|Year : 2016 | Volume
| Issue : 1 | Page : 17-22
Effectiveness of health education intervention among the school teachers regarding management of traumatic dental injury in Modinagar
Vaibhav Vashishtha, Ritu Gupta, Patthi Basavaraj, Ashish Singla, Ravneet Kaur Malhi, Venisha Pandita
Department of Public Health Dentistry, D. J. College of Dental Sciences and Research, Ghaziabad, Uttar Pradesh, India
|Date of Web Publication||15-Mar-2016|
Ashok Nagar, Near Santosh Medical College, House No. 43, Ghaziabad, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: Tooth avulsion is one of the most serious dental emergencies in children often occurring in school or during play time in school, therefore, the knowledge and perception of schoolteachers regarding the appropriate measures to be taken immediately after tooth avulsion is crucial to good prognosis. Objective: To assess the knowledge and attitude regarding dental trauma and its management among primary school teachers of Modinagar (Uttar Pradesh) before and after oral health promotional intervention. Methodology: A questionnaire based interventional study was done in Modinagar among 248 school teachers and carried out in three phases. In the initial phase, a self-administered structured questionnaire was delivered directly to the respondents. Afterward, an informative 45-min lecture on dental trauma and its management was given during the second phase and in the third phase; a follow-up survey was done to assess the outcome. Statistical analysis was done using Chi-square test with statistical significance at 5%. Results: Insufficient knowledge regarding dental trauma and its management was seen in the preliminary phase, but significant improvement of 90% and above, was observed in follow-up phase after the interventional period (P < 0.0001). Conclusion: The school teacher's level of knowledge on the management of dental trauma appears to be inadequate. This study highlights the importance of the provision of oral health promotion in improving the knowledge regarding management of dental trauma.
Keywords: Awareness, dental trauma, teachers, tooth avulsion
|How to cite this article:|
Vashishtha V, Gupta R, Basavaraj P, Singla A, Malhi RK, Pandita V. Effectiveness of health education intervention among the school teachers regarding management of traumatic dental injury in Modinagar. J Indian Assoc Public Health Dent 2016;14:17-22
|How to cite this URL:|
Vashishtha V, Gupta R, Basavaraj P, Singla A, Malhi RK, Pandita V. Effectiveness of health education intervention among the school teachers regarding management of traumatic dental injury in Modinagar. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2020 Jan 21];14:17-22. Available from: http://www.jiaphd.org/text.asp?2016/14/1/17/178729
| Introduction|| |
Traumatic dental injuries are unscheduled (and often urgent) events, both for the patients and for the dentist managing the condition. As the traumatic dental injuries occur suddenly, so a planned organized approach to treat these traumatic dental injuries should be done within limited time. Further, providing proper care, based on accurate diagnosis, can be expected to favor successful healing.
As most of the traumatic dental injuries occur in the school students which has been seen in the previous studies also that the prevalence of these injuries in primary and permanent teeth is quite high throughout the world. It has seen from the statistics of most of the countries that one-fourth of all school children and almost one-third of adults have been suffered from dental trauma.
It is known that majority of dental injuries is seen in children between ages of 8–17 years. As young children remain active, trauma to both primary and permanent dentition continues to be a frequent dental problem., Physical activity is a basic need for the growth of a child. WHO theme for the year 2002 says, “Move for Health” which emphasizes on the role of physical activity in the healthy living of an individual. During these physical activities, injuries to the face are one of the major risks associated with it.
Children, especially school children face particular health challenges including oral health problems related to stages of their physical and mental development, which makes them especially vulnerable to traumatic dental injuries including the tooth avulsion, fracture.,
The prognosis of traumatized teeth depends on prompt and appropriate treatment, which often relies on knowledge of child's parents and their school teachers. Therefore, the teachers play an important role to carry out or handling role of taking care of oral health of school children.
Hence, the study was conducted to assess the knowledge and attitude regarding dental trauma injuries and first aid among primary school teachers of Modinagar (Uttar Pradesh) before and after promotional intervention.
| Methodology|| |
The study was conducted in schools of Modinagar located in Western part of Uttar Pradesh India.
Questionnaire based educational interventional study.
Sample size estimation
The sample size was calculated using 95% confidence interval. As the population variance was unknown, we adopted P = 50% to allow for the largest possible variance. Based on the data obtained from the District Education Office, a sample size of 243 was required from a total 658 primary school teachers in Modinagar. To allow for missing answers and nonparticipation of teachers, an extra 20% was recruited and the final sample size opted was therefore rounded off to 320 teachers who were randomly selected of which 248 primary school teachers agreed to be the part of the study or responded to the questionnaire.
Modinagar city was divided into four zones: North, South, East, and West. Five schools were randomly selected from each zone, so a total of 20 schools were selected. Sixteen primary school teachers were randomly selected from each school. From the total of 320 teachers, 248 teachers responded to the questionnaire in the initial survey who were followed in the second and third phase of the study [Figure 1].
