Most dental trauma like tooth avulsion or tooth fracture occurs at schools. ... the knowledge of the immediate management of avulsed teeth by school staff in ...
(14)
Vol. 55, 1:15, April, 2009
SCHOOL TEACHERS’ KNOWLEDGE AND ATTITUDE ABOUT EMERGENCY MANAGEMENT OF AVULSED PERMANENT INCISORS- IN MANSOURA CITY Abeer M. Abdellatif* and Salwa A. Hegazy*
ABSTRACT Most dental trauma like tooth avulsion or tooth fracture occurs at schools. Immediate
appropriate management of the situation by school staff is very important. However, no study
has investigated the knowledge that school staffs possess for the management of these dental emergencies in Egypt. Therefore, the purpose of this study was to assess “by questionnaire” the knowledge of the immediate management of avulsed teeth by school staff in Mansoura city. A total of 200 questionnaires were distributed among the teachers of 4 public (group 1) and 4
private schools (group 2). The questionnaires concerned first-aid knowledge of tooth avulsion
and replantation, with all questions written in the mother (Arabic) language. Knowledge scores given, ranged from 0-3 according to the number of the correct answers. Relatively high general
knowledge of permanent teeth avulsion and replanation noticed in group 1 teachers (61.11%).
Both groups revealed lower level of general knowledge about primary teeth avulsion and replanation. For tooth cleaning and handling methods, 50.94% of group 1, and 35.28% of group 2 showed complete knowledge. For extra-oral time and storage medium, only (9.01%) of group 1, while (35.28%) of group 2 had complete knowledge.
This study revealed the need for educational campaigns aimed at school staff to increase
their knowledge of the emergency procedures required when a tooth is avulsed.
KEY WORDS: Dental trauma; School accidents; Trauma knowledge; Tooth avulsion.
INTRODUCTION Dental trauma remains one of the most important
oral health problems in childhood, which can
cause pain and distress.1 Many studies showed that
accidents are very common in children, and that the
permanent dentition revealed signs of dental trauma in over 20% of children. 1,2
The most serious tooth injury is the tooth avul-
sion. The avulsed tooth should be replanted in its
socket as soon as possible to avoid further damage
* Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Mansoura University.
to the periodontal membrane. 3-6 The prognosis is related to the injury of the periodontal membrane during the time the tooth is out of its socket. Dry tooth storage will cause irreversible injury, resulting in loss of the replanted tooth over time. 7 Storing the avulsed tooth in solutions compatible with cell viability until replantation is a critical procedure. 5,8 Although primary teeth could be avulsed, they should not be replanted to avoid damage of the underlying permanent tooth germ.6 The 7-12 years-old age group (school age group) is the most commonly affected age range.1 Accidents as falls in the school environment are very common and are the main cause of traumatic tooth injuries.9 For this reason school professionals should be aware about the importance of the immediate treatment in case of avulsed teeth.10 Many international studies have demonstrated lack in knowledge of school professionals regarding the emergency management of avulsed teeth. 11-14 The aim of this study was to investigate the knowledge and attitude of a sample of school teachers about the emergency management of avulsed teeth by using a standardized structured questionnaire.
empty. Also, the incomplete questionnaires were not included in the study. Thus the study group was categorized into: public schools teachers (Group 1), and private schools teachers (Group 2). The questionnaire was based on that described by AlAsfour et al.15 It concerned first-aid knowledge of tooth avulsion and replantation, with all questions given in the mother language (Arabic language). It contained demographic data about gender, specialty, and years of experience, in addition to four sections about their dental knowledge and management of avulsed teeth. Questionnaires were collected at the end of the same school day The written questions were designed in sections to measure the teachers knowledge regarding first aid with particular focus on the following areas: General knowledge 1. Permanent teeth, avulsion and replantation. 2. Primary teeth, avulsion and replantation. Special knowledge 3. Cleaning and handling methods of an avulsed teeth before replanation.
MATERIALS AND METHODS
4. Extra-oral time and storage media for an avulsed tooth.
After the approval of the authorities, the teachers of 4 public primary schools, and 4 private schools randomly selected from Mansoura City, Dakahlia Governorate, Egypt. All teachers were assured about the voluntary nature of the study and full privacy was guaranteed. They did not know in advance what the questionnaire was about in detail, only dental questions would be asked. About 200 questionnaires were distributed among the teachers of the schools through the headmaster of each school. When they were retrieved, the teachers of one private school did not answer any question and returned them
Each section comprised 3 questions to evaluate the general and special knowledge of the participants. For each area a knowledge score ranged from 0-3, according to the number of the correct answers was given. Score 0 (no knowledge), was given, when no correct answer was demonstrated. Score 1 (minor knowledge) was given, when only one correct answer was demonstrated. Score 2 (adequate but incomplete knowledge) was given, when 2 correct answers were demonstrated. Score 3 (complete knowledge), given when 3 correct answers were demonstrated.
