|Year : 2019 | Volume
| Issue : 4 | Page : 328-332
Prevalence of traumatic dental injuries among 5–16-year-old children and knowledge of teachers in the management of traumatic dental injuries
Mayank Das, L Vamsi Krishna Reddy, Sanjay Singh
Department of Public Health Dentistry, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
|Date of Submission||15-Sep-2018|
|Date of Decision||12-Oct-2019|
|Date of Acceptance||01-Nov-2019|
|Date of Web Publication||12-Dec-2019|
Dr. Mayank Das
Department of Public Health Dentistry, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: Dental injuries may occur throughout life. Traumatic dental injuries (TDIs) are a very significant problem among children. The main etiology was fall, fight, and sports activities. They were associated with biological, socioeconomic, and psychological factors. Aim: The aim of the study was to investigate the prevalence of TDI among 5–16-year-old schoolgoing children and knowledge in emergency management of dental injury among teachers. Materials and Methods: A cross-sectional study was carried out among 5–16-year-old schoolgoing children. A cluster random sampling method was used among 500 schoolchildren from different schools, and 100 schoolteachers were selected. Data were collected using the questionnaire form, and clinical dental examination was performed using the WHO Oral Health Assessment Form 2013. Statistical analysis was performed using the Statistical Package for the Social Sciences version 20.0. The Chi-square test was used to compare the results. All values were considered statistically significant at P < 0.05. Results: The prevalence of traumatic injury in male and female was 59.2% and 40.8%, respectively. Male teachers 78.8% and females 89.6% did not know in which medium tooth should be kept, whereas only (7.7%) male and none of female thought that medium should be saliva, and this value was statistically significant (P = 0.035). Conclusion: The prevalence in male was slightly higher than female. We suggest that educational programs should be organized for the schoolteachers, children, and parents to improve their knowledge and timely management of dental trauma.
Keywords: Knowledge, prevalence, schoolchildren, teachers, traumatic dental injury
|How to cite this article:|
Das M, Reddy L V, Singh S. Prevalence of traumatic dental injuries among 5–16-year-old children and knowledge of teachers in the management of traumatic dental injuries. J Indian Assoc Public Health Dent 2019;17:328-32
|How to cite this URL:|
Das M, Reddy L V, Singh S. Prevalence of traumatic dental injuries among 5–16-year-old children and knowledge of teachers in the management of traumatic dental injuries. J Indian Assoc Public Health Dent [serial online] 2019 [cited 2020 Apr 2];17:328-32. Available from: http://www.jiaphd.org/text.asp?2019/17/4/328/272782
| Introduction|| |
Dental injuries may occur throughout life., Sports, fall, assaults, collisions, physical leisure activities, and traffic accidents were the major cause of TDIs among children. Dental trauma can vary from minor tooth fracture to extensive dentoalveolar damage that involves the supporting tissues, tooth displacement, or avulsion.,
According to Prasanna et al., there was poor knowledge in the management of avulsed teeth among the schoolteachers. They do not feel capable of replanting an avulsed tooth. As one of the child supervisors, all the schoolteachers should have the basic knowledge to recognize oral emergencies and regarding conservation of avulsed teeth to prevent its consequences in the child's future. Tooth avulsion was a situation where as a result of trauma, a tooth has been removed from the socket. It comprises 0.5%–16% of all TDIs., The prognosis quite often depends on people such as child's parents and schoolteachers who were present at the site of an accident, before referral to a dentist, and who had only a little information about the prompt treatment that needs to be rendered in cases of TDI.,,
A number of studies had examined the knowledge and attitude regarding tooth avulsion and its immediate management by parents.
According to Blakytny et al., the majority of respondents possessed, at best, rudimentary knowledge of the emergency management of dental avulsion. Teachers, and other individuals who supervise children in schools, should receive simple instruction in dental first aid. The peak age for TDIs was between 7 and 12 years, and such children were more prone to injuries. It is essential that all children supervisors such as schoolteachers should be well prepared to intervene when such dental emergencies arise.,
The purpose of this study was to assess the prevalence of TDIs among 5–16-year-old schoolchildren as well as knowledge in the management of dental injuries among schoolteachers of Lucknow city.
| Materials and Methods|| |
A cross-sectional study was conducted among 5–16-year-old school-going children and schoolteachers of Lucknow city, belonging to government, semi-aided, and private schools. They were selected using cluster random sampling method. Permission for the study was obtained from the concerned authorities. The objectives of the study were explained to all the schoolteachers who participated in the study, and also informed consent was obtained from all the teachers. Ethical clearance was obtained from the institutional ethical committee (18518).
