• Users Online: 78
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 7  |  Issue : 3  |  Page : 177-181

Knowledge and attitude of emergency management of avulsed teeth among a sample of Indian parents in Vadodara, Gujarat


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 Submission26-Apr-2019
Date of Decision04-Nov-2019
Date of Acceptance20-Jan-2020
Date of Web Publication25-Jan-2021

Correspondence Address:
Harleen Kaur Soni
B-402, K.P. Luxuria, Vasna Bhayli Road, Vadodara - 391 410, Gujarat
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_48_19

Rights and Permissions
  Abstract 


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 Top


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[1] and from 7% to 13% in the primary dentition.[2] 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.[3],[4] 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.[3],[4],[5],[6]

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.[2]

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.[7] A combination of delayed replantation and unphysiological storage leads to low survival rate of the replanted tooth.[8] 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.[9],[10],[11],[12] 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.[11],[12]

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.[13] 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 Top


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[14] 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 Top


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].
Table 1: Demographic data

Click here to view


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].
Table 2: Possibility of self-replantation

Click here to view
Table 3: Attempt for self.replantation

Click here to view


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].
Table 4: Timing of replantation

Click here to view


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].
Table 5: Cleaning medium

Click here to view
Table 6: Transporting medium

Click here to view


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].
Table 7: Previous information

Click here to view
Table 8: Sources of information

Click here to view


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].
Table 9: Interest in saving the tooth

Click here to view
Table 10: Previous avulsion

Click here to view


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].
Table 11: Previous management of avulsion

Click here to view



  Discussion Top


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.[8] 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[14] 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.[15],[16]

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.[16],[17],[18],[19]

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.[1] According to Andersson and Bodin, an avulsed tooth if handled properly in the first 15 min can be retained for life.[20] This indicates that immediate reimplantation is of absolute necessity in order to achieve a propitious sequel of the reimplanted tooth.[14] 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.[16],[17] However, in a study by Namdev et al.,[21] nearly 63.1% of the patients reported of immediate replantation of an avulsed tooth. On the contrary, Raphael and Gregory[14] 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.[22] 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.[16] and Kaul et al.[23] 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.[16],[17],[24] 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.,[16] 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.
Table 12: Comparison with Indian studies

Click here to view



  Conclusion Top


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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Flores MT, Andersson L, Andreasen JO, Bakland LK, Malmgren B, Barnett F, et al. Guidelines for the management of traumatic dental injuries. II. Avulsion of permanent teeth. Dent Traumatol 2007;23:130-6.  Back to cited text no. 1
    
2.
Trope M. Clinical management of the avulsed tooth: Present strategies and future directions. Dent Traumatol 2002;18:1-1.  Back to cited text no. 2
    
3.
Hammarström L, Blomlöf L, Lindskog S. Dynamics of dentoalveolar ankylosis and associated root resorption. Endod Dent Traumatol 1989;5:163-75.  Back to cited text no. 3
    
4.
Loe H, Waerhaug J. Experimental replantation of teeth in dogs and monkeys. Arch Oral Biol 1961;3:176-84.  Back to cited text no. 4
    
5.
Kenny DJ, Barrett EJ. Pre-replantation storage of avulsed teeth: Fact and fiction. J Calif Dent Assoc 2001;29:275-81.  Back to cited text no. 5
    
6.
Layug ML, Barrett EJ, Kenny DJ. Interim storage of avulsed permanent teeth. J Can Dent Assoc 1998;64:357-69.  Back to cited text no. 6
    
7.
Lindskog S, Blomlöf L. Influence of osmolality and composition of some storage media on human periodontal ligament cells. Acta Odontol Scand 1982;40:435-41.  Back to cited text no. 7
    
8.
Barrett EJ, Kenny DJ. Avulsed permanent teeth: A review of the literature and treatment guidelines. Endod Dent Traumatol 1997;13:153-63.  Back to cited text no. 8
    
9.
Andreasen JO, Andreasen FM. Textbook and Colour Atlas of Traumatic Injuries to the Teeth. 3rd ed. Copenhagen: Munksgaard Publishers; 1994.  Back to cited text no. 9
    
