Lay and professional knowledge of methods for emergency management of avulsed teeth.

Proper treatment during the first 30 minutes offers the best prognosis for traumatically avulsed teeth. This study sought to determine both lay people's and dental professionals' knowledge of and attitude to emergency procedures. A 12-question survey was administered to 5 groups: (a) parents of learner swimmers and (b) coaches of college sports teams (lay); (c) State Dental Nurses, (d) dentists and (e) dental nurse/receptionists (professional). Respondents totalled 184 (a 32, b 86, c 24, d 18, e 24) i.e. 118 lay and 66 professional. Data revealed that group b had the greatest personal experience of avulsed teeth and groups c and e the least. Public hospital accident and emergency services (A & E) were perceived by all groups as most available. 18% of lay groups could not cite an emergency service. Lay people thought first of A & E for management whereas profession groups preferred the victim's own dentist. Most professional people would replant avulsed permanent teeth and about 1/3 would replant deciduous teeth: 1/2 lay people would replant permanent teeth and 1/8 deciduous teeth. Where treatment was not straightforward lay people would seek advice before acting. Half of the lay groups would transport an avulsed tooth dry. All the professionals had had advice on management of avulsed teeth but only 1/4 of the lay groups. This study highlighted the need for educational campaigns aimed at members of the lay public likely to be involved in the emergency management of traumatically avulsed teeth.     

Knowledge of the management of paediatric dental traumas by non-dental professionals in emergency rooms in South Araucanía, Temuco, Chile

Abstract –  Aim : The objective of this study was to investigate the level of knowledge and attitudes regarding first aid for dental trauma in children (TDI) by non-dental professionals and paramedical technicians of hospital emergency rooms in the South Araucanía Health Service, Chile, which was attained through application of a survey. Materials and methods : Samples were collected from people with occupations in the respective emergency rooms. The participants were 82 people that were interviewed using a questionnaire regarding management of dental trauma. Paramedic technicians, general and specialist doctors, and nurses were included in this survey. The appraisal covered diverse aspects: birth date, age, sex, years of experience in the emergency room, and questions regarding specific dental trauma topics, which focused on crown fractures, luxation injuries in permanent dentition, avulsion in primary and permanent teeth, and the respective emergency treatments. Results : Of the participants, 78.1% reported to have been presented with a TDI patient. The majority (90.2%) had not received formal training on TDI. These results revealed a wide distribution of responses. The overall dental trauma knowledge among the participants was relatively poor. For crown fractures management 54.9% indicated that they would ask the affected child about the crown remnants. In regard to transport and storage medium of avulsed permanent teeth, only 9.8% of the participants answered correctly and 43.9% of respondents stated that they would not replant an avulsed permanent tooth, since that procedure is considered the responsibility of a dentist. Conclusions : The majority of the respondents were not knowledgeable regarding TDI or the management and benefits of timely care, particularly in cases of avulsed permanent teeth. Therefore, formal education and training on the topic is suggested during undergraduate studies.     

Lay knowledge of physical education teachers about the emergency management of dental trauma in Hong Kong

Abstract – The purpose of this study was to investigate the knowledge of a group of physical education (PE) teachers about the emergency management of dental trauma in Hong Kong. A postal questionnaire was sent to PE teachers in 100 randomly selected secondary schools in Hong Kong. A total of 166 teachers from 65 schools responded. Results show that a majority of the respondents have received formal teaching training (98.8%). While all but one teacher had received formal first aid training, only eight of them recalled that they had received advice on the management of dental trauma. Concerning the management of tooth fracture, 118 respondents (71.1%) gave an appropriate answer. In contrast, only 29 teachers (17.5%) were able to indicate the appropriate management for an avulsed tooth. Over 60% (102) of the respondents indicated it was "very urgent" to seek professional assistance if a permanent tooth has been avulsed, but they had little knowledge of the correct procedures for replanting or transporting avulsed teeth. Only 15 respondents (9%) pointed out that milk was the medium of choice for transporting avulsed teeth. Finally, over 90% (157) of respondents indicated that they had never received advice on the emergency procedures for the management of dental avulsion. The present study showed that the level of lay knowledge of management of dental injuries in a selection of PE teachers in Hong Kong is inadequate and educational campaigns are necessary to improve their emergency management of dental injuries.     

