|Year : 2020 | Volume
| Issue : 3 | Page : 177-181
Knowledge and attitude of emergency management of avulsed teeth among a sample of Indian parents in Vadodara, Gujarat
Harleen Kaur Soni1, Kajol V Jariwala2
1 Department of Pedodontics and Preventive Dentistry, Manubhai Patel Dental College, Vadodara, Gujarat, India
2 Department of Orthodontics, Manubhai Patel Dental College, Vadodara, Gujarat, India
|Date of Submission||26-Apr-2019|
|Date of Decision||04-Nov-2019|
|Date of Acceptance||20-Jan-2020|
|Date of Web Publication||25-Jan-2021|
Harleen Kaur Soni
B-402, K.P. Luxuria, Vasna Bhayli Road, Vadodara - 391 410, Gujarat
Source of Support: None, Conflict of Interest: None
Background: Traumatic injuries are commonly seen in children and adolescents, affecting their teeth and supporting structures. The most severe form of traumatic injury is tooth avulsion which leads to major psychological and esthetic problems in children. The prognosis of avulsed teeth significantly depends on prompt and efficient action at the site of the accident, thus requiring that parents or caretakers be knowledgeable about the correct management of this situation. Aim: The objective of the present study was to assess the level of knowledge of parents and caretakers regarding the emergency management for tooth avulsion by the help of a questionnaire. Materials and Methods: The study included 1000 parents of children, aged between 6 years and 12 years, who were asked to fill the modified Ralph and Gregory questionnaire for avulsed teeth. Data were analyzed using SPSS software version 20.00, and descriptive statistics were used to compare the results. Results: Nearly 68.8% of the parents believed in self-replantation, but only 42% would attempt self-replantation themselves. Only 15.4% of the parents felt that replantation should be done immediately. Water and salt solution were the most accepted cleaning medium for avulsed teeth by majority of the parents (77.4%). Almost 92% of the parents were interested in saving the tooth and 2.5% of the parents had encountered previous dental avulsion injuries in children. Conclusion: The study shows a significant lack in knowledge among parents with regard to management of tooth avulsion. There is a definitive need to hold educational campaigns imparting knowledge regarding emergency management of tooth avulsion for parents.
Keywords: Avulsion, periodontal ligament, replantation, trauma
|How to cite this article:|
Soni HK, Jariwala KV. Knowledge and attitude of emergency management of avulsed teeth among a sample of Indian parents in Vadodara, Gujarat. CHRISMED J Health Res 2020;7:177-81
|How to cite this URL:|
Soni HK, Jariwala KV. Knowledge and attitude of emergency management of avulsed teeth among a sample of Indian parents in Vadodara, Gujarat. CHRISMED J Health Res [serial online] 2020 [cited 2021 Feb 26];7:177-81. Available from: https://www.cjhr.org/text.asp?2020/7/3/177/307822
| Introduction|| |
Dental avulsion following trauma to the face and dentoalveolar structures is one of the most common dental emergencies for dentists. The frequency of tooth avulsion following traumatic injuries ranges from 0.5% to 16% of traumatic injuries in the permanent dentition and from 7% to 13% in the primary dentition. It is best to place the tooth back into its socket immediately post avulsion, to allow for normal healing and repair. It has been stated that for the success of replantation, maintenance of viable periodontal ligament cells present on the root surface is crucial., Therefore, immediate replantation (within 15 min after avulsion) of the avulsed tooth or appropriate storage of the exarticulated tooth in solutions which are compatible with cell viability until replantation is of paramount importance.,,,
The most commonly avulsed permanent anterior teeth are the maxillary central incisors, which are not only important for esthetics, but are also essential for speech, mastication, and psychological and mental health of children. These injuries that result in the loss of tooth may have long-lasting cosmetic, functional, economic, and psychosocial effects. Hence, immediate replantation of avulsed permanent incisors contributes to an improved self-image and enhanced self-esteem in children.
