|Year : 2017 | Volume
| Issue : 5 | Page : 1-6
Assessment of knowledge and awareness among medical doctors toward emergency management of dental trauma in State of Himachal Pradesh: A survey
I Sood, K Gupta, AK Sharma, A Gaur, V Pathania, V B. S Thakur
Department of Pedodontics, Himachal Dental College, Sunder Nagar, Mandi, Himachal Pradesh, India
|Date of Web Publication||15-Sep-2017|
Department of Pedodontics, Himachal Dental College, Sunder Nagar - 175 002, Mandi, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
Aim and Objectives: The aim of this study was to assess the knowledge and attitude of medical doctors towards the emergency management of dental trauma in the state of Himachal Pradesh. Materials and Methods: A cross-sectional survey in which, 500 medical doctors were randomly included in the study and the participation was voluntary. Data regarding the emergency management of avulsed tooth was collected using a self-administered questionnaire having questions which were close ended. Statistical analysis was carried out. Chi-square test was used to analyze the data gathered. Results: It was found that frequency of occurrence of soft tissue injuries of the face was 83%, laceration injuries was 79%, nasal bone fracture was 66%, intraoral soft tissue injuries of the lip was 67%, avulsion was 77%, and frequency of dental trauma of maxillary central incisor was 63%. Furthermore, the frequency of respondents having the knowledge about reimplantation was 46% and frequency of respondents having knowledge about the time of reimplantation was 60%. Frequency of respondents having knowledge about the preservation of tooth for reimplantation was 51%, whereas frequency of respondents having no knowledge about the preference of preservative medium was 47%. Frequency of respondents who have not seen traumatic injuries of primary teeth was 55% and the most frequently administered first aid was tetanus injection having 67%. Conclusion: The results from this study suggest that knowledge of the management of dental injuries among medical professionals/doctors was inadequate. However, appropriate training can significantly increase their knowledge.
Keywords: Dental trauma, frequency, medical doctors, survey
|How to cite this article:|
Sood I, Gupta K, Sharma A K, Gaur A, Pathania V, Thakur V B. Assessment of knowledge and awareness among medical doctors toward emergency management of dental trauma in State of Himachal Pradesh: A survey. Indian J Dent Sci 2017;9, Suppl S1:1-6
|How to cite this URL:|
Sood I, Gupta K, Sharma A K, Gaur A, Pathania V, Thakur V B. Assessment of knowledge and awareness among medical doctors toward emergency management of dental trauma in State of Himachal Pradesh: A survey. Indian J Dent Sci [serial online] 2017 [cited 2018 Sep 20];9, Suppl S1:1-6. Available from: http://www.ijds.in/text.asp?2017/9/5/1/214935
| Introduction|| |
Traumatic dental injuries are the fourth most common bodily injury as well as facial injury among the 7–30 year age group, in which incidence ranges from 3.9% to 58.6%. Crown fractures form the most frequent type of injury, comprising 26%–76% of injuries to the permanent dentition  whereas luxation injuries comprise 15%–61% of all dental injuries  and mainly involving maxillary central incisors. The soft tissue laceration as a result of trauma is most commonly associated with road traffic accidents but can also be seen in sports injuries or from fall.,
Avulsion accounts for approximately 0.5%–16% traumatic injuries in the permanent dentition and 7%–13% in the primary dentition.,, Prognosis in avulsion depends on the time avulsed tooth is kept outside the mouth, storage medium, and the place where the traumatic incident occurred.,, Avulsed teeth can be saved if replanted immediately within 30 min ,, or stored in a physiologic solution such as saline, Hank's balanced salt solution, milk,,, saliva, or cold tap water until professional help is attained.,
The objective for treatment in case of avulsed permanent teeth is reimplantation as soon as possible and stabilizing the replanted tooth to optimize the healing and neurovascular supply. However, reimplantation in the primary dentition is contraindicated because of possibility of damage to the permanent successor.,,,
Importance of providing dental knowledge regarding immediate management of traumatic dental injuries to general population as well as medical professionals, to make them more aware of the problem which could affect the final prognosis and has received wide acknowledgment. Hence, there is a need to involve nondental primary health-care professionals, for providing primary diagnosis and required basic supportive therapy for dental trauma patients, until proper treatment is given to the patient.,
Studies ,,,,, have shown that, there is little knowledge regarding the immediate management of dental trauma among general population which can be present at the time of injury. The general medical practitioners and physicians are frequently the first to actually provide primary treatment and to ensure proper and appropriate management of the dental trauma.,,, So keeping in view of the importance of the medical practitioners' information regarding the dental trauma, the present study aims to assess the knowledge, awareness, and attitude among medical doctors toward the emergency management of the dental trauma in the state of Himachal Pradesh.
