Physician and emergency medical technicians' knowledge and experience regarding dental trauma

Abstract –  The purpose of the present study was to evaluate the knowledge of physicians and emergency medical technicians (EMT) regarding primary treatment for dental trauma and to assess the experience they have in treating dental injuries. The study population consisted of 70 military physicians and EMT during their military service. A questionnaire was distributed relating to demographic data, such as age, gender, position, and type of military service, as well as the following issues: past experience in treating or witnessing dental trauma, former education regarding diagnosis and treatment of dental trauma, assessment of knowledge regarding dental trauma, etc. Of all participants, only 4 (5.9%), all physicians, received education regarding dental trauma. Nevertheless, 42 (61.8%) reported they witnessed such an injury during their military service. Dental injuries were first seen by the EMT in 41.2% of the cases, by the physician in 25%, and by a dentist in only 7.3%. Overall, 58 (85.3%) of the physicians and EMT stated that it was important to educate the primary health care providers regarding diagnosis and treatment of dental trauma. Special emphasis should be given to providing primary caregivers with the relevant education to improve their knowledge and ability of dealing with diagnosis and treatment of dental trauma.     

Perceptions of emergency department physicians regarding the management of traumatic dental injuries

Background/Aim

The purpose of this study was to investigate the self-reported confidence level and education of Atlantic Canada emergency department physicians in the management of traumatic dental injuries and to assess the need for further education surrounding the management of dental trauma.

Material and Methods

An 18-item survey was developed and distributed electronically to physicians by their respective provincial medical associations.

Results

Traumatic dental injuries were reported in the emergency department on a weekly basis (78%). Most respondents reported that they were somewhat confident (51%) or very confident (7%) in managing traumatic dental injuries. Physicians' years in practice correlated positively with self-reported confidence levels in managing dental trauma. Urban and rural emergency department physicians reported similar levels of access to general dentists (38% and 30%, respectively); however, urban emergency department physicians reported greater access to pediatric dental specialists (43%) and oral and maxillofacial surgeons (81%) than rural practicing colleagues (4% and 30%, respectively). Most emergency department physicians (85%) agreed that it was important to receive training on the management of traumatic dental injuries and reported that education on managing traumatic dental injuries during residency (37%) and access to a dental trauma decision-making pathway (30%) would be of most value.

Conclusions

This study highlights the role of emergency department physicians as first responders and demonstrates opportunities for improvement in the initial management of traumatic dental injuries. These implications can be achieved through the incorporation of further training in emergency medicine residency programs and through the implementation of decision-making pathways in emergency departments.     

Knowledge of physicians in hospital emergency rooms in Israel on their role in cases of avulsion of permanent incisors

Summary. Objective. The purpose of this study was to assess the knowledge of physicians in hospital emergency room care on their possible role in cases of traumatic loss of permanent incisors. Methods. A questionnaire was sent to directors of emergency room facilities in hospitals in Israel regarding the medical team at the emergency room in the hospital, availability of an in‐house dental service and existence of a protocol for management of avulsed teeth. Another questionnaire, completed by physicians in the emergency room, contained demographic questions and questions regarding their knowledge of management of avulsed permanent teeth. Results. The findings of the study showed that only 4% (12 of 335 physicians) would provide an appropriate initial treatment that, if followed by treatment by a dentist as recommended, could save the avulsed tooth. No correlation was found between knowledge of appropriate treatment of avulsed teeth and type of speciality, years of experience, previous exposure to information on trauma to the teeth and gender. The only significant association was found between physicians’ knowledge and having a dentist spouse. Most of the physicians had never attended any formal seminar or lecture or received printed instructions on the management of avulsed teeth. Conclusions. Medical students and physicians in hospitals’ emergency rooms should be made aware of their possible role in cases of avulsion of permanent teeth, in order to minimize late complications associated with such injuries. One possible way to achieve this goal is through education during and after training and introduction of a formal protocol for treatment of avulsed permanent teeth and other dental injuries.     

