Dentistry Section DOI : 10.7860/JCDR/2016/20682.8208
Year : 2016 | Month : Jul | Volume : 10 | Issue : 07 Page : ZC95 - ZC101

Knowledge, Awareness and Attitude towards Emergency Management of Dental Trauma among the Parents of Kolkata-An Institutional Study

Rahul Kaul1, Parul Jain2, Paras Angrish3, Subrata Saha4, Tamal Kanti Patra5, Nilanjana Saha6, Malay Mitra7

1 Post Graduate Student, Department of Pedodontics and Preventive Dentistry, Dr. R Ahmed Dental College and Hospital, Kolkata, West Bengal, India.
2 Post Graduate Student, Department of Pedodontics and Preventive Dentistry, Dr. R Ahmed Dental College and Hospital, Kolkata, West Bengal, India.
3 Post Graduate Student, Department of Pedodontics and Preventive Dentistry, Dr. R Ahmed Dental College and Hospital, Kolkata, West Bengal, India.
4 Professor, Department of Pedodontics and Preventive Dentistry, Dr. R Ahmed Dental College and Hospital, Kolkata, West Bengal, India.
5 Professor and Head, Department of Orthodontics and Dentofacial Orthopedics, Burdawan Dental College, Burdawan, West Bengal, India.
6 Assistant Professor, Department of Pedodontics and Preventive Dentistry, Dr. R Ahmed Dental College and Hospital, Kolkata, West Bengal, India.
7 Professor, Department of Pedodontics and Preventive Dentistry, Dr. R Ahmed Dental College and Hospital, Kolkata, West Bengal, India.


NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: Dr. Rahul Kaul, Room No. 2C, Department of Pedodontics and Preventive Dentistry, Dr. R Ahmed Dental College and Hospital, 114, AJC Bose Road, Kolkata-700014, West Bengal, India.
E-mail: dr.rahulkaul@gmail.com
Abstract

Introduction

Traumatic dental injuries are one of the commonly encountered dental emergencies. Missing anterior tooth in children due to any injury can be a source of considerable physical and psychological discomfort for the child. The prognosis of some dental injuries depends to a great extent on parents’ knowledge of correct and prompt emergency measures.

Aim

The purpose of this cross-divtional study was to assess the knowledge, attitude and awareness level of parents regarding the emergency management of dental trauma and to find out the relation of the responses to social variables.

Materials and Methods

A total of 2000 parents were surveyed over a period of three months using a pretested close ended questionnaire prepared in English, Hindi as well as in the regional language which was divided into three parts: Part 1 contained questions on personal information, Part 2 on an imaginary case of trauma to assess their knowledge regarding trauma management and Part 3 related to their attitude towards dental trauma management education. The data was statistically analysed using descriptive and chi-square statistics.

Results

The overall knowledge of parents regarding emergency management of trauma was not satisfactory. Although most of the people were in favour of taking professional consultation for emergency management of trauma but most of them were unaware of the steps that need to be taken on their part so as to minimize complications and improve prognosis.

Conclusion

Educational campaigns are the need of the day to increase the knowledge of parents regarding emergency management of dental trauma.

How to cite this article

Rahul Kaul, Parul Jain, Paras Angrish, Subrata Saha, Tamal Kanti Patra, Nilanjana Saha, Malay Mitra, .KNOWLEDGE, AWARENESS AND ATTITUDE TOWARDS EMERGENCY MANAGEMENT OF DENTAL TRAUMA AMONG THE PARENTS OF KOLKATA-AN INSTITUTIONAL STUDY.Journal of Clinical and Diagnostic Research [serial online]2016 Jul[cited:2019 Sep 20] 07 ZC95 - ZC101
 Available from
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Introduction

Injuries in children have become a global public health problem. In 2011, WHO projected that more than 6,30, 000 children under the age of 15 were killed by an injury. Childhood injuries are associated with high morbidity: for every injured child who dies, there are several thousand others who live on with varying degrees of disability [1].

Dental traumatic injuries remain one of the important oral health problems of childhood. They range from minor enamel chipping to extensive maxillofacial damage involving the supporting structures and displacement or avulsion of teeth.

The frequency of tooth avulsion following traumatic injuries varies from 0.5% to 16% of traumatic injuries in the permanent dentition [25] and from 7% to 13% in the primary dentition [3].

