This cross-sectional study was carried out over 2000 parents in the Outpatient Department of Pedodontics and Preventive Dentistry, Dr. R Ahmed Dental College and Hospital, Kolkata, India over a period of three months. Sample size was determined on the basis of previous studies [11–13]. Prior to conducting this study; ethical approval was taken from the institutional ethical committee.

A pre tested close ended questionnaire taken from previous studies [11–13] and then modified which contained 17 questions was used in the study. The questionnaire consisted of three different parts: Part 1-questions pertaining to personal information, Part 2 - questions based on an imaginary case of dental trauma to evaluate the knowledge and awareness of parents and Part 3 - questions related to attitude towards dental trauma management and its education.

It was first prepared in English and then translated to Hindi as well as Bangla language using ‘forward and backward blind translation’ method. Two professional translators each fluent in English and having Hindi and Bangla as their native languages forward translated the questionnaire from English to Bangla and Hindi respectively. The services of two other professionals were used to back translate the Bangla and Hindi translated versions of questionnaire. The blinding process thus helped reduce bias in translation.

The first and second authors reviewed the back translated versions. Any mismatch between the original version and the back translated version was rectified with the help of translators. A pre test was conducted on a target Bangla and Hindi speaking population with a sample of 20 patients attending the out patient department, who were given the final back translated version (i.e.,, Bangla and Hindi) of the questionnaire. As they were filling up the questionnaire, a few questions were asked so that it could be confirmed if they understood the questions in the questionnaire. Any confusion or difficulty in comprehension so highlighted was rectified instantly and the final version (in all 3 languages English, Bangla and Hindi) was used for the study.

Kappa statistics were applied to determine the intra-examiner reliability and its value was found to be 0.81 which was deemed satisfactory.

Parents accompanying children to visit OPD, aged more than 18 years and who gave their consent to participate in the survey were included in the study. Parents of special children (Children with any physical, developmental, mental, sensory, behavioural, cognitive, or emotional impairment, medically compromised children, etc.,) and those who did not give their consent were excluded.

Those 20 parents who completed the questionnaire on their first visit, were given an appointment after a week. All of them reported after one week and completed the same questionnaire. After the final version of the questionnaire was made in all three languages, the study was extended to include 2000 parents.

The nature and purpose of the study was explained to the parents in the preferred language. Its voluntary nature was emphasized and strict confidentiality was assured. Two pre-trained investigators were available throughout to make any required clarifications to the participants. Filled questionnaires were collected on the same day.

Descriptive and inferential analysis was done for the data using SPSS version 20.0. The results were tabulated and expressed as both number and percentage. Chi-square test was employed to evaluate the effect of different variables such as age, level of education, residing area, gender and previous dental trauma experience on each question.

The demographic characteristics of the participating parents as shown in [Table/Fig-1] which indicate that 43.3% parents were from rural area, 51% were females and 65.6% belonged to >than 30 years of age group. A total of 71.9% of parents were educated below graduate level and 30.1% had a previous experience of trauma to self or others.

Knowledge & Awareness: It was seen that majority of parents were not able to correctly identify the damaged front tooth in an eight-year-old child. Most of them considered it an emergency treatment and were willing to seek professional advice immediately. Majority of them were aware of methods to control bleeding which was quite encouraging.

Another finding was that most of the parents were willing to seek professional advice even if the child doesn’t have any pain after injury and for them the first place to take the child was to dental hospital after dental trauma to seek professional advice.

It was observed that half the population would search for the lost tooth after control of bleeding but most of them would not go for re-implantation of tooth by their own. Majority of the respondents were unaware of the proper method of cleaning tooth before placing it back into its socket if the tooth was dirty.

Most of the people did not know what to do if the knocked out tooth was broken similarly only a few people were aware of the correct medium to store the tooth before reaching the dentist. Most of the parents considered follow-up of the child by dentist necessary.

Attitude: Most of the parents had not ever received any advice on do’s and don’ts in case of dental trauma and they were of the opinion that it is necessary to have an educational program on management of dental trauma.

Almost half of the parents were not satisfied with their knowledge on management of dental trauma and most of them were willing to attend an educational program on management of dental trauma. [Tables/Fig-3,4,5,6 and 7] shows the number of correct and incorrect responses to Part 2 of questionnaire based on different variables and their opinion regarding Part 3 of questionnaire.

The study was carried out at Dr. R Ahmed Dental College and Hospital, Kolkata, India and included 2000 parents attending the Outpatient Department of Pedodontics and Preventive Dentistry; oldest tertiary dental care institution of India. Their knowledge, attitude and awareness regarding emergency management of trauma were assessed by virtue of a questionnaire.

Out of 2000 participants, only a few number of parents were aware that maxillary incisor is a member of the permanent dentition in an eight-year-old child. Similar results have been reported by Namdev et al., [12].

