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 migration of Lithuanian oral health professionals: a survey of graduates

Aim: To assess the intentions of general dentists, dental specialists, dental hygienists, assistants and technicians graduated from Lithuanian educational institutions in 0032010 to engage in practice in foreign countries. Material and methods: A questionnaire survey was carried out among all graduates (N = 347) general dentists, dental specialists, dental hygienists, assistants and technicians in Lithuania in 2010. The response rate was 82.7%. Results: 32.4% of graduates from all oral health specialties mentioned their intentions to emigrate from Lithuania. The highest rate of emigration intentions was found among dental assistants (35.5%) and general dentistry graduates (26.9%). Factors related to higher reported intentions to emigrate were relatives or friends residing in other states, self‐rating of personal unhappiness, or residing in large cities. As many as every fourth (23.1%) dental hygienist, assistant and technician graduates had already planned, arranged and organised for emigration. Major destination countries are the UK, Ireland, Norway and Sweden. Of all oral health professionals, the highest rate of reported intentions to emigrate was among dental hygienists, assistants and technicians, therefore many of them will not join the professional community in Lithuania. Conclusion: The survey gives indications about the possible magnitude of emigration of oral health professionals from Lithuania and is the first study of its kind. The results show that Lithuania is a major sending country in the context of international oral health professionals’ migration flows.     

牙撕脱的辅助治疗方法

牙再植术是牙撕脱最基本的治疗方法,主要并发症为牙髓坏死和牙根吸收。牙撕脱的临床治疗涉及到牙髓病学、牙周治疗学、创伤外科、正畸与美学等多个学科,总体疗效较差。近年来,一些相应的辅助治疗方法,在提高患牙再植成功率和预防其术后并发症方面显示了较为优良的疗效。     

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影响牙再植的因素众多,牙再植的成功率并不高。如何改善牙再植的预后一直是儿童牙科临床面临的一大挑战。牙再植的过程一般包括患牙及牙槽窝的处理、惠牙再植和固定。辅助治疗则包括全身性抗生素的应用、局部抗菌措施、破伤风疫苗的强化等。由于牙根发育程度的不同以及惠牙根面牙周膜细胞活性状态的差异等原因,患牙的根面处理及再植后的固定措施有所差异。此外,还需根据患牙牙根发育是否完全、患牙根面是否有活性牙周膜细胞覆盖等对患牙牙髓进行相应的观察或处理。本文拟就这些方面进行简要的介绍。     

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.     

Role and models for compensation of tobacco use prevention and cessation by oral health professionals

Appropriate compensation of tobacco use prevention and cessation (TUPAC) would give oral health professionals better incentives to provide TUPAC, which is considered part of their professional and ethical responsibility and improves quality of care. Barriers for compensation are that tobacco addiction is not recognised as a chronic disease but rather as a behavioural disorder or merely as a risk factor for other diseases. TUPAC‐related compensation should be available to oral health professionals, be in appropriate relation to other dental therapeutic interventions and should not be funded from existing oral health care budgets alone. We recommend modifying existing treatment and billing codes or creating new codes for TUPAC. Furthermore, we suggest a four‐staged model for TUPAC compensation. Stages 1 and 2 are basic care, stage 3 is intermediate care and stage 4 is advanced care. Proceeding from stage 1 to other stages may happen immediately or over many years. Stage 1: Identification and documentation of tobacco use is part of each patient's medical history and included into oral examination with no extra compensation. Stage 2: Brief intervention consists of a motivational interview and providing information about existing support. This stage should be coded/reimbursed as a short preventive intervention similar to other advice for oral care. Stage 3: Intermediate care consists of a motivational interview, assessment of tobacco dependency, informing about possible support and pharmacotherapy, if appropriate. This stage should be coded as preventive intervention similar to an oral hygiene instruction. Stage 4: Advanced care. Treatment codes should be created for advanced interventions by oral health professionals with adequate qualification. Interventions should follow established guidelines and use the most cost‐effective approaches.     

