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.     

An investigation into dentists' perceptions of barriers to providing care of dental trauma to permanent maxillary incisors in children in Victoria, Australia

BACKGROUND: Perceived barriers in the treatment of dental trauma may influence the optimum management of dental trauma. Any hesitation that dentists might have in managing dental trauma is important to investigate. The aim of this study was to investigate dentists' perceptions of barriers to providing care of dental trauma to permanent maxillary incisors in children. METHODS: A self-completion questionnaire survey containing six questions on demographic data and 15 questions relating to barriers to treating dental trauma was mailed to 693 dentists in Victoria, Australia. RESULTS: The response rate achieved was 61 per cent. Of the respondents, 90 per cent had no hesitation in treating dental injuries and 80 per cent of these frequently agreed that dentists should treat all dental trauma. Approximately half the dentists (51.5 per cent) frequently found uncooperative children to be the main barrier to providing care. CONCLUSION: The overall consensus from the present study was that treating dental trauma is not unappealing for dentists in general practice.     

An investigation into dentists' management methods of dental trauma to maxillary permanent incisors in Victoria, Australia

Abstract –  Trauma to anterior teeth in children could become a long-term problem to dental health. To a large extent, the management actions of the dentists involved will determine the clinical outcome and, in turn, these actions will be related to their levels of knowledge. The aim of this study was to investigate dentists' knowledge of managing traumatic injuries to maxillary permanent incisors in children. A self-completion questionnaire containing 19 questions on management methods of treating dental trauma was mailed to 693 dentists in Victoria, Australia. The response rate achieved was 61%. This survey found that some of the respondents had adequate management knowledge for the different types of traumatic injuries, while others did not have the correct information. Approximately half the dentists considered milk as the preferred extraoral storage medium of choice for avulsed teeth and a period of 7–10 days splinting after replantation. A large proportion of dentists showed inadequate knowledge with regard to understanding the biological mechanisms causing replacement root resorption (61%) and external inflammatory root resorption (74%). Overall, the respondents to this survey demonstrated only a moderate level of knowledge in management of traumatic injuries to maxillary permanent incisors in children. Continuing professional development programmes may be a means of improving this deficient knowledge base.     

Has the education of professional caregivers and lay people in dental trauma care failed?

Abstract – Background/Aim: Several reports have been published during the past decades showing a lack of care of traumatic dental injuries (TDIs) as well as dentists and lay people having insufficient knowledge on how to manage TDIs. This situation could seriously affect the outcome of TDIs, especially a complicated TDI. The overall aim of this study was to present a review of dental trauma care with focus on treatment and dentists and lay persons’ lack of knowledge on how to manage a TDI. A further aim is to introduce the actors involved and the outcome of their education. Material and method: The databases Medline, Cochrane, SSCI, SCI and CINAHL from the year 1995 to the present were used. Focus was on treatment need, inadequate care, lack of knowledge and poor organization of emergency care. Result: Studies from different countries demonstrated that treatment needs were not properly met despite the fact that not all untreated teeth needed treatment. Treatment in emergency dental care was often inadequate or inappropriate. With the exception of lay people, teachers, medical personnel and even dentists performed inadequate care. Furthermore, information to the public was insufficient. Despite a low level of knowledge, lay people expressed a strong interest in helping someone with a TDI. Conclusion: The conclusion from this review is that consideration must be given the problematic results from different studies on education or information about dental trauma care. Despite that the studies reviewed were from different countries and groups of people, the results seem to be consistent, i.e. that a large part of the educational process of professional caregivers and lay people has failed. Too much hope seems to be put on lay people to handle difficult cases such as tooth avulsion. Education of caregivers and lay people is a field where much remains to be explored.     

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.     

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and followup are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.     

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

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

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.     

Domiciliary dental care

Domiciliary dental care is an important and growing area of treatment provision. However, adequate training is required in order to develop the knowledge and skills necessary to perform such care. This article draws attention to the likely increase in demand for domiciliary dental care services and the reasons for it; and highlights the issues and skills involved for dentists, hygienists and their teams in providing domiciliary dental care in order to facilitate quality of care and safe practice.     