10.
Hammarström L, Pierce A, Blomlöf L, Feiglin B, Lindskog S. Tooth avulsion and replantation – A review. Endod Dent Traumatol 1986;2:1-8.  Back to cited text no. 10
    
11.
Andreasen JO, Kristerson L. The effect of limited drying or removal of the periodontal ligament. Periodontal healing after replantation of mature permanent incisors in monkeys. Acta Odontol Scand 1981;39:1-3.  Back to cited text no. 11
    
12.
Blomlöf L, Lindskog S, Andersson L, Hedström KG, Hammarström L. Storage of experimentally avulsed teeth in milk prior to replantation. J Dent Res 1983;62:912-6.  Back to cited text no. 12
    
13.
Kinoshita S, Kojima R, Taguchi Y, Noda T. Tooth replantation after traumatic avulsion: A report of ten cases. Dent Traumatol 2002;18:153-6.  Back to cited text no. 13
    
14.
Raphael SL, Gregory PJ. Parental awareness of the emergency management of avulsed teeth in children. Aust Dent J 1990;35:130-3.  Back to cited text no. 14
    
15.
Borssén E, Holm AK. Traumatic dental injuries in a cohort of 16-year-olds in northern Sweden. Endod Dent Traumatol 1997;13:276-80.  Back to cited text no. 15
    
16.
Loo TJ, Gurunathan D, Somasundaram S. Knowledge and attitude of parents with regard to avulsed permanent tooth of their children and their emergency management—Chennai. J Indian Soc Pedod Prev Dent 2014;32:97-107.  Back to cited text no. 16
[PUBMED]  [Full text]  
17.
Shashikiran ND, Reddy VV, Nagaveni NB. Knowledge and attitude of 2,000 parents (urban and rural-1,000 each) with regard to avulsed permanent incisors and their emergency management, in and around Davangere. J Indian Soc Pedod Prev Dent 2006;24:116-21.  Back to cited text no. 17
[PUBMED]  [Full text]  
18.
Nikam AP, Kathariya MD, Chopra K, Gupta A, Kathariya R. Knowledge and Attitude of Parents/Caretakers toward Management of Avulsed Tooth in Maharashtrian Population: A Questionnaire Method. J Int Oral Health 2014;6:1-4.  Back to cited text no. 18
    
19.
Murali K, Krishnan R, Kumar VS, Shanmugam S, Rajasundharam P. Knowledge, attitude, and perception of mothers towards emergency management of dental trauma in Salem district, Tamil Nadu: A questionnaire study. J Indian Soc Pedod Prev Dent 2014;32:202-6.  Back to cited text no. 19
[PUBMED]  [Full text]  
20.
Andersson L, Bodin I. Avulsed human teeth replanted within 15 minutes – A long-term clinical follow-up study. Endod Dent Traumatol 1990;6:37-42.  Back to cited text no. 20
    
21.
Namdev R, Jindal A, Bhargava S, Bakshi L, Verma R, Beniwal D. Awareness of emergency management of dental trauma. Contemp Clin Dent 2014;5:507-13.  Back to cited text no. 21
[PUBMED]  [Full text]  
22.
Ozer S, Yilmaz EI, Bayrak S, Tunc ES. Parental knowledge and attitudes regarding the emergency treatment of avulsed permanent teeth. Eur J Dent 2012;6:370-5.  Back to cited text no. 22
    
23.
Kaul R, Jain P, Angrish P, Saha S, Patra TK, Saha N, et al. Knowledge, awareness and attitude towards emergency management of dental trauma among the parents of Kolkata-An institutional study. J Clin Diagn Res 2016;10:ZC95-101.  Back to cited text no. 23
    
24.
Hegde AM, Kumar KN, Varghese E. Knowledge of dental trauma among mothers in Mangalore. Dent Traumatol 2010;26:417-21.  Back to cited text no. 24
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed238    
    Printed0    
    Emailed0    
    PDF Downloaded37    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]