Dentists' knowledge of dental trauma based on the International Association of Dental Traumatology guidelines: A survey in South Brazil

Long-Term Outcome of Horizontal Root Fractures in Permanent Teeth: A Retrospective Cohort Study

INTRODUCTION

Horizontal root fracture (HRF) is a complex traumatic dental injury that affects the pulp, dentin, cementum, and periodontal ligament. This retrospective cohort study evaluated treatment outcomes in permanent teeth with HRF.

METHODS

We analyzed clinical and radiographic data from a dental trauma center (2006-2022). Permanent teeth with HRF with a follow up of ≥12 weeks were considered for outcome assessment (defined as clinical normalcy and radiographic healing at the fracture line). Prognostic factors were identified through multivariable logistic regression analyses (P value ≤ .05).

RESULTS

125 teeth from 103 patients were included. After a median follow-up of 79 weeks, the overall favorable outcome was 92%. This includes teeth that received emergency splinting/repositioning at baseline (62.2%) and those that received subsequent endodontic intervention for the coronal fragment (baseline: 85%; subsequent follow-ups: 91.8%). Being male and incomplete root development were both significantly associated with a better outcome of splinting/repositioning (OR = 2.58; 95% CI, 1.06-6.24 and OR = 4.37; 95% CI, 1.16-16.41, respectively) and a reduced likelihood of requiring endodontic treatment (OR = 0.44; 95% CI, 0.20-0.96 and OR = 0.24; 95% CI, 0.08-0.76, respectively). Treatment delays surpassing one week were significantly associated with an increased likelihood of requiring endodontic treatment compared to timely presentations within 24 hours (OR = 3.06; 95% CI, 1.07-8.77; P value < .05).

CONCLUSION

With timely diagnosis and treatment, and close monitoring, HRF cases can achieve a 92% favorable outcome. Male sex and incomplete root development correlate with improved baseline outcomes and a reduced need for endodontic treatment. Conversely, delayed presentation increases the likelihood of requiring endodontic intervention.

Knowledge of undergraduate and postgraduate dental students about managing traumatic dental injuries based on the 2020 International Association of Dental Traumatology guidelines: A online survey of 10 dental schools from 10 countries

BACKGROUND/AIM

The knowledge of dental students about managing traumatic dental injuries (TDIs) may not be uniform, depending on global location and dental education. The aim of this study was to evaluate the level of knowledge of undergraduate and postgraduate students specializing in endodontics and pediatric dentistry at 10 dental schools in 10 countries about the 2020 International Association of Dental Traumatology (IADT) guidelines regarding the management of TDIs.

MATERIALS & METHODS

A previously published questionnaire was used in the current survey. It was an online survey with 12 questions regarding the management of TDIs and some additional questions regarding sociodemographic and professional profiles of the participants were added. The survey was distributed to final-year undergraduate students and postgraduate students in pediatric dentistry and endodontics from 10 dental schools. Simple frequency distributions and descriptive statistics were predominantly used to describe the data. Differences in the median percentage scores among the student categories were assessed using the Kruskal-Wallis test followed by Dwass-Steel-Critchlow-Fligner pairwise comparisons.

RESULTS

A total of 347 undergraduates, 126 postgraduates in endodontics, and 72 postgraduates in pediatric dentistry from 10 dental schools participated in this survey. The postgraduates had a significantly higher percentage score for correct responses compared with the undergraduates. No significant difference was observed between the endodontic and pediatric dentistry postgraduates.

CONCLUSION

The knowledge possessed by undergraduate and postgraduate students concerning the IADT-recommended management of TDIs varied across the globe and some aspects were found to be deficient. This study emphasizes the critical importance of reassessing the teaching and learning activities pertaining to the management of TDIs.

Validation of an educational comic book to guide conducts in situations of dental trauma

BACKGROUND/AIM

Childhood dental trauma poses a prevalent concern, and the limited knowledge of lay caregivers toward the needed immediate actions can adversely affect a child's well-being. This study aimed to create and validate an educational comic book for lay individuals, designed to guide immediate actions in dental trauma cases, and assess its effects toward enhancing reader knowledge.

METHODOLOGY

The four-stage study involved: (1) Literature review and script development; (2) Version 1 of the comic book creation (including illustrations, layout, and design) and Flesch Readability Index (FI) calculation; (3) Version 1 validation by expert judges, assessed by the Content Validity Index (CVI); (4) Version 1 refinement based on the judges' feedback, recalculation of FI, and a pilot test (CVI) involving lay individuals who validated the final material (Version 2). The validation process involved 67 participants, including 13 specialist judges and 54 elementary school teachers.