Oral and facial trauma among paratroopers in the Israel Defense Forces

Abstract – Background: Military fighters are one of the highest risk populations for dental and oro‐facial trauma. The aim of this study was to evaluate the incidence and etiology of oro‐facial injuries among active duty paratroopers in the Israeli Defense Forces. Methods: Paratroopers from selected companies were interviewed using a structured questionnaire regarding oro‐facial trauma during active service years. The study consisted of 311 male paratroopers, with a mean age of 21.1 years (± 1.7). Mean duration of military service until the study was conducted was 25.9 months (± 6.9). Results: Oro‐facial injuries during military service was found in 87 (28.0%) of the participants, with an incidence rate of 129.6 cases per 1000‐fighter‐years. Extra‐oral lacerations (lip, chin, cheek/facial muscles) were the most common injury. Tooth injuries were reported by 48 of the participants, of whom 44 (50.6%) suffered from dental fractures and four (4.6%) from subluxation/luxation. Most oro‐facial injuries occurred in an isolated training or operational field. Thirty‐seven participants (42.5%) reported postevent disturbance and 10 (11.5%) reported loss of operative activities because of the event (mean 8.6 ± 4.0 day loss). Conclusions: Military paratroopers are highly predisposed to oro‐facial trauma. Besides the physical and mental associated damage, these injuries result in the interference of their continuous daily activity. Prevention, mouth‐guard usage and treatment intervention are two important actions that should be adopted to reduce trauma and its interference.     

伴全身多系统创伤颌面伤患者的综合救治

目的:研究伴发身体其他部位创伤的颌面伤患者综合救治中专科确定性手术时机和适应证。方法:回顾性统计4所大型综合医院口腔科病房近20年收治的4 869例口腔颌面部创伤患者的临床资料,分析伴发身体其他部位创伤状况和专科手术时机。结果:4 869例患者中,面骨骨折3 364例,软组织伤1 505例。伴发其他部位创伤1 524例(占31.3%),其中颅脑伤570例(37.4%),肢体伤545例(35.8%),胸部伤170例(11.2%),眼创伤151例(9.9%),脊柱伤54例(3.3%),腹部伤34例(2.2%)。74%的颅脑伴发伤患者伤后4周内、76.2%的眼伴发伤患者伤后7d内进行了面骨骨折手术治疗。而肢体、脊柱、胸腹部伴发伤患者,面骨骨折手术均有不同程度延误。结论:伴发多系统创伤的颌面伤患者的救治需要多学科间的合作,在患者呼吸系统、循环系统等全身状况稳定的情况下,大部分颌面多发伤患者可以同期或早期进行专科处理。     

现代创伤救治理念与口腔颌面部多发伤救治

多发伤的救治需要应用现代创伤救治理念,通过加强多学科间的合作,共同制定救治方案,达到理想的救治效果。本文在了解现代创伤救治理念,理解理念要点的基础上,分析口腔颌面部多发伤救治中伤情评估的策略和方法,探讨专科救治的时机和影响因素,提出伴发身体其他部位损伤的颌面伤患者综合救治中专科确定性手术的时机和适应证,以加深口腔医学专业医生对现代创伤救治理念的理解,提高其对口腔颌面部多发伤的救治能力和治疗效果。     

E-scooter injuries referred to the oral and maxillofacial surgical service at Christchurch Hospital: a retrospective observational study and cost analysis of 17-months of data

Personal and shared stand-up electronic scooters (e-scooters) have rapidly increased in popularity, leading to an increase in the number of patients with e-scooter-related trauma presenting to hospital Emergency departments. This study aimed to assess the patterns of oral and maxillofacial trauma directly related to e-scooter use and provide a cost-analysis related to the management of these patients. A retrospective, controlled interval study was conducted to examine all patients referred to the oral and maxillofacial surgical service at Christchurch Hospital, New Zealand, who sustained facial injury as a result of e-scooter accidents between 15 October 2018 and 15 April 2020. A total of 30 patients with e-scooter-related facial injuries were referred to the maxillofacial service and required a total of 23 operative procedures. The majority of patients (70%) were aged between 20-39 years and 63.3% were male. Two-thirds reported having consumed alcohol before the e-scooter accident. The total estimated cost for the treatment of patients was $298,054 NZD. E-scooter-related maxillofacial trauma represents an emerging mechanism of injury that is associated with significant facial trauma and results in a treatment cost that adds significant burden on the health care system.     

Knowledge of emergency management of avulsed teeth among young physicians and dentists

This study was designed to investigate the knowledge and attitude of newly graduated physicians and dentists regarding emergency management of avulsed teeth. Data were collected using a self-administered questionnaire. Thirty physicians and 30 dentists who graduated during the period 2000-2004 were surveyed. They all served in either hospitals or dental centres with emergency settings. All the participants that were asked were willing to participate. The majority of the physicians (83.3%) surveyed had not received information on what to do if a tooth is knocked-out and 96.6% did not have any dental health education course during their study. In contrast, nearly all the dentists (93.3%) had received information on what to do if a tooth is knocked-out. Regarding knowledge level, eight of the physicians (26.6%) demonstrated low knowledge while the remaining 22 (73.3%) had some knowledge; none of the physicians showed a high knowledge level. In sharp contrast, 22 dentists (78.5%) had high knowledge, six (21.4%) showed some knowledge and none demonstrated low knowledge. We conclude that emergency dental treatment is sometimes required to be provided by a physician before any dental contact. Unfortunately, the findings from this survey clearly suggest that very few physicians would provide appropriate emergency treatment. All medical staff personnel need to receive simple instructions about management of dental trauma. Most dentists had high knowledge regarding this issue; nevertheless, a few dentists, not graduated in Kuwait, were found to have limited knowledge, which needs to be improved.     

