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 Table of Contents  
Year : 2017  |  Volume : 9  |  Issue : 3  |  Page : 194-197

Knowledge, attitude, and practice of elementary school teachers toward emergency management of dental trauma in Sirmaur District, Himachal Pradesh: A questionnaire study

Department of Pedodontics, Himachal Institute of Dental Sciences, Paonta Sahib, Himachal Pradesh, India

Date of Web Publication7-Aug-2017

Correspondence Address:
Abhishek Kumar
Department of Pedodontics, Himachal Institute of Dental Sciences, PaontaSahib-173025, Himachal Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJDS.IJDS_24_17

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Background: Traumatic dental injuries (TDIs) are widespread in the population and are a serious dental public health problem among children. Dental trauma may cause both functional and esthetic problems, with possible impacts on the patient's quality of life. Aim: The aim of the study is to assess the knowledge, attitude, and practice of elementary school teachers regarding dental trauma and its management. Materials and Methods: A questionnaire study consisting of 12 closed-ended questions were used to interview 150 elementary school teachers who participated in this study. The questions assessed the knowledge and attitude of teachers toward their student's dental trauma and its management. Statistical analysis was performed using Statistical Packages of Social Sciences (SPSS) version 17.0. Results: Among 150 teachers, 54% had dealt with trauma to their students, 91.3% school teachers said that they would save the avulsed tooth, 64% had heard about reimplantation of tooth, and 37% school teachers stated that they would not carry the tooth in any media reflecting their lack of knowledge regarding management of avulsed tooth. Conclusion: As many teachers have a low level of knowledge regarding dental trauma, there is a need for greater awareness to improve knowledge and attitude of teachers related to the emergency management of TDIs in children by organizing educative and motivational programs.

Keywords: Attitude, dental trauma, knowledge

How to cite this article:
Kumar A, Mangla R, Dua P, Madan M, Saini S, Kesar N. Knowledge, attitude, and practice of elementary school teachers toward emergency management of dental trauma in Sirmaur District, Himachal Pradesh: A questionnaire study. Indian J Dent Sci 2017;9:194-7

How to cite this URL:
Kumar A, Mangla R, Dua P, Madan M, Saini S, Kesar N. Knowledge, attitude, and practice of elementary school teachers toward emergency management of dental trauma in Sirmaur District, Himachal Pradesh: A questionnaire study. Indian J Dent Sci [serial online] 2017 [cited 2021 Jan 20];9:194-7. Available from: http://www.ijds.in/text.asp?2017/9/3/194/212390

  Introduction Top

Traumatic dental injuries (TDIs) are widespread in the population and are a serious dental public health problem among children.[1] It may cause both functional and esthetic problems, with possible impacts on the patient's quality of life.[2] Primary and permanent anterior teeth are not only important for esthetics but also are essential for phonetics, mastication, integrity of supporting tissues as well as psychological and mental well-being of children.[3] Sports account for 60% of TDIs and school is the place where one can find a noticeable risk of TDI. Significant number of school-aged children experience trauma of some sort to primary or permanent dentition.[4]

The greatest incidence of trauma to the primary teeth occurs at 2–3 years of age, when motor coordination is developing. Most dental injuries occur to permanent teeth with incomplete root development in mixed dentition period. Due to their immature motor coordination, these young children are predisposed to falls and hence are at a risk of sustaining TDIs.[1] When teeth and their supporting structures are subjected to impact trauma, the resultant injury manifests either as a separation or a crushing injury or a combination of both. Separation injuries are exemplified by the displacement of teeth during which there is a cleavage of tissues, such as the periodontal ligament. This occurs during avulsions and extrusive luxations.[5] TDIs are usually a combination of trauma to the perioral soft tissues, teeth, and their supporting tissues. Dental injuries can be classified into enamel fracture, crown fracture without pulp involvement, crown fracture with pulp involvement, root fracture, crown–root fracture, luxation, avulsion, and fracture of the alveolar process.

Among the different types of dental trauma, avulsion results in the greatest functional and esthetic impairment due to its worse prognosis.[6] Prompt and pertinent emergency management is not only the responsibility of the dentist but also of lay people, such as the parents and the school teachers available at the site of accident.[3] School is one of the locations with the greatest prevalence of the occurrence of dental trauma in adolescents. Falls and collisions followed by sports activities such as cycling and running are the most prevalent etiological factors.