The selection criteria followed as the individuals who were not undergoing orthodontic treatment and the children who were present on the day of examination were included in the study. The children with dental anomalies such as amelogenesis imperfecta, dentinogenesis imperfecta, and supernumerary teeth were excluded from the study. The study was carried out from July 2017 to September 2017.
A confidence interval of 95% was used for the sample size calculation, with an absolute precision of 0.03. As the population variance was unknown, the prevalence (P = 50%) was used. A sample size of 485 was required. Therefore, around 500 school-going children of aged 5–16 years were selected for estimation of prevalence and risk factors of TDIs, and around 100 schoolteachers were selected on the basis of previously published studies for the evaluation of knowledge in the management of dental injuries.
The study participants were examined in a well-ventilated classroom under natural daylight using diagnostic armamentarium and the WHO Oral Health Assessment Form 2013. The armamentaria used in examination were mouth mirror, dental probe, kidney dishes, disinfectants, and cotton pallet. The knowledge, attitude, and practice management among the teachers was collected using a questionnaire. The questionnaire consisted of part 1 with knowledge-based questions and part 2 with self-assessment questions (SAQ) related to dental trauma. There were a total of 17 knowledge-based questions and SAQ. The part 1 consisted of eight SAQ regarding emergency management and first aid management of dental trauma, supervising the children during sports activity, etc., The part 2 consisted of nine knowledge-based questions  regarding ideal time for tooth replantation, medium in which tooth is kept before going to dentist, and correct time to approach dentist in case of knocked-down tooth.
The selection of questionnaire was checked for validation using content validity and was found satisfactory.
The returned and completed questionnaires were coded and entered into the computer using the Statistical Package for the Social Sciences (SPSS) software, version 20.0 (SPSS Inc., Chicago, IL, USA). The Chi-square test was used to compare the results. The level of significance was set at P ≤ 0.05.
The responses obtained were tabulated and expressed as frequency distributions and then computed in percentages. Each question was given a score of 1 for correct answer and 0 for incorrect answer and a response of “don't know.” A total score was assigned to each respondent. A score >50% was described as good knowledge, whereas a score <50% was described as poor knowledge. The results were expressed in number and proportion.
| Results|| |
The study results showed that the prevalence of TDI among males was slightly more, i.e., 59.2% than females, i.e., 40.8%. No statistically significant difference was found between gender and TDI among children (P = 0.084) [Table 1].
Of TDI according to type of injury was not found statistically significant difference among the children. However, 125 (43.0%) male and 166 (57.0%) female children had no sign of any dental injury [Table 2].
|Table 2: Gender-wise prevalence of traumatic dental injury according to type of injury|
Click here to view
With respect to the questionnaire about the SAQ, among 100 schoolteachers, only 24 (46.2%) male and 21 (43.8%) female teachers had encountered dental trauma in children. Furthermore, about 42 (80.8%) male and 37 (77.1%) female teachers answered that they could not do emergency management of dental trauma. Regarding whether the school had first-aid safety kit, 38 (73.1%) male and 41 (85.4%) female teachers responded positively, and this was statistically significant [P = 0.049, [Table 3]a.
Regarding the case of student's upper left tooth was dislocated, 40 (76.9%) male and 45 (93.8%) female teachers did not know when tooth was dislocated, whereas 12 (23.1%) male and 3 (6.2%) female teachers would try to relocate the teeth in the socket, and this was statistically significant [P = 0.019, [Table 3]b. Furthermore, 41 (78.8%) male and 43 (89.6%) female teachers did not know in which medium tooth should be kept, whereas only 4 (7.7%) males and none of female thought that medium should be saliva, and this was statistically significant. [P = 0.035, [Table 3]b.
| Discussion|| |
In the present study, the prevalence of injury among male and female children was 59.2% and 40.8%, respectively. Therefore, TDI among male children was slightly higher than female children. This prevalence was higher than the study done by Murthy et al. in 2014 and Siqueira et al. in 2013. The higher prevalence in the present study was due to outdoor activity, sports, and fall. In this study, the prevalence was slightly higher in male probably because males are usually more involved in outdoor or sport activity. Similar result was obtained by another study done by Ahlawat et al. in 2013. There was no statistical significance between the genders. In the present study, treated injury in male was only 18.8% and female was 81.3% which may be due to low awareness in children and parents. The study done by Murthy et al. in 2014 among same age group children showed that only 3.8% had sought treatment.