RESULTS
numbers of teachers (25.49%, 22.71%) have had
A total of 135 teachers; 51 teachers public schools, and 84 from private schools completed the questionnaires and were considered valid for the study. The demographic data of the teachers in both public and private schools is presented in Table 1, while the knowledge level of the teachers is presented in Figures1-4. General dental knowledge (permanent teeth) A considerable ratio of teachers in both groups; 1 and 2 (61.11%, 49.10%) had complete general dental knowledge about permanent teeth eruption date, possibility of avulsion and replantation. On the other hand, very few in both groups had no knowledge (8%, 3.27%), as shown in Fig. 1. General dental knowledge (primary teeth) Almost equal numbers in the two groups have showed no knowledge (12.10%, 13.11%) and close
complete knowledge about primary teeth avulsion and replantation (Fig. 2).
Tooth cleaning and handling knowledge Knowledge about the ideal cleaning methods
and the proper handling of the avulsed permanent tooth is presented in Fig. 3. It is evident than half of
the teachers in group 1 and a considerable number of group 2 had complete knowledge (50.94%, and35.28% respectively).
Extra-oral time and storage medium knowledge In group 1, only minority (9.01%) had complete
knowledge, while 35.28% of group 2 had the same level of knowledge. Around 50% of group I teachers
have weak knowledge while, nearly the same ratio in group 2 showed adequate but incomplete level of knowledge (Fig. 4).
Table (1) demographic data of the participating teachers. Demographic Data Gender
Years of experience
Specialty
Group 1
Group 2
Male
19
31
1-year
-
1
Female
32
53
10 years or more
9
42
23
Social science
6
10
9
13
1-5 years
Arabic langue
10
Mathematics
10
Foreign langue
7
Sciences Sports
Computer science
8 1
60 16 16 8
16 5
Fig. (1) Percentage of teachers’ general dental knowledge about permanent teeth of both groups.
Fig. (2) Percentage of teachers’ general dental knowledge about primary teeth of both groups.
Fig. (3) Percentage of teachers’ knowledge about different methods of avulsed tooth cleaning and handling of both groups.
Fig. (4) Percentage of teachers’ knowledge about extra-oral time and storage media for avulsed tooth of both groups.
DISCUSSION
to participate in the study. The refusal may reflect
Provided that they are carefully designed, questionnaires are good tools for screening studies In this study, a systematic questionnaire was used to check the general and special level of teacher’s dental knowledge. Questions were formulated in simple Arabic language considering avulsion of a tooth in primary and permanent dentitions, with attention to the measures necessary for managing avulsed permanent teeth.
their low interest, or the absence of knowledge
Unfortunately, filled questionnaires of one private school have not retrieved as they refused
of informing the public can be evaluated, and
about the subject of the study. Some questionnaires from the other schools were not complete, which suggest their lack of knowledge.
Teachers’ dental knowledge was measured
using structured standardized questionnaire, which
was found suitable in a recent study on children 15,
and has the advantage of the possibility to compare knowledge level over time. Also, different ways compared. 16
Persons likely to be involved in avulsion trauma
at the accident site are school-aged children, who are frequently injured , and persons in their surroundings
as teachers.12 Some studies have shown that the level
of knowledge of avulsed teeth and first aid of school teachers is generally inadequate.11,12,17 Regarding
the general dental knowledge of the permanent teeth, a reasonable number of the two groups
showed complete knowledge. They were familiar
with the date of eruption and possible avulsion and replantation. Although this is a good sign, however,
a considerable number of the teachers especially in group 1 showed no, minor and incomplete knowledge. On the other hand, the knowledge
of both groups about primary teeth avulsion and replantation was almost minor, and incomplete in
group 2. The risk of replanting the avulsed primary
tooth is the most serious and overlooked problem by these teachers18.
In the present study, a good number of teachers
of in both groups revealed that they would hold
the avulsed tooth from the crown, clean it with tap-water, and would not use a brush to clean it. Contrary to these knowledgeable teachers, a
considerable percentage failed to show complete knowledge by their preference to use antiseptics or
brushes to clean the avulsed tooth as well as holding the root instead of the crown. They are not aware that one of the most important factors for tooth replantation success is the integrity and viability of
the periodontal ligaments of the avulsed tooth.7 This
comes in accordance with the study performed by Raphael and Gregory. . They revealed in their study 19
that 15% of respondents would scrub a tooth that
was dirty before replanting it, unaware they would be severely decreasing the chance of successful replantation.
