Opinions and attitudes of endodontists and general dental practitioners in the UK towards the intracanal fracture of endodontic instruments: part 1

Aim  To investigate the attitudes and opinions of general dental practitioners (GDPs) and endodontists in the UK towards fracture of endodontic instruments. It was hypothesized that there would be no significant difference between GDPs and endodontists regarding their experience of fracture of endodontic instruments.
Methodology  A pilot questionnaire was carried out on 20 postgraduate dental students to ensure that the questions were easily understood. This was followed by a further pilot survey on a group of GDPs and endodontists (50) to facilitate sample size calculation. The sample size comprised 330 systematically selected GDPs, and all endodontic specialists working in the UK (170). The questionnaire comprised both close-ended and partially close-ended questions in four categories: demographics; pattern of practice and experience of instrument fracture; management of fractured instruments; and unsuccessful management of fractured instruments. Nonrespondents were sent another two mailings (first and second reminders). After collecting the responses, data were analysed using chi-square and Linear-by-Linear Association tests at the 0.05 level of significance.
Results  The overall response rate was 75% (82.82% for endodontists and 70.92% for GDPs). Overall, 88.8% of respondents had experienced fractured instruments with a significantly higher proportion of endodontists (94.8%) compared with that of GDPs (85.1%).
Conclusion  Both endodontists and GDPs were aware of most factors contributing to endodontic instrument fracture. With experience and knowledge, fracture of endodontic instruments was associated with the number of root canal treatments performed.     

Abstracts from other journals

The purpose of this study was to assess the awareness of pre-school teachers concerning the management of traumatized teeth. A questionnaire survey of teachers' backgrounds, attitudes/practices and knowledge was distributed to all teachers who attended a dental education program organized by the Singapore Dental Health Foundation. Of a total of 291 teachers surveyed, 29% had received tertiary education, while the rest (71%) had received secondary education. The mean teaching experience was 6·8 ± 6·9 years. About a quarter had previous experience in handling dental trauma. Sixty-three percent admitted having no knowledge of dental trauma; 79% were unsatisfied with their level of knowledge in this area; 95% were keen to have further education in dental trauma, 65% thought a dental trauma emergency should be dealt with as soon as possible. Concerning knowledge, during-office hour emergency services were more familiar (84%) than after-office hour emergency services (15%), as was the concept of management of avulsed teeth (71%) compared to that of fractured teeth (51%). Knowledge about optimal storage media for avulsed permanent teeth was especially poor – being as low as 15%. Using multiple logistic regression analysis, it was found that teaching experience significantly influenced the respondents' self-assessed knowledge and their level of satisfaction with their knowledge ( P  = 0·012). Teachers with more teaching experience had better knowledge about the replantation of permanent teeth ( P  = 0·003). It is recommended that public education targeted at teachers should be carried out to increase dental trauma management awareness.     

Opinions and attitudes of endodontists and general dental practitioners in the UK towards the intra‐canal fracture of endodontic instruments. Part 2

Aim To investigate the attitudes of general dental practitioners (GDPs) and endodontists in the UK towards management of fractured endodontic instruments. Methodology A questionnaire was sent to 330 systemically selected GDPs and all endodontists working in the UK (170). It was accompanied by a covering letter explaining the aims of the study and indicating that all the information given would remain confidential. Those who did not respond to the first mailing were sent another two mailings. Data were analysed using chi‐square test at P ≤ 0.05. Results The overall response rate was 75%. Only 18.5% of respondents reported that they would retrieve instruments located in the apical third of root canals with a significantly higher proportion of endodontists (25.9%) compared with that of GDPs (14%) doing so. A significantly higher proportion of endodontists (98.5%) used ultrasonics for removal of fractured instruments compared with GDPs (75.8%). The most common complication of fractured instrument retrieval was thought to be excessive removal of dentine (67%). The majority of respondents (88.5%) reported that they would leave the unsuccessfully removed file in situ and obturate the root canal. Conclusion Both endodontists and GDPs were aware of the limitations of root canal anatomy when removal of fractured instruments was considered. Excessive removal of dentine, the most common complication associated with the removal process, suggests the need for more conservative techniques. Both endodontists and GDPs demonstrated a conservative approach when management of fractured instruments failed. Further studies regarding attitudes of GDPs and endodontists towards some specific aspects of fractured instruments management are required.     