Tooth replantation after traumatic avulsion: a report of 10 cases

Abstract  – This report compares the manner in which the avulsed tooth was handled at home versus at school, and presents the different outcomes of the replanted teeth in both groups. Eighteen of 32 avulsed teeth were not replanted, and four replanted teeth could not be followed. Thus, the material comprised 10 avulsed permanent incisors of 10 traumatized children, aged between 8 and 13 years, who were treated at the Pediatric Dental Clinic of Niigata University Dental Hospital. Half of the patients avulsed the tooth at school and the other half at or near home. Of the five teeth avulsed at school, three were kept under wet conditions. The time until their replantation ranged between 0.5 and 3.5 h. Their outcomes were fairly good, except for one incisor that was extracted about 3 years later owing to the undesirable replantation procedures by the dentist. Of the avulsed teeth at or near home, three were left under dry conditions. Their time until replantation ranged scattered between 0.5 and 12 h. Of these, two incisors preserved under wet conditions survived without significant root resorption. These results suggested that information about the way to keep the avulsed tooth was relatively well known to school nurse-teachers compared with parents. Depending on the kind of lay people, it appears that it is necessary to select the best way to convey information about the management of avulsed permanent teeth.     

Parental awareness of the emergency management of avulsed teeth in children

Although public awareness campaigns on avulsed teeth have been mounted in the past, no study has investigated the knowledge parents possess of the protocol for the management of this dental emergency. The purpose of this investigation was to evaluate, by means of a questionnaire, the parental awareness of the emergency management of avulsed teeth in children. Over 2000 parents were surveyed during a four-week period at 20 suburban vacation swimming centres. The results indicated that almost two-thirds of respondents would attempt replantation of an avulsed tooth but further questioning showed they did not know the correct procedures. Thirty-three per cent of respondents were unaware of any after-hours emergency dental services. Ninety-two per cent felt they should seek professional help urgently following an avulsion injury, but their knowledge of transport media for the tooth was poor. Only 5 per cent knew that milk was the medium of choice for both washing and transporting an avulsed tooth. Ninety per cent of parents surveyed had never received advice on what to do in the event of an accident where a permanent tooth was avulsed. This study revealed the need for educational campaigns aimed at parents to increase their knowledge of the emergency procedures required when the tooth is avulsed.     

Emergency management of avulsed permanent incisors: knowledge and attitudes of teachers in 15 Irish schools

STATEMENT OF THE PROBLEM: Appropriate immediate management of an avulsed permanent incisor is critical because a delay in replantation significantly reduces the long-term prognosis of the tooth. PURPOSE OF THE STUDY: This study was designed to examine the knowledge and attitudes of teachers with regard to the emergency management of avulsed permanent incisors. MATERIALS AND METHODS: A total of 198 teachers in 15 schools in Balbriggan, Co. Dublin, or within a 15km radius of the town, were invited to take part in the study. Data were collected by use of a self-administered questionnaire, which had been employed in a previously published study. RESULTS: A total of 139 teachers returned the questionnaire, a response rate of 70.2%. While almost all (96.4%) of these teachers stated that they supervised children during sports or lunch break, the majority neither possessed a recognised first aid qualification (80.6%) nor had received advice on the management of an avulsed permanent incisor (74.8%). Perhaps unsurprisingly, the majority of respondents (81.3%) stated that they would not be prepared to replant a tooth avulsed by a child in their care. Reassuringly, however, 45.3% of respondents chose milk as an appropriate transport medium for the tooth. A total of 131 respondents (94.2%) expressed a desire for further information and advice. CONCLUSIONS: The majority of teachers possessed inadequate knowledge of emergency treatment of tooth avulsion. It is the authors' view that teachers and other individuals who supervise children in schools would benefit from instruction in dental first aid.     

Parental behavior regarding traumatically avulsed teeth: case reports

The prognosis for an avulsed tooth depends primarily on appropriate emergency management, which usually must be provided by lay people prior to the child's initial dental contact. As immediate replantation is considered the best therapy for an avulsed tooth in permanent dentition, parents should be made aware of first aid procedures for this situation. This article describes three cases involving avulsed teeth in children and discusses the parents' approaches concerning emergency procedures.     