RESULTS

The CVI for Version 1 was calculated at 0.89 (89%), indicating a favorable level of agreement on the evaluated criteria. The FI was determined as 91.1%, indicating a high level of readability. The FI for Version 2 was 92.1% (indicating a very easy level of comprehension). The CVI calculated for the target audience after the pilot test was 0.99 (99%), denoting a substantial agreement among the participants. In assessing the level of knowledge, a significant increase was observed in the rate of correct answers after the comic book was read by lay individuals (p < 0.05), inasmuch as the percentage rose from 50.5% before to 81.2% after reading it.

CONCLUSION

The educational comic book proved valid in terms of readability, appearance, and content. Furthermore, it had a positive impact on gaining the knowledge needed to take the appropriate actions, thus making it a valuable tool for guiding the lay population in cases of dental trauma.

International teaching practices in dental trauma education

BACKGROUND/AIM

Several publications highlight the insufficient knowledge possessed by dentists and dental students regarding the management of traumatic dental injuries (TDIs). A lack of clinical experience during Undergraduate (UG) education could explain the reported deficits in managing dental trauma post-graduation. Despite its importance in dentistry, there are very few reports on how, where and who teaches Dental Traumatology (DT) in the UG curriculum. The aim of this study was to investigate teaching practices in DT around the world in UG education.

MATERIALS AND METHODS

UG educators involved in DT teaching activities were invited to complete an online questionnaire hosted on Qualtrics®. The survey consisted of close-ended and open-ended questions on their teaching practices in DT. Only one answer per institution was included in the final descriptive analysis.

RESULTS

A total of 203 responses from 164 institutions were obtained from 69 countries. All institutions reported that DT is included in their UG curriculum, and is mainly taught within Paediatric Dentistry and Endodontics. Most teaching and evaluation was delivered in traditional format. The number of contact hours dedicated to DT teaching activities ranged from 2 to 185 h (median = 10). Only 35% of institutions had a unified approach across disciplines. DT was taught as a separate course/module in 23% of the universities. Insufficient exposure to emergency care and the lack of formal clinical exposure to TDI was highlighted by many institutions. The need for a core curriculum was supported by 84% of the institutions with agreement on essential topics required at UG level.

CONCLUSIONS

Teaching practices in DT varied internationally. Very few teaching hours were devoted to DT and many institutions identified a need for increased clinical exposure. There was a desire for a standardised coherent approach to DT in the UG education with suggestions to improve educational resources.

Indications for root canal treatment following traumatic dental injuries to permanent teeth

The dental pulp may respond favourably or unfavourably to traumatic dental injuries. The most serious unfavourable responses are pulp necrosis and infection of the root canal system. These cause apical periodontitis and/or external inflammatory resorption of the tooth. The following injuries require root canal treatment as part of their emergency management-(A) complicated crown fractures (but some may be suitable for conservative pulp treatments, such as pulp capping, partial pulpotomy or pulpotomy), (B) complicated crown-root fractures, (C) supra-crestal coronal third root fractures and (D) injuries where pulp necrosis is predictable or highly likely to occur AND where there has been damage to the root surface and/or periodontal ligament with the aim of preventing external inflammatory resorption. This latter group of injuries are avulsion, intrusion, lateral luxation with a crown fracture, extrusion with a crown fracture (all in fully developed teeth) plus avulsion with a crown fracture and intrusion with a crown fracture (both in incompletely developed teeth). All other injuries should not have root canal treatment commenced as part of the emergency management, but they must be reviewed regularly to monitor the pulp for any adverse changes to its status, particularly pulp necrosis and infection of the root canal system.

Evaluation of Knowledge and Practice of Resident Dentists in Iasi, Romania in the Management of Traumatic Dental Injuries: A Cross-Sectional Study

Dentists play an essential role in the treatment of dental and periodontal traumatic injuries by providing early and correct treatment. The purpose of the present study was to assess the level of knowledge of dental residents regarding dental trauma. The cross-sectional study was conducted at the Faculty of Dental Medicine within the "Grigore T. Popa" University of Medicine and Pharmacy in Iasi, Romania on a sample of 366 residents in General Dentistry, Pediatric Dentistry and Periodontology. To assess their knowledge, a questionnaire was created containing 18 questions about the clinical signs and therapy of dental trauma, with a focus on tooth avulsion. A very low level of knowledge (<25%) was found only for the type of splinting required to maintain an avulsed tooth on the arch. The highest number of correct answers was provided by the residents in Periodontology. Physiological serum as storage medium was recognized by a percentage of 75.9-80% of the subjects, and 60-77% of them recognized pulp necrosis as complication of dental avulsion. The study underlines the need to introduce in the curriculum of all categories of residents additional information, not only in the already existent theoretical form, but also as possible scenarios of various clinical situations.

