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.     

Dental practitioners' knowledge and implementation of the 2007 International Association of Dental Traumatology guidelines for management of dental trauma

Abstract –  Aim : To evaluate the knowledge, adoption, and diffusion rate of the 2007 International Association of Dental Traumatology guidelines among practicing military dental professionals, 1 year after publication. Methods : Fifty-four military dental professionals in the Medical Corps of the Israel Defense Forces participated in the study and completed a questionnaire, consisting of demographic questions, and multiple choice questions that presented critical points that a military dentist should know when treating a tooth injury. Results : Seven dentists (13%) graduated in the summer of 2007 after publication of the current guidelines. Military instructions (37%) and the official guidelines published in Dental Traumatology (25.9%) were the most common sources of updating the current guidelines. Twenty-six percentage of the participants were not updated with the new guidelines at all. Based on the current guidelines, the overall correct answer response rate for the 10 questions was 71.7%. Tetracycline, as an antimicrobial agent of choice in avulsion, yielded the lowest percentage of correct answers (20.4%), with duration of splinting after root fracture, the next most incorrectly answered question (50.0%). Conclusions : High level of knowledge regarding the 2007 guidelines was found among Israeli military dentists, 1 year after publication. However, knowledge regarding several issues (e.g., medication, splinting) should be reinforced.     

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.     

青岛市口腔医生对乳牙牙外伤处理的认知调查

目的研究青岛地区口腔医生对乳牙牙外伤处理的认知水平。 方法利用2018年8月青岛市儿童口腔疾病预防公益项目培训会议期间,向参会医生发放经过验证的调查问卷,进行乳牙牙外伤处理认知调查,使用χ²检验对结果进行统计分析。 结果调查相关口腔医生170名,共回收有效调查问卷168份（98.8%）。结果分析：青岛地区口腔医生对乳牙折断性损伤处理方案选择的正确率为53.57%,对乳牙牙脱位性损伤处理方案选择的正确率为72.62%,对乳牙全脱位处理方案选择正确率为58.33%。卡方检验显示,不同医疗机构和不同职称的口腔医生在大多数问题的选择正确率上没有明显差异（P>0.05）,第7、9、11、13题中,儿童口腔医生对乳牙外伤处理方案选择正确率分别为88.9%、55.6%、97.2%和91.7%,非儿童口腔医生选择正确率分别为67.2%、13.7%、76.2%和81.1%,差异均具有统计学意义（χ²⁷ = 6.844,P₇ = 0.009;χ²⁹ = 17.3,P₉<0.001;χ²¹¹ = 9.056,P₁₁ = 0.003;χ²₁₃ = 2.291,P₁₃ = 0.130）。 结论青岛市口腔医生对乳牙牙外伤处理方案的选择整体正确率较低,不同的医疗机构和不同职称的口腔医生在处理方案的选择上没有明显差异,儿童口腔医生对乳牙外伤处理方案选择的正确率更高。     

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.     

Knowledge of first-aid measures of avulsion and replantation of teeth: an interview of 221 Kuwaiti schoolchildren

Abstract –  The prognosis of replantation of an avulsed tooth is determined by which first-aid measures are taken during the first 15 min after avulsion. Knowledge of the correct first-aid measures is therefore crucial to successful replantation. The aims of this study were (i) to assess the present knowledge level of emergency measures for tooth avulsion in Kuwaiti schoolchildren, and (ii) to design and test an interview form with structured standardized questions. A total of 221 Kuwaiti schoolchildren (aged 7–15 years old) were interviewed by professionals using a standardized method to score several areas of knowledge about tooth avulsion and replantation. Earlier experience of first-aid information and subjection to dental trauma was registered. The following fields of knowledge were assessed: general body injury treatment principles, tooth avulsion and replantation principles, avulsed permanent/primary teeth, cleaning of avulsed tooth before replantation, extra alveolar time and storage media. The form for interviewing children proved to be sufficiently structured in performing the interviews and data management. The results of the interviews showed that 30.3% of the children had been exposed to dental trauma in the past. Among children 7–9 years of age, 25% had received information on general first aid as compared with 75% in children 10 years and older. Children 10 years and older, in general, had a high knowledge level of general principles of how to manage injuries to the body. Regardless of age group, there were generally a low knowledge level regarding tooth avulsion, replantation, extra-alveolar time and storage media. We conclude that first-aid knowledge in Kuwaiti schoolchildren is low on avulsion and replantation of teeth despite a high knowledge level of body injuries. The knowledge level of first-aid measures on avulsion and replantation of teeth could be increased through intervention programs.     