There are various dental traumas that can be encountered during sports such as soft tissue injuries, fractures, temporomandibular joint injuries, tooth intrusion, tooth extrusion, crown and root fractures, and avulsion.[7] Teachers are generally present at the time when dental trauma occurs as such accidents often take place during or after school activities. Bearing in mind, the importance of this issue and the lack of information in district Sirmaur teachers, the aim of this study was to investigate the knowledge, attitude, and practice of school teachers working in the elementary school about dental injuries caused by trauma.

  Materials and Methods Top

A total of 150 teachers from total 50 Elementary schools of Paonta sahib, District Sirmaur, Himachal Pradesh state were included in this study. All the available subjects who were willing to participate in the survey were included in the study. Before scheduling the present study, permission for conducting the survey in the schools was obtained from the Principal/Headmaster/Head Mistress of the respective schools. Before the data collection and clinical examination, the purpose and methodology of the survey were explained to each of the subject and informed consent was obtained. Data were collected through a survey, which included a self-administered questionnaire.

The questionnaire comprised questions assessing participants' knowledge with regard to dental trauma [Table 1]. This part was further divided into the following sections:
Table 1: Questionnaire response of teachers toward emergency management of dental trauma

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  • Basic knowledge on the growth patterns of child's dentition
  • General knowledge of dental trauma
  • Knowledge of fractured teeth
  • Knowledge of avulsed teeth.

The questionnaire was aimed at evaluating the attitudes of the teachers regarding this attitude toward referral of oral trauma and the other regarding teachers' reaction to avulsion injuries. Responses were entered onto a personal computer and Microsoft Excel was used for analysis and presentation.

  Results Top

A total of 150 teaching staff in 50 schools agreed to participate in the study. Completed questionnaires were returned by all 150 teachers, 92 females (61.3%) and 58 males (38.7%). 54% of the teachers related with an experience of dental trauma to their students as shown in the [Graph I] while 46% never had such an experience. Thirty percent teachers reported fall as the cause of accident whereas 20.7% related to it with sports injuries and 4.7% related it with impact or collision.

73.3% teachers stated the need for treatment [Graph I] whereas 26.7% stated that no treatment was needed. Fifty-four percent of the teachers would take the child immediately to the dentist [Graph I], 25.3% stated next day, 6% after a week, and 14.7% would take the child if any pain or symptoms occur.

54.7% stated that visiting a dentist is necessary in a TDI, 25.3% preferred physicians whereas 15.7% preferred self-medication and according to 4.7%, there was no need of treatment.

In cases of avulsion, 82.7% stated that they would place the tooth back into the alveolus and 13.3% stated that they would remove it from the child's mouth, 91.3% would save the tooth [Graph I] whereas 8.0% would discard the avulsed tooth.

Regarding the knowledge about the storage media [Graph II], 40% of the teachers would wash the avulsed tooth under tap water, 11.3% would keep the tooth wrapped in a roll of gauge, 8% would not clean the tooth, and 40.7% had no knowledge about it. 28.7% would prefer water, 20% cloth, 12.7% milk [Graph II] whereas 38.7% stated that there was no need of any storage media.

Regarding the knowledge about reimplantation [Graph II], 64% had heard about it whereas 36% had no idea, 59.3% reported that upper jaw was most commonly affected [Graph II] whereas 13.3% stated lower jaw, 14.7% stated both upper and lower jaw, and 12.7% had no idea.

  Discussion Top

Appropriate management is important for the future prognosis of teeth affected by TDIs, especially in young children. Those most likely to be involved at the site of a TDI are school-aged children and school teachers, making knowledge of TDI emergency management fundamental to the provision of correct care to an injured child.[1]

In the present study, 54% of the teachers would seek immediate professional help in case of dental trauma whereas 43% of the teachers would do so as reported in a study done by Singh et al. in Mathura India in 2015.[8]

In the present study, 40% of the teachers would use tap water to rinse the avulsed tooth which is in contrast to the study by Olatosi et al. where the percentage is 22% only.[9]

56% of the teachers in the present study preferred trauma referral to the dental hospital. On the contrary, the study done by Singh et al. concluded that only 14% of the teachers would do so.[8]

Only 12.7% of the teachers in the present study would prefer the use of milk as storage media in the present study. In contrast, 87% of the teachers preferred milk to other storage media in a study done by Singh et al. in Mathura India in 2015.

Between various wet media, milk is better than saliva due to its composition and its osmolarity. Furthermore, milk is a storage medium of relatively easy access at the location of trauma. In milk, the storage may be as long as 6 h. Toure and Benoist [10] reported that saliva contains microorganisms which may affect the survival of the cells.