The tooth most commonly involved in avulsion in both primary as well as in permanent dentition is the maxillary central incisor [69]. Avulsion injuries are three times more common in boys than girls because of their active participation in sports and games and occur most commonly at the age of 7-9 years when permanent incisors are erupting [69].

Loss of anterior teeth can lead to an extreme psychological trauma in children, along with functional and aesthetic debilitation. Correct emergency intervention can greatly help in improving the prognosis of a traumatized tooth, ultimately helping us in preserving the smile of a child.

Prognosis of an avulsed tooth is largely determined by the viability of the periodontal ligament left on the root prior to replanation. This in turn is determined by the extra-oral dry time and the storage media [79]. Epidemiological studies on dental trauma have shown that most of the dental accidents in children occur in or around home (41%) [10], and therefore, the ultimate prognosis of an avulsed tooth occurring in a child may depend on knowledge of the correct emergency procedures by his/her parents.

The aim of this study was to assess the knowledge and attitude of parents towards the emergency management of dental trauma and to evaluate the effect of variables like age, sex, residence, educational qualifications, past experience of trauma on the responses. Before planning educational campaigns for parents, it is necessary to be aware of the knowledge level of parents. The objective was to enable the clinician to formulate a set of instructions which can be given to parents, so as to make them aware and increase their knowledge, which will help them to promptly and properly manage an emergency case of dental trauma.

Materials and Methods

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 [1113]. Prior to conducting this study; ethical approval was taken from the institutional ethical committee.

A pre tested close ended questionnaire taken from previous studies [1113] 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.

Statistical Analysis

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.

Results

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.

Descriptive data of the study population.

VARIABLESN%
Age<30 years68834.4
>30 years131265.6
EducationBelow Graduate143871.9
Above Graduate56228.1
AreaRural86643.3
Urban113456.7
GenderMale98049.0
Female102051.0
Past HistoryYes60230.1
No139869.9
Total2000100.0

[Table/Fig-2] shows overall results.

Overall results of whole sample.

QuestionCorrect Responses (n)n%Incorrect Responses (n)n%
Correct identification of tooth72836.4127263.6
Wether dental trauma is an emergency treatment or not183991.91618.1
How to control bleeding126863.473236.6
Ist tetanus toxoid necessary147073.553026.5
Urgency to seek professional advice168884.431215.6
Professional advice in absence of pain169284.630815.4
Ist place to contact158179.141920.9
Look for lost tooth103451.796648.3
Attempt reimplantation on their own42821.4157278.6
How to clean dirty tooth81340.7118759.3
What to do if knocked out tooth was broken70735.35129364.65
Correct-medium for storage of tooth till approaching a dentist41320.65158779.35
Follow up by dentist necessary1880941206
QuestionYes (n)n%No (n)n%
Ever received advice on what to do or not to do in case of dental trauma56428.2143671.8
Importance of educational program177488.722611.3
Satisfied with knowledge of trauma102551.397548.7
Wether you would like to attend educational program on trauma management169484.730615.3

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.

Distribution of parent’s response based on gender.

MaleFemaleChi-square valuep-value
n%n%
Is the damaged tooth likely to be
Correct Response35836.537036.30.0142.905278
Incorrect Response62263.565063.7
Is it an emergency treatment?
Correct Response90191.993892.00.0003.985571
Incorrect Response798.1828.0
What would you do to control bleeding?
Correct Response61863.165063.70.095.757864
Incorrect Response36236.937036.3
Do you think Tetanus toxoid is necessary in case of dental trauma?
Correct Response74776.272370.97.32310.006808*
Incorrect Response23323.829729.1
How urgent do you think is it necessary to seek professional help if a permanent tooth has been knocked out?
Correct Response83284.985683.90.36190.547459
Incorrect Response14815.116416.1
If the child doesn’t have any pain after injury, would you still go for professional advice?
Correct Response86688.482681.020.9332<0.00001*
Incorrect Response11411.619419.0
Where will you take the child i.e., the first place to contact?
Correct Response72774.285483.727.4772<0.00001*
Incorrect Response25325.816616.3
After control of bleeding will you search for the lost tooth?
Correct Response51152.152351.30.15090.697658
Incorrect Response46947.949748.7
Would you prefer to put back the knocked out tooth into the socket immediately?
Correct Response20721.122121.70.0880.766729
Incorrect Response77378.979978.3
If you decide to put back the knocked out tooth back into its socket but that had fallen onto the ground and is covered with dirt, what would you do?
Correct Response18819.220620.20.32380.569312
Incorrect Response79280.881479.8
What would you do if the ‘knocked out’ tooth was broken?
Correct Response34335.036435.70.1030.74826
Incorrect Response63765.065664.3
How would you keep the tooth till you approach a dentist?
Correct Response21521.919819.41.94780.162825
Incorrect Response76578.182280.6
Is the follow up of child by the dentist necessary?
Correct Response93195.094993.03.4070.064919
Incorrect Response495.0717.0
Have you ever received any advice on what to do and what not to do in case if any tooth has been knocked out?
Yes28729.327727.21.11870.290199
No69370.774372.8
Do you think it is important to have an educational program regarding management of trauma?
Yes86688.490889.00.21210.64509
No11411.611211.0
Are you satisfied with your knowledge regarding the management of dental trauma?
Yes45946.840239.413.53910.00114*
No43744.653852.7
Don’t Know848.6807.8
Would you like to attend an educational program on the management of dental trauma?
Yes84586.284983.23.52380.171719
No767.8999.7
Don’t Know596.0727.1

