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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 3  |  Issue : 4  |  Page : 140-143

Knowledge of emergency management of avulsed tooth among undergraduate preclinical and clinical dental students: Questionnaire-based study


Department of Conservative Dentistry, Faculty of Dentistry, University of Medical Sciences and Technology, Khartoum, Sudan

Date of Web Publication13-Feb-2017

Correspondence Address:
Elhadi Mohieldin Awooda
Department of Conservative Dentistry, Faculty of Dentistry, University of Medical Sciences and Technology, Khartoum
Sudan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-2915.200014

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  Abstract 

Background: Dental students in the community are considered as dentists and are expected or might be asked to provide emergency aid, especially when the problem related to the teeth as in the case of avulsion. Aim: The aim of this study is to assess and compare the knowledge and practice of 2nd- and 5th-year undergraduate dental students regarding management of tooth avulsion. Materials and Methods: Descriptive cross-sectional study among registered and regular attendee 2nd- and 5th-year dental students from nine dental schools in Khartoum state. The study was conducted during period from November 2015 to February 2016. Sample size was 309 (186 from 2nd year and 98 from 5th year) out of total number of 1575. Participants were selected by systematic random sampling technique. Self-administered questionnaire was used to assess the knowledge of emergency management of avulsed tooth. Comparison between variables by Chi-square test with the level of significance set at P < 0.05. Results: Majority of 5th-year students have enough information about avulsion and its emergency management while very few of 2nd-year students have the correct knowledge. Only 12.4% of 2nd-year students mentioned the correct storage media where an avulsed tooth can be placed compared to 64.3% of 5th-year students. There was also no statistical significant difference of P = 0.186 when knowledge about avulsion in students who personally experienced dental trauma was compared to those who did not have an experience of dental trauma. Conclusion: Second-year undergraduate dental students had poor knowledge about emergency management of avulsed tooth. Experience of dental trauma and students gender have no significant association with the management of tooth avulsion.

Keywords: Dental trauma management, tooth avulsion, traumatic dental injuries, undergraduate dental students


How to cite this article:
Azmi MA, Awooda EM. Knowledge of emergency management of avulsed tooth among undergraduate preclinical and clinical dental students: Questionnaire-based study. J Dent Res Rev 2016;3:140-3

How to cite this URL:
Azmi MA, Awooda EM. Knowledge of emergency management of avulsed tooth among undergraduate preclinical and clinical dental students: Questionnaire-based study. J Dent Res Rev [serial online] 2016 [cited 2020 Apr 6];3:140-3. Available from: http://www.jdrr.org/text.asp?2016/3/4/140/200014


  Introduction Top


Traumatic dental injuries are more prevalent in permanent dentition (58.6%) than in primary dentition (36.8%), and they mainly involve the front upper teeth.[1] They occur between ages 8 years and 11 years in majority of cases.[2],[3] As many studies have stated that dental trauma in children occurs mainly in school and home.[4],[5] According to old data and only one available in the literature, about 5.1% of Sudanese primary school children presented with incisal trauma, where the male to female ratio was 2.6:1.[6] Avulsion is the condition where the tooth is completely displaced out of its socket. It occurs in 1%–16% of all dental injuries, and it is the most serious type of all dental traumas.[2] Clinically, the socket is found empty or filled with a coagulum. In case of avulsion, the consequence expected could be serious, for example, root resorption with its different types and degrees.[1] Furthermore, other complications may include pulp necrosis and periapical inflammation.[7]

Management of an avulsed tooth depends on whether it is a primary tooth or a permanent one. In case of primary tooth, replant is not recommended as this may affect the successor permanent one. Only follow-up is done clinically and radiographically until the eruption of the permanent successor.[8],[9] In case of permanent tooth avulsion, the emergency management should be as follows: Tooth is picked from the crown and not from the root, if the tooth is dirty, it must be washed under cold running water before repositioning it, tooth is repositioned, patient can bite on a handkerchief to hold it in place, if repositioning was not possible, the tooth must be stored in a physiological media such as milk, saliva, or saline. Storage in water must be avoided. Dental clinic must be visited immediately.[10] Dental trauma could be considered as an emergency and immediate intervention is needed, so it should be taught early as a first aid. Freshly and newly undergraduate dental students are considered as dentists in the community, and they might be asked for help when they are around during an emergency of dental trauma.

The knowledge of emergency management of tooth avulsion among Sudanese undergraduate dental students has not been evaluated before, and no previous data are available regarding this issue. The objective of this study was to assess and compare the knowledge and practice of 2nd- and 5th-year undergraduate dental students regarding management of tooth avulsion.


  Materials and Methods Top


Descriptive cross-sectional study was conducted in the period from November 28, 2015, to March 12, 2016 among students from faculties, schools, or programs of dentistry from nine universities or colleges in Khartoum state. Neither newly established nor not reaching 5th year included along with students that repeated the academic year. Registered and regular 2nd- and 5th-year students, males and females, and those who have frozen the year were included in the study. A systematic random sample was used for data collection; the first one was selected by simple random from the list of students index number which provided by each faculty registrar office.