Investigation of lay knowledge of the management of avulsed permanent incisors

Abstract The prognosis of replanted avulsed permanent incisors depends largely on prompt and appropriate emergency management. The aim of this study was to investigate lay knowledge and attitudes in this respect. Postal questionnaires were sent to all physical education teachers, school nurses and secretaries, attendants in swimming baths and leisure centres and to 220 parents of teenage children in a defined area of North West England. The overall questionnaire response rate was 86.9%. Knowledge of methods of dealing with this problem was generally inadequate in both parents and the other groups. Although 53.6% of respondents claimed to have received first aid training only 3.1% could remember dental injuries being included. There was evidence that dental health education in this field can be effective, since the highest mean knowledge score was found in the 1 1.5% of respondents who recalled receiving advice from sources such as posters, magazines and newspapers. More than 80% of the respondents stated that they would not want to replant an avulsed incisor themselves, the main reason being lack of knowledge and training. It is suggested that there is a need for potentially effective dental health education in relation to this problem.     

学龄儿童1 54颗恒前牙外伤诊治分析

目的：调查学龄儿童恒前牙外伤的相关因素,评价对脱位牙进行即刻再植治疗的效果。方法：对122例7～12岁学龄儿童恒前牙外伤病例进行调查,了解前牙外伤的相关因素,并对外伤导致的56颗脱落牙进行即刻再植治疗,随访观察1a,评价疗效。结果：跌伤为主要外伤原因,上中切牙受伤最多,左右侧无差异。单个牙外伤在所有年龄组占多数,深覆盖的儿童遭受外伤的几率较大。154颗外伤牙中,冠折89颗,占57．79％：根折9颗,占5．84％：脱位56颗,占36．36％。大多数老师及家长不了解脱位牙保存介质问题。56颗行脱位再植牙,53颗成功,成功率为94．64％。结论：学龄儿童在学校受伤较多,在日常教育中应强调儿童的自我保护意识。外伤导致脱落的年轻恒牙再植成功率高．临床效果良好。     

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目的对脱位牙再植术后龈沟液（gingival cervicular fluid,GCF）内基质金属蛋白酶（matrix metalloproteinase,MMP）-2和基质金属蛋白酶组织抑制因子（tissue inhibitor of metalloproteinase,TIMP）-2的含量进行定量分析,并研究术后不同时间段其变化规律,探讨GCF内MMP-2及TIMP-2在牙周组织改建中的作用。方法选择2010年8月至2012年3月在温州医科大学附属口腔医院就诊的20例7~13岁上颌中切牙外伤脱位患儿,参照国际牙外伤协会的年轻恒牙外伤管理指南2（2007年版）中的处理步骤行脱位牙再植术并进行固定,分别于术后第1、3、7天采集再植牙的GCF并定量测定其中MMP-2及TIMP-2的含量,比较不同时间段GCF内MMP-2及TIMP-2含量的差别,并比较MMP-2与TIMP-2比值（MMP-2/TIMP-2）的差别。结果术后第1天GCF内MMP-2及TIMP-2的含量均显著高于第3天和第7天,且术后第1天两者比值亦显著高于第3和第7天。结论脱位牙再植术后前期阶段（1~3 d）GCF中MMP-2及TIMP-2的含量变化剧烈,后期阶段（4~7 d）变化程度较小。提示MMP-2及TIMP-2可能在牙再植后牙周组织改建过程中扮演重要角色。     

Avulsed permanent incisors: knowledge and attitudes of primary school teachers with regard to emergency management

Objectives. This study was designed to examine the knowledge and attitudes of primary school teachers with regard to the emergency management of avulsed permanent incisors. Design. Data were collected by self‐administered questionnaire. Setting. The study was conducted in primary schools lying within a 2‐mile radius of the University Dental Hospital, Cardiff. Sample and methods. A total of 388 teachers in 31 participating schools were asked to complete a questionnaire, which was subsequently collected by two of the authors (CS and AT). Results. Two hundred and seventy‐four teachers returned completed questionnaires, a response rate of 70·6%. One hundred and eighty‐one respondents (60·1%) had received no advice about the emergency management of dental avulsion. Of the 133 teachers (48·5%) who possessed a first aid certificate, 39 (29·3%) had been given relevant advice as part of this training. Less than one‐third of respondents (85 (31%)) cited an optimum extra‐oral time of 30 min or less, with only 43 (15·7%) considering that this should be 10 min or less. However, 125 (45·6%) knew milk to be the best transport medium. Two hundred and four teachers (74·5%) stated that they would not be prepared to replant an avulsed tooth themselves, 133 (80%) basing this decision on lack of expertise and training. Two hundred and sixty‐two teachers (95·6%) expressed a desire for further information. Conclusions. 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.     