Transport media for avulsed teeth: A review

Management protocols for avulsed teeth should include management of the pulp and periodontal ligament (PDL) cells in order to improve the long‐term prognosis and survival of these teeth. The use of an inappropriate transport or storage medium potentially increases the risk of PDL cell necrosis, which can result in ankylosis and replacement resorption of the tooth root. Considering the critical role of these media, an informed choice of a suitable medium is essential for a favourable outcome. The literature regarding transport media for avulsed teeth was reviewed using PubMed/MEDLINE up to February 2010. This review outlines the common storage media that are available and highlights their specific features or problems. Although HBSS, ViaSpan and Eagle's medium have great potential to maintain the PDL cells in a viable state after avulsion, the practicalities of using these solutions, the costs and the lack of ready availability to the general public make them less than ideal. Milk remains the most convenient, cheapest and readily available solution in most situations while also being capable of keeping PDL cells alive. Hence, milk remains the storage medium of choice for avulsed teeth that cannot be replanted immediately or very soon after the avulsion.     

Evaluation of long-term calcium hydroxide treatment in avulsed teeth — an in vivo study

Calcium hydroxide has been advocated for use in avulsed teeth as a temporary dressing in an attempt to prevent or inhibit external resorption. However, there have been no long-term histological studies that have examined gutta-percha versus calcium hydroxide treatment in avulsed teeth. The purpose of this study was to determine the long-term therapeutic effect of calcium hydroxide therapy in avulsed teeth. Six adult macaca monkeys were anesthetized and all four maxillary incisors were extracted and bench-dried for 25 min. The teeth were replanted and splinted with composite for approximately 2 weeks. Each animal served as its own control and the teeth were accessed, instrumented, and filled with either Ca(OH)₂ or gutta-percha and AH26 cement. All access openings were filled with composite. The Ca(OH)₂ was replaced twice during the experimental period (approximately every 8 weeks). The animals were killed between 5 and 7.5 months postavulsion. The teeth were removed, sectioned, and examined histologically by two examiners. The results of the histological evaluation of external resorption indicated that there were no statistically significant differences in resorption indices between the teeth obturated with gutta percha or with calcium hydroxide (P>0.05). Replacement resorption was the primary cause of root destruction and only a few histological sections exhibited evidence of inflammatory resorption.     

Effect of catalase supplementation in storage media for avulsed teeth

Abstract – The type of liquid medium used to store avulsed teeth prior to replantation has been shown to affect the long‐term prognosis. One possibility is that some storage media contain hydrogen peroxide (H₂O₂) that may be toxic to periodontal ligament cells. Therefore, the aim of this study was to determine if the addition of catalase to storage media improved the prognosis of replanted dog teeth. Forty‐eight mongrel premolar roots were endodontically treated, extracted, randomly divided and placed into one of four storage media: Hank's balanced salt solution (HBSS), containing no antioxidant); Viaspan, containing the antioxidant, glutathione, or the same two media supplemented with catalase(100 U ml^?1) for 1, 5, or 26 h prior to replantation. After 2 months, the dogs were euthanized and the roots histologically examined to evaluate the attachment tissues. Regardless of the storage medium used, overall healing was excellent and only 4% of the roots displayed inflammatory or replacement resorption. When roots from the different storage media were compared, those stored in HBSS were found to display the highest incidence of surface resorption (55.7%). Supplementation of HBSS with catalase resulted in a lower level of surface resorption (48.6%) that was statistically significant (P < 0.05). Roots stored in Viaspan – or + catalase displayed even lower levels of surface resorption (41.3 and 38.2%, respectively). The improvement observed with catalase‐supplemented HBSS was confined to the 45‐min incubation period; only Viaspan – or + catalase reduced surface resorption at the 5‐ and 26‐h incubations. Collectively, these data demonstrate that roots stored in media containing antioxidant activity undergo less surface resorption. These results suggest that low levels of H₂O₂ in storage media for avulsed teeth may adversely affect periodontal ligament cells.     