| Materials and Methods|| |
A total of 500 medical doctors were included in the study, of which 32 were interns, 152 graduates, 136 post graduates, and 180 were medical specialists and staff from different faculties. The participation in the study was voluntary and strict confidentiality was assured to the participants. The data were collected by distributing a self-designed questionnaire consisting of 13 questions. The self-administered questionnaire used for the study was adopted and modified from some previous studies,,,, with some new questions added to it. The questionnaire consisted of two different parts: one pertaining to questions for assessing awareness of dentofacial injury in general and second part to assess awareness about dental trauma and its management, all comprising 13 questions. The data collected were analyzed and expressed using Chi-square test with P< 0.05 considered to be significant.
- Medical professionals including medical specialists, postgraduate students, graduates, and interns
- Medical doctors and practitioners in both government and private settings
- Teaching staff from medical colleges also included.
| Results|| |
A total of 500 individuals participated in this study, of which 32 were interns, 152 graduates, 136 post graduates, and 180 were medical specialists from different faculties. Among them, 339 were males and 161 were females. The data collected were analyzed and expressed using Chi-square test with P< 0.05 considered statistically significant.
Response to basic questions
Most common injury was soft tissue injuries followed by jaw fractures which were witnessed by 42% medical specialists, followed by 30% postgraduates and 28% graduates among different dentofacial injuries. In soft tissue injuries, laceration was the most commonly seen injury observed by 44% of medical specialists/masters, followed by 32% postgraduates followed closely by 28% graduates. Maxilla and mandible fractures were the most common fractures seen among facial bone fractures by 48% medical specialists, followed by 28% postgraduates and 23% graduates. While among intraoral soft tissue injuries, lip and tongue injuries were most commonly witnessed by around 45% medical specialists followed by 29% postgraduates and 27% graduates [Table 1].
Results to applied questions
Tetanus injection and bleeding arrest were reported to be the most common first aid measures administered by 48% medical specialists, followed by 31% postgraduates and 23% graduates. Among dental trauma injuries, avulsion and displacement injuries were most commonly witnessed by 40% medical specialists, followed by 34% postgraduates and 24% graduates. For the most commonly involved tooth in dental trauma, maxillary central incisor was witnessed by 39% medical specialists followed by 28% postgraduates and 27% graduates. Reimplantation of an avulsed tooth was known to about 42% medical specialists, followed by 32% postgraduates and 22% graduates [Table 2].
For awareness regarding time for reimplantation, all four categories of medical specialists, postgraduates, graduates, and interns had low knowledge [Table 3]. About preservation of a knocked out tooth, around 40% medical specialists followed by 31% postgraduates and 23% graduates had knowledge, whereas awareness regarding the preservative/storage medium, saline was thought to be the most appropriate medium by 45% medical specialists, followed by 28% postgraduates and 24% graduates. Traumatic injuries in primary teeth were witnessed by 46% medical specialists followed by 29% postgraduates and 21% graduates, whereas avulsion was the most commonly witnessed by 50% medical specialists, followed by 33% postgraduates and 13% graduates among different types of dental trauma injuries in primary teeth.
| Discussion|| |
Traumatic dental injury is not the result of a disease but a consequence of several factors that will accumulate throughout life if not looked upon. A number of studies have been done pertaining to the knowledge of emergency management of dental trauma among dentist.,,,,,, Few studies have already reported the low level of knowledge among nondental health professionals such as physicians.,,,, However, there is a paucity of research like this which compared the knowledge and awareness of interns, graduates, postgraduates, and medical specialists regarding dental trauma, hence our study is being done.