Regarding the use of tissue paper/handkerchief/towel as transport media, 20% of the teachers in the present study gave this as answer, but only 41% gave this answer in a study done by Olatosi et al. in Nigeria in 2013 which was wrong.

At least half of school children face the possibility of suffering dentoalveolar trauma during school time. Dental trauma is relevant in children and adolescents since their permanent teeth are erupting at this phase. Children spend great part of their time at school where sporting activities become predisposing factors for dental trauma.

In addition, at school, during sporting and recreational activities, children and adolescents are the main groups with an increased likelihood of dental trauma there by rendering investigation of knowledge of school teachers with regard to dental injuries and treatment approaches. Early loss of a primary tooth due to trauma may affect the physiological sequence of permanent teeth and may be etiological factors for malocclusions, thus stimulating incorrect exercise of perioral musculature or cause phonological changes related to teeth.[11],[12]

  Conclusion Top

The study reveals that there is a lack of awareness among school teachers regarding the emergency management of dental trauma. This necessitates the need for the school teachers and others individuals who supervise children in schools to receive simple instruction in dental first aids. Hence, the communication between dental professionals and elementary school teachers is necessary to enable them to detect and proceed correctly when facing any dental trauma. However, they have few or limited knowledge regarding the recommended course of action in such situations. It is therefore of fundamental importance for coaches, teachers, and undergraduate students in physical education to be duly informed with regard to the correct first-aid measures. Hence, school teachers should have knowledge of basic dental physiology and the treatment protocol for such injuries.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Bayrak S, Tunc ES, Sari E. Evaluation of elementary school teachers' knowledge and attitudes about immediate emergency management of traumatic dental injuries. Oral Health Prev Dent 2012;10:253-8.  Back to cited text no. 1
Pagliarin CL, Zenkner CL, Barletta FB. Knowledge of physical education teachers about emergency management of tooth avulsion. Stomatos 2011;17:32-42.  Back to cited text no. 2
Pujita C, Nuvvula S, Shilpa G, Nirmala S, Yamini V. Informative promotional outcome on school teachers' knowledge about emergency management of dental trauma. J Conserv Dent 2013;16:21-7.  Back to cited text no. 3
[PUBMED]  [Full text]  
Krishnan B, Joseph J. Knowledge of basic dental physiology among teachers can improve preliminary management of acute dental avulsion in school children. Int J Clin Exp Physiol 2014;1:63-7.  Back to cited text no. 4
  [Full text]  
Bakland LK, Andreasen JO. Dental traumatology: Essential diagnosis and treatment planning. Endod Topics 2004;7:14-34.  Back to cited text no. 5
Zakirulla M, Togoo RA, Yaseen SM, Al-Shehri DA, Al-Ghamdi AS, Al-Hafed MS. Knowledge and attitude of Saudi Arabian school teachers with regards to emergency management of dental trauma. Int J Clin Dent Sci 2011;14:25-9.  Back to cited text no. 6
Chan AW, Wong TK, Cheung GS. Lay knowledge of physical education teachers about the emergency management of dental trauma in Hong Kong. Dent Traumatol 2001;17:77-85.  Back to cited text no. 7
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. 8
Olatosi OO, Iwuala SO, Isiekwe GI, Oredugba FA, Adenaike AS, Oluwo AO. Knowledge and attitude of some nigerian school teachers on the emergency management of avulsed permanent incisor. J West Afr Coll Surg 2013;3:30-52.  Back to cited text no. 9
Touré B, Léye Benoist F, Faye B, Kane AW, Kaadioui S. Primary school teachers' knowledge regarding emergency management of avulsed permanent incisors. J Dent (Tehran) 2011;8:117-22.  Back to cited text no. 10
Glendor U. Aetiology and risk factors related to traumatic dental injuries – A review of the literature. Dent Traumatol 2009;25:19-31.  Back to cited text no. 11
Campos MI, Henriques KA, Campos CS. Level of Information about the conduct of emergency trauma dental front. Pesqui Bras Odontopediatria Clin Integr 2006;6:155-9.  Back to cited text no. 12


  [Table 1]

This article has been cited by
1 Prevalence of traumatic dental injuries among 516-year-old children and knowledge of teachers in the management of traumatic dental injuries
Mayank Das,LVamsi Krishna Reddy,Sanjay Singh
Journal of Indian Association of Public Health Dentistry. 2019; 17(4): 328
[Pubmed] | [DOI]


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