even more prevalent in high-risk populations. It should be emphasized and acknowledged that many cases of dental trauma are preventable. Appropriate management includes primary prevention, i.e. avoidance of pathology development, and secondary prevention, i.e. early diagnosing and treatment of the pathology before significant morbidity occurs. The aim of this article is to provide a review of the current dental trauma literature with regard to education and knowledge and with relevance to primary and secondary prevention. As the duty of providing the public with measures for the maintenance of proper oral health is of the dental profession, the responsibility of providing primary and secondary prevention of dental trauma is of dentists, dental hygienists, and dental nurses. They may, and should, educate other medical, paramedical, and non-medical professionals, taking into account that those non-dental professionals could not maintain a high level of knowledge and service regarding dental trauma without a continuous backing by the dental professionals. It should be remembered that as the prevalence of dental decay has reduced in the Western world during recent decades, dental trauma plays a significant part in causing dental morbidity and mortality (tooth loss). It seems that now is the time to act for the benefit of our community and move from 'treating' toward 'managing' risk factors and prevention.

Knowledge and management of traumatic dental injuries in a group of Saudi primary schools teachers

The purpose of this study was to evaluate the knowledge level of a group of Saudi primary school teachers in the management of dental trauma. A three-part questionnaire on demographic data and knowledge was distributed to the teachers in Riyadh city. Twenty-four selected schools were visited and 277 teachers participated in the study of which 5 of them had formal education in dental injuries. Concerning knowledge, 124 teachers (44.8%) believed dental trauma emergency should be dealt with immediately. This study showed that majority of teachers were not aware of the most favorable storage media for avulsed permanent teeth. It was concluded that the majority of Saudi primary school teachers in Riyadh city do not know how to handle a child who sustains dental injury.