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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 14  |  Issue : 4  |  Page : 419-423

Pediatrician's perspectives on dental trauma management: A cross-sectional survey


1 Department of Pedodontics, JSS Dental College and Hospital, JSS University, Mysore, Karnataka, India
2 Department of Pediatrics, JSS Medical College and Hospital, JSS University, Mysore, Karnataka, India
3 Department of Statistics, Yuvaraja's College, Mysore, Karnataka, India

Date of Web Publication15-Dec-2016

Correspondence Address:
H P Chanchala
Department of Pedodontics, JSS Dental College and Hospital, JSS University, Mysore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-5932.195839

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  Abstract 

Introduction: Pediatricians play a pivotal role in the provision of primary care following dental trauma, especially for population with limited access to dental care. The criticality of time and knowledge is very important in the success of dental trauma management. Objective: The objective of this study was to evaluate the knowledge and experience of pediatricians in the primary management of dental trauma. Materials and Methods: A questionnaire-based cross-sectional survey was conducted among 261 pediatricians from various regions of India who attended the National Pediatric Conference, Mysore 2015. The survey addressed demographic- and knowledge-related data concerned to dental trauma, experience in treating and witnessing dental trauma, diagnosis, preliminary management, and attitude of the pediatricians toward the same. The collected data were analyzed using the SPSS version 17. Results: Among 261 respondents analyzed, 65.5% of them had encountered dental trauma in their practice. Avulsed tooth can be saved as opined by 67.8% of pediatricians. A higher percentage of the pediatricians, 94.3% knew the significance of time lapse. Saline was preferred medium of transport by 90.8%, followed by ice-cold water (78.2%). A fair awareness of the emergency treatment protocol of the avulsed teeth was observed among 59.8% of the pediatricians. Conclusion: Among pediatricians, the knowledge regarding handling of avulsed tooth, medium of transportation, and significance of time lapse between avulsion and reimplantation were found to be at a good level. The knowledge regarding the type of tooth to be reimplanted, method of cleaning the tooth was lacking.

Keywords: Dental trauma, knowledge and attitude, pediatricians


How to cite this article:
Chanchala H P, Shanbhog R, Ravi M D, Raju V. Pediatrician's perspectives on dental trauma management: A cross-sectional survey. J Indian Assoc Public Health Dent 2016;14:419-23

How to cite this URL:
Chanchala H P, Shanbhog R, Ravi M D, Raju V. Pediatrician's perspectives on dental trauma management: A cross-sectional survey. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2019 Jul 22];14:419-23. Available from: http://www.jiaphd.org/text.asp?2016/14/4/419/195839


  Introduction Top


Dental trauma is a common event during childhood and adolescence.[1],[2],[3],[4] Prompt and appropriate management is necessary to significantly improve the prognosis for many dentoalveolar injuries, especially in a young patient. Treatment of a traumatized tooth requires fastidious diagnosis and coordination between all treating health-care professionals from the moment of injury. Unfortunately, much of this trauma remains untreated, mistreated, or over treated, leading to more complicated treatment in the future.[5],[6],[7]

Active participation in physical activities, such as sports and military training, often increases the risk of traumatic injury to dental and oral tissues.[8],[9],[10],[11],[12] Among all the dental injuries, avulsion of teeth is a critical dental injury which is defined as the total displacement of the tooth out of its socket. The incidence of avulsion constitutes 0.5%–16% of all traumatic injuries in the permanent dentition.[13] Avulsion is more commonly seen in children and young adults, at an age when the alveolar bone is resilient and provides only minimal resistance to extrusive forces. The maxillary central incisors are the teeth most commonly affected.[14]

These traumatic injuries, beyond their direct effect on the afflicted patient, have additional consequences, including forced interruption of activity, sometimes of an entire team. Treatment of these injuries and short- or long-term disturbance of activity of the patient may also cause considerable financial burden. As well, traumatic dental injuries could have a detrimental psychological effect on the injured person and their parents.[12] Primary care providers (e.g., family physicians, pediatricians, nurses, physician assistants, and emergency medical technicians [EMT]) could play a pivotal role in the provision of primary care following dental trauma, especially for population groups with limited access to dental care.

Given the current problems with access to dental care among low-income patients, we contend there is a need to involve nondental primary health-care professionals in providing primary diagnosis and treatment for dental trauma. The purpose of the present study was to evaluate the knowledge of pediatricians regarding primary treatment for dental trauma and to assess the experience they have in treating dental injuries.


  Materials and Methods Top


This was a questionnaire-based cross-sectional survey conducted in a National Pediatric Conference 2015. Ethical clearance for conducting the study was obtained from the Ethical Committee of the University. The study population consisted of pediatricians who arrived at the conference from various regions of India. The participation was voluntary. Of 576 pediatricians who attended the conference, 284 consented and answered the questionnaire, of which 261 survey forms were found completely filled.