Dental therapists' experience in the immediate management of traumatized teeth

Abstract –  The optimal immediate management of traumatized teeth is known to be important for long-term success. One hundred and sixty-seven school dental therapists with General Certificate of Education 'Ordinary' (GCE 'O') level qualification were surveyed on their knowledge and experience on immediate management of dental trauma. The results showed only 41.2% felt comfortable with their present knowledge on the subject. A high proportion of the respondents (94.6%) indicated a need for more knowledge. All therapists concurred on the need to replant a permanent tooth and most (85.1%) agreed that this should be done within 30 min. More than half (54.8%) were not sure of the optimal storage medium for avulsed teeth. Their attitude towards acquiring knowledge in this aspect was good (80.5%) and all would take immediate action to settle appointments for trauma cases.     

Knowledge of oral health professionals of treatment of avulsed teeth

Abstract –  The management and immediate treatment of an avulsed permanent tooth will determine the long-term survival of the tooth. The aim of this study was to evaluate the knowledge of oral health professionals on the new guidelines for emergency treatment of avulsed teeth. A 12-item questionnaire was distributed among general dentists, specialists, dental hygienists and dental assistants attending Continuing Education courses at the School of Dentistry, University of Southern California, between 2003 and 2004. This study reports only on the general practitioners who comprised 83% of the participants. The results revealed an uneven pattern of knowledge among them regarding the emergency management of an avulsed tooth. Statistically significant associations were related to the participants' previous dental trauma education and their age. In conclusion, there is a need to improve the knowledge of general dentists in the current guidelines for emergency treatment of avulsed teeth.     

Unexpected formation of root-like structures subsequent to the avulsion of immature permanent teeth: Case report

This report describes the unexpected formation of root-like structures following the avulsion of immature permanent teeth without replantation. A 6-year-old female patient had avulsed the four permanent mandibular incisors and the two deciduous mandibular canines. The patient was seen in an emergency healthcare unit but did not receive specialized treatment for tooth replantation. As follow-up treatment, she received a removable prosthesis. After 4 years of follow-up, an image obtained by panoramic radiography showed formations similar to four root structures in the alveolus of the previously avulsed permanent teeth. This finding was confirmed by periapical radiography and computed tomography. This case report demonstrates that in teeth with incomplete root development, even after avulsion without replantation, cells from the pulp stump may have the capacity to form mineralized structures that appear radiographically comparable to root dentin.     

Prognosis of replanted primary incisors after injuries

Abstract – Between 1979 and 1997, 58 avulsed primary teeth were treated at the Pedodontic Clinic of Niigata University Dental Hospital. Among these, we replanted six avulsed incisors of four patients and treated two teeth of two patients replanted at other dental clinics. Referring to the clinical records, oral photographs and radiographs, we examined the injury age, cause of injury, condition of tooth storage, length of time until replantation, and also the prognosis after replantation. Three teeth of two cases remained until eruption of their permanent successors, and one tooth of one case remained under observation without extraction. Although the other four teeth of three cases resulted in extraction, no secondary infection was detected due to replantation. The following reasons were suspected for the poor prognosis of the four teeth. One avulsed tooth was not fixed immediately after replantation. One replanted tooth might not have been compatible with the alveolar socket. In the other two teeth, the periodontal vital tissues might have been removed before replantation. It is generally suggested that replantation of primary teeth is not a good option. However, from the present results, it was considered that replantation can be an effectual method when the condition of the avulsed primary tooth is suitable.     

Knowledge of physicians in hospital emergency rooms in Israel on their role in cases of avulsion of permanent incisors

Summary. Objective. The purpose of this study was to assess the knowledge of physicians in hospital emergency room care on their possible role in cases of traumatic loss of permanent incisors. Methods. A questionnaire was sent to directors of emergency room facilities in hospitals in Israel regarding the medical team at the emergency room in the hospital, availability of an in‐house dental service and existence of a protocol for management of avulsed teeth. Another questionnaire, completed by physicians in the emergency room, contained demographic questions and questions regarding their knowledge of management of avulsed permanent teeth. Results. The findings of the study showed that only 4% (12 of 335 physicians) would provide an appropriate initial treatment that, if followed by treatment by a dentist as recommended, could save the avulsed tooth. No correlation was found between knowledge of appropriate treatment of avulsed teeth and type of speciality, years of experience, previous exposure to information on trauma to the teeth and gender. The only significant association was found between physicians’ knowledge and having a dentist spouse. Most of the physicians had never attended any formal seminar or lecture or received printed instructions on the management of avulsed teeth. Conclusions. Medical students and physicians in hospitals’ emergency rooms should be made aware of their possible role in cases of avulsion of permanent teeth, in order to minimize late complications associated with such injuries. One possible way to achieve this goal is through education during and after training and introduction of a formal protocol for treatment of avulsed permanent teeth and other dental injuries.     