It was found that most of the parents would look for the lost avulsed tooth. It shows that many people are aware that there is a possibility of replantation following avulsion of tooth. It can also be assumed that parents want to make sure that the child didn’t accidentally swallow or ingest the tooth. In similar studies [12,14], it was found that many attendants would look for the lost tooth. These findings were contrary to those of Murali et al., and Hegde et al., where only few parents were aware of a possibility of reimplantation [15,16].

Majority of parents considered it an emergency treatment and most of them wanted to seek professional advice immediately following trauma, which was similar to results obtained from other studies [11,12]. This shows that parents are aware of the importance of emergency management, but further responses revealed that they have limited knowledge of the subsequent procedures.

Most of the parents chose dental hospital as the first place of contact after dental trauma, which was in accordance with the study done by Loo et al., [14]. Reports have indicated that there is a lack of knowledge amongst the professionals expected to deal with trauma such as physical education teachers, medical professionals and sports coaches [17–23].

Most of the times, pain is the main reason for seeking professional advice. The results of this study showed that majority of parents would seek professional advice even if the child doesn’t complain of pain. This was contrary to the findings of Namdev et al., [12].

It was found that only few parents would attempt replantation of the avulsed tooth on their own. Most of them were not willing to replant the tooth on their own. This might be due to lack of knowledge about what all has to be done at that particular point of time and place. Underconfidence, fear of hurting the child and moreover fear of bleeding prevents them from taking prompt action. Similar results have been reported by others [12–14].

Regarding cleaning of contaminated avulsed tooth, only a few parents knew the correct method to clean the tooth. Many parents chose scrubbing of the tooth and were unaware of the fact that they can severely hamper the prognosis of the tooth. Results of other studies by [11–13], suggested that most of the parents knew the correct method of cleaning the contaminated tooth.

The storage of avulsed tooth in a medium compatible with cell viability till replantation is a critical procedure. Only a small number of parents opted for milk as storage medium. Most of the others preferred ice box or ice water as storage medium. This was in accordance with findings of study by Loo et al., where only a few parents opted for milk as storage medium while most of the parents opted for water as storage medium [14]. Similarly, Murali et al., reported that majority of the parents were unaware of proper storage medium [15].

Most of the parents understood the importance of follow up and also realized the importance of an educational program on management of dental trauma. Loo et al., reported that most of people were looking forward to attend educational programs regarding management of dental trauma [14].

Educational background reflected positively on the attitude and perceived importance of immediate management of dental trauma, but it did not reflect on the knowledge of management of dental trauma. Even among the parents who were above graduate, surprisingly only a few had received some advice on what all to do in case of avulsion of a tooth. An overwhelming number of parents had never received any advice on emergency management of an avulsed tooth. Similarly other researchers [13,14] reported that only a few parents had received some advice on what to do in case of avulsion.

Dental injury accompanied by bleeding is an alarming situation which worries parents. Controlling bleeding along with maintenance of sterilization is of utmost importance at the site of injury. Interestingly, majority of parents were aware of this fact. They knew the correct method to control bleeding simultaneously maintaining sterilization and most of them were well aware of the significance of tetanus vaccination. These key issues were not included in previous studies.

A large number of parents were dissatisfied with their knowledge and were willing to attend educational programs related to management of dental trauma. This indicates the need for educational programes, which by providing information, will help improve parental awareness and increase their knowledge of the procedures required for the emergency management of an avulsed tooth.

Most healthcare providers and educators agree that it is better to prevent injury rather than dealing with the consequences of the injury. In the dental field however, more interest is shown towards the prevention and control of other dental diseases rather than towards creating awareness regarding emergency management of dental trauma.

A simple replantation of an avulsed permanent tooth in a child can make a huge difference in the prognosis of that tooth. It results in retention of that tooth for a significant number of years, thereby not compromising with speech and aesthetics of the child; thereby preventing social and psychological trauma. In addition to this, it also allows the development of alveolar bone up to its full growth potential during the critical years of growth, which also reduces the economic burden of prosthetic rehabilitation of that tooth.

Till date, in India, little has been done to educate people about this emergency situation.

Steps need to be taken to broaden the knowledge of parents. This can be done by organizing educational campaigns, mounting posters or distributing leaflets at public places. Posters depicting flow charts of what to do in case of dental trauma should be put up in all emergency departments of all hospitals and even primary health centres. In addition to this gynaecologists and pediatricians need to play a role as well. If such posters and pamphlets are there in the offices of pediatricians and gynaecologists this will help in creating more awareness; since parents and their children are in contact with them more often. Audio-visual, multimedia aids do have a significant role to play in creating such awareness. School camps can be held in which both children as well as teachers can be educated in this regard. Further studies to assess and compare the knowledge and attitude of people regarding emergency management of trauma at other places would be helpful in giving a broader perspective.

Within the limitations of this study, it can be concluded that despite the lack of proper knowledge on emergency management of dental trauma among the participants of this survey, there was willingness among parents to gain knowledge regarding emergency management of dental trauma.