Knowledge of the management of paediatric dental traumas by non-dental professionals in emergency rooms in South Araucanía, Temuco, Chile

Abstract –  Aim : The objective of this study was to investigate the level of knowledge and attitudes regarding first aid for dental trauma in children (TDI) by non-dental professionals and paramedical technicians of hospital emergency rooms in the South Araucanía Health Service, Chile, which was attained through application of a survey. Materials and methods : Samples were collected from people with occupations in the respective emergency rooms. The participants were 82 people that were interviewed using a questionnaire regarding management of dental trauma. Paramedic technicians, general and specialist doctors, and nurses were included in this survey. The appraisal covered diverse aspects: birth date, age, sex, years of experience in the emergency room, and questions regarding specific dental trauma topics, which focused on crown fractures, luxation injuries in permanent dentition, avulsion in primary and permanent teeth, and the respective emergency treatments. Results : Of the participants, 78.1% reported to have been presented with a TDI patient. The majority (90.2%) had not received formal training on TDI. These results revealed a wide distribution of responses. The overall dental trauma knowledge among the participants was relatively poor. For crown fractures management 54.9% indicated that they would ask the affected child about the crown remnants. In regard to transport and storage medium of avulsed permanent teeth, only 9.8% of the participants answered correctly and 43.9% of respondents stated that they would not replant an avulsed permanent tooth, since that procedure is considered the responsibility of a dentist. Conclusions : The majority of the respondents were not knowledgeable regarding TDI or the management and benefits of timely care, particularly in cases of avulsed permanent teeth. Therefore, formal education and training on the topic is suggested during undergraduate studies.     

A survey on the experience of UK endodontists and general dental practitioners in the management of intra-canal fractured endodontic files

Aim To investigate the attitudes of general dental practitioners (GDPs) and endodontists in the UK towards management of fractured endodontic file (SEF).
Methodology A questionnaire was sent to 330 systemically selected GDPs and all endodontic specialists working in the UK (170). It was accompanied by a covering letter explaining the aims of the study and indicating that all information given would remain confidential. Those who did not respond to the first mailing were sent another two mailings comprising a differently worded covering letter and another copy of the questionnaire. Data were analysed using chi-squared test at the 0.05 level of significance.
Results The overall response rate was 75% (82.82% for endodontists and 70.92% for GDPs). 18.5% of respondents reported they would retrieve files located in the apical third of root canals with a significantly higher proportion of endodontists (25.9%) compared with that of GDPs (14%) doing so. A significantly higher proportion of endodontists (98.5%) used ultrasonics for removal of SEF compared with GDPs (75.8%). The most common complication of SEF retrieval was excessive removal of dentine (67%). The majority of respondents (88.5%) reported that they would leave the un-removed file in situ and obturate the root canal.
Conclusion This study showed that both endodontists and GDPs are aware of the limitations of root canal anatomy when removal of separated instruments is considered. Excessive removal of dentine, which was the most common complication associated with the removal process, suggests the need for more conservative techniques. Both endodontists and GDPs demonstrated a conservative approach towards unsuccessful management of SEF. Further studies regarding attitudes of GDPs and endodontists towards some specific aspects of management of SEF are required.     

Medical emergencies in general dental practice in Great Britain. Part 3: Perceptions of training and competence of GDPs in their management

OBJECTIVES: To ascertain the training received in management of medical emergencies recalled by general dental practitioners (GDPs), as undergraduates and since graduation, to examine how well prepared they felt to manage such events and how their readiness might be improved. DESIGN: Postal questionnaire survey of a random sample of GDPs in Great Britain. SUBJECTS: 1500 GDPs, 1000 in England & Wales and 500 in Scotland. RESULTS: There was a 74% response. Among respondents, 75% had received training as undergraduates in the management of medical emergencies, 95% had subsequently received training. The proportion considering themselves 'well' or 'fairly well' prepared to manage emergencies rose from 30% at graduation to 80% currently. The 20% who felt themselves 'not very well' or 'not at all' prepared were less likely to possess the drugs and equipment to manage an emergency. Nevertheless, a need for further training was expressed by 96%: only 3% felt no need. CONCLUSIONS: Virtually all GDPs (99.2%), had received training in the management of medical emergencies at some time, principally since graduation. The 20% who feel inadequately prepared are less likely to possess the necessary drugs and equipment. There is a perceived need for further training among the majority of respondents.     

