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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 4  |  Page : 256-260

Paediatrician's perspective and awareness regarding dental trauma and its emergency management


1 Department of Pediatric and Preventive Dentistry, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
2 Department of Intern, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India

Date of Submission15-Jul-2021
Date of Decision13-Aug-2021
Date of Acceptance17-Oct-2021
Date of Web Publication20-Dec-2021

Correspondence Address:
Akanksha Juneja
Department of Pediatric and Preventive Dentistry, Faculty of Dentistry, Jamia Millia Islamia, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrr.jdrr_120_21

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  Abstract 


Background: Traumatic injuries to dentoalveolar tissues in children are considered the most grievous oral health problem and the prognosis of these injured teeth depends on the primary care. Pediatricians must hold sufficient knowledge on primary management of dental injuries such as tooth avulsion before referring to dentists as they experience such type of dental trauma in an emergency more routinely. Objectives: To evaluate the knowledge and perception of the practicing pediatricians of New Delhi about dental trauma and its emergency management in children and adolescents and to understand the experience of Paediatricians in the primary therapy of dental trauma. Results: Fifty-seven of 60 respondents completed the questionnaire, of which 87.7% had encountered dental trauma in their career. Although 89% of respondents had received training regarding oral injuries and their management; still they felt that their knowledge was incomplete and they wanted to attend further training. Conclusion: More and more workshops and short-term courses should be conducted to improve the current knowledge of pediatricians. In the current scenario, the management of dental and dentofacial trauma should be included in the undergraduate and postgraduate programs.

Keywords: Avulsion, dental trauma, pediatrician, storage media


How to cite this article:
Sultan A, Juneja A, Bhaskar S, Siddiqui M. Paediatrician's perspective and awareness regarding dental trauma and its emergency management. J Dent Res Rev 2021;8:256-60

How to cite this URL:
Sultan A, Juneja A, Bhaskar S, Siddiqui M. Paediatrician's perspective and awareness regarding dental trauma and its emergency management. J Dent Res Rev [serial online] 2021 [cited 2022 Aug 18];8:256-60. Available from: https://www.jdrr.org/text.asp?2021/8/4/256/332916




  Introduction Top


Dental trauma in children is the most serious oral health problem, and the prognosis of these injured teeth depends upon primary care.[1] In the case of children, injuries related to the orofacial region must be dealt with urgency, as time appropriate management is the key in having favorable prognosis.[2] Following a dental injury, we take the child to the dental hospital to prevent esthetic, functional, psychological, and economic ramifications.[3] Besides, a traumatized tooth requires accurate diagnosis and planning by the treating healthcare personals from the time of reporting trauma itself. In most dental trauma, rapid and appropriate treatment can lessen its impact from both an oral health and an esthetic standpoint.[4]

When dental trauma occurs, parents, guardians, teachers, coaches, or anybody with the child during that particular time are referred to pediatric dentists or pediatric surgeons and even to doctors of various specialties, most often pediatricians.[5] Usually, during the primary interaction, doctors tend to look at the tooth injuries more like a general trauma where they focus on the wound, bleeding, and bony injury. Pediatricians play a very vital role in the immediate care in cases of traumatic dental injuries (TDI), especially in communities with limited awareness and access to dental facilities. The timely referral, awareness, and knowledge are critical in the success of dental trauma management.[6]

Most TDI can be avoided or be less in severity if extensive knowledge and awareness of these injuries existed, especially among people who frequently come across them.[6] Unfortunately, many traumatized teeth remain untreated or ill-treated thereby increasing the complications in future treatment. It leads to a much complex therapy at the time of permanent restoration at adulthood.[7]

Pediatricians must hold sufficient knowledge on primary management of dental injuries such as tooth avulsion before referring to dentists as they experience such type of dental trauma in an emergency more routinely. Pediatricians can manage to be an ideal channel, and they must have adequate awareness about urgent treatment needs and the significance of timely therapy.[6]

The study was planned to evaluate the knowledge and perception of the practicing pediatricians of New Delhi about dental trauma and its emergency management in children and adolescents and to understand the experience of Pediatricians in the primary therapy of dental trauma.