Few teachers in both groups chose immediate replantation to avoid tooth dryness and the child mouth, saline or milk as storage medium. The majority of teachers, specially group 1 teachers showed no, minor and incomplete knowledge. It is well known that the single most important factor to ensure a favorable outcome is the ‘speed’ with which the tooth is replanted.20 The ideal storage medium must be of correct osmolality and pH, thus Milk fulfils these requirements and considered as an excellent medium.21 However, child’s mouth and saline were also considered as they would prevent dehydration of the root surface during transportation. The results of the present study confirmed that
Egyptian primary school teachers are also have a
low knowledge level of traumatic tooth avulsion first
aid. An absence of knowledge will result in avulsed teeth not being replanted, improperly cleaned, or
handled or stored in a non-physiological medium prior to replantation, which will severely affect
the prognosis of the tooth. Therefore, educational programs should be developed for school teachers
to encourage them to start proper management immediately, when a traumatic dental injury occurs to the school children. These programs should also
include school nurses and even physicians. Thus it would be beneficial if instructions in how to manage
dental injuries would be more widespread in all public and private schools.
CONCLUSION AND RECOMMENDATION In conclusion, school staff participated in this
study lack some of important knowledge about
managing avulsed teeth. They need informing and training programs for dealing correctly with such
cases. Moreover, it is highly recommended to train
the nurses and increase the efficiency of the school clinics to manage the dental emergency cases.
REFERENCES 1- Roberts G, Longhurst P. Oral and dental trauma in children and adolescents. 1st edn. London: Oxford University Press; 1996. 2- Andreasen JO. Traumatic injuries of teeth, 2nd edn.copenhagen: Munksgaard; 1981. 3- Andreasen JO. The effect of extra-alveolar storage and storage media upon periodontal and pulpal healing after Replantation of mature permanent incisors in monkeys. Int J Oral Surg 1981; 10: 43-53. 4- Andresson L, Bodin I, Sorensen S. Progression of root resorption following Replantation of human teeth after extended extra- oral storage. Endod Dent Traumatol 1989; 5: 37-74. 5- Andresson L, Bodin I. Avulsed human teeth replanted within 15 minutes- a long- term clinical follow up study. Endod Dent Traumatol 1990; 6: 37-42. 6- Heimdal A, Von Konow L, Lundquist G. Replatation of avulsed teeth after long extra- alveolar periods. Int J Oral Surg 1983; 12: 413- 417. 7- Sigalal E, Regan ID, Kramer PR, Witherspoon DE, Operman LA. Survival of human periodontal ligament cells in media prosposed for transport of avulsed teeth. Dent Traumatol 2004; 20: 21- 28. 8- Kenny DJ, Barrett EJ. Pre-replantation storage of avulsed teeth: fact and fiction. J. Calif Dent Assoc 2001; 29 (4): 275- 281. 9- O’Neil DW, Clark MV, Lowe JW, Harrington MS. Oral trauma in children: a hospital survey. Oral Surg Oral Med Oral Pathol 1989; 68: 691- 696. 10- Mori GG, Turcio KHL, Borro VP, Mariusso AM. Evaluation of the knowledge on tooth avulsion of school professionals from Adamantina, San Paulo, Brazil. Dent Traumatol 2007; 23 (1): 2- 5. 11- Chan AWK, Wong TKS, Cheung GSP. Lay knowledge of physical education teachers about the emergency manage-
ment of dental trauma in Hong Kong. Dent Traumatol 2001; 17: 7785. 12- Sae- Lim V, Lim LP. Dental trauma management awareness of Singapore pre- school teachers. Dent Traumatol 2001; 17: 71- 76. 13- Al- Jundi SH, Al- Waeili H, Khairalah K: Knowledge and attitiude of Jordanian school health teachers with regards the emergency management of dental trauma. Dent Traumatol 2005; 21(4): 183- 187. 14- Calgar E, Ferreira IP, Kargul B. Dental trauma management knowledge among a group of teachers in two south European cities. Dent Traumatol 2005; 21(5): 258-262. 15- Al-Asfour A, Andresson L, Al-Jame Q. School teachers’ knowledge of tooth avulsion and dental first aid before and after receiving information about avulsed teeth and replantation. Dent Traumatol 2008; 24: 43- 49. 16- Andersson A, Al-Asfour A, Al-Jame Q. Knowledge of first aid measures of avulsion and Replantation of teeth. An interview study of 221 Kuwaiti school children. Dent Traumatol 2006; 22: 57- 65. 17- Pacheco le, Filho PFG, Letra A, Menezes R, Villoria GEM, Ferreira SM. Evaluation of the knowledge of the treatment of avulsions in elementary school teachers in Rio de Janeiro, Brazil. Dent traumatol. 2003; 19:76-8. 18- Andreasen JO, Madgren B, Bakland LF. Tooth avulsion in children: to replant or not. Ingen conn 2006; 14:(1)28-34. 19- Raphael SL, Gregory PJ: Parental awareness of the emergency management of avulsed teeth in children. Aust Dent J 1990; 35:130-133. 20- Phol Y, Flippi A, Krischner H. Results after replantation of avulsed permanent teeth Parts I-III. Dent traumatol 2005; 21:80-110. 21- Marino TG, West LA, Liewehr FR, Mailhot JM, Buxton TB, Runner RR et al. Determination of periodontal ligament cell viability in long shelf- like milk. J Endo 2000; 26:(1) 699-702.