Medical doctors’ knowledge of dental trauma management: A review

Education in dental trauma is extremely important to promote knowledge on the assessment and management of a traumatized tooth. Medical doctors are normally only required to manage the emergency phase of traumatic dental injury (TDI) treatment before referring to a dentist, endodontist or oral and maxillofacial surgeon for continuing care. Medical doctors who possess sufficient theoretical knowledge and are competent enough clinically to handle TDI can provide a higher standard of treatment care and ultimately achieve a better patient outcome. The aim of this literature review was to assess the extent of medical doctors’ knowledge of dental trauma management for injuries in the following four areas: (a) tooth structure; (b) to the supporting bone; (c) to the periodontal tissues; and (d) to the soft tissues. Based on the findings from this literature review, an overall deficiency in knowledge and confidence in managing dental trauma has been identified. Knowledge and understanding to categorize TDI using the same classification of dental injuries commonly used amongst dentists would allow medical doctors to better manage and communicate with dental colleagues concerning referral for further care. If the medical education curriculum provided medical doctors with more information and skills for the management of dental trauma and an understanding of the importance of early management, then more favourable outcomes may prevail for dental trauma patients.     

The effect of short dental trauma lecture on knowledge of high-risk population: an intervention study of 336 young adults

Abstract – Aim: The purpose of this interventional study was to evaluate the effect of a short dental trauma lecture on knowledge of first‐aid management of dental avulsion among high‐risk population. Methods:  A total of 336 army recruits were randomly assigned to two groups. To evaluate the level of knowledge, we used a structured questionnaire, adapted from Andersson et al. (Dent Traumatol, 22, 2006, 57) and translated to Hebrew. The control group (n = 137) answered the questionnaire. The intervention group (n = 199) received a 60‐min slides lecture by a (military) dental practitioner, regarding general concepts of body injuries, facial and oral injuries and practise first‐aid management of these injuries. The intervention group filled the same questionnaire following this lecture. Results:  General knowledge of emergency treatment of injuries to other parts of the body was rather good for all participants; however, the level of knowledge was significantly higher in the intervention group (P < 0.05). General knowledge regarding tooth and avulsion was quite disappointing in the control group but was significantly higher in the intervention group (P < 0.001). The same was observed when interpreting the results regarding special knowledge of avulsion first‐aid management: How to clean the tooth before replantation, extra‐alveolar time and storage method and medium (P < 0.001). Conclusions:  The present study revealed excellent results following a short dental trauma instruction lecture. As raising the public awareness on the subject of dealing with dental trauma is important for the prognosis of the tooth, this way of improving knowledge to high‐risk populations should be further examined in long‐term studies.     

A study into dentists' knowledge of the treatment of traumatic injuries to young permanent incisors

OBJECTIVE: The aims of this study were to evaluate dentists' knowledge of the emergency treatment of traumatic injuries to young permanent incisors, and to investigate barriers to treatment. DESIGN: A closed-ended questionnaire was sent to 1023 general dental practitioners (GDPs) and community dental officers (CDOs) in West/North Yorkshire and Humberside, UK. METHODS: The questionnaire comprised 17 questions. Six questions asked for general information about the participants (i.e. profession, age, gender, year of graduation, training or education on dental trauma, and willingness to provide emergency care), 10 were relevant to the emergency treatment of crown fractures, root fractures, luxation and avulsion injuries, and the last question queried any perceived barriers to treatment. Results. Seven hundred and twenty-four questionnaires were returned, a response rate of 71%, and these indicated that dentists' knowledge of the emergency treatment of dentoalveolar trauma in children was inadequate. The CDOs were significantly more knowledgeable than the GDPs, as were younger and more recently graduated dentists compared with older ones. The GDPs regarded the difficulty of treating children and the inadequate fees of the UK National Health Service as important barriers to treatment. Dentists who attended continuing dental education courses on dental traumatology had a more thorough knowledge than those who did not. CONCLUSION: Overall, the dentists' knowledge of the emergency treatment of dentoalveolar trauma in children was inadequate. Greater emphasis on undergraduate and postgraduate education in this area is indicated.     