In the present study, medical specialists had seen maximum cases of dentofacial injuries (161) followed by post graduates (117). Soft tissue injuries (83%) were the most commonly seen dentofacial injury, and the similar results were seen in the studies done by Díaz et al. (78%). After analyzing knowledge on the type of soft tissue injury witnessed, laceration (79%) was the most common which is similar to the results shown by Ozinko et al. and Perez et al. with specialist's practitioners again being the majority, followed by postgraduates [Table 1].
Regarding facial bone fractures, majority of medical professionals said to have witnessed maxilla and mandible fractures 60%, which are similar to the studies done by Kelly andHarrigan  and Yildirgan et al. (53%). When the knowledge on intraoral soft tissue injury was analyzed, majority of medical professionals had witnessed lip injury the most (73%). These results were similar to the study done by Flores et al. and Nazan et al., who also stated lip injuries to be the most common soft tissue injuries seen by medical specialists [Table 1].
Regarding knowledge and awareness of general first aid administration, it was observed that, for all events, knowledge was ample among all medical professionals, with tetanus injection 67% being the most common first aid delivered. Avulsion (65%) occurrence was the most commonly seen dental trauma type, with medical specialists being majority followed by postgraduates, which was similar to studies done by Dali et al. and Jyothi et al., where 56.6% and 78.5% knew about avulsion, but the results were contrary to the study done by Nazan et al. where crown fractures (53%) were the most common fracture [Table 2].
In the present study, maxillary central incisor 63% was the most commonly seen fractured tooth by the medical specialists, which is similar to studies done by Calişkan and Türkün, Kowash et al., Qazi et al., and Saroğlu and Sönmez, who also had stated maxillary central incisor as the most commonly fractured. On knowledge regarding reimplantation of an avulsed tooth, interestingly 46% of participants had correct knowledge, specialists medical again forming majority 43%, and postgraduates 33%, which was similar to the study done by Talluri et al. where 65% of doctors knew about reimplantation [Table 2].
Regarding knowledge on time of reimplantation, it was observed that 60% respondents had no knowledge on this query. In the present study, 22% gave the correct answer which is immediate or within ½ h of trauma  with postgraduates and medical specialists being the majority giving correct answer, which is similar to the study done by Venkataramana et al. where 23% of doctors gave correct answer. Nearly 52% doctors had the right knowledge that knocked out tooth can be preserved for reimplantation, which is similar to the study done by Hamilton et al. where 36.4% had no knowledge but was different from Abu-Dawoud et al. Nearly 83% and Walker and Brenchley  67% had no knowledge of the concerned. When knowledge on preservation medium for avulsed tooth was assessed, it was observed that 47% of respondents had no knowledge of the preservation medium among all the medical professionals. Moreover, saline (37%) was the most common medium chosen by the rest of the respondents, with specialists medical respondents being the majority, followed by postgraduates, the results being similar to the studies done by Dali et al. (59%), Venkataramana et al. (53%), and Hashim  (42%), where saline was observed to be the most accepted preservation medium, being chosen because of its physiologic osmolarity. Only 10% had correct knowledge that hanks balanced salt solution was the best preservative medium, which is the ideal medium as observed by Qazi et al., Trope, and Baginska et al. Only 40% medical professionals had seen traumatic injuries in primary teeth, which is similar to the results as shown by the study done by Ahuja et al. where 34% had witnessed dental trauma injury to the children. Avulsion 26% being observed the most in primary teeth trauma cases, which is contrary to the results observed by Talluri et al. which stated luxation injuries to be the most in primary [Table 3].
| Conclusion|| |
In the present study, it was observed that seniority in profession and specialization field did play a role in the responses given by the participants to some of the queries. However, overall, it was observed that awareness regarding dental trauma and its management was comparatively poor among all categories of medical professionals. As these medical professionals provide a vital link between the patients with dental trauma and the dentists, we need to educate them on emergency management of dental trauma at their level.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lin S, Levin L, Emodi O, Fuss Z, Peled M. Physician and emergency medical technicians' knowledge and experience regarding dental trauma. Dent Traumatol 2006;22:124-6.