Impact of case complexity on paediatric dentists' ability to radiographically diagnose traumatic dental injuries

BACKGROUND/AIMS

Being able to correctly interpret radiographs after a traumatic dental injury is an essential skill for providing appropriate and timely treatment. The aim of this study was to assess the impact of case complexity on paediatric dentists' performance when radiographically diagnosing traumatic dental injuries (TDI) and to investigate a possible added value of cone-beam computed tomography (CBCT) when compared with digital intra-oral radiography (2D vs 3D).

MATERIALS AND METHODS

A test panel of paediatric dentists was instructed to detect, identify and interpret radiographic findings using either 2D or 3D images. Intra-oral radiographs and CBCT images of 20 trauma cases were presented in random order, and the findings were recorded using structured scoring sheets. Case complexity was determined by two experienced benchmark scorers. Results were analysed using generalized linear mixed modelling.

RESULTS

In general, performance for detection, identification and interpretation of findings was low, both with 2D and 3D images, with significantly lower values for difficult cases (p < 0.05). For easy as well as for difficult cases, 3D imaging resulted in a significantly better performance for detection and identification of findings (P < 0.001). This was not the case for correct interpretation, where significantly poorer performance was seen when using 3D images for difficult cases (p < 0.05).

CONCLUSION

This study provides evidence that case complexity of traumatic dental injuries influences diagnostic performance. The use of CBCT enhanced detection and identification of findings but when case complexity increased, 3D imaging adversely affected correct interpretation.

Effectiveness of an educational cartoon animation on the knowledge of children about traumatic dental injuries

BACKGROUND/AIM

Although children are frequently exposed to traumatic dental injuries (TDIs), their knowledge and attitude regarding the emergency management of TDIs are largely insufficient. The aim of this study was to determine the knowledge of children about TDIs utilizing a questionnaire before and after watching a custom animated instructional video.

MATERIAL AND METHODS

The study was conducted with 332 children aged 8 to 13 years. The children were asked to complete a 3-part questionnaire that included socio-demographic data, past experiences related to TDIs, and knowledge of the emergency management of TDIs. An educational video containing evidence-based information about the management of TDIs was shown to the children. They then completed the questionnaire again immediately after viewing the video and 1 week later. The data were analyzed using Friedman's two-way ANOVA by ranks test, McNemar's test, and the Mann-Whitney U-test.

RESULTS

The children's scores increased significantly following the viewing of the video (p = .0001). Prior to watching the animation, children who had previously received dental trauma education had considerably higher scores than their peers (p = .004). The animation was considered to be beneficial by 96.7% of the children. Prior to watching the animation, 49.1% of the children believed they could help their friends in the event of dental trauma, and after viewing the animation, this rate increased to 86.4%, but decreased to 77.1% after 1 week (p < .001).

CONCLUSIONS

After watching the video, the children's scores improved dramatically and their self-confidence in helping their friends in the event of dental trauma increased.

Does clinical experience with dental traumatology impact 2D and 3D radiodiagnostic performance in paediatric dentists? An exploratory study

Background

The aim of this study is to evaluate the impact of experience with traumatic dental injuries (TDI) on paediatric dentists’ performance and self-assessed confidence when radiodiagnosing traumatic dental injuries (TDI) and to explore whether this is influenced by the imaging technique used (2D versus 3D).

Materials and methods

Both 2D and 3D radiological images of young anterior permanent teeth having experienced dental trauma were assessed randomly by a panel of paediatric dentists using structured scoring sheets. The impact of level of experience with dental traumatology on radiological detection, identification and interpretation of lesions and on observer’s self-assessed confidence was evaluated. Findings were compared to benchmark data deriving from expert consensus of an experienced paediatric endodontologist and dentomaxillofacial radiologist. Results were analysed using generalized linear mixed modelling.

Results

Overall, observers performed moderately to poor, irrespective of their level of TDI experience and imaging modality used. No proof could be yielded that paediatric dentists with high TDI experience performed better than those with low experience, for any of the outcomes and irrespective of the imaging modality used. When comparing the use of 3D images with 2D images, significantly higher sensitivities for the detection and correct identification of anomalies were observed in the low experienced group (P < 0.05). This was not the case regarding interpretation of the findings. Self-assessed confidence was significantly higher in more experienced dentists, both when using 2D and 3D images (P < 0.05).

Conclusion

There was no proof that paediatric dentist’s higher experience with TDI is associated with better radiodiagnostic performance. Neither could it be proven that the use of Cone Beam Computed Tomography (CBCT) contributes to an improved interpretation of findings, for any experience level. More experienced dentists feel more confident, irrespective of the imaging modality used, but this does not correlate with improved performance. The overall poor performance in image interpretation highlights the importance of teaching and training in both dental radiology and dental traumatology.