The survey questionnaire contained 13 questions (Annexure I) covering demographic and knowledge and attitude data concerned to dental trauma which was prepared by the authors. The Knowledge, attitude, and practice of dental trauma included experience in treating or witnessing dental trauma, former education regarding diagnosis and treatment of dental trauma, assessment of knowledge regarding dental trauma, and attitude of the pediatricians to treat the case of dental trauma. To help the respondents make quick decisions, they were given alternative choices, which resemble real situations with dental trauma. The questionnaire had been tested and validated in a pilot study before the survey was conducted. Anonymity of the participants was maintained.

The collected data were analyzed using the Statistical Package for the Social Sciences (SPSS) Version 17 (SPSS CUSTOMER ID:225031). Results were expressed as a number and percentage of respondents for each question.


  Results Top


Of the 284 survey forms filled by pediatricians, 261 forms were found complete and were considered for statistical analysis. The participants had varied clinical experience ranging from 2 to 40 years with an average of 14.5 years. Among 261 respondents analyzed, 65.5% of them had encountered dental trauma in their practice.

Assessing comprehensive knowledge regarding reimplantation of avulsed tooth, 67.8% of pediatricians felt that the avulsed tooth can be saved, 14.9% felt it cannot be saved. Of the 67.8% who opined as the avulsed tooth can be saved, 35.6% were aware that only permanent tooth requires reimplantation. Of the 14.9% who felt that the avulsed tooth cannot be saved reasoned it as, 1.9% told that there is no way to fix it and that it would fall out again, 0.4% told that it may harm the adjacent tooth, 6.1% told that there would be risk of spread of infection caused by the contaminated tooth when it is returned to the socket, 2.7% told that the replaced tooth may be rejected as a foreign body [Table 1].
Table 1: Pediatrician's opinion regarding reimplantation of avulsed tooth

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Among 94.3% pediatricians who felt that the time lapse is important, only 36.8% were aware of the fact that implantation should be done as soon as possible, if not within the 1st h of avulsion tooth stored in a moist medium [Table 2].
Table 2: Significance of time lapse and medium of transportation in avulsed tooth management

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Asked regarding cleaning protocol of avulsed tooth before reimplantation, 34.5% preferred cold tap water wash, 26.45% preferred normal saline wash, and 21.8% preferred cold distilled water wash. Enquired for handling during reimplantation, 85.1% of them gave a correct response as the tooth should be held at the crown surface.

When knowledge was evaluated on the desirable media for transportation of the avulsed tooth, 90.8% of them preferred normal saline as the medium followed by ice-cold water 78.2%, clean cloth 74.7%, and disinfecting solution 73.6%. However, Hank's balanced salt solution, one of the best transportation media, was preferred by 19.5% of pediatricians [Table 3].
Table 3: Opinion regarding most desirable to undesirable ways of storing a tooth before reimplantation

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A fair awareness of the emergency treatment protocol of the avulsed teeth was observed among 59.8% of the pediatricians.

A positive attitude was observed as 92% of pediatricians preferred to have the dental trauma management protocol in the academic curriculum of their specialty [Table 4]. Pearson correlation test was used to correlate the clinical experience of pediatrician to dental trauma management knowledge; a negative correlation (−0.149) was observed (P = 0.016) indicating recently passed out pediatricians had better knowledge than the more experienced [Table 5].
Table 4: Attitude of the pediatricians toward inculcating the dental trauma management protocol in academic curriculum

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Table 5: Correlation between knowledge of pediatricians in trauma management to years of practice experience

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  Discussion Top


Facial esthetics plays an important role in self-identification, self-presentation, and interpersonal confidence. Mouth is of primary importance in determining the overall facial attractiveness. The effect of traumatic dental injuries on self-esteem and self-awareness is important because most of the traumatic dental injuries occur in the early life and adolescence.[15] A large number of children who sustained accidental damage to their maxillary incisors had increased over jet and incompetent lips at rest as reported in the previous study.[16] This could be due to the fact that lips cushion the impact of colliding materials with anterior teeth, thus minimizing the possibility of a fracture. Furthermore, increased over-jet means increased exposure of teeth which predisposes to trauma during sports and road traffic accidents.

In such a scenario, the primary contact doctors tend to look at the tooth avulsion more like a general trauma where they focus on the wound, bleeding, and bony injury. As the pediatricians get an opportunity to attend a case of dental trauma in an emergency, it is imperative that they hold sufficient knowledge on the primary management of tooth avulsion, before referring to dentists.

In the present study, findings regarding the importance of reimplantation, approximately 40% of the pediatricians were not sure of undertaking the tooth saving procedure, and regarding the storing of avulsed tooth in a solution compatible with cell viability until reimplantation which is a critical procedure, more than half of the pediatricians were unaware of the most apt storage medium. Similar findings were observed in a study by Vishal et al.[17] and Sae-Lim and Yucn, Levin et al., Andreasen et al.,[18]

Correlation between the clinical experience of pediatrician to dental trauma management knowledge evaluated through Pearson correlation test gave a negative correlation indicating recently passed out pediatricians had better knowledge than the more experienced. Similar findings were noted in a study conducted by Vishal et al.[17] This might be due to escalating incidence of orofacial trauma and increased awareness.