Knowledge of medical hospital emergency physicians about the first-aid management of traumatic tooth avulsion

International Journal of Paediatric Dentistry 2012; 22: 211–216 Objective. The aim of this study was to evaluate the knowledge of emergency medical physicians employed in hospital emergency rooms as to their potential role in the treatment for traumatic teeth avulsion injuries (TTAI). Methods. A 15‐item questionnaire was distributed to the emergency rooms of one university and 10 public hospitals. The questionnaire gathered data on the respondents’ professional profiles and self‐assessed perceived knowledge and actual knowledge of the emergency management of TTAIs. Results. The study was implemented with 69 emergency physicians present at their workplaces during the time of data collection. Of these, 55 (79.7%) were employed at public hospitals and 14 (20.3%) at a university hospital. The professional profiles indicated that 47 (68.1%) of the participants were general practitioners and the remaining 22 (31.9%) were distributed among various other medical specialties. Overall, 28 respondents (40.6%) assessed their knowledge regarding medical treatment for TTAI as insufficient, and the majority (78.3%) stated that they would like further education. Importantly, a large majority of practitioners could not provide correct answers to questions related to the emergency management of TTAI. Conclusion. There is a need to improve the knowledge of emergency medical physicians regarding the emergency treatment for TTAI.     

Maxillofacial injuries in military personnel treated at the Royal Centre for Defence Medicine June 2001 to December 2007

Since its formation in June 2001, the Royal Centre for Defence Medicine (RCDM) at Birmingham University Hospitals NHS Foundation Trust has treated most of the British military personnel who have sustained serious maxillofacial injuries while serving abroad. We retrospectively analysed all recorded maxillofacial injuries of personnel evacuated to the RCDM between June 2001 and December 2007. We know of no existing papers that describe oral and maxillofacial injuries of military personnel, or workload in the 21st century. During the period 119 personnel with maxillofacial injuries were evacuated to the RCDM for treatment 83% of whom were injured in Iraq or Afghanistan. In total 61% (72/119) of injuries were caused by improvised explosive devices, 9% (11/119) were gun shot wounds, and 1% were caused by aircraft incidents. A further 29% (35/119) of patients had injuries not associated with battle. The most common injuries were facial lacerations (106/119). There were 54 facial fractures of which 17 primarily affected the maxilla, and 15 the mandible. Associated injuries were to the brain (24%), torso (26%), upper limb (39%), and lower limb (31%). The number of maxillofacial injuries has risen over the last 7 years, and has also increased in proportion to the total number of injured soldiers evacuated between 2005 and 2007.     

Referral patterns for the treatment of facial trauma in teaching hospitals in the United States

PURPOSE: The management of facial trauma is considered an integral part of the training of several specialties, including general plastic surgery, otolaryngology, and oral and maxillofacial surgery. Referral patterns of patients who have sustained facial trauma to these various specialty services, however, vary at different institutions according to physician preferences and protocols. The purpose of this project was to examine the referral patterns of facial trauma in the United States at teaching hospitals. MATERIALS AND METHODS: A questionnaire survey of physician-chiefs of emergency or trauma services at teaching hospitals was carried out. Scenarios involving a variety of facial injury patterns were presented, and a hypothetical referral was requested. In addition, questions regarding preferences and opinions regarding the various services were included. RESULTS: Most teaching hospitals had a formal protocol for the referral of patients with facial injuries. With the exception of mandible fractures, referral patterns for patients with facial injuries were relatively even across the 3 specialties. Interestingly, only 56% of respondents would seek the same referral for themselves or relatives in the same way as they would refer a patient based on their in-house protocol. In regard to timeliness, efficiency, and perceived competency in the handling of facial trauma, oral and maxillofacial surgery had statistically significant higher scores than otolarygology and plastic surgery, which were not statistically distinguishable between each other. CONCLUSIONS: All 3 specialties appear to be involved in the management of facial trauma at teaching institutions in the United States; therefore, it seems unlikely that any one specialty will be singled out as the sole provider of these services at all institutions.     