Dentists' knowledge of dental trauma based on the International Association of Dental Traumatology guidelines: An Australian survey

Background/Aim

Traumatic dental injuries are the result of impact injuries to the teeth and/or soft and hard tissues within and around the vicinity of the oral cavity and pose a very serious public health dilemma. The aim of this study was to appraise the level of knowledge of dentists in Australia regarding the management of traumatic dental injuries based on the International Association of Dental Traumatology (IADT) guidelines.

Methodology

A link to an electronic questionnaire investigating personal and professional information and twelve questions about dental trauma was distributed by email using the Qualtrics Survey Software to ensure anonymity of the respondents, to members of the Australian Dental Association. The respondents were grouped according to demographic characteristics and practice profiles. Data were evaluated by the Student’s T test or one‐way ANOVA with post hoc testing using Fisher's least significant difference, with the α level set at 5%.

Results

A total of 180 complete responses were obtained. The overall mean number of correct answers was 7.55 ± 1.91 from a maximum possible score of twelve. Gender, year of primary dental qualification, dentist identity (general dentist or specialist), area of main practice or region worked by the practitioner did not significantly affect the mean scores. However, increased knowledge of the IADT guidelines was significantly associated with the number of trauma cases treated and the dentists' self‐reported knowledge.

Conclusions

The overall knowledge of Australian dentists regarding the management of traumatic dental injuries based on the IADT guidelines was generally good but it was also deficient in some areas.

Effect of dental trauma management resources on dental practitioners' confidence and knowledge: A pilot cross-sectional study

BACKGROUND/AIM

The knowledge of standardized care guidelines is critical to the confidence of practitioners in managing dental trauma. Therefore, the aim of this study was to assess the awareness, use and impact of the International Association of Dental Traumatology guidelines, and the online Dental Trauma Guide on general dental practitioners' self-reported confidence and knowledge in managing traumatic dental injuries in the primary and permanent dentitions.

MATERIALS AND METHODS

A cross-sectional, pre-piloted, 27-item self-administered questionnaire survey was distributed electronically to general dental practitioners' working within five member states of the Gulf Cooperation Council countries (Kingdom of Bahrain, Kingdom of Saudi Arabia, Kuwait, Oman, and Qatar) between September and December 2020. Data were collected and analysed using descriptive statistics and Wilcoxon Signed Rank test analysis for relevant comparisons.

RESULTS

A total of 294 respondents completed the survey, with the majority being from the Kingdom of Saudi Arabia (47.4%) and Qatar (27.3%). A lack of evidence-based knowledge in managing traumatic dental injuries was evident among more than half of the respondents. Respondents who were cognizant of the recent International Association of Dental Traumatology guidelines (2020) and those who use the Dental Trauma Guide routinely demonstrated a higher self-reported confidence level in managing both simple and complex primary dentition trauma, as well as simple traumatic dental injuries in the permanent dentition (p < .05).

CONCLUSION

This survey highlights critical deficiencies in the knowledge of a large number of the respondents in the management of dental trauma which is likely to cause irreversible long-term patient effects.

Parental and training coaches' knowledge and attitude towards dental trauma management of children

BACKGROUND

The aim of this study was to evaluate parental and training coaches' knowledge and attitude towards traumatic dental injuries (TDIs) among children.

MATERIAL AND METHODS

A 31-item questionnaire was distributed to the parents and training coaches attending local sporting clubs in Brisbane region, Australia. The questionnaire consisted of five parts (i) demographic and professional information; (ii) TDIs in the primary dentition; (iii) fractures and subluxation of permanent teeth (iv) avulsion of permanent teeth, and (v) information and knowledge related to the management of traumatized teeth. The jamovi (Version 1.6.3) and GraphPad Prism were used for data analysis.

RESULTS

A total of 233 participants were surveyed, 211 parents and 22 coaches. Of all types of injuries, parental knowledge of managing avulsion to permanent teeth was poorest (9.5%), followed by management of injuries of primary teeth (17.5%) and management of fractures or subluxation of permanent teeth (29.4%). Parents in health care occupations had higher satisfaction on self-knowledge in managing TDIs however there was no significant difference in knowledge levels between health care personnel and other professions (P = 0.128). There was a discrepancy between the lack of knowledge and willingness to further self-educate with online platforms being the preferred medium.

CONCLUSION

The study showed a gap in parents' and training coaches' knowledge regarding the management of TDIs among children.