  Materials and Methods Top


The present cross-sectional survey was planned in the Department of Pediatric and Preventive Dentistry of a dental college in Delhi and was reviewed and approved by an Institutional Ethics Committee (Proposal letter no: 17/12/304/JMI/IEC/2020) This study was conducted as a questionnaire-based cross-sectional survey on 60 respondents of Delhi-NCR. A self-administered questionnaire was prepared after reviewing the old studies conducted in different countries for assessment of knowledge regarding dental trauma.[1],[2],[3],[6] Reliability and validity of these questionnaire were already tested. It included general information of respondents, information on education and employment, knowledge of emergency procedures, and the necessity for further education on the management of dental trauma. Informed consent was taken from each participant before the commencement of the study. The pediatricians practising in New Delhi City were selected and approached based on the following inclusion/exclusion criteria. Pediatricians in private practice in Delhi who had a postgraduate diploma or a Master's Degree or both, Diplomate of National Board, and other degrees in Pediatrics and agreed to participate in the survey were included. Pediatricians working in a hospital or multispecialty setups or not into practice were excluded from the study. The questionnaire was delivered to them by google forms via E-mail and WhatsApp (social media application).

Statistical analysis was performed using SPSS software (Statistical Package for the Social Sciences (SPSS) Version 17, Delhi, India). Data analysis included frequency and percentage distribution and cross-tabulation. Statistical analysis was performed using the Chi-square test (P < 0.05). Results were expressed as a number and percentage of respondents for each question.


  Results Top


Fifty-seven of 60 respondents completed the questionnaire. Results are expressed as a number and percentage of respondents for each question. The participants had varied clinical experiences. More than 70% were aged above 45 years and had a private practice of more than 15 years. Among 57 respondents analyzed, 87.7% of them had encountered dental trauma in their career [Graph 1].



The results regarding the knowledge about dental injuries and management are displayed in [Table 1]. [Table 2] mentions findings related to the education about dental injuries.
Table 1: Knowledge about dental injuries and management

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Table 2: Education about dental injuries

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Assessing the knowledge related to the avulsion of the tooth, 94.7% of pediatricians felt that the avulsed tooth could be saved. Not only that, 94.7% knew the importance of time-lapse between avulsion and reimplantation. When asked about the possible unfavorable consequences of a reimplanted tooth, 43.9% felt that the reimplanted tooth would not remain fixed, while 19.3% felt that the tooth might be rejected as a foreign body. 24.6% felt that there is a chance of spread of infection with the replanted tooth [Table 1].

When evaluated regarding the transport media for avulsed tooth, 35% preferred normal saline as medium followed by milk 29.8%, wrapped in a clean cloth 21%. 1.8% advised tap water or disinfectant solution, while 10.8% advised patient vestibule as the transport media [Table 1].

Eighty-nine percentage of respondents had received training regarding oral injuries and their management through workshops. They even wanted to attend further training to improve their knowledge regarding the same [Graph 1] and [Graph 2].




  Discussion Top


TDI are a complex problem which if not treated, can adversely affect the growth, esthetics, and psychosocial development of the child.[8] In case of dental injuries, parents tend to approach health professionals of all fields. It could be a dentist, ENT Specialist and/or Pediatrician. Hence, this study was conducted to investigate Paediatrician' awareness and understand their perspectives on dental trauma and its emergency management. Pediatricians working in a hospital or multispecialty setups or not into practice were excluded because, in the hospital or multispecialty setups, patients regularly report in an emergency with maxillofacial injuries and associated dental trauma, hence it would have created a bias in the results. This study aimed at assessing the practicing Paediatricians who see daya to day patients in their clinic, hence multispeciality setups affiliated or nonpracticing respondents were excluded.