The single-most important factor determining the prognosis of a replanted tooth is the viability of the periodontal ligament present on the root prior to replantation. A combination of delayed replantation and unphysiological storage leads to low survival rate of the replanted tooth. To prevent dehydration of the root surface during transportation, it has been suggested that the tooth may be placed in saliva (buccal vestibule), saline, and milk or wrapped in a plastic wrap.,,, Milk serves as an excellent medium for storage of the avulsed teeth due to its correct osmolality and pH. Avulsed teeth stored in milk for up to 6 h have shown a low rate of tooth resorption.,
Majority of traumatic injuries occur at home and therefore, the ultimate prognosis of an avulsed tooth occurring in a child depends on the knowledge regarding the immediate steps taken by his or her parents to achieve a successful treatment outcome. Therefore, the aim of the study was to assess the level of knowledge of parents by means of a regarding the emergency management for tooth avulsion in children.
| Materials and Methods|| |
The study was carried out on 1000 parents of children aged from 4 to 12 years attending the Department of Pediatric and Preventive Dentistry of Manubhai Patel Dental College, Vadodara, from June 2016 to June 2018. The study was approved by the university's Ethics Committee, and a written informed consent was taken from the parent/guardian prior to the participation of individuals in the study. The nature and purpose of the study were explained to the parents in vernacular language. Participation of parents in the study was completely voluntary and strictly confidential.
Parents of children, aged <18 years who gave consent to participate in the study, were included. Parents of children with special health-care needs (physical, mental, developmental, medically compromised children, etc.) and those parents who did not give their consent were excluded from the study.
A questionnaire comprising 13 questions concerning avulsion of a tooth in primary and permanent dentitions based on Raphael and Gregory's study was prepared in vernacular language for data collection. A total of 1000 questionnaires in English and vernacular language were distributed among the parents, and the completed questionnaires were collected from the parents on the same day. They were given the opportunity to make inquiries or comments about the questions. This was followed by the distribution of information leaflets including the proper measures for managing avulsed teeth.
Statistical analysis was done using (IBM Corp, Chicago, USA). The data were tabulated on an Excel Spreadsheet and expressed both as numbers and percentages. Descriptive statistics were used to compare the results.
| Results|| |
A total of 1000 parents who visited the Outpatient Department of Pedodontics, Manubhai Patel Dental College and Hospitals, Vadodara, for the first time with their children for receiving dental care were surveyed to assess their level of knowledge regarding the emergency management for tooth avulsion of their children. Out of them, 47.1% were male and 52.9% were female. About 90.3% of the parents were educated and only 9.7% were uneducated. Parents who accompanied their children in the age range of 20–39 years constituted 66.1% and that above 40 years constituted 33.9% [Table 1].
Possibility of self-replantation and attempt to self-replantation
On questioning them about the possibility of self-replantation, 68.8% of the parents believed in self-replantation, but only 42% would attempt self-replantation themselves [Table 2] and [Table 3].
Timing of replantation
The knowledge of the timing of replantation was found to be highly variable among all parents. Only 15.4% of the parents felt that replantation should be done immediately, whereas majority of the parents (63.1%) feel that the replantation procedure should be postponed to a later dental visit. Almost 21.5% of the parents felt that replantation could be performed after an hour or within the same day of tooth avulsion [Table 4].
Cleaning and transporting media
Water and salt solution were the most accepted cleaning medium for avulsed teeth by majority of the parents (77.4%) [Table 4]. The most common response for the transporting medium was disinfecting solution (53.1%). Only 17% of the parents felt milk to be the ideal transporting medium for avulsed teeth [Table 5] and [Table 6].
Previous information about dental avulsion
Out of the 1000 patients, only 18% of them had previous information of dental avulsion, out of which 10.3% were male and 7.7% were female. The major source of information was from books [Table 7] and [Table 8].
Parents' interest in saving the tooth
Nearly 92% of the parents were interested in saving the tooth, out of which 43.8% were male and 48.2% were female. Very few parents (8%) presented no interest in saving an avulsed tooth [Table 9] and [Table 10].