A total population of students was 1575 (1063 from 2nd year and 512 from 5th year). The sample size was determined according to the formula:



Where n is sample size, N is the population size, Z is Z statistics for the level of confidence, P is the expected proportion, and D is precision.

Sample size obtained was 309 (211 students from 2nd year and 98 from the 5th year).

A self-administered questionnaire with close-ended questions distributed to the targeted population during one of the morning lectures. Permission was taken from a teacher of the selected class to collect data, and he/she was requested to wait for 15 min outside class so as to enable the students to answer the questions freely. Students were given brief about the objectives of the study and how to fill the questionnaire. The questions included demographic data which include name of university, year (2nd or 5th) and gender, history of trauma, and experience of avulsed tooth. More questions were asked about the management of avulsed tooth. A pilot study was conducted among 25 undergraduate students from the University of Medical Sciences and Technology (UMST) to test reliability of the questionnaire, and corrections were made according to the feedback received. Those involved in the pilot study were not included in the final study.

The study was approved by the ethical committee of the UMST. The eligible participant was requested to participate voluntary. They signed written informed consents from administration of all the universities, in which the research was conducted.

Data were analyzed by SPSS version 16 (SPSS Inc., Chicago, IL, USA). Comparison between variables by Chi-square with the level of significance set at P < 0.05.


  Results Top


Due to the presence of different schedules in each university, some students had examinations and were not able to fill in the questionnaire; therefore, the response rate for 2nd-year students was 88% (186 students) while the response rate for 5th-year students was 100% (98 students). The percentage of female and male was 60.2% and 39.8%, respectively.

It was shown that 89.8% of 5th-year students have taken course regarding the management of dental trauma compared to 15.1% among 2nd year. Only 17% of those who have not taken the course before have read about dental trauma elsewhere.

The results of the question to assess knowledge about avulsion revealed that most of 5th-year students have sufficient information, especially regarding questions asked about definition of avulsion (79.6%), time as an important factor (90.8%), and storage medias to be used (64.3%). Most of 2nd-year students have no information at all regarding dental traumas and some do not even know what the word trauma means as shown in [Table 1],[Table 2],[Table 3].
Table 1: Definition of avulsion of a tooth 2nd- and 5th-year dental students

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Table 2: Second and 5th-year students' knowledge of correct management of 4-year-old boy with an avulsed tooth

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Table 3: Knowledge of students regarding the best time for management of avulsed tooth to have the best prognosis

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Majority of 5th-year students (90.8%) and almost half of 2nd-year students (52.7%) thought that yes time is an important factor in management of a permanent avulsed tooth with P = 0.000 as well.

Only 12.4% of 2nd-year students mentioned the correct storage media where an avulsed tooth can be placed compared to 64.3% of 5th-year students.

Regarding the difference between males and females undergraduate dental students, it was found that the difference was not highly significant in most of the questions mentioned above. In the definition of avulsion, 72 (25.4%) females from a total of 171 (100%) chose the correct answer compared to 41 (14.4%) males from a total of 113 (100%) with P = 0.050.

Female students who chose to just reassure a 4-year-old boy along with his mother were 47 (16.5%) compared to 29 (10.2%) males with P = 0.949 while 109 females (38.4%) and 78 males (27.5%) stated that time is an important factor in the management of an adult patient with avulsed tooth, P = 0.002 shows a highly statistical difference.

Regarding the storage media to be used, 60 (21.1%) female students mentioned the correct storage media while only 26 males (9.2%) were able to mention them. P = 0.240 which shows no significance.

There was also no statistical significant difference of P = 0.186 when knowledge about avulsion in students who personally experienced dental trauma was compared to those who did not have an experience of dental trauma.


  Discussion Top


Studying dentistry in most of the schools is to pass through 5-year courses, including basic sciences, preclinical and clinical courses. First, second and third even fourth and fifth year students may not be taught, trained, or had experience of the management of dental trauma. The teaching of dental trauma management seems to be lacking although early management of dental trauma, especially tooth avulsion, is critical for good prognosis.

If tooth avulsion was handled and treated quickly and in an efficient way, then it may have an excellent prognosis regarding function and esthetics and will decrease the physiological effect caused to the child.[11]

Results from the undergraduate dental students had insufficient information regarding the management of tooth avulsion. Although when 5th-year students were compared to 2nd year, they were more knowledgeable still their knowledge was deficient regarding management. Similar results were obtained by Fujita et al.[2] and Al-Shamiri et al.[4] This may be due to their inexperience of trauma in the dental clinic as most of the schools do not provide a trauma emergency department. These results are also due to lack of education about this topic in elementary schools, high schools, and even in early years of studying dentistry as the course of dental trauma is only taken theoretically in 4th or 5th year in most dental schools. Moreover, it should be considered to be included in the curriculum instructions about clinical examination, diagnosis, and treatment of trauma.