[Application of the dental trauma guide of the international association of dental traumatology in a group of paraguayan dentists]

Objective

To evaluate the application of the dental trauma guide according to the International Association of Dental Traumatology in a group of Paraguayan dentists from April to May 2021. The was a descriptive, cross-sectional, observational study. A group of Paraguayan dentists with internet access accepted to participate in the study. The measurement instrument was a closed questionnaire from Google Forms, distributed by instant messaging (WhatsApp) from January to April 2021. Based on the Guidelines for the Evaluation and Management of Traumatic Dental Injuries by the International Association of Dental Traumatology (IADT), the questionnaire includes 20 questions on the assessment of clinical and radiographic signs, determination of treatment variables, differentiation of the type of treatment, biological consequences of trauma, materials and splint time, and postoperative indications and medication.

Results

230 dentists participated; the mean age was 33 (SD = 6.4) years, 70.43% were women, 30.87% were general dentists, and 70.87% were practicing exclusively in private practice. 68.70% responded that they were familiar with the management and treatment of dentoalveolar trauma, while 70.87% had not heard or read about the IADT dental trauma guide. Regarding the level of knowledge, 60.00% scored an average mark.

Conclusion

Most of the dentists surveyed had moderate knowledge regarding the evaluation and management of traumatic dental injuries.

Dentists' knowledge about osteoporosis and their ability to identify the disease

BACKGROUND

Osteoporosis is an underdiagnosed condition, and its seriousness is not considered until severe complications arise. This study aimed to evaluate general dentists' knowledge about osteoporosis and their ability to identify patients with this disease by assessing mandibular cortical width (MCW) and mandibular cortical index (MCI) on panoramic dental radiographs using a visual method.

METHODS

In this cross-sectional study, an email questionnaire regarding the diagnosis and prevention of osteoporosis was sent to 20,773 dentists in 2016. Those who completed the questionnaire were invited to participate in radiomorphometric training and then to analyze the MCI and MCW of 114 panoramic radiographs of postmenopausal women who underwent both panoramic radiography and bone densitometry. Based on the radiomorphometric indices and while blinded to the densitometry results, the dentists determined whether they would indicate densitometry for these patients.

RESULTS

The response rate was 2.3%: 485 dentists completed the questionnaire, and 50 evaluated panoramic radiographs using the MCW and MCI. All of them reported some knowledge about osteoporosis, but 41.6% demonstrated a misleading conceptualization of the disease. Approximately 90% reported minimal access to this information during graduation, and only 27.0% were exposed to the topic during their postgraduate studies. Interest in osteoporosis prevention was expressed by 70.7% of the respondents, and interest in learning the radiomorphometric indices was expressed by 99.0%. The sensitivity in the detection of low bone mineral density through the MCW and MCI was 52.9%, and the specificity was 64%.

CONCLUSIONS

Brazilian dentists demonstrated insufficient knowledge about osteoporosis and a low ability to detect osteopenia or osteoporosis by applying radiomorphometric indices.

A 5-year data report of traumatic dental injuries in children and adolescents from a major dental trauma center in Greece

BACKGROUND/AIM

Prevalence and demographic characteristics of traumatic dental injuries (TDI) differ in different countries. The aim of this retrospective study was to assess TDI in primary and permanent teeth among children and adolescents who presented to the Department of Paediatric Dentistry, National and Kapodistrian University of Athens, Greece, during the last 5 years.

MATERIAL AND METHODS

Dental records of 236 new patients who presented with dento-alveolar trauma to the Postgraduate Dental Clinic from 1/1/2014 to 31/12/2019 were reviewed. Data recorded were gender, age, month of the year the injury occurred, type of trauma, and number of traumatized teeth. Injuries were classified as fracture, luxation, or combination injuries. Descriptive statistics, chi-squared (x² ), and Fisher's exact tests were used to evaluate the results. Level of significance was set at 5%.

RESULTS

The age of the patients ranged from 1 to 18 years old, with a mean of 8.63 years (SD: 3.52). There were 395 anterior traumatized teeth and 2 cases with traumatized posterior teeth. Children suffered trauma more often at the ages of 5 years, 7 years, and 11 years. In this cohort, 60% were boys who had a higher chance of having trauma than girls (odds ratio = 1.418 95% CI = 0.724, 2.777). Most TDI occurred in March and May, followed by June and February, and most traumatized teeth were permanent (80%). Maxillary central incisors in both dentitions were injured most often and significantly more compared to lateral incisors (p < 0 .01). The most common type of injury was a fracture in the permanent dentition (60%) and luxation injuries (69%) in the primary dentition.

CONCLUSIONS

Traumatic dental injuries in this cohort occurred mostly in spring, affected boys more than girls, permanent teeth more than primary teeth, maxillary incisors more than mandibular incisors, and central incisors more than lateral incisors, while children aged 5, 7, and 11 years old had the most injuries.