Hashim R. Physicians' knowledge and experience regarding the management of avulsed teeth in United Arab Emirates. J Int Dent Med Res 2012;5:91-5.
Andreasen JO. Etiology and pathogenesis of traumatic dental injuries. A clinical study of 1,298 cases. Scand J Dent Res 1970;78:329-42.
Trivedy C, Kodate N, Ross A, Al-Rawi H, Jaiganesh T, Harris T, et al.
The attitudes and awareness of emergency department (ED) physicians towards the management of common dentofacial emergencies. Dent Traumatol 2012;28:121-6.
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.
Dali M, Naulakha D, Rajbanshi L. Knowledge, attitude and practice in emergency management of avulsed tooth among medical doctors in Nobel Medical College, Biratnagar, Nepal: A cross sectional survey. Int J Dent Health Sci 2014;1:3-12.
Kinoshita S, Kojima R, Taguchi Y, Noda T. Tooth replantation after traumatic avulsion: A report of ten cases. Dent Traumatol 2002;18:153-6.
Holan G, Shmueli Y. Knowledge of physicians in hospital emergency rooms in Israel on their role in cases of avulsion of permanent incisors. Int J Paediatr Dent 2003;13:13-9.
Dewhurst SN, Mason C, Roberts GJ. Emergency treatment of orodental injuries: A review. Br J Oral Maxillofac Surg 1998;36:165-75.
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.
Glendor U. Epidemiology of traumatic dental injuries – A 12 year review of the literature. Dent Traumatol 2008;24:603-11.
Qazi SR, Nasir KS. First-aid knowledge about tooth avulsion among dentists, doctors and lay people. Dent Traumatol 2009;25:295-9.
Al-Jundi SH, Al-Waeili H, Khairalah K. Knowledge and attitude of Jordanian school health teachers with regards to emergency management of dental trauma. Dent Traumatol 2005;21:183-7.
Sakai VT, Moretti AB, Oliveira TM, Silva TC, Abdo RC, Santos CF, et al.
Replantation of an avulsed maxillary primary central incisor and management of dilaceration as a sequel on the permanent successor. Dent Traumatol 2008;24:569-73.
Weiger R, Heuchert T. Management of an avulsed primary incisor. Endod Dent Traumatol 1999;15:138-43.
Flores MT, Malmgren B, Andersson L, Andreasen JO, Bakland LK, Barnett F, et al.
Guidelines for the management of traumatic dental injuries. III. Primary teeth. Dent Traumatol 2007;23:196-202.
Holan G. Disturbing conclusions. Br Dent J 2006;200:123.
Subhashraj K. Awareness of management of dental trauma among medical professionals in Pondicherry, India. Dent Traumatol 2009;25:92-4.
Walker A, Brenchley J. It's a Knock out: Survey of the management of avulsed teeth. Accid Emerg Nurs 2000;8:66-70.
Talluri D, Bommireddy VS, Rao V, Ravoori S. Management of dental injuries by South Indian medical professional – A hospital based questionnaire design study. Int J Appl Dent Sci 2014;1:18-21.
Emien EJ, Omole OJ. Knowledge and attitude regarding management of tooth avulsion injuries among school teachers in rural India. J Int Soc Prev Community Dent 2014;4 Suppl 1:S44-8.