Online dental trauma course for medical education

A literature review identified a knowledge deficit among medical doctors about dental trauma management. To overcome this knowledge gap, a proposal to integrate dental traumatology teaching into the medical curriculum was made to raise medical students' awareness of, and familiarity with managing dental injuries. Despite the challenges of teaching dental trauma, online courses are viewed as a practical learning approach for students to access course material during their busy university schedules. In focusing on the constructivist model, this article details the design and development of the online dental trauma course. It is an example of a learner-led, fully online course. The six steps involved in the course development were as follows: (1) structured order from preclinical to clinical topics; (2) content covering all essential information on TDI diagnosis and management; (3) illustrative materials to support engagement and motivation to complete the course; (4) feedback processes to evaluate the learning process; (5) interactions between peers, educators, and learning materials to help facilitate learning; and (6) content that encompasses mainly visual learning styles. The online dental trauma course has the potential to make important contributions to medical education.     

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.     

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations of these teeth are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning, and follow up are important for achieving a favorable outcome. Guidelines should assist dentists and patients in decision making and in providing the best care possible, both effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed these Guidelines as a consensus statement after a comprehensive review of the dental literature and working group discussions. Experienced researchers and clinicians from various specialties and the general dentistry community were included in the working group. In cases where the published data did not appear conclusive, recommendations were based on the consensus opinions of the working group. They were then reviewed and approved by the members of the IADT Board of Directors. These Guidelines represent the best current evidence based on literature search and expert opinion. The primary goal of these Guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines cover the management of fractures and luxations of permanent teeth. The IADT does not, and cannot, guarantee favorable outcomes from adherence to the Guidelines. However, the IADT believes that their application can maximize the probability of favorable outcomes.     

Dental health care waste disposal among private dental practices in Bangalore City, India

Any waste generated consequent to health care activity including any from a home environment is health care waste. Dental practices generate large amounts of waste cotton, plastic, latex, glass and other materials much of which may be contaminated with body fluids. OBJECTIVE: To assess the knowledge, attitude and behaviour of private dental practitioners on health care waste management in Bangalore City. METHODS: A cross-sectional study of 432 private dental practitioners in Bangalore City using a self-administered questionnaire. RESULTS: 389 dentists responded; 64.3% do not segregate waste before disposal and 47.6% hand over health care waste to street garbage collectors; 42.1% felt that there was a lack of waste management agency services and 16.9% felt that a lack of knowledge were the main hurdles. CONCLUSIONS: Dentists need education regarding health care waste disposal methods to improve their knowledge. A large proportion of the dentists are not practising proper methods of health care waste disposal. The existence of legislation governing healthcare waste disposal is not sufficient alone to motivate many practitioners to comply with guidelines.     

Knowledge of general practitioners dentists about the emergency management of dental avulsion in Curitiba, Brazil

Abstract –  The prognosis of traumatized teeth in general and of avulsed teeth in particular depends on prompt and appropriate treatment. Management of traumatic injuries may be a challenge to the non-specialized dentist, as they may occur when dentists are least prepared for it. The objective of this research was to investigate the knowledge of general practitioner dentists about the emergency management of dental avulsion in Curitiba, PR, Brazil. A group of 250 professionals were interviewed. The questions were related to knowledge of how to treat traumatic avulsion of teeth. The results suggest that the level of knowledge on the management of dental avulsion of the general practitioners dentists in Curitiba is adequate.     

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??Traumatic dental injuries are caused by a collision that can generate enough mechanical energy to produce the injury. Injuries involve the hard dental tissues?? the pulp and the periodontal tissues. Crown fractures and luxations of permanent teeth occur most commonly in all dental injuries. Proper diagnosis?? treatment planning and follow-up are important for improving a favorable outcome. The study highlighted Chinese dentists’ need for continuing education in order to improve current knowledge in emergency management of teeth injuries. The International Association of Dental Traumatology??IADT??Guidelines for management of fractures and luxations of permanent teeth represent the best current evidence based on literature search and professional opinion. Guidelines should assist dentists and other health care professionals in decision making in order to provide the best care effectively and efficiently.     

Dental care for children under general anaesthesia by private dental practitioners in New Zealand

An overall reduction of approximately one-third in the availability of private dental care under general anaesthesia in New Zealand has occurred in the past 5 years. Private dentists providing dental care under general anaesthesia are disproportionately located in Auckland. Specialist anaesthetists or general medical practitioners are used to provide almost all the general anaesthetics; approximately half the dentists providing this service continue to use their dental surgeries for the procedure. Private dentists provide approximately one-third of the dental care under general anaesthesia for children each month in New Zealand, but utilise a greater number of sessions per month than the public-sector hospitals. Fees associated with dental care under general anaesthesia for children provided by private dentists are predominantly privately funded. Barriers to dental care for children provided by private dentists are primarily cost, difficulties for the dentists and anaesthetists to fit a general anaesthetic session into the practising day, and difficulties providing care for children under 3 years of age and for those with medical problems and disabilities.     