What is new in the 2020 International Association of Dental Traumatology emergency treatment guidelines?

Over the past eight years, there have been marked changes in the recommendations for the management of traumatic dental injuries (TDIs). The recently published International Association of Dental Traumatology (IADT) guidelines for the emergency management of TDIs provide a comprehensive manual for clinicians to refer when assessing and managing patients presenting with these types of injuries. Clinicians should be prepared to utilize these new guidelines which were released in 2020. The aim of this short communication is to support those with previous knowledge regarding the IADT guidelines, to identify the changes in treatment modality, and to provide backing for those exposed to trauma guidelines for the first time. In the present communication, the areas of TDIs have been separated into primary and permanent teeth plus avulsions, with a tabular format highlighting the main changes in the emergency management from the previous version in 2012. This format has been devised to aid the clinicians' understanding of the variations over time and facilitate recall of the new guidelines. For the first time, the 2020 IADT Guidelines present a Core Outcomes Set (COS) that includes outcomes that were relevant to all TDIs and outcomes related to only one or several TDIs. However, the COS is not the object of the present publication.

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.

Traumatic Dental Injuries, Treatment, and Complications in Children and Adolescents: A Register-Based Study

Objective  Traumatic dental injury (TDI) is a common dental concern among children worldwide. We performed a retrospective patient register study among children under 18 years to investigate TDIs with respect to causes, treatment, and complications.

Materials and Methods  We collected information on TDIs from the original patient records of 407 child patients visiting dental clinic of Lithuanian University of Health Sciences, Kaunas, Lithuania. We analyzed all child patients’ ( n = 407) background, cause, type of TDI, treatment, complications, and time elapsed from injury to visit to the dentist.

Statistical Analysis  The χ² -test, analysis of variance (ANOVA), and Kruskal–Wallis and Mann–Whitney tests served in the statistical analyses.

Results  A total of 579 TDI cases occurred during 2010 to 2016. Lateral luxation (19.8%) and intrusion (14.8%) occurred more often in the primary than the permanent dentition ( p < 0.05). The most common cause of TDI was falling (56%). Avulsion occurred in approximately 10% of cases. Follow-up (44.5%) and tooth extraction (48.3%) were the most frequent treatments in the primary and splinting (25.3%) in the permanent teeth. Pulp necrosis was the most frequent complication in primary (92%) and permanent (54%) dentition. About 1% of the patients obtained dental care during the first hour after injury.

Conclusion  The most frequent TDIs included lateral luxation in primary teeth and enamel-dentine fractures in permanent teeth. We observed a delay in patients obtaining emergency dental care.

Knowledge of Emergency Management of Avulsed Teeth among Italian Dentists-Questionnaire Study and Next Future Perspectives

(1) Background: In Italy, about one fourth of all schoolchildren experience a trauma to the permanent dentition. Management of avulsion trauma is challenging and requires adherence to clinical protocols. The aim of this study was to investigate the management knowledge of avulsed teeth among Italian dentists and to promote the guidelines’ dissemination through the use of new social media. (2) Methods: The survey was carried out during the COVID-19 lockdown in Italy (March–May 2020). The questionnaire was sent anonymously to a total of 600 dentists. The questionnaire consisted of two parts. Part A—demographic and professional data and Part B—management of traumatic avulsion. (3) Results: The response rate was 50.6% and the mean fraction of correct responses was 0.524. Issues related to the therapeutic management of avulsed teeth were shown to be not well understood by the respondents. Professionals with qualifications in dentistry and those who declared to know the guidelines responded better, while other demographic and professional factors were insignificant. (4) Conclusions: Italian dentists’ knowledge of the management of avulsion trauma should be improved. Educational programs and campaigns must be undertaken to improve their awareness and adherence to the Italian and international guidelines.

Global status of knowledge for prevention and emergency management of traumatic dental injuries in dental professionals: Systematic review and meta-analysis

BACKGROUND

Dental professionals are the primary care providers for traumatic dental injuries (TDI). The dental traumatology literature has a number of studies evaluating the knowledge of dental professionals from different parts of the world but its global status is unknown. Hence, the aim of this systematic review was to assess the global status of knowledge for the prevention and emergency management of TDI in dental professionals and to provide recommendations for future research.

MATERIALS AND METHODS

The protocol was designed as per the PRISMA guidelines and registered in PROSPERO (CRD42020192381). A broad-based search using text words and MeSH terms was performed in established databases as per a pre-defined strategy without any distinction of language and year of publication. Studies without details of the questionnaire, knowledge score, validity and reliability were excluded. Data extraction was performed, risk of bias assessment was done using the Joanna Briggs Institute's critical appraisal tool, and a meta-analysis was performed.