Soriano EP, Caldas Ade F
Jr., Diniz De Carvalho MV, Amorim Filho Hde A. Prevalence and risk factors related to traumatic dental injuries in Brazilian schoolchildren. Dent Traumatol 2007;23:232-40.
Oliveira TM, Sakai VT, Moretti AB, Silva TC, Santos CF, Machado MA, et al.
Knowledge and attitude of mothers with regards to emergency management of dental avulsion. J Dent Child (Chic) 2007;74:200-2.
Sae-Lim V, Chulaluk K, Lim LP. Patient and parental awareness of the importance of immediate management of traumatised teeth. Endod Dent Traumatol 1999;15:37-41.
Raphael SL, Gregory PJ. Parental awareness of the emergency management of avulsed teeth in children. Aust Dent J 1990;35:130-3.
Al-Jundi SH. Knowledge of Jordanian mothers with regards to emergency management of dental trauma. Dent Traumatol 2006;22:291-5.
Stokes AN, Anderson HK, Cowan TM. Lay and professional knowledge of methods for emergency management of avulsed teeth. Endod Dent Traumatol 1992;8:160-2.
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.
Díaz J, Bustos L, Herrera S, Sepulveda J. Knowledge of the management of paediatric dental traumas by non-dental professionals in emergency rooms in south araucanía, temuco, chile. Dent Traumatol 2009;25:611-9.
Ozinko MO, Bassey GO, Otei OO, Ekpo RG, Mgbe RB. (Epidemiology and Management of Facial Soft Tissue Trauma in Calabar, Southern Nigeria. World Journal of Research and Review (WJRR) 2016:3:12-5.
Perez R, Berkowitz R, McIlveen L, Forrester D. Dental trauma in children: A survey. Endod Dent Traumatol 1991;7:212-3.
Kelly DE, Harrigan WF. A survey of facial fractures: Bellevue hospital, 1948-1974. J Oral Surg 1975;33:146-9.
Yildirgan K, Zahir E, Sharafi S, Ahmad S, Schaller B, Ricklin ME, et al.
Mandibular fractures admitted to the emergency department: Data analysis from a swiss level one trauma centre. Emerg Med Int 2016;2016:3502902.
Nazan E, Fahinur E, Ozant O, Menije M, Ilhan U. Evaluation of high risk university students' knowledge about dental trauma and emergency procedures. J Int Dent Med Res 2013;6:100-4.
Calişkan MK, Türkün M. Clinical investigation of traumatic injuries of permanent incisors in Izmir, Turkey. Endod Dent Traumatol 1995;11:210-3.
Kowash MB, Fayle SA, Curzon ME. A retrospective analysis of traumatic injuries to permanent incisor teeth. Ital J Paediatr Dent 1999;2:25-30.
Saroğlu I, Sönmez H. The prevalence of traumatic injuries treated in the pedodontic clinic of Ankara University, Turkey, during 18 months. Dent Traumatol 2002;18:299-303.
Venkataramana M, Pratap K, Padma TM, Kalyan VS, Bhargava A, Varma LS. Knowledge and attitude of medical professionals towards emergency management of avulsed tooth in a teaching medical hospital, Khammam Town, South India. J Indian Assoc Public Health Dent 2016;13:183-7.
Hamilton FA, Hill FJ, Holloway PJ. An investigation of dento-alveolar trauma and its treatment in an adolescent population. Part 1: The prevalence and incidence of injuries and the extent and adequacy of treatment received. Br Dent J 1997;182:91-5.
Trope M. Clinical management of the avulsed tooth. Dent Clin North Am 1995;39:93-112.
Baginska J, Rodakowska E, Milewski R, Wilczynska-Borawska M, Kierklo A. Polish school nurses' knowledge of the first-aid in tooth avulsion of permanent teeth. BMC Oral Health 2016;16:30.
Ahuja R, Ahuja R, Thakur G. An evaluation of awareness and practices regarding management of avulsed teeth among Paediatricians in a district of North India. J Dent Med Sci 2014;13:15-7.
[Table 1], [Table 2], [Table 3]