局部应用多西环素对脱位恒牙愈合效果的影响

目的 评价使用多西环素和生理盐水处理脱位恒牙对牙髓及牙周愈合的影响。方法 将38例患者（男22例,女16例,年龄7~14岁）的44颗脱位恒牙随机分为2组。在复位植入牙槽窝前,A组21颗牙使用0.05 mg/mL多西环素溶液浸泡5 min,B组23颗牙使用生理盐水浸泡5 min。术后定期随访并观察牙根发育情况, 使用Mann-Whitney U检验评价2组愈合情况的差异。结果 2组脱位牙之间的基本特征无显著差异。A组18颗牙被诊断为牙髓坏死,3颗牙有炎症性吸收,13颗牙有骨性黏连,6颗被拔除。B组16颗牙被诊断为牙髓坏死,4颗牙有炎症性吸收,12颗牙有骨性黏连,7颗被拔除。2组间的主要临床随访结局差异无统计学意义。结论 与生理盐水相比,使用多西环素溶液处理脱位恒牙并未显示出明显的优势。     

Use of soymilk as a storage medium for avulsed teeth

Abstract

Objective. Tooth avulsion is one of the most severe forms of dental trauma. In these cases, immediate reimplantation is ideal; however, it almost never happens. The purpose of this study was to evaluate the viability of cells stored in soymilk and compare with other several storage media. Materials and methods. The media tested were: long-shelf-life coconut water, long-shelf-life whole milk, long-shelf-life soymilk, Gatorade, egg white, and Hank's Balanced Salt Solution. Cells cultured in DMEM and distilled water served as positive and negative controls, respectively. Plates containing confluent 3T3 fibroblast were soaked in the various media for 2, 12 and 24 h. After incubation at 37°C, viability of the cells was determined using the MTS assay. Data were analyzed by using one-way ANOVA and complemented by Tukey test with a significance level of 5%. Results. Statistical analysis showed that DMEM, whole milk, HBSS and soymilk were the most effective media for maintaining cell viability at all tested times (p < 0.05), followed by coconut water, egg white and Gatorade. The least amount of viable cells was observed in the distilled water group. Conclusions. The present study shows that the efficacy of soymilk in maintaining the viability of 3T3 fibroblasts is similar to that of HBSS and milk. Therefore, it can be concluded that soymilk could be a suitable alternative storage medium for avulsed teeth.     

口腔专业人员开展临床研究的现状调查与分析

目的: 了解口腔专业人员对临床研究的知识、态度、行为及临床研究培训的需求,探讨影响临床研究知识水平的相关因素。方法: 采用自行设计的问卷,对国家口腔疾病临床研究中心（上海交通大学医学院附属第九人民医院）及其协同创新网络成员单位的口腔专业人员进行在线调查,内容包括调查对象的基本情况,对临床研究的知识、态度、行为及培训需求。采用SAS 9.4软件包对数据进行统计学分析。结果: 281名口腔专业人员参与调查,大部分调查对象对临床研究持积极态度,80%的调查对象曾经有开展临床研究的想法,但最终实施者较少（22.8%）。制约口腔专业人员开展临床研究的三大主要原因为时间少（68.3%）、团队不足（63.7%）及缺少经费支持（60.9%）。调查对象临床研究知识平均分为（13.72±7.20）分（总分38分）,经多元线性回归,医院类型、近5年主持或参与临床研究情况、近1次项目是否有流行病或统计学专家参与是调查对象知识水平高低的相关因素。结论: 口腔专业人员对临床研究态度积极,但行为与知识水平较为薄弱。加强临床研究的顶层设计离不开临床医师临床研究能力的培养。国家临床医学研究中心应发挥“国家队”使命,加快建立专业化、常态化、规模化的临床研究培训模式,为协同创新网络单位提供培训机会。     

Replantation of 45 avulsed permanent teeth: a 1-year follow-up study

Abstract –  Thirty-four patients with 45 avulsed and replanted permanent teeth were followed for 1 year. All teeth were soaked in tetracycline before replantation. In addition, enamel matrix derivative was used in teeth with dry storage times exceeding 30 min. Splinting was carried out with a non-rigid titanium splint and was limited to 7–10 days. Within that period, root canal treatment was begun in all teeth with a closed apex, whereas teeth with an open apex and ideal post-traumatic storage were not instrumented. All patients were given tetracycline systematically for 10 days. The survival rate of replanted avulsed permanent teeth was 95.6% at the 1-year follow-up. In 82.2%, root canal treatment was performed. Pulp survival was never observed, but three teeth had pulp canal obliteration. Normal periodontal healing was observed in 57.7% of teeth; 42.3% of teeth showed external root resorption (28.9% replacement resorption, 6.7% infection-related resorption, 6.7% surface resorption). The occurrence of replacement resorption correlated with the period of extraoral dry storage. Compared with other clinical studies on avulsed and replanted teeth, the present study reports a higher percentage of periodontal healing. The favorable treatment outcome may be associated with a strict protocol to enforce endodontic treatment, the use of topical and systemic tetracycline, and the relatively high number of ideally stored teeth following avulsion. In contrast, the present study has a follow-up period limited to 1 year.     