RESULTS

Sixteen studies, which had been published between 2008 and 2020, were included for qualitative synthesis. Most of them were cross-sectional, used convenience sampling and evaluated knowledge for avulsion. Previous dental trauma training was undertaken by <50% of the participants of five studies, <50% knew about the correct approach in management of complicated crown fractures in three studies and ≤60% in four studies knew the critical time for replantation. There was insufficient level of knowledge in >50% of the included studies. High risk of bias was found in three studies.

CONCLUSION

The knowledge level in several areas of the world was unknown. The studies lacked uniformity in methods and well-designed questionnaires and they revealed insufficient levels of knowledge among dental professionals.

A cross-sectional evaluation of knowledge among Chinese dentists regarding the treatment of traumatic injuries in primary teeth

BACKGROUND/AIM

Injuries to the primary dentition affect children's esthetics, function, and mental health. They may also affect the development of the permanent teeth. The knowledge of dentists about deciduous tooth trauma is rarely evaluated. The aim of this study was to evaluate the knowledge and attitude of dentists in China regarding traumatic dental injuries to primary teeth.

MATERIAL AND METHODS

A self-administered online questionnaire containing questions on demographic data and knowledge based on a clinical scenario was given to a purposive sample of dentists, recruited by a non-probability convenience sampling method. The chi-square test was used for statistical analysis, with the significance level set at P <.05.

RESULTS

A total of 394 out of 409 dentists provided valid data. There was no significant difference in demographic data. Questions about the treatment of hard dental tissue injuries in primary teeth presented a correct-response rate of 66.4%, with the highest correct-response rate for enamel fracture (n = 368, 93.4%) and lowest for complicated crown-root fracture with pulp exposure (n = 104, 26.4%). Questions about treatment of luxation injuries in primary teeth presented a correct-response rate of 66.6%, with subluxation presenting the highest correct-response rate (n = 391, 99.2%). Factors associated with higher correct-response rates were specialist disciplines, educational qualifications, workplaces, experience of injured teeth treated, and educational experience about primary tooth trauma. No significant differences were found in the correct-response rates of dentists with different years of work experience. Lack of cooperation from children was considered a major obstacle for treatment. Special lectures and Internet courses were the most preferred methods of obtaining knowledge.

CONCLUSION

The results suggest that it is necessary to enhance dental trauma education for dentists in China. More attention needs to be paid to trauma in primary dentition to ensure adequate treatment for traumatized primary teeth.

Evaluating the knowledge level, attitudes, and therapeutic approaches of Greek dentists for traumatic dental injuries

BACKGROUND/AIM

Greek dentists are facing a new era of a globally continuous effort to improve the first-aid management and long-term treatment outcome of traumatic dental injuries (TDI). In Greece, where the basic and clinical research in the field of dental trauma has been limited until recently, assessing the attitudes and therapeutic strategies of Greek dentists for dental trauma is of great importance. The aim of this study was to evaluate the knowledge attitudes and therapeutic approaches of Greek dentists in different clinical scenarios of TDI.

MATERIALS AND METHODS

A cross-sectional study was conducted among 448 dentists. A questionnaire-based survey of demographic characteristics, attitudes, and a scenario-based knowledge test, of TDI, which was used to formulate a "Dental Trauma Knowledge Score" with a 0-8 score range, was administered. Mann-Whitney U tests (for two categories variables) and Kruskal-Wallis tests (for more than two categories variables) were performed.

RESULTS

The median knowledge score was 5.0 (IQR: 4-7), a level considered as "Acceptable." Knowledge scores were found to significantly differ by age group, with the younger dentists presenting the highest scores. Dentists with a self-evaluation as "Acceptable" had significantly higher scores. Most of the dentists would refer for CBCT in severe trauma cases. A significant association was found between younger ages and on awareness of the mobile application ToothSOS. Female dentists had significantly higher scores compared to males when asked about avulsion management.

CONCLUSION

An acceptable level of knowledge on TDI management was revealed among dentists in Greece. Higher knowledge scores were observed among younger dentists.

Assessment of Knowledge and Attitudes of Traumatic Dental Injuries among Saudi Dental Students: A Multicenter Cross-Sectional Study

Introduction

The aim of this multicenter cross-sectional study was to assess the knowledge and attitudes of senior dental students in Riyadh, Saudi Arabia, regarding the management of traumatic dental injuries.