Knowledge of Brazilian general dentists and endodontists about the emergency management of dento-alveolar trauma

Abstract –  The purpose of this study was to determine Brazilian dentists' knowledge of emergency management of dento-alveolar trauma. A two-part questionnaire containing questions on demographic data and knowledge were mailed to 230 general dental practitioners (GDPs) and 70 endodontists. Questionnaires were returned by 42.6% of the GDPs and 62.8% of the endodontists. The survey data were statistically analyzed using Mann–Whitney U -test for practitioners' knowledge and Pearson's correlation coefficient for association between knowledge scores and practitioner age or years since graduation. The mean knowledge score of endodontists was significantly greater than for GDPs ( P  < 0.0001). Dentists with trauma experience in their practices and those who had attended postgraduate courses on dental trauma had a significant higher mean knowledge score. In contrast, there was a poor correlation between the knowledge score and the ages of the respondents ( r  = 0.086) or the years since graduation ( r  = 0.108). In conclusion, this survey showed a poor knowledge of dental trauma management among the surveyed dentists and highlights the need to develop strategies to improve the knowledge base in this area of dentistry for the benefit of the dental trauma patient.     

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.     

Awareness of dental practitioners to cope with a medical emergency: a survey in Belgium

Objective: The aim of the study is to determine whether in Belgium dentists feel confident to diagnose a medical emergency situation in their dental practice. Methods: A questionnaire was completed by 7.0% of the active Belgian general dental practitioners (n = 548) including questions on the frequency and knowledge of medical emergency situations in the dental office, history of dental training to treat emergency situations and confidence level in treating emergency situations. Results: A medical history of each patient was taken by 55.3% of the dentists. A link was found between years since graduation and the systematic decline of a medical history in a new patient (P = 0.001): the older the dentist, the less consistent was the updating of medical history. Almost 50% of the dentists (49.4%) never participated in any basic life support (BLS) training during their undergraduate education. Moreover, 78.3% never had any paediatric BLS training during undergraduate education and BLS training after graduation was lacking by 37.2% of the dentists. Conclusion: Knowledge of BLS should be fundamental to medical professionals. The more BLS training a practitioner has experienced, the more self-secure they feel coping with an emergency situation.Key words: Basic life support (BLS) training, dentist and medical emergency situations, dentists and medical history     

Dental injuries among children and adolescents aged 1–15 years attending to public hospital in Temuco,Chile

Abstract –  A cross‐sectional study was carried out in children and adolescents of both sexes, aged 1–15 years that sought dental emergency attention to the Regional Hospital between 2004 and 2007 in Temuco, Chile. The purpose of this study was to identify the aetiology, types of traumatic dental injuries in primary and permanent dentitions, sex and age distributions, accident location; and time elapsed before emergency treatment in children and adolescents. The sample consisted of 359 patients with 145 primary teeth and 525 permanent teeth affected by dental trauma. The results showed a 2:1 male:female ratio distribution (242/117) with a mean age of 8.4 years. The 7‐ to 12‐year‐old group had the highest frequency of dental injuries (66.6%). Unspecific accidental falls were the main cause of injury to primary and permanent dentition (51.8%), followed by striking teeth against objects (15.6%) and bike accidents (13.9%). In primary dentition the most common diagnosis were subluxation (38.6%) and avulsion (16.6%), whereas in permanent dentition was uncomplicated crown fracture (32.9%). A high proportion of the patients received their first emergency attention 24 h after the accident (32.6%). This study revealed a high frequency (37.9%) in 1–15 aged population that sought emergency attention by dental trauma in the period of time study. A large proportion of children with dental trauma received delayed first emergency care, even 24 h after the accident. Considering the high frequency of traumatic dental injuries in 1–15 aged population and the high percentage of delayed emergency attention is necessary to develop effective educational campaigns in regard to causes, prevention and emergency management of traumatic dental injuries, especially in deprived areas. In conclusion, traumatic dental injury may be considered as a serious dental public health problem especially in children of deprived areas.     

Multidisciplinary approach to the rehabilitation of a tooth with two trauma episodes: systematic review and report of a case

Abstract – Studies have shown that some children and adolescents are affected only once with dental trauma, while others seem to be accident‐prone and suffer from multiple dental trauma episodes. Less is known about treatment consequences related to repeated traumatic dental injuries to the same tooth and treatment guidelines are not well established. Complicated crown fractures and crown‐root fractures pose difficulties for dentists to establish adequate treatment plans because these fractures require multidisciplinary knowledge and approach for a correct case planning and prognosis. The objective of this paper was to present and discuss a case of a child who sustained a second trauma to the same tooth following treatment of an earlier sustained crown fracture. The research‐based background for establishment of the treatment plan is discussed. Reattachment of tooth fragment is a minimal invasive and esthetic method. Essential advantage of the reattached teeth is the fact that all the alternative methods as direct adhesive resin reconstruction, veneers and crowns can be performed in case of failure or a refracture. As a consequence of initial trauma, the tooth suffered a complicated crown fracture which was resolved by endodontic therapy and fragment reattachment. During follow‐up, the child suffered a second trauma resulting in dislodgement and fracture of the reattached fragment and a crown‐root fracture extending subgingivally with involvement of the biologic width. A conservative restorative option is described. After 1 year of follow‐up, the clinical and radiographic findings demonstrated that the adopted clinical protocol was successful and yielded healthy periodontal tissues with no signs of periradicular pathosis. The occurrence of repeated traumatic dental injuries to teeth involving conservative management of both crown‐root fracture and complicated crown fracture on the same tooth is extremely rare and a challenge for dental professionals to treat.     