An oral health promotion program for the prevention of complications following avulsion: the effect on knowledge of physical education teachers

Abstract – The aim was to assess the knowledge levels of physical education teachers before and after a seminar, presented by dental faculty as part of a community outreach program, in which the need for immediate treatment because of avulsion of permanent teeth has been emphasized, and to compare knowledge levels of teachers who attended the seminar with those who did not. Physical education teachers attended a seminar presented by senior faculty of the Hebrew University–Hadassah School of Dental Medicine as part of an educational campaign in the community. The seminar included clear instructions on the appropriate treatment of avulsed permanent teeth, which were appropriate for physical education teachers. The teachers completed two multiple‐choice self‐administered anonymous questionnaires related to immediate treatment they could provide in cases of permanent teeth avulsion. One hundred and twenty‐six teachers completed the first questionnaire, 2 months before the seminar. One hundred teachers completed the second questionnaire 10 months after the seminar. Of these, 70 attended the seminar and 30 did not. Thirty‐two teachers who attended the seminar had completed both questionnaires. The percentage of teachers who provided expected ‘correct’ answers in the first questionnaire (11% and 16%) was significantly lower than that in the second questionnaire (23% and 68%). The percentage of teachers who provided correct answers in the second questionnaire among those who attended the seminar (24% and 69%) was not significantly different from those who did not attend the seminar (20% and 66%). An educational campaign in the community with a seminar targeted towards a cohort of physical education teachers can improve the knowledge of the teachers, even those who did not attend the seminar, probably by means of a contamination effect. Despite the improvement, which was found, the level of knowledge after the campaign remained low and more public health promotion efforts are indicated.     

Investigation of the children referred to a dental hospital with avulsed permanent incisor teeth

Abstract The management of children referred to a dental hospital because of avulsed permanent incisor teeth was considered in a retrospective study. The group consisted of 49 children between the ages of 6 and 14 years. Most of the children (60%) had their avulsed teeth stored dry while only 7% had them stored in milk, and 19% in saliva. Following avulsion the majority of the children attended a dental surgeon or general hospital. Twenty-three children contacted health care personnel within 30 minutes but only 13 had their teeth replanted in this time period. Thirty-six children had 46 incisors replanted. No relationship was demonstrated between the place or personnel who replanted the teeth, and a successful outcome.     

Efficiency of different storage media for avulsed teeth in animal models: a systematic review

Background/Aims

Tooth avulsion consists of the complete displacement of a tooth from the alveolar socket. When immediate replantation is not possible, the avulsed tooth should be kept in a storage medium capable of maintaining the viability of periodontal ligament (PDL) cells on the root surface. However, there is no consensus on the best storage medium able to prevent sequels such as ankylosis and tooth resorption. The aim of this study was to perform a systematic review to evaluate the in vivo effectiveness of different storage media for avulsed teeth.

Methods

Two reviewers performed a database search for studies published between January 1950 and December 2015 which were indexed in the PubMed, Scopus, Web of Science, and Bireme databases. An additional manual search was performed. Studies with animal models that evaluated tooth avulsion, storage media, and replantation were included. After full‐text analysis of the potentially relevant studies, the selected studies were included in the systematic review.

Results

The database search found 157 distinct studies evaluating avulsed teeth storage media. However, only six studies met the selection criteria and were included in the review. There was a high variability in the study estimates for the parameters analyzed. When assessing the quality and level of evidence of each study, one study was rated as having a very low level of evidence, four studies had low levels of evidence, and one had a moderate level of evidence.

Conclusion

As a result of data heterogeneity and limitations of the studies, there was insufficient evidence to determine the most effective storage medium for avulsed teeth.