After assessing the results, it appears that knowledge regarding management amongst paediatricians is not adequate. The current study did give an encouraging sign, with 70% of the respondents being familiar with cases of Dental trauma. However, out of the rest 30%; 18% had seen dental trauma cases only once in their practice and 12% had never seen any case. When compared with other studies, this percentage was low as 44.7% as reported by Atas and Gok (2020)[8] to as high as 95% (Nikolic et al., 2018). In the study conducted by Chanchala et al.[6] in 2016, this percentage was found to be 65.5%.

The respondents of the current study are practicing Pediatrician of the Delhi NCR region catering to a densely populated area of all socioeconomic status. Furthermore, the awareness in the general population regarding dental health and visiting dentists in case of TDI is low;[9] a possible explanation as to why a very high percentage of respondents have seen dental trauma cases in their practice.

Avulsion of the dental tooth is a kind of trauma when parents tend to visit the nearby doctor immediately for consultation. In the current study, it was observed that 86% of the respondents were familiar with this term.

Bahammam (2018)[1] observed in his study that only 68.9% of emergency physicians were familiar with the term Avulsion, while researchers in their study, observed this percentage to be 67.5% (Kumar et al.)[10] and 33.3% (Atas and Gok).[8]

64.9% of Pediatrician responded that they would hold an avulsed tooth by the crown. When compared with studies conducted by Dali et al.[11] and Atas and Gok,[8] this percentage was found to be higher. Nikolic et al.[2] conducted a study to assess the knowledge of Paediatricians of Croatia and observed that almost 75% knew the correct way to hold the avulsed tooth. Another aspect that needs to be considered seriously is that in the current study, 26.3% of respondents did not want to touch the tooth. Though they knew how to hold the avulsed tooth, 43.9% believed that even after reimplantation, the tooth would not sustain and exfoliate. 24.6% believed that this implanted tooth would spread the infection to the surrounding tissue.

The period for which an avulsed tooth remains extra orally is a crucial factor in deciding the prognosis of the tooth post reimplantation. A suitable transport media helps maintain the viability of periodontal cells present on the root, thereby preventing ankyloses or resorption. Hank's Balanced Salt Solution (HBSS) and ViaSpan are considered the best transport media, however not freely available and are expensive.[12],[13] Milk is a media that is available easily, cheap and one of the ideal mediums to maintain the viability of cells.[8],[14],[15] A dry media like wrapping the tooth in a dry cloth etc., is not recommended as it causes irreversible damage to the cells and increases the chances of failure in case of reimplantation. 15 96% of the respondents in the study understood the importance of extraoral time in case of avulsed tooth. Though 73.7% of respondents had heard about HBSS; still the transport media advised by them to the patient was normal saline (31%), milk (29.8%), Clean and dry cloth (21.1%), Tap water (1.8%) and patient's vestibule (10.8%).

When we compared the results, it was found that Normal saline was chosen for about 21.3% to 60% of studies.[1],[2],[10] An alarming aspect observed in the current study was that 21% of respondents believed in dry media as the best way of transport for avulsed tooth;

Another finding of the study was that only 42.9% believed in referring a patient with trauma to the oral cavity to the dental professional, while 57% only prescribed medication and gave them tetanus shots. It is a startling finding because despite having some knowledge regarding dental trauma, the understanding and awareness are incomplete.

Pediatricians need to have the necessary knowledge and understanding so that precise and timely aid, can be given to patients with dental trauma. A multidisciplinary approach is needed when dealing with a patient of dental trauma, where dental and medical health professionals come together and provide prompt referral and timely treatment. It is evident from the current study that pediatricians do not have sufficient awareness about dental trauma in children and, more than 90% are interested in attending courses on the same. Hence, there is a need for new short-term courses on dentofacial trauma management for medical professionals. These courses can be a part of postgraduate programs, which will ultimately improve their knowledge and handling of cases of dental trauma.

This current study has some limitations; it was conducted on a small sample in Delhi NCR. Also, the questionnaire focused primarily on knowledge regarding tooth avulsion and its management and did not include other forms of trauma.