Awareness of management of dental trauma among medical professionals in Pondicherry, India

Abstract –  The aim of the study was to establish the level of knowledge on the management of dental trauma among physicians at Pondicherry, India. A questionnaire was designed and was given to physicians working in medical colleges or as residents in advanced training programs in medicine in Pondicherry, India. The questionnaire contained a clinical situation of tooth avulsion and various treatment options. Only 5.5% of the medical professionals knew about reimplantation and none knew that the patients' mouth was the best transport medium. 90% of them accepted that they had no knowledge on dental trauma management. As the physicians get an opportunity to attend a case of dental trauma in emergency or private practice, it is vital that they possess sufficient knowledge on primary management of tooth avulsion, before referring to dentists.     

Knowledge of lay people and dentists in emergency management of dental trauma

Abstract –  The multidisciplinary nature of the follow-up evaluations of traumatic dental injuries (TDI) requires that both the lay public and practitioners possess knowledge of the treatment strategies involved. The aim of this paper was to assess the level of knowledge of elementary public schoolteachers, parents and dentists of the city of Joaçaba, Southern Brazil, about the emergency management of TDI. Three independent cross sectional studies were carried out involving samples of elementary public schoolteachers ( n  = 245), parents ( n  = 107) and dentists ( n  = 85) in the city in 2001. Data were collected through structured interviews for schoolteachers and dentists, and questionnaires for parents, containing questions about socio-demographic characteristics and about incidents resulting in TDI. The responses in the three studies showed a wide variability of indicated procedures for the situations of TDI proposed. The results of association studies showed that older schoolteachers ( P  = 0.003), older dentists ( P  = 0.013) and dentists who had graduated more recently ( P  = 0.032) chose significantly more correct answers in some TDI incidents. The answers of schoolteachers, parents and dentists showed a wide variability of indicated procedures for the situations proposed. The great majority of them would not follow the approaches most recommended in the literature. A greater importance should be placed on TDI through educational campaigns aiming schoolteachers and parents and also through undergraduation and postgraduation dental curricula in order of improving its management.     

Current update on portable dental equipment

The dental care needs of the elderly are increasing as their population grows. For some of the elderly (eg, the nonambulatory, homebound, institutionalized), accessing dental care is a problem because they are unable to visit a traditional dental clinic. In the past, dental care has been taken to the homebound or institutionalized elderly by dentists using portable dental equipment. However, the perception that such equipment is difficult or impossible to obtain has limited the availability of on-site care. The purpose of this article is to describe various types of portable dental equipment and their features so that dentists interested in providing care to this group of patients are aware of them.     

A retrospective study of traumatic dental injuries in a Brazilian dental trauma clinic

Abstract – The purpose of this retrospective study was to analyse data from the records of patients seen in the dental trauma emergency clinic in a general hospital in the city of Recife, Brazil, during the years 1997–1999, according to sex, age, cause, number of injured teeth, type of tooth and type of trauma. The records of all patients seen by dentists were collected. Altogether, 250 patients from 1 to 59 years of age presenting 403 dental injuries were examined and/or treated. The causes of dento-alveolar trauma were classified in five categories: home injuries, street injuries, school injuries, sports activities, violence. The type of trauma was classified by dentists working at the dental trauma clinic on the basis of Andreasen's classification. The gender difference in the number of cases of trauma was statistically significant (males 63.2% vs females 36.8) ( P <0.0001). Fracture in enamel only (51.6%) and fractures in dentine (40.8%) were the most commonly occurring types of injury. Injuries were most frequently diagnosed as serious among the youngest patients (up to 15 years of age); 82.4% of intrusive luxation cases were diagnosed in the 1–5 years age group. The main causes of tooth injury were falls (72.4%), collisions with objects (9.2%), violence (8.0%), traffic accidents (6.8%) and sports (3.6%). Trauma caused by violence was found to be statistically significant in the 6–15 years age group ( P <0.0005).