Ethical approval was received from the Institutional Review Board and informed written consent was obtained from all the study participants. Participation in the study was voluntary, and confidentiality of data was maintained.
Collection of data
The study was carried out in three phases–initial phase (preliminary survey) to assess the existing knowledge of teachers regarding dental trauma and its management using self-administered structured questionnaire consisting of 15 questions prepared both in English and Hindi (local language), delivered directly by hand to the respondents at their respective schools. The questions were explained to the respondents and then asked to tick the most appropriate answer according to their judgment to assess their knowledge and attitude toward dental trauma and its management.
In the second phase, an informative 45-min lecture on dental trauma and its management, and general oral health education was given to the schoolteachers using MS PowerPoint presentation (Microsoft Corporation, Redmond, Washington, USA) or with the help of a self-prepared manual (flipchart) containing pictures, in places without projector facility. The lecture was delivered using simple language with emphasis on important information such as stages of tooth development, possible etiology of dental trauma, immediate emergency management of dental trauma cases, tooth replantation, and emergency measures to be taken in case of avulsion before reaching the dentist.
After the lecture, time was allotted for discussions and clarification of doubts encouraging interaction and participation. At the end of the discussion, pamphlets were distributed to teachers containing all the information regarding dental trauma and its management.
In the third phase of the study, at follow-up survey after 1 month, was assessed to know about the outcome of the informative promotion on the knowledge of 248 school teachers using the same set of questionnaire.
Fifty item self-administered structured questionnaire in which 7 questions were related to knowledge, 2 were related to attitude and 5 were related to practice, was prepared both in English and Hindi. Criterion and construct validity of the questionnaire were assessed using Spearman's correlation coefficient. Reliability of the questionnaire was assessed using Test Retests. Internal consistency of the questionnaire was assessed by applying cronbach's-alpha.
The completed questionnaires were coded and entered on the computer, using SPSS (Statistical Package for Social Sciences) software, version 16.0 (SPSS Inc., Chicago, IL, USA). Chi-square test was used to compare the knowledge of teachers (both government and private teachers) before and after the informative promotion. The level of significance was set at P ≤ 0.05.
| Results|| |
A questionnaire based prospective interventional study was done in Modinagar among 248 school teachers and carried out in three phases. Criterion and construct validity of questionnaire was assured using Spearman's correlation coefficient (P < 0.001). Reliability of the questionnaire was assessed using Test-Retests and the values of measured kappa (k) were 0.86 and weighted kappa (k) was 0.9. Internal consistency of the questionnaire was assessed by applying Chronbach's alpha (α̨) and the value of α̨ = 0. 79 were obtained.
The study sample comprised 85 (34.3%) males and 163 (65.7%) females. The mean age of the study sample was 32.5 ± 16.1 years. No attrition was assured following the initial survey. It has been seen through this study that there was insufficient knowledge of teachers about dental trauma in the initial survey while after informative intervention the knowledge was significantly improved.
[Table 1] shows only 20% of teachers had come across a case of dental trauma during their teaching tenure. Only 13.82% of the teachers had some knowledge about instructions that should be given during dental trauma, and only 12% received information on management of knocked out tooth with only 18% of the total 248 teachers believing that knocked out tooth should be placed back into the socket. While 18% knew what tooth replantation is, only 28.2% had the knowledge to take action if tooth is knocked out and falls on the ground.
|Table 1: Knowledge of teachers for each question before and after informative intervention|
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[Table 2] shows before the informative intervention only 20.2% of the teachers thought a child should be sent to a nearby doctor if available whereas after intervention 90.3% (P < 0.001) of the teachers thought the same. Regarding the ideal time within which the knocked out tooth should be replanted, majority of 71.8% were unaware about it and only 14 (6%) of the teachers thought the teeth should be replanted immediately while after the intervention 183 (73.7%) of the teachers gave the response as immediately (P < 0.001). As for the knowledge, regarding the procedure of cleaning dirty knocked out tooth, only 32 (13%) were of the opinion that it should be washed with saline water and 18 (7%) thought it should be washed with milk whereas after intervention 214 (86.2%) of the teacher were of the opinion that the dirty tooth should be washed with saline water (P < 0.001).
|Table 2: Knowledge attitude and practices of teachers regarding dental trauma before and after informative intervention|
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[Table 3] shows knowledge regarding immediate management of fractured teeth, majority of 198 (80%) of the teachers were unaware of the management, only 11 (4%) of the teachers thought the fractured teeth should be placed in an appropriate liquid medium and brought for examination whereas after informative intervention 209 (84.2%) thought the same (P < 0.001). A total of 198 (80%) of the teachers thought information regarding management of tooth avulsion to be important in the initial survey and 149 (60%) teachers gave the response, dentist nearby was the first place to seek for treatment for dental trauma and after intervention majority 202 (81.4%) responded as dentist nearby was the first place to seek treatment for dental trauma. A positive attitude by teachers was observed, when 245 (99.0%) of the teachers believed it is important to include a topic on dental trauma in a school syllabus in the initial survey and after informative intervention all 248 (100.0%) believed the same.