In this study, the enamel fracture was 40.6% in male and 59.4% in female, whereas in the study done by Siqueira et al. in 2013, the enamel fracture in male was 83.1% and female was 80%. Furthermore, enamel and dentin fracture in male was 31.6% and female was 68.4%, whereas in the other study done by Murthy et al. in 2014, enamel and dentin fracture in permanent tooth was 41% and in primary it was 43%. In the present study, pulpal involvement in male was 23.8% and female was 76.2%, whereas in the study done by Murthy et al. in 2014, pulpal involvement in permanent tooth was 2.7% and primary teeth was 4.3%. Furthermore, in other study done by Ahlawat et al. in 2013, enamel fracture in males was 81%, enamel and dentin fracture was 70%, and pulpal involvement was 60%, whereas in females, enamel fracture was 80%, enamel and dentin fracture was 29.2%, and pulpal involvement was 40%.
In the present study, missing tooth due to trauma in male was 17.6% and in female was 82.4%. In the study done by Murthy et al. in 2014, the number of missing primary tooth and permanent tooth was 1%. In the present study, around 73.1% of male teachers and 81.3% of female teachers did not know to find the knocked down teeth. Similar study done by Sharma et al. in 2016 showed that 90% of teachers would not find knocked down teeth. In the present study, 77% of males and 81.3% of females did not know ideal time of replacing tooth. Another study done by Sharma et al. in 2016 showed that 44.3% of teachers thought that tooth should replace within 30 min and 69% thought that tooth should be replaced within few hours. Similar study done by Prasanna et al. in 2011 showed that 72% teachers did not know correct time to replace teeth.
In the present study, male (76.9%) and female (93.8%) teachers did not know to relocate the tooth in the socket. Similar study done by Prasanna et al. in 2011 showed that 76% did not know to replace the tooth in socket. In the present study, 71.2% of males and 64.6% of females did not know to clean the dirty tooth. Another study done by Prasanna et al. in 2011 showed that 45% did not had knowledge regarding cleaning of tooth. In the present study, 78.8% of male and 89.9% of female teachers did not know the knowledge of transport media. Similar study done by Prasanna et al. in 2011 showed that 81% did not have knowledge of transport media. In the present study, 80.8% of males and 77.1% of females did not have knowledge of emergency management of dental trauma. In another study done by Prasanna et al. in 2011, 60% teachers thought that nearby dentist should be approached. Similar study done by Touré et al. in 2011 showed that around 501 schoolteachers (82.82%) know the importance of emergency management, and according to them, 21.95% will keep the tooth in milk.
The limitations of the study were sample size of the study was considered with small affect size and the different age group of children was not considered.
Public health significance
TDI is a challenging public health problem to professionals, and it has been seriously neglected. The consequence of traumatic injuries to teeth includes alteration in physical appearance, speech defects, and emotional impacts, thus affecting the child's quality of life; unfortunately, even in the dental field, the prevention of accidental trauma to the teeth is perhaps overshadowed by the tremendous interest worldwide in the prevention and control of other dental diseases. Dental injury prevention and management should be recognized as a major public health issues and adequate resources to be allocated for research in this area along with the development of prevention programs. Managing dental trauma is never the same and presents a challenge to careers. Emergency management should be considered to begin at the time of injury rather than the time the patient first sees the dentist as this impacts recovery. This highlights the importance of first aid and the need to educate the public.
Scope for future research
TDI is an impact injury to the teeth or other hard and soft tissues within and around the vicinity of the mouth and oral cavity. It is usually sudden, circumstantial, unexpected, and accidental and often requires emergency attention.
Establishing a research basis for the effective management, resource allocation, education, and planning for dental trauma is challenging. Unlike the most fields of dentistry, trauma data are obtained only as a result of an incident that has occurred unexpectedly. As such, randomized controlled studies are nonexistent for ethical reasons. More of such studies including randomized clinical trial with vigorous follow-up with larger sample size should be carried out so that the problem which these children are facing can be brought into limelight and they can be met with seriousness.