Materials and Methods

A stratified random sample of fourth- and fifth-year dental students in different dental schools was given a two-part questionnaire; the first part included demographic questions, while the second part included case scenario questions related to knowledge and attitudes regarding the emergency management of concussion, crown fractures, luxation injuries, root fracture, and alveolar bone fracture. Data were statistically analysed using chi-square and ordinal logistic regression tests. The significance was set at p < 0.05.

Results

A total of 359 dental students participated in this study. The proportion of students from all dental schools with correct responses to each set of questions was as follows: alveolar bone fracture (78.4%), root fracture (70.1%), intrusive luxation (57.1%), complicated crown fracture (39.7%), uncomplicated crown fracture (35.5%), extrusive luxation (35%), concussion (31.1%), and lateral luxation (26.8%). The mean overall knowledge score of the participants was 3.421 ± 0.49. No statistically significant difference was found on any of the questions regarding the gender or year of study (p > 0.05).

Conclusion

Based on the findings of this study, dental students' knowledge of the management of traumatic dental injuries in the Riyadh region of Saudi Arabia ranges from low to moderate. Thus, there is a need to improve the knowledge of management of traumatic dental injuries among dental students.

Traumatic dental injuries presenting to a paediatric emergency department in a tertiary children's hospital, Adelaide, Australia

BACKGROUND/AIM

There is a scarcity of data regarding paediatric traumatic dental injuries (TDI) in tertiary teaching hospitals. Therefore, the aim of this study was to review the TDI presenting to the Women's and Children's Hospital in Adelaide (Australia) on an emergency basis and to identify the characteristics of the presenting patient cohort, their accident, injuries and management.

METHODS

Medical health records of 337 paediatric patients attending the Paediatric Emergency Department (PED) for the management of TDI over 18 months were prospectively reviewed.

RESULTS

TDI were more frequent in children under 5 years of age (56.1%) with a predominance of injuries sustained by males (63.8%). The accident characteristics included weekend occurrence (35.6%), the most common aetiology was falls (64.4%) and many incidents occurred at home (48.5%). Overall, 654 teeth were injured with the majority affecting deciduous teeth (58.4%) and the maxillary central incisors (69.9%). The most frequent injury was lateral luxation (27.5%). The majority of patients were referred to the Paediatric Dentistry Department (60.8%). However, almost half of presenting patients did not require further management locally and were subsequently discharged to their dental practitioners (39.2%). Most patients receiving treatment were managed under general anaesthetic (36.9%), and there was often a delay of 3-12 hours before treatment commenced (49.1%). Similarly, more severe injuries in the permanent dentition (avulsion, extrusion, root fracture, intrusion, alveolar fracture) were more frequently managed between 3 and 12 hours following the accident.

CONCLUSION

The patient, accident, injury and management characteristics are comparable to what has previously been reported in other studies in paediatric populations. Injuries affecting the permanent dentition are more likely to be managed within 3 and 12 hours in an outpatient setting, whereas injuries affecting the deciduous dentition had a delay in management between 12 and 24 hours under general anaesthetic.

Knowledge of orthodontic treatment approach of traumatized teeth by a group of Belgian general dentists, pediatric dentists, and orthodontists

BACKGROUND/AIM

Traumatized teeth are more susceptible to complications during orthodontic tooth movement. The aim of this study was to explore current practices among Belgian dental practitioners regarding orthodontic treatment of children with a history of dental trauma.

MATERIAL AND METHODS

A questionnaire survey was organized among general dentists, pediatric dentists, and orthodontists in Flanders (Belgium). Questionnaires were distributed at the occasions of annual meetings or symposia. They consisted of questions regarding exposure to dental trauma and orthodontic treatment approach for patients with a dental trauma history.

RESULTS

The questionnaire was completed by 121 general dentists, 47 pediatric dentists, and 99 orthodontists. A history of dental trauma influenced referral for orthodontic treatment by general dentists and pediatric dentists moderately (median VAS scores of 5 and 6, respectively, on a scale of 0 (not at all) to 10 (utmost)), indicating uncertainty and doubt. Additional checkups during tooth movement were usually not organized by general dentists in 33.6% and by pediatric dentists in 19.1% of cases (P = 0.006). One-third of the orthodontists (33.3%) experienced tooth loss linked to orthodontic movement of a tooth with dental trauma history in at least one patient. Only a minority of the practitioners knew of the existence of specific guidelines (7.6%, 15.6% and 22.7%, respectively, of general dentists, pediatric dentists, and orthodontists) (P = 0.007). The Dental Trauma Guide was the guideline mentioned most frequently, although this tool does not contain recommendations regarding orthodontic treatment after trauma.

CONCLUSION

In the group of Belgian general dental, pediatric and orthodontists surveyed, there was uncertainty regarding the orthodontic management of patients with a history of dental trauma especially among general practitioners. Further educational training is recommended.