Knowledge about previous avulsion
Almost 12.5% of the parents had encountered previous dental avulsion injuries in children and 91.5% of these parents took the tooth immediately to the dentist. However, only 3.2% of the parents took the tooth under moist conditions [Table 11].
| Discussion|| |
Although dental injuries can occur at any age, they are more often seen between 1 and 4 years. During this developmental period, children learn to walk and then to run. As their coordination and judgment are not completely developed, falls are common. As the children gain confidence and coordination, the incidence of dental injuries decreases, which rises again later during the active age range (8–12 years) as a result of bicycle, skateboard, playground, and sports accidents. Therefore, the parents of children aged 4–12 years were included in the study.
Questionnaires are excellent tools for screening a large number of samples provided they are carefully designed. For this study, the Ralph and Gregory questionnaire was used to check the level of parents' knowledge regarding tooth avulsion and its management. The questionnaire had simple and close-ended questions, and the answers were categorized according to the parents' direct selections. The questionnaire has been used in various other studies across India, suggesting a need for increased educational campaigns.,
Avulsion of tooth takes place when a tooth directly sustains trauma, which displaces the tooth from the socket. The prognosis of the avulsed tooth depends on the immediate management of the tooth after it is displaced out of the socket. The results of this study showed that knowledge about tooth avulsion and first-aid procedures is low among parents in Vadodara. The results of our study are consistent with the results of other studies.,,,
As parents are not aware of replantation of an avulsed tooth, the methods of cleaning, and the medium for storing them prior to replantation, the prognosis of the compromised tooth will be severely affected, leading to loss of the tooth eventually. Nearly 90% of our parents were educated, but still the level of knowledge regarding avulsion was low.
According to the guidelines of dental trauma management published by the American Academy of Pediatric Dentistry and the International Association of Dental Traumatology, the immediate replantation of a tooth is recommended for the best prognosis. According to Andersson and Bodin, an avulsed tooth if handled properly in the first 15 min can be retained for life. This indicates that immediate reimplantation is of absolute necessity in order to achieve a propitious sequel of the reimplanted tooth. The current results demonstrated a significant lacunae of knowledge in parents about the management of dental avulsion.
In the present study, more than half of the parents believed in replantation of an avulsed tooth, but only 42% would attempt self-replantation themselves. Only 15.4% of the parents felt that replantation should be done immediately. The results of the study are comparable to that of the studies by Shashikiran et al. and Loo et al., However, in a study by Namdev et al., nearly 63.1% of the patients reported of immediate replantation of an avulsed tooth. On the contrary, Raphael and Gregory had reported that about two-thirds of the respondents in their study were willing for attempting self-reimplantation.
The timing for replantation of an avulsed tooth plays a crucial role in its prognosis. In the present study, only 15.4% of the patients were aware of the fact that the tooth should be reimplanted immediately in its socket. The results of a study by Ozer et al. indicate that 68.2% of their respondents knew the correct timing of replantation.
Most of the respondents in our study considered water to be the cleaning medium of choice for an avulsed tooth. The results of the study are consistent with those of the studies by Loo et al. and Kaul et al. More than half of the parents in the present study selected disinfecting solution as the transporting medium of choice for a avulsed tooth, which shows a large gap in the knowledge of handling the teeth. Such choices would lead to loss of the viable periodontal ligament cells on the tooth, ultimately leading to either ankylosis or failure of replantation.
Less than one-third of the parents had previous knowledge of avulsion. The results are comparatively lower than those from other Indian studies.,, However, 92% of the parents showed interest toward saving an avulsed tooth. The experience to avulsion injuries by parents was 12.5%, which is in comparison to a study by Loo et al., who reported it nearly at 14.6%.
A comparison of knowledge about tooth avulsion in parents among various Indian studies has been depicted in [Table 12] injuries is noted from the present study. Significant steps need to be taken to increase the knowledge of parents and caretakers about tooth avulsion. Leaflets and posters depicting the steps and procedure for management of tooth avulsion should be placed in all first-aid centers of schools and clinics of pediatricians for immediate treatment.
| Conclusion|| |
The study shows a significant lack in knowledge among parents with regard to management of tooth avulsion. There is a definitive need to hold educational campaigns imparting knowledge regarding emergency management of tooth avulsion for parents and caretakers, which would be helpful in preventing unnecessary loss of permanent anterior teeth.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12]