Lack of knowledge about the management of trauma among the dental students, especially the 1st and 2nd year maybe arise due to their deficiency in the community and primary and secondary school teachers and even lack of knowledge of mothers and parents.[3],[12],[13],[14] All these studies concluded that there is a lack of knowledge about dental trauma, especially avulsion and its management among teachers and parents. Since children are usually traumatized in school or home, then it is very important to have campaigns and courses to increase knowledge of teachers and parents.

Most of medical doctors would prefer to refer the patient to a dentist, and only a very few have the courage to manage the case by replanting the tooth. Lack the knowledge about emergency management of avulsed tooth is also with a high prevalence among physicians [7],[15] and also among medical graduates.[16],[17],[18]

It was thought that if students personally experienced dental trauma, then this would have increased their knowledge about emergency management, but this study showed that there was no relation between personally experiencing dental trauma and knowledge about the management of an avulsed tooth.

Even though females are more concerned about their teeth and appearance, males are more subjected to trauma than females, but there was no statistical significant difference found about knowledge of emergency management of avulsed tooth between males and females.

Students are the future dentists. For good prognosis, students must be able to properly manage such emergency cases. From the results, only 15% of 2nd-year students have taken the dental trauma course, and therefore, this can only be achieved by giving this course as a first aid course and by allowing dental students to have enough clinical practice on how to manage this emergency case.


  Conclusion Top


Most of undergraduate dental students (2nd year and 5th year) are not qualified enough to manage avulsion of teeth, and some have very weak and insufficient knowledge about the emergency management of this situation, especially those in 2nd year. It is recommended to consider giving a course of emergency management of dental trauma, especially avulsed tooth as a first aid course to the 1st-year undergraduate dental students.

Financial support and sponsorship

This study was financially supported by University of Medical Sciences and Technology, Sudan.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Zaleckiene V, Peciuliene V, Brukiene V, Drukteinis S. Traumatic dental injuries: Etiology, prevalence and possible outcomes. Stomatologija 2014;16:7-14.  Back to cited text no. 1
    
2.
Fujita Y, Shiono Y, Maki K. Knowledge of emergency management of avulsed tooth among Japanese dental students. BMC Oral Health 2014;14:34.  Back to cited text no. 2
    
3.
Mohandas U, Chandan GD. Knowledge, attitude and practice in emergency management of dental injury among physical education teachers: A survey in Bangalore urban schools. J Indian Soc Pedod Prev Dent 2009;27:242-8.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.
Al-Shamiri HM, Alaizari NA, Al-Maweri SA, Tarakji B. Knowledge and attitude of dental trauma among dental students in Saudi Arabia. Eur J Dent 2015;9:518-22.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.
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.  Back to cited text no. 5
    
6.
Baghdady VS, Ghose LJ, Enke H. Traumatized anterior teeth in Iraqi and Sudanese children – A comparative study. J Dent Res 1981;60:677-80.  Back to cited text no. 6
    
7.
Hashim R. Physcians' knowledge and experience regarding the management of avulsed teeth in United Arab Emirates. J Int Dent Med Res 2012;5:91-5.  Back to cited text no. 7
    
8.
American Academy on Pediatric Dentistry Council on Clinical Affairs. Guideline on management of acute dental trauma. Pediatr Dent 2008-2009;30 7 Suppl: 175-83.  Back to cited text no. 8
    
9.
Malmgren B, Andreasen JO, Flores MT, Robertson A, DiAngelis AJ, Andersson L, et al. Guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Pediatr Dent 2016;38:377-85.  Back to cited text no. 9
    
10.
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. 10
    
11.
Soares DM, de Souza Santos Palmeira PT, de Almeida Souza CM, Maciel WV, Santos ME. Knowledge on tooth avulsion in a population of students enrolled in health science programs in Brazil. Arq Odontol Belo Horizonte 2012;48:203-10.  Back to cited text no. 11
    
12.
Singh M, Ingle NA, Kaur N, Yadav P. Evaluation of knowledge and attitude of school teachers about emergency management of traumatic dental injury. J Int Soc Prev Community Dent 2015;5:108-13.  Back to cited text no. 12
    
13.
Francisco SS, de Jesus Soares A, Murrer RD. Evaluation of elementary education teachers' knowledge on avulsion and tooth replantation. RSBO 2015;12:32-40.  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.
Jyothi KN, Venugopal P, Nanda S, Shah MK. Knowledge and attitude of medical doctors towards emergency management of avulsed tooth – A cross sectional survey. J Dent Sci Res 2011;2:156-67.  Back to cited text no. 15
    
16.
Nayak SS, Basaiwala AK, Ankola AV. Awareness regarding emergency dental trauma management among graduates of medical institutes in a city in India. J Dent Res Sci Dev 2016;3:6-12.  Back to cited text no. 16
    
17.
Skapetis T, Gerzina T, Hu W. Management of dental emergencies by medical practitioners: Recommendations for Australian education and training. Emerg Med Australas 2011;23:142-52.  Back to cited text no. 17
    
18.
Abu-Dawoud M, Al-Enezi B, Andersson L. Knowledge of emergency management of avulsed teeth among young physicians and dentists. Dent Traumatol 2007;23:348-55.  Back to cited text no. 18
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]


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