Brazilian dentists' knowledge regarding immediate treatment of traumatic dental injuries

Abstract –  The objective of this study was to assess the knowledge of dentists working in the city of Tubarão, southern Brazil, about the immediate treatment of traumatic dental injuries. A cross-sectional study was carried out involving all dentists who were working in the city in 2004 ( n  = 108). Data were collected through self-applied questionnaires with questions about sex, time elapsed since graduation, whether the dentists had attended postgraduate courses and also four questions about traumatic dental injuries in which the dentists selected the best answer. The response rate was 86.1%. For the two questions related to dental avulsion, 36.6% and 16.1% of professionals respectively, chose the correct answer according to the literature. For the question related to coronal fracture, 75.3% chose the correct answer. For the questions related to an incident without dental avulsion or fracture, 73.1% chose the correct answer. Time elapsed since graduation was the only variable statistically associated with the correct answer for the question related to coronal fracture. A significantly greater number of professionals with ≤10 years of experience chose the correct answer when compared with professionals with >10 years experience ( P  < 0.001). It can be concluded that the great majority of professionals would not intervene according to the literature in the cases of avulsion. Less time elapsed since graduation was statistically associated with the correct answer in the coronal fracture case.     

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.     

Dental trauma management awareness of Singapore pre-school teachers

Abstract – The purpose of this study was to assess the awareness of pre-school teachers concerning the management of traumatized teeth. A questionnaire survey of teachers' backgrounds, attitudes/practices and knowledge was distributed to all teachers who attended a dental education program organized by the Singapore Dental Health Foundation. Of a total of 291 teachers surveyed, 29% had received tertiary education, while the rest (71%) had received secondary education. The mean teaching experience was 6.8±6.9 years. About a quarter had previous experience in handling dental trauma. Sixty-three percent admitted having no knowledge of dental trauma; 79% were unsatisfied with their level of knowledge in this area; 95% were keen to have further education in dental trauma; 65% thought dental trauma emergency should be dealt with as soon as possible. Concerning knowledge, during-office hour emergency services were more familiar (84%) than after-office hour emergency services (15%), as was the concept of management of avulsed teeth (71%) compared to that of fractured teeth (51%). Knowledge about optimal storage media for avulsed permanent teeth was especially poor – being as low as 15%. Using multiple logistic regression analysis, it was found that teaching experience significantly influenced the respondents' self-assessed knowledge and their level of satisfaction with their knowledge ( P= 0.012). Teachers with more teaching experience had better knowledge about the replantation of permanent teeth ( P= 0.003). It is recommended that public education targeted at teachers should be carried out to increase dental trauma management awareness.     

A survey of self-perceived educational needs of general dental practitioners in the Merseyside region.

AIM: The aim of this study was to evaluate the self-perceived educational needs of a randomly selected group of general dental practitioners (GDPs) in the Merseyside region (UK). MATERIALS AND METHODS: Eighty-seven GDPs were randomly selected from 850 in the region and asked to complete a self-evaluation questionnaire regarding their self-perceived educational needs. RESULTS: Seventy-five (86%) responded, of which 52 (69.3%) were male and 23 (30.7%) female. There was no significant difference in self-perceived knowledge in any of the dental disciplines when gender and period of time since qualification were used as predictor variables. The majority of the GDPs felt they had a good knowledge of restorative dentistry and dental radiography. Some of the GDPs felt they had poor knowledge in implant dentistry, oral medicine, orthodontics, dental sedation techniques, oral surgery, endodontics, periodontics and dental radiography. None of the respondents felt they had poor knowledge in restorative dentistry, prosthodontics and paediatric dentistry. Seventy-four (98.7%) of the responding GDPs were motivated to attend continuing professional development (CPD) courses because of an interest in a particular dental discipline and only one reported attending out of personal learning needs. Implant dentistry was indicated by 30 (40.0%) of the respondents as their training programme of choice. CONCLUSIONS: The respondents had high self-perceived knowledge of restorative dentistry, dental radiography, periodontics, endodontics, paediatric dentistry and prosthodontics. The respondents had low self-perceived knowledge of implant dentistry, orthodontics, oral medicine and dental sedation techniques. Of GDPs surveyed, 98.7% applied for courses they liked to attend, rather than needed to attend. Fifty-two per cent of male GDPs surveyed expressed a desire for training in implant dentistry.     