年轻恒牙脱位性损伤的诊疗原则

年轻恒牙外伤是影响儿童及青少年牙颌发育与健康的重要疾病，其中脱位性牙外伤常同时累及多颗牙齿和口腔颌面部其他软硬组织，病情复杂，治疗相对困难，远期并发症较多。文章结合2020年国际牙外伤学会颁布的指南，对年轻恒牙脱位性损伤的检查诊断要点、治疗原则和预后进行介绍，为临床儿童牙外伤的诊疗提供参考。     

Dental and maxillofacial injuries among older New Zealanders during the 1990s

Not only is the number of older people increasing in New Zealand, but a greater number of them are keeping their own teeth, with predictable consequences for the costs of treating (and rehabilitating) dental and maxillofacial trauma in that group. The aim of the study was to describe the occurrence of dental and maxillofacial trauma involving New Zealanders aged 65 and over during the 1990s. The investigation was a secondary analysis of routinely collected, national-level compensation and hospital treatment data. The analysis showed that: (1) there was an increase in the rate and absolute number of injuries among older people; (2) the dental trauma rate was highest among males in the youngest age group, while the facial fracture rate was highest among older females; and (3) there was a general increase in the contribution of falls to the occurrence of trauma. Measures which aim to reduce the occurrence of falls among older people will also reduce the oral and maxillofacial trauma rate in that age group.     

Dento-alveolar and maxillofacial injuries – a retrospective study from a level 1 trauma center in Israel

Abstract –  To evaluate the frequency and causes of dental and maxillofacial trauma in hospitalized patients. From January 1, 2000 to December 31, 2003, data from hospitalized trauma patients in a level 1 trauma center in Israel were analyzed according to age, gender, time, place, and cause of injury. Maxillofacial and tooth injuries were separated and further analyzed according to the above parameters. The analysis was based on data from the Israel Trauma Registry (ITR). Of all 14 040 trauma patients, 1038 (7.4%) involved maxillofacial or dental injuries. Common causes of injury were motor vehicle crashes (41%), falls (27%) and intentional injuries (23%). Fifty percent occurred on the street/road, 17% at home and 14% in public buildings. Surgery was required in 55.5% of all maxillofacial injuries. Males were hospitalized three times more than females, and young people, ages 19–28, were at greatest risk (30.2%). Oral and maxillofacial trauma is common, requiring dental health training for primary caregivers.     

Incidence of oral and maxillofacial skiing injuries due to different injury mechanisms.

PURPOSE: This study emphasizes the significance of maxillofacial injuries in skiing accidents, correlating injury mechanisms and patterns, by evaluating a large population of maxillofacial injuries over a 6-year period. PATIENTS AND METHODS: Between 1991 and 1996, of 5,623 patients showing oral and maxillofacial injuries, 1,859 were sports-related. Records of 579 patients with 882 incidents of oral and maxillofacial injury due to skiing were reviewed and analyzed according to age, sex, type of injury, cause of accident, location, and frequency of fractures. Additionally, the five main injury mechanisms were analyzed. RESULTS: The oral and maxillofacial injuries in 10.3% of all trauma patients, or 33% of all sports-related trauma patients, were due to skiing. A total of 310 patients (53.5%) had facial bone fractures, 236 patients (40.8%) suffered from dentoalveolar trauma, and 336 patients (58%) showed soft tissue injuries. Five major causes and mechanisms of injury existed, namely, 263 falls (45%); 135 collisions with other skiers (23%); 70 individuals struck by their own ski equipment (12%); 46 collisions against stationary objects (8%); and 34 lift-track accidents (6%). Sex distribution showed an overall male-to-female ratio of 1.9:1.0, but varied depending on the injury mechanism. The age distribution ranged from 2 to 81 years. CONCLUSION: The results of this study show the high incidence of oral and maxillofacial injuries due to skiing accidents. Depending on the mechanism of injury, different patterns occur. Facial bone fractures are more likely in collisions with other persons, falls, and collisions with stationary objects, whereas dentoalveolar trauma is more common when persons are struck by their own ski equipment, or when accidents on lift-tracks occur.     

华西口腔医院口腔颌面创伤专科医师规范化培训的实践探索

专科医师规范化培训是我国毕业后医学教育的重要组成部分,已经从局部试点转入了全面实施阶段。口腔颌面创伤是口腔颌面外科重要亚专业,目前我国口腔颌面创伤外科专科医师数量较少,主要集中在大城市的少数专科医院中,尚缺乏全面系统的规范化培训。文章通过分析我国口腔颌面创伤专科医师规范化培训现状,介绍华西口腔医院口腔颌面创伤专科医师规范化培训体系方面的经验,为培养能够独立规范地承担口腔颌面创伤专科常见多发疾病、疑难重症诊疗工作且具备良好执业道德的高素质口腔颌面创伤专科人才提供参考。