Knowledge of emergency management of avulsed teeth among young physicians and dentists

This study was designed to investigate the knowledge and attitude of newly graduated physicians and dentists regarding emergency management of avulsed teeth. Data were collected using a self-administered questionnaire. Thirty physicians and 30 dentists who graduated during the period 2000-2004 were surveyed. They all served in either hospitals or dental centres with emergency settings. All the participants that were asked were willing to participate. The majority of the physicians (83.3%) surveyed had not received information on what to do if a tooth is knocked-out and 96.6% did not have any dental health education course during their study. In contrast, nearly all the dentists (93.3%) had received information on what to do if a tooth is knocked-out. Regarding knowledge level, eight of the physicians (26.6%) demonstrated low knowledge while the remaining 22 (73.3%) had some knowledge; none of the physicians showed a high knowledge level. In sharp contrast, 22 dentists (78.5%) had high knowledge, six (21.4%) showed some knowledge and none demonstrated low knowledge. We conclude that emergency dental treatment is sometimes required to be provided by a physician before any dental contact. Unfortunately, the findings from this survey clearly suggest that very few physicians would provide appropriate emergency treatment. All medical staff personnel need to receive simple instructions about management of dental trauma. Most dentists had high knowledge regarding this issue; nevertheless, a few dentists, not graduated in Kuwait, were found to have limited knowledge, which needs to be improved.     

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth

Avulsion of permanent teeth is one of the most serious dental injuries, and a prompt and correct emergency management is very important for the prognosis. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the task group. The guidelines represent the current best evidence and practice based on literature research and professionals' opinion. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of avulsed permanent teeth.     

Knowledge of general practitioners dentists about the emergency management of dental avulsion in Curitiba, Brazil

Abstract –  The prognosis of traumatized teeth in general and of avulsed teeth in particular depends on prompt and appropriate treatment. Management of traumatic injuries may be a challenge to the non-specialized dentist, as they may occur when dentists are least prepared for it. The objective of this research was to investigate the knowledge of general practitioner dentists about the emergency management of dental avulsion in Curitiba, PR, Brazil. A group of 250 professionals were interviewed. The questions were related to knowledge of how to treat traumatic avulsion of teeth. The results suggest that the level of knowledge on the management of dental avulsion of the general practitioners dentists in Curitiba is adequate.     

Effect of a single dental health education on the management of permanent avulsed teeth by different groups of professionals

Abstract – Introduction: Tooth avulsion is the complete displacement of a tooth from its socket due to intentional or non‐intentional injuries. Treatment in these cases comprises tooth replantation. This accident is very critical as the success of tooth replantation is directly dependent on several factors, such as extra‐alveolar period, storage of the tooth until replantation, type of retention employed, time of endodontic intervention, type of drug prescribed, oral hygiene status as well as general health. This trauma commonly occurs during sports practice, school, and leisure activities. The first measures are critical for the prognosis of the avulsed tooth. Several studies report lack of knowledge of the population, educators, sports professionals, and health professionals in the management of tooth avulsion. This study evaluated the influence of education on different groups of professionals, addressing the knowledge and prevention and emergency management of the avulsed tooth. Method: The study was conducted on five different groups of professionals (elementary school teachers, physical education professionals, bank employees, dental doctors, and pediatricians) from the city of Brasília, DF, Brazil. The professionals attended a lecture and were evaluated by a questionnaire applied twice, before and after the lecture. Results: The results of the 479 returned questionnaires were analyzed. The difference between questionnaires before and after the lecture was statistically analyzed by the Wilcoxon test. There was statistically significant change in the performance of professional groups after information was provided (P < 0.0001). Conclusion: Education is extremely important to favor the knowledge on prevention and emergency management of an avulsed tooth, and may enhance the prognosis of tooth avulsion.