Knowledge level of primary school teachers regarding traumatic dental injuries and their emergency management before and after receiving an informative leaflet

Abstract – Aim: The aim of this study was to evaluate via a questionnaire the knowledge level of primary school teachers in Ankara, Turkey, regarding dental trauma; to inform them on the subject through a leaflet; and to evaluate the effectiveness of the leaflet by reapplying the questionnaire. Materials and methods: A questionnaire was distributed to 500 teachers in seven randomly selected primary schools. The questionnaire consisted of four different scenarios presented with photographs and a total of eight questions on crown fracture, lateral luxation, root fracture, and avulsion. After responding to the questionnaire, teachers were given a leaflet containing information about traumatic dental injuries and their emergency management. After 1 month, the same questionnaire was distributed, and the responses collected. Results: A total of 450 of 500 teachers responded to the questionnaire. Initial responses indicated the knowledge level of teachers to be quite low. Following the distribution of the information leaflet, the rate of correct answers increased for each of the individual questions, and the total scores for the questionnaire increased significantly (P = 0.0001). Conclusion: There is a clear need to inform teachers about traumatic dental injuries. The use of educational leaflets can be a successful and appropriate means of providing teachers with information.     

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.     

Traumatic dental injuries in children presenting for treatment at the Department of Pediatric Dentistry, Faculty of Dentistry, University of Jordan, 1997–2000

Abstract  – Data pertaining to traumatic dental injuries of children seeking care at the teaching clinics of the Department of Pediatric Dentistry, Faculty of Dentistry, University of Jordan over a period of 4 years were analyzed. The prevalence of traumatic dental injuries was 14.2% from 2751 subjects. The peak incidence of injury was 10–12-year age group. Boys were more affected (18.3%) than girls (10.1%). Most injuries occurred at home (63.2%), and falls were the leading cause of injuries (49.9%). Most injuries involved one tooth (69.3%) and maxillary central incisors were the most affected teeth (90.4%). The commonest injury was uncomplicated crown fracture (62.5%), then complicated crown fracture (28.7%). Only 17.1% of children sought treatment the same day or the day after the injury. At the initial examination, cases seen after a long post-traumatic period required more complicated treatment than those presented within a short time period. Preventive educational program should be instituted in Jordan, directed at parents and school teachers to inform them about the importance of traumatic dental injuries and the benefit of immediate attendance for dental treatment. Furthermore, improving the knowledge of dental practitioners through continuing education would also help in minimizing sequelae of traumatic dental injuries.     

Dentists' management of dental injuries and dental trauma in Australia: a review

Abstract –  This article reviews the available literature on the investigation of dentists' management of dental trauma injuries and their perceptions of barriers to providing care. The levels of knowledge demonstrated by surveys of dentists were not high and dentists perceive inadequate financial remuneration as the main barrier to trauma management. With only a limited number of new dental traumatic injuries occurring annually, dentists may not be competent in providing appropriate care. The management of dental trauma and any hesitations that dentists might have in terms of knowledge and skills are important to investigate to formulate an approach to overcome their reluctance. There is a deficiency of literature on this subject.     

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 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.     

German general dentists' knowledge of dental trauma

Abstract –  The purpose of this study was to evaluate the knowledge of German general dentists on different scenarios in dental traumatology, as well as to analyse, whether there was any correlation between practitioners' perceptions of their knowledge and their actual expertise. A questionnaire containing questions on demographic data and knowledge was handed out to general dentists at the beginning of different lectures in dental traumatology given by the authors. A total number of 181 questionnaires were evaluated. Sixty-three per cent of the dentists considered their knowledge as being sufficient or comprehensive, while only 37% indicated to have fragmentary knowledge in dental traumatology. Irrespective of the self-assessment, 40% of the questions were answered correctly. Although not statistically significant, there was a trend towards slightly better knowledge for dentists whose graduation was more recent. On the basis of the findings of this study, it can be suggested that the level of knowledge among general dentists in Germany is rather poor on different scenarios regarding dental traumatology and their self-assessment is inaccurate.