  Conclusion Top


This study demonstrates that although most pediatricians have seen cases of dental trauma in their practice, they still do not have enough knowledge and awareness regarding the same. More and more workshops and short-term courses should be conducted to improve the current knowledge of Pediatricians. In the current scenario, the management of dental and dentofacial trauma should be included in the undergraduate and postgraduate programs. This will make them understand the severity of the condition which in turn will help provide multidisciplinary treatment to the patient. Due to the limitation of small sample size, more studies are needed to regularly assess their awareness regarding dental trauma.

Ethical clearance

Institutional Ethics Committee clearance obtained (letter no: 17/12/304/JMI/IEC/2020).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bahammam LA. Knowledge and attitude of emergency physician about the emergency management of tooth avulsion. BMC Oral Health 2018;18:57.  Back to cited text no. 1
    
2.
Nikolic H, Ivancic Jokic N, Bakarcic D, Hrvatin S, Jakljevic N. Knowledge about emergency procedure in case of dental trauma among paediatricians in Croatia. Eur J Paediatr Dent 2018;19:277-81.  Back to cited text no. 2
    
3.
Alyasi M, Al Halabi M, Hussein I, Khamis AH, Kowash M. Dentists' knowledge of the guidelines of traumatic dental injuries in the United Arab Emirates. Eur J Paediatr Dent 2018;19:271-6.  Back to cited text no. 3
    
4.
Flores MT, Andreasen JO, Bakland LK. Guidelines for the evaluation and management of traumatic dental injuries note. Dent Traumatol 2001;17:145-8.  Back to cited text no. 4
    
5.
Ulusoy AT, Onder H, Cetin B, Kaya S. Knowledge of medical hospital emergency physicians about the first-aid management of traumatic tooth avulsion. Int J Paediatr Dent 2012;22:211-6.  Back to cited text no. 5
    
6.
Chanchala HP, Shanbhog R, Ravi MD, Raju V. Pediatricians' perspectives on dental trauma management: A cross-sectional survey. J Indian Assoc Public Health Dent 2016;14:419-23.  Back to cited text no. 6
  [Full text]  
7.
Suganya M, Vikneshan M, Hiremath A. Timely management of knocked out teeth – Are the nurses aware? J Clin Nurs 2017;26:1257-63.  Back to cited text no. 7
    
8.
Atas O, Gok A. Evaluation of knowledge levels and attitudes of pediatricians on traumatic dental injuries. Ann Med Res 2021;28:43-8.  Back to cited text no. 8
    
9.
Juneja A, Sultan A, Siddiqui M. A retrospective evaluation of traumatic dental injuries in children visiting dental setup in Delhi NCR. Int J Curr Res Rev 2020;12:78-81.  Back to cited text no. 9
    
10.
Kumar S, Sajjanar AB, Athulkar M, Sajjanar J, Shewale A, Wasnik M, et al. The status of knowledge related to the emergency management of avulsed tooth amongst the medical practitioners of Nagpur, Central India. J Clin Diagn Res 2017;11:ZC21-4.  Back to cited text no. 10
    
11.
Dali M, Naulakha D, Rajbanshi L. Practice in emergency management of avulsed tooth among medical doctors in Nobel medical college, Biratnagar, Nepal: A cross sectional survey. Int J Dent Health Sci 2014;1:3-12.  Back to cited text no. 11
    
12.
Poi WR, Sonoda CK, Martins CM, Melo ME, Pellizzer EP, de Mendonça MR, et al. Storage media for avulsed teeth: A literature review. Braz Dent J 2013;24:437-45.  Back to cited text no. 12
    
13.
Andreasen JO, Andreasen FM. Textbook and Color Atlas of Traumatic Injuries to the Teeth. Munksgaard: Copenhagen; 2008.  Back to cited text no. 13
    
14.
Zampogna S, Filippo S, Talarico V, Aloe M, Severini N, Pizzi S, et al. First aid in dental trauma in pediatric age. Ital J Pediatr 2014;40 (Suppl 1):A72.  Back to cited text no. 14
    
15.
Trope M. Avulsion of permanent teeth: Theory to practice. Dent Traumatol 2011;27:281-94.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2]



 

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