* Significant at p<0.05


Distribution of parent’s response based on Age.

<30 years>30 yearsChi-square valuep-value
n%n%
Is the damaged tooth likely to be
Correct Response25637.247236.00.29670.58594
Incorrect Response43262.784064.0
Is it an emergency treatment?
Correct Response62791.1121292.40.94410.331228
Incorrect Response618.91007.6
What would you do to control bleeding?
Correct Response44664.882262.70.91850.33785
Incorrect Response24235.249037.3
Do you think Tetanus toxoid is necessary in case of dental trauma?
Correct Response52476.294672.13.81790.050708
Incorrect Response16423.836627.9
How urgent do you think is it necessary to seek professional help if a permanent tooth has been knocked out?
Correct Response52275.9113686.636.5415<0.00001*
Incorrect Response16624.117613.4
If the child doesn’t have any pain after injury, would you still go for professional advice?
Correct Response59185.9110183.91.36390.243039
Incorrect Response9714.121116.1
Where will you take the child i.e., the first place to contact?
Correct Response54480.1103779.00.00020.987449
Incorrect Response14420.927521.0
After control of bleeding will you search for the lost tooth?
Correct Response35551.667951.80.00430.947727
Incorrect Response33348.463348.2
Would you prefer to put back the knocked out tooth into the socket immediately?
Correct Response14420.928521.70.16380.68175
Incorrect Response54479.1102778.3
If you decide to put back the knocked out tooth back into its socket but that had fallen onto the ground and is covered with dirt, what would you do?
Correct Response12217.825319.30.71270.398564
Incorrect Response56682.2105980.7
What would you do if the ‘knocked out’ tooth was broken?
Correct Response25637.244533.92.1480.142751
Incorrect Response43262.886766.1
How would you keep the tooth till you approach a dentist?
Correct Response16824.424518.79.09030.00257*
Incorrect Response52075.6106781.3
Is the follow up of child by the dentist necessary?
Correct Response64093.0124094.51.77410.182881
Incorrect Response487.0725.5
Have you ever received any advice on what to do and what not to do in case if any tooth has been knocked out?
Yes20930.435527.12.45690.117009
No47969.695772.9
Do you think it is important to have an educational program regarding management of trauma?
Yes59185.9118390.28.19670.004197*
No9714.11299.8
Are you satisfied with your knowledge regarding the management of dental trauma?
Yes30644.555542.314.78770.000615*
No30644.566951.0
Don’t Know7611.0886.7
Would you like to attend an educational program on the management of dental trauma?
Yes56482.0113086.17.53130.023153*
No7611.0997.6
Don’t Know487.0836.3

* Significant at p<0.05


Distribution of parent’s response based on Location.