Relative analgesia and general dental practitioners: attitudes and intentions to provide conscious sedation for paediatric dental extractions

Aim. To examine the attitudes and intentions of general dental practitioners (GDPs) who work within the remit of the National Health Service (NHS) to provide relative analgesia (RA) for paediatric extractions. Methods. All 45 GDPs working within the boundaries of one Trust were asked to complete a questionnaire to assess demography, etc., intention and attitudes to provide RA for paediatric extractions. Results. Ninety‐eight per cent of GDPs took part. All GDPs worked within the NHS. Twenty‐nine per cent of GDPs stated that they had RA equipment available in their practices and 68% stated that they discussed RA as treatment alternative. Eighty‐seven per cent referred their paediatric extraction cases for dental general anaesthesia. The behavioural intention was predicted by total attitude score and the availability of RA equipment in the practice (R² = 0·97, F(37,5) = 260·11, P < 0·001). Total attitude was predicted by clinical competency, few financial worries or time concerns and the availability of RA equipment (R² = 0·91, F(38,4) = 106·21, P < 0·001). Conclusions. This study suggests that GDPs’ concerns of clinical competence and costs have an inhibiting effect upon their intention to provide RA for paediatric extractions. These concerns must be addressed by planners and policy makers if there is to be a shift from hospital‐based DGA to surgery‐based RA services for paediatric extractions.     

Knowledge of nurses working at schools in Bialystok, Poland, of tooth avulsion and its management

Abstract – Aim: The purpose of this study was to evaluate the knowledge of first aid in tooth avulsion among nurses working at schools in Bialystok, Poland. A part of this population attended a lecture on the management of dental trauma 2 years before. Methods: The survey was conducted in September 2010 and covered 50 (96.15%) school nurses from Bialystok. Thirty‐eight of them attended the dental trauma lecture conducted 2 years before the survey. They were asked to fill in an anonymous questionnaire consisting of 20 closed questions referring to demographic data, previous dental trauma experience, and training. Seven questions referred directly to the knowledge of management of dental avulsion and on that basis, the level of nurses’ knowledge was evaluated. The data were analyzed statistically using the Mann–Withney U‐test with P < 0.05 to find factors influencing the level of knowledge. Results: The study showed that nurses’ knowledge about tooth avulsion was at an appropriate level. 86% of the participants chose the correct definition of the term of replantation, 92% understood that the time is crucial for the result of a replantation, 94% knew that an avulsed tooth should be held by the crown, and 96% pointed the proper transport medium. A half of the surveyed nurses declared that they would provide tooth replantation and another 16% would consult the procedures by calling a dentist. One statistically significant correlation between the level of knowledge and previous dental trauma training was revealed (P < 0.01). Conclusions: The lay knowledge of tooth avulsion in the population of nurses working at schools in Bialystok, Poland, was at an appropriate level. There was a strong correlation between this level and the participation in the lecture on the management of dental trauma conducted 2 years before.     