Teachers Training Oral Health programs and School-based Oral Health Program should be organized for schoolteachers and children to improve their knowledge regarding the management of dental injuries. Schoolchildren should be guided to follow preventive measures such as use of helmets, mouth guards, and other protective gears. Dentist should also take lead in educational research and public service activities as it is the duty of dentist to create awareness among the people, teachers, as well as students and children. These programs should be precisely designed to assure that proper information is retained with a positive effect on attitude and self-assessed competence.
| Conclusion|| |
The study concluded that there was poor knowledge in emergency management of dental trauma among schoolteachers, and also, they did not feel capable to conserve the teeth in proper medium as well as they did not have idea about tooth avulsion and correct time to approach dentist not have idea about ideal time for replacing and replantation of tooth. Therefore, the educational programs should be organized for schoolteachers to improve their knowledge so that proper dental first aid procedures can be undertaken, and children, parents, and schoolteachers should be educated about the prevention and timely management of TDI.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kumar A, Mangla R, Madan M, Saini S, Kesar N. Knowledge, attitude and practice of elementary school teachers towards emergency management of dental trauma in Sirmaur district, Himachal Pradesh: A questionnaire study. Indian J Dent Sci 2017;9:194-7. [Full text]
Megalamanegowdru J, Parakh A, Agrawal R, Bhatnagar S, Farista S, Farheen S. Perception of teachers toward traumatic tooth avulsion and its management among school children in durg, Chhattisgarh. Int J Prevent Public Health Sci 2015;1:16-20.
Young C, Wong KY, Cheung LK. Emergency management of dental trauma: Knowledge of Hong Kong primary and secondary school teachers. Hong Kong Med J 2012;18:362-70.
Udoye CI. Traumatic injuries to the anterior teeth of Nigerian urban public school children. J Coll Med 2006;11:88-91.
Andreasen JO, Andreasen FM. Textbook and Colour Atlas of Traumatic Injuries to the Teeth. 3rd
ed.. Cophenhagen: Munksgaard Publishers; 1994. p. 762.
Prasanna S, Giriraju A, Narayan NL. Knowledge and attitude of primary school teachers toward tooth avulsion and dental first aid in Davangere city: A cross-sectional survey. Int J Clin Pediatr Dent 2011;4:203-6.
Gojanur S, Yeluri R, Munshi AK. Prevalence and etiology of traumatic injuries to the anterior teeth among 5 to 8 years old school children in Mathura city, India: An epidemiological study. Int J Clin Pediatr Dent 2015;8:172-5.
Ahlawat B, Kaur A, Thakur G, Mohindroo A. Anterior tooth trauma: A most neglected oral health aspect in adolescents. Indian J Oral Sci 2013;4:31. [Full text]
Chopra A, Lakhanpal M, Rao N, Gupta N, Vashisth S. Traumatic dental injuries among 12-15-year-old-school children in Panchkula. Arch Trauma Res 2014;3:e18127.
Blakytny C, Surbuts C, Thomas A, Hunter ML. Avulsed permanent incisors: Knowledge and attitudes of primary school teachers with regard to emergency management. Int J Paediatr Dent 2001;11:327-32.
World Health Organization. Oral Health Surveys. 5th
ed.. Geneva: World Health Organization; 2013.
Murthy AK, Mallaiah P, Sanga R. Prevalence and associated factors of traumatic dental injuries among 5- to 16-year-old schoolchildren in Bangalore city, India. Oral Health Prev Dent 2014;12:37-43.
Siqueira MB, Gomes MC, Oliveira AC, Martins CC, Granville-Garcia AF, Paiva SM. Predisposing factors for traumatic dental injury in primary teeth and seeking of post-trauma care. Braz Dent J 2013;24:647-54.
Sharma R, Mallaiah P, Kadalur UG, Verma S. Knowledge and attitude of school teachers with regard to emergency management of dental trauma in Bangalore city. Int J Oral Health Med Res 2016;3:38-43.
Touré B, Benoist FL, Faye B, Kane A, Kaadioui S. Primary school teachers' knowledge regarding emergency management of avulsed permanent incisors. J Dent (Tehran) 2011;8:117-22.
Nayak SS, Basaiwala A, Ankola AV. Awareness regarding emergency dental trauma management among graduates of medical institutes in a city in India. Trauma 2016;4:7.
[Table 1], [Table 2], [Table 3]