RuralUrbanChi-square valuep-value
n%n%
Is the damaged tooth likely to be
Correct Response34439.738433.97.28450.006955*
Incorrect Response52260.375066.1
Is it an emergency treatment?
Correct Response79992.3104091.70.202050.652701
Incorrect Response677.7948.3
What would you do to control bleeding?
Correct Response55764.371162.70.5550.456061
Incorrect Response30935.742337.3
Do you think Tetanus toxoid is necessary in case of dental trauma?
Correct Response69179.877968.731.0456<0.00001*
Incorrect Response17520.235531.3
How urgent do you think is it necessary to seek professional help if a permanent tooth has been knocked out?
Correct Response74586.094383.23.07340.79581
Incorrect Response12114.019116.8
If the child doesn’t have any pain after injury, would you still go for professional advice?
Correct Response75387.093982.80.09850.753609
Incorrect Response11313.019517.2
Where will you take the child i.e., the first place to contact?
Correct Response66476.791780.95.20490.022524*
Incorrect Response20223.321719.1
After control of bleeding will you search for the lost tooth?
Correct Response43850.659652.60.77090.3979953
Incorrect Response42849.453847.4
Would you prefer to put back the knocked out tooth into the socket immediately?
Correct Response20623.822219.65.1760.022901*
Incorrect Response66076.291280.4
If you decide to put back the knocked out tooth back into its socket but that had fallen onto the ground and is covered with dirt, what would you do?
Correct Response11613.425922.828.7503<0.00001*
Incorrect Response75086.687577.2
What would you do if the ‘knocked out’ tooth was broken?
Correct Response29133.641636.72.0400.153188
Incorrect Response57566.471863.3
How would you keep the tooth till you approach a dentist?
Correct response17320.024021.20.42330.51592
Incorrect Response69380.089478.8
Is the follow up of child by the dentist necessary?
Correct Response82294.9105893.32.28790.130382
Incorrect Response445.1766.7
Have you ever received any advice on what to do and what not to do in case if any tooth has been knocked out?
Yes28032.329626.19.29480.002298*
No58667.783873.9
Do you think it is important to have an educational program regarding management of trauma?
Yes75387.0102190.04.65870.030897*
No11313.011310.0
Are you satisfied with your knowledge regarding the management of dental trauma?
Yes39045.047141.624.455<0.00001*
No43550.254047.6
Don’t Know414.812310.8
Would you like to attend an educational program on the management of dental trauma?
Yes75487.194082.918.46950.000098*
No839.61049.2
Don’t Know293.3907.9

* Significant at p<0.05


Distribution of parent’s response based on Education.

Below GraduateAbove Graduatechi-square valuep-value
n%n%
Is the damaged tooth likely to be
Correct Response49234.223642.010.56140.001155*
Incorrect Response94665.832658.0
Is it an emergency treatment?
Correct Response132191.951892.20.05150.820489
Incorrect Response1178.1447.8
What would you do to control bleeding?
Correct Response88661.638268.07.03980.007972*
Incorrect Response55238.418032.0
Do you think Tetanus toxoid is necessary in case of dental trauma?
Correct Response111477.535663.341.3826<0.00001*
Incorrect Response32422.520636.7
How urgent do you think is it necessary to seek professional help if a permanent tooth has been knocked out?
Correct Response125487.243477.230.569<0.00001*
Incorrect Response18412.812822.8
If the child doesn’t have any pain after injury, would you still go for professional advice?
Correct Response119082.850289.313.3880.00025324*
Incorrect Response24817.26010.7
Where will you take the child i.e.,, the first place to contact?
Correct Response109976.448285.821.283<0.00001*
Incorrect Response33923.68014.2
After control of bleeding will you search for the lost tooth?
Correct Response72950.730554.32.0680.150399
Incorrect Response70949.325745.7
Would you prefer to put back the knocked out tooth into the socket immediately?
Correct Response32122.310719.02.59010.107536
Incorrect Response111777.745581.0
If you decide to put back the knocked out tooth back into its socket but that had fallen onto the ground and is covered with dirt, what would you do?
Correct Response25517.712021.43.47460.062319
Incorrect Response118382.344278.6
What would you do if the ‘knocked out’ tooth was broken?
Correct Response47032.723742.215.91190.000066*
Incorrect Response96867.332557.8
How would you keep the tooth till you approach a dentist?
Correct Response29920.811420.30.06370.800807
Incorrect Response113979.244879.7
Is the follow up of child by the dentist necessary?
Correct Response134293.353895.74.1460.041733*
Incorrect Response966.7244.3
Have you ever received any advice on what to do and what not to do in case if any tooth has been knocked out?
Yes38626.817831.74.6550.0303096323*
No105273.238468.3
Do you think it is important to have an educational program regarding management of trauma?
Yes125587.351992.31.34010.247018
No18312.7437.7
Are you satisfied with your knowledge regarding the management of dental trauma?
Yes65745.720436.315.230.000493*
No67346.830253.7
Don’t Know1087.55610.0
Would you like to attend an educational program on the management of dental trauma?
Yes120083.449487.99.3130.009499*
No1439.9325.7
Don’t Know956.7366.4

* Significant at p<0.05


Distribution of parent’s response based on past history.