Dental trauma management knowledge among a group of teachers in two south European cities

Abstract –  The purpose of the present study is to assess the teachers' knowledge regarding dental trauma management in two south European cities. A three-part questionnaire comprised of questions on demographic data and knowledge was distributed to teachers in Porto and Istanbul. Seventy-eight teachers participated in the study; 23 had previously had formal dental trauma education. From the teachers interviewed, 58 of them admitted having no knowledge of dental trauma. Concerning knowledge, 29 teachers from Porto and 12 from Istanbul thought dental trauma emergency should be dealt with immediately. Knowledge of optimal storage media for avulsed permanent teeth was especially poor. In the present study, the majority of teachers did not know the importance of tetanus vaccine control in dental trauma. It is recommended that public education targeted at teachers should be carried out to increase dental trauma management knowledge.     

An audit of the time to initial treatment in avulsion injuries

Abstract –  The prognosis of avulsed teeth depends on prompt and appropriate treatment. Good outcome requires education of the general public and non-dental professionals.
Aim:  Retrospective observational survey of case records of avulsion injuries attending a dental hospital trauma clinic.
Method:  Data collected included: hospital number, date of birth, gender, source of patient's referral, date of trauma, number of avulsed teeth, place of initial presentation, storage, hours till initial presentation, and initial treatment.
Results:  One hundred and twenty teeth with avulsion were identified in 75 children. The mean age of the patients was 9.8 years (SD = 2.3 years) at the time of trauma with avulsions recorded in 44 (58.7%) boys and in 31 (41.3%) girls. Only 51 (42.5%) teeth were stored in an appropriate medium before attendance at any site and only 48 (40%) of the teeth were seen within 1 h. 83.3% received emergency treatment at general hospital, 89.7% in dental practice and 92.9% at dental hospital.
Conclusions:  A minority of avulsion injuries were seen within the first hour and a minority were in appropriate storage medium at presentation. Geographical location plays a huge role in the time taken to reach secondary care. However, improving public and non-dental professional knowledge about tooth storage in avulsion injuries is critical to long-term prognosis of the teeth.     

Elementary school staff knowledge about dental injuries

Abstract –  Elementary school staff can play a crucial role in managing traumatic dental injuries (TDIs) because they are often in proximity to children and are frequently called upon to assist with children's accidents. International studies reveal that elementary school personnel have little knowledge about emergency dental care and management. The purpose of this study was to assess the knowledge, practice and experience regarding TDIs among a sample of elementary school personnel in the USA. Assessment was performed using a demographic questionnaire and a newly developed TDI survey instrument. Results revealed a wide distribution of responses. Overall, dental trauma knowledge among this group was poor. The majority of respondents were not well-versed regarding TDIs, their management, the benefits of timely care or treatment costs. However, staff reported a keen interest in receiving more TDI information and training. TDI education and management are needed among all elementary school staff members to improve the prognosis of these accidents when they occur.     

Across-sectional survey on medication-related osteonecrosis of the jaws' knowledge and awareness in a sample of dental society

BackgroundMedication-related osteonecrosis of the jaws (MRONJ) is a prominent complication and growing problem related to the oral and maxillofacial region due to antiresorptive and antiangiogenic agents. Awareness about MRONJ is crucial for all dental practitioners identify ‘at risk’ patients for appropriate advice and management. This cross-sectional survey aimed to appraise MRONJ awareness and knowledge among dentists.Materials and methodsA questionnaire-based survey was carried out through one hundred and seventy eight dentist who recruited in three groups; the first group comprised 113 general dental practitioners (GDP), 33 dental radiologist (DR) included in the second, and 32 oral and maxillofacial surgeon (OMS) in the third group. MRONJ awareness was evaluated by asking all respondents a question of “Did you heard about MRONJ? In addition, the detailed knowledge on the subject in question were addressed through fourteen, nine, and three questions for OMSs, DRs, and GDPs respectively.ResultsA significant difference were existed among groups with a rate of MRONJ's awareness of 33.6%, 48.5%, and 84.4% for GDPs, DRs, and OMSs respectively. Concerning MRONJ knowledge, significantly highest rates seen in OMSs set with 48.55%. In contrast, the average scores of DRs were 30.64%, and the GDPs group recorded the least value with 16.67%.ConclusionsStrengthen the MRONJ awareness and knowledge among general dentists and dental specialists are essential to identify ‘at risk’ patients for appropriate advice and management.