Collaborative actions between dental and medical professionals are needed to develop continued education programs. All members of the medical staff need to receive simple instructions about the management of dental trauma. The existing health education system should provide more courses on dental and dentofacial trauma management for physicians, pediatricians, and medical residents. The standard operating protocol [19],[20] explaining steps involved in dental trauma management should be made as flowcharts or posters and displayed in all emergency departments. This would be very informative for the doctors in the emergency department to provide appropriate primary care to the child with dental trauma. Furthermore, special emphasis should be given to provide pediatricians with education during pre- and post-graduate programs. This will improve their knowledge and ability of handling dental trauma.

Special emphasis should be given to provide primary caregivers with education during pre- and post-graduate programs. This will improve their knowledge and also the ability of handling dental trauma. The fact that most dental injuries were first seen by the EMT or the physician compared to only 7.3% by a dentist, underlines the educational importance. This is supported by the physicians and EMTs, who stated that it was important to educate the primary health care providers regarding diagnosis and treatment of dental trauma.

Limitation

The questionnaire was framed focusing on tooth avulsion and its management and did not cover the other types of dental trauma.

Recommendation

It is recommended to add the standard operating protocol of dental trauma management in the postgraduate curriculum of pediatrics.


  Conclusion Top


Among pediatricians, the knowledge regarding the handling of avulsed tooth, medium of transportation, and significance of time lapse between avulsion and reimplantation was found to be at a good level. The knowledge regarding the type of tooth to be reimplanted, method of cleaning the avulsed tooth, and agent of transportation was lacking. Lesser experienced pediatricians had better knowledge in managing dental trauma compared to more experienced. Pediatricians have a positive attitude toward acquiring knowledge on the management of avulsed tooth.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Nik-Hussein NN. Traumatic injuries to anterior teeth among schoolchildren in Malaysia. Dent Traumatol 2001;17:149-52.  Back to cited text no. 1
    
2.
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Rocha MJ, Cardoso M. Traumatized permanent teeth in Brazilian children assisted at the Federal University of Santa Catarina, Brazil. Dent Traumatol 2001;17:245-9.  Back to cited text no. 3
    
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Andreasen JO, Andreasen FM. Essentials of Traumatic Injuries to the Teeth. 2nd ed. Copenhagen, Denmark: Munksgaard; 2000. p. 7-9.  Back to cited text no. 4
    
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Levin L, Ashkenazi M, Schwartz-Arad D. Preservation of alveolar bone of un-restorable traumatized maxillary incisors for future implantation. J Israel Dent Assoc 2004;21:54-9.  Back to cited text no. 5
    
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Schwartz-Arad D, Levin L. Post-traumatic use of dental implants to rehabilitate anterior maxillary teeth. Dent Traumatol 2004;20:344-7.  Back to cited text no. 6
    
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Schwartz-Arad D, Levin L, Ashkenazi M. Treatment options of untreatable traumatized anterior maxillary teeth for future use of dental implantation. Implant Dent 2004;13:120-8.  Back to cited text no. 7
    
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Blinkhorn FA. The aetiology of dento-alveolar injuries and factors influencing attendance for emergency care of adolescents in the north west of England. Endod Dent Traumatol 2000;16:162-5.  Back to cited text no. 8
    
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Pinkham JR, Kohn DW. Epidemiology and prediction of sports-related traumatic injuries. Dent Clin North Am 1991;35:609-26.  Back to cited text no. 9
    
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Levin L, Friedlander LD, Geiger SB. Dental and oral trauma and mouthguard use during sport activities in Israel. Dent Traumatol 2003;19:237-42.  Back to cited text no. 12
    
13.
Andreasen JO, Andreasen FM, editors. Avulsions. In: Textbook and Colour Atlas of Traumatic Injuries to the Teeth. Copenhagen: Munksgaard; 1994. p. 383-425.  Back to cited text no. 13
    
14.
Andreasen JO, Andreasen FM, Andreasen L. Textbook and Colour Atlas of Traumatic Injuries to the Teeth. 4th ed. Oxford: Blackwell Munksgaard; 2007. p. 383-427.  Back to cited text no. 14
    
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Goenka P, Marwah N, Dutta S. Biological approach for management of anterior tooth trauma: Triple case report. J Ind Soc Pedodon Prev Dent 2010;3:223-9.  Back to cited text no. 15
    
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[PUBMED]    
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Khandelwal V, Gupta A. Awareness about management of 'avulsed teeth' among primary contact doctors. Journal of Indian Association of Pediatric Surgeons 2013;18:92.  Back to cited text no. 17
    
18.
Andreasen JO, Andreasen FM. Avulsions. In: Andreasen JO, Andreasen FM, Andersson L, editors. Textbook and Color Atlas of Traumatic Injuries to the Teeth. 4th ed. Oxford, UK: Wiley-Blackwell; 2007. p. 444-88.  Back to cited text no. 18
    
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American Academy of Pediatric Dentistry. Guideline on management of acute dental trauma. Pediatr Dent 2011;34:230-8.  Back to cited text no. 19
    
20.
Andersson L, Andreasen JO, Day P, Heithersay G, Trope M, Diangelis AJ, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol 2012;28:88-96.  Back to cited text no. 20
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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