YesNochi-square valuep-value
n%n%
Is the damaged tooth likely to be
Correct Response21034.951837.10.85530.355057
Incorrect Response39265.188062.9
Is it an emergency treatment?
Correct Response55291.7128792.10.0760.782734
Incorrect Response508.31117.9
What would you do to control bleeding?
Correct Response36660.890264.52.51410.112832
Incorrect Response23639.249635.5
Do you think Tetanus toxoid is necessary in case of dental trauma?
Correct Response46577.2100571.96.19320.012824*
Incorrect Response13722.839328.1
How urgent do you think is it necessary to seek professional help if a permanent tooth has been knocked out?
Correct Response52887.7116083.07.15630.00747*
Incorrect Response7412.323817.0
If the child doesn’t have any pain after injury, would you still go for professional advice?
Correct Response52086.4117283.82.0910.148169
Incorrect Response8213.622616.2
Where will you take the child i.e., the first place to contact?
Correct Response48179.9110078.70.3760.53975
Incorrect Response12120.129821.3
After control of bleeding will you search for the lost tooth?
Correct Response33655.869849.95.8370.0156925*
Incorrect response26644.270050.1
Would you prefer to put back the knocked out tooth into the socket immediately?
Correct Response14323.828520.42.83860.092081
Incorrect Response45976.2111379.6
If you decide to put back the knocked out tooth back into its socket but that had fallen onto the ground and is covered with dirt, what would you do?
Correct Response10817.926719.10.37070.54261
Incorrect Response49482.1113180.9
What would you do if the ‘knocked out’ tooth was broken?
Correct Response25141.745632.615.16830.000098*
Incorrect Response35158.394267.4
How would you keep the tooth till you approach a dentist?
Correct Response15926.425418.217.49490.000029*
Incorrect Response44373.6114481.8
Is the follow up of child by the dentist necessary?
Correct Response57395.2130793.52.1360.143874
Incorrect Response294.8916.5
Have you ever received any advice on what to do and what not to do in case if any tooth has been knocked out?
Yes19532.436926.47.4750.0062571*
No40767.6102973.6
Do you think it is important to have an educational program regarding management of trauma?
Yes53588.9123988.60.0250.87436
No6711.115911.4
Are you satisfied with your knowledge regarding the management of dental trauma?
Yes27645.858541.86.0930.0475249*
No28948.068649.1
Don’t Know376.21279.1
Would you like to attend an educational program on the management of dental trauma?
Yes51585.5117984.33.8080.148972
No579.51188.5
Don’t Know305.01017.2

* Significant at p<0.05


Discussion

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 [1723].

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 [1214].

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 [1113], 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.

[Table/Fig-8] shows comparison of various studies.

Comparison with different studies.

ParameterPresent Study,Kolkata, IndiaRaphael &Georgey,Australia[11]Namdev et al.,Rohtak, India [12]Shashi-karan et al.,Davan-gere, India[13]Loo et al.,Chennai, India[14]Murali et al.,Salem, India[15]
Correct identification of tooth36.4%32.6%
Possibility of reimplantation/looking for lost tooth51.7%43%43.3%7%
Emergency treatment82.9%92%63.17%17.3%
Seeking professional advice immediately84.4%91.8%32.5%
Dentist as first person to contact79.1%62.5%27.2%50.9559.7%
Seeking professional advice in absence of pain84.6%32.5%
Attempting reimplantation on their own21.4%62.1%31.8%20%27.6%
Correct method of cleaning tooth18.75%54.9%46.4%54.3%
Milk as storage media of avulsed tooth9.95%5%24.3%2.25%10%6%
Attending educational program on trauma management94%95.13%87.9%
Ever received advice on what to do in case of trauma31.7%7.9%18.85%25.4%

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.

Limitation

It was an institutional study; a field survey including more institutes should have been covered to get a better idea.

No previous studies of this region were available for comparison.

Study should have involved other people like teachers, doctors etc., who deal with dental trauma.

Conclusion

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.

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