|Table 3: Knowledge, attitude and practices of teachers regarding dental trauma before and after informative intervention|
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| Discussion|| |
The results of the study showed insufficient knowledge regarding dental trauma and its management among school teachers of Modinagar city in the preliminary phase. More than three-fourth of the teachers had not come across a case of dental trauma and also did not know what is dental trauma or tooth replantation. This is very astonishing since dental trauma cases occur commonly in primary and even sometimes among secondary school children too. At least half of schoolchildren face the possibility of suffering dentoalveolar trauma during school time.,,,, This could be due to lack of education and experiences of teachers in Modinagar city, as no campaigning or exposure that may contribute to the development of strategies to improve their knowledge and behavior regarding dental trauma and its management were ever conducted. Therefore, an informative promotion was carried out in the second phase of the study following which there was a significant improvement in the knowledge regarding dental trauma and its first aid management.
In this study, nearly half (48.2%) of the teachers did not know what is knocked out tooth and only 18% of the teachers thought that knocked out tooth should be placed back into the socket and had no knowledge regarding tooth replantation respectively. This could be due to unawareness of the teachers regarding importance of replantation of avulsed tooth. These finding are in accordance with study conducted by Prasanna et al. in 2011 Davangere city, where only 43% of the teachers knew what is knocked out tooth, only 24% thought that knocked out tooth should be placed back into the socket with only 32% having knowledge regarding tooth replantation. However, following the informative promotional intervention, a 100% improvement in the knowledge of teachers regarding these findings was noted.
Extraoral time is a paramount importance in determining the success of tooth replantation. A delay in providing emergency dental treatment may jeopardize the prognosis of avulsed tooth. Majority (71.8%) of the teachers in the present study lacked knowledge about the maximum time gap for tooth replantation. Only 5.7% and 8.9% thought tooth replantation should be carried out immediately or within 5 min respectively. These finding are similar to the study conducted by Prasanna et al. in 2011 in Davengere city. However, 69.3% of the teachers recognised the urgency of seeking professional help by contacting the parents and advising them to take their child to the dentist immediately which is similar to the finding of the study conducted by Namdev et al. in 2014, where 63% of the parents recognised the urgency of seeking professional help as immediately for avulsion injury. Danish study conducted by Al-Jundi et al. in 2005 had reported that teeth replanted within 5 min had the best prognosis. However, other studies suggest that 20–30 min is the maximum limit.
In this study, 41.9% of the teachers did not know how to clean the tooth which showed an urgent need to educate the teachers regarding the same and following the informative promotional intervention 86.2% responded they would clean with saline water or milk as in case of tooth avulsion mostly avulsed tooth would fall on the ground and get dirty, so it's important to know about method to clean the dirty avulsed tooth.
The appropriate storage media to permit periodontal and pulpal healing are milk, saline water, and saliva. Although saliva is the only quick media available most of the time but in the present study majority (80%) of the teachers did not know that immediate management of fractured teeth and 10% of the teachers thought the fracture part is useless and it should be ignored.
Storing the avulsed tooth in a solution compatible with cell viability until replantation is a critical procedure. Following the promotional intervention, 99.1% of the teachers thought the fracture teeth should be placed in an appropriate liquid medium and brought for examination and treatment emphasizing the importance of providing information as a way to increase the knowledge regarding tooth avulsion and replantation procedures to be followed in emergency. Majority of the teachers thought, dental trauma and its first aid management should be included as a topic in school syllabus.
Our study highlighted the importance of informative promotion on improving the knowledge of school teachers regarding dental trauma and its management. A significant improvement in most of the areas regarding teachers' knowledge on management on tooth avulsion after an informative lecture 45-min lecture was observed. However, a repeated reinforcement of the information is important to get sustainable results.
Prevention and management of dental injury should be recognised as a major public health problem, and the adequate preventive program should be carried out. In many cases, the trauma may have been unavoidable, but sports-related injuries are largely preventive. Any child that is involved in a contact sport should be provided with a custom made sports guard.
| Conclusion|| |
The finding of the study indicated a substantial lack of knowledge regarding dental trauma management among school teachers in the initial survey which significantly improved following the informative promotion, thus, we recommend such programs for school teachers emphasising the importance of educational programs and training to improve the knowledge as they are usually first to respond in cases of dental trauma accident in school.
- The school teachers should be equipped with basic knowledge and management of traumatic dental injuries through continuing dental education programs
- Emergency management of dental trauma can be included as part of the curriculum of school teachers especially the physical education teachers
- Children should be educated to use mouth protectors to prevent contact sport accidents
- School dental kit along with first aid box and also emergency mobile dental units should be available nearby any school
- Each school should have dental office for any dental traumatic injury
- Emergency dental aids kit should be available in each school
- Physical education's teacher should demonstrate about dental trauma management process through special class session by the help of projector
- Dental trauma management promotional visual aid like poster and banners must be placed
- Promoting school dental health nurse for dental trauma management and in Indian scenario Physical education teachers can be trained for emergency management of dental trauma.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]