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Table of Contents
ORIGINAL ARTICLE
Year : 2018  |  Volume : 6  |  Issue : 4  |  Page : 58-63

Assessment of knowledge and attitude of school teachers regarding emergency management of dental trauma in Udaipur city, India: A cross-sectional study


Department of Pediatric and Preventive Dentistry, Pacific Dental College and Hospital, Udaipur, Rajasthan, India

Date of Web Publication14-May-2019

Correspondence Address:
Dr. Mukesh Panwar
Postgraduate Student, Department of Pediatric and Preventive Dentistry, Pacific Dental College and Hospital, Udaipur, Rajasthan.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_6_19

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  Abstract 

Background: Dental trauma is common in childhood. The home, school, and playground are the most common places where one can find a noticeable risk of traumatic injuries. Teachers are usually in proximity to children and are often called upon to provide initial care. The aim of this study was to evaluate the school teacher’s knowledge and attitude toward emergency management of dental trauma (EMDT). Material and Methods: The cross-sectional study was carried out among 400 school teachers from 24 selected schools in a city by simple cluster sampling. A closed-ended, structured, modified questionnaire was used for the survey. Data obtained from 400 completed questionnaires were statistically analyzed using descriptive statistics. Results: The study achieved around 88% response rate. Majority of school teachers accepted that their knowledge of EMDT was not enough. Maximum of teachers wanted future education in EMDT. Very few teachers reported that they were unable to provide proper action when needed in case of dental trauma. Conclusion: The present study revealed considerably low knowledge and attitude of school teachers regarding EMDT.

Keywords: Attitude, dental trauma, knowledge, school teachers, traumatic dental injuries


How to cite this article:
Panwar M, Rao D, Bhaskar SA, Panwar S. Assessment of knowledge and attitude of school teachers regarding emergency management of dental trauma in Udaipur city, India: A cross-sectional study. Int J Oral Care Res 2018;6:58-63

How to cite this URL:
Panwar M, Rao D, Bhaskar SA, Panwar S. Assessment of knowledge and attitude of school teachers regarding emergency management of dental trauma in Udaipur city, India: A cross-sectional study. Int J Oral Care Res [serial online] 2018 [cited 2019 Jul 16];6:58-63. Available from: http://www.ijocr.org/text.asp?2018/6/4/58/258115




  Background Top


Dental trauma (DT) is common in childhood,[1] causing a major psychological, social, and economic impact on children as well as parents.[2] For avulsed permanent teeth, any delay in replantation dramatically reduces the long-term prognosis and leads to loss of traumatized teeth.[3] The most common cause of DT among children is an accident because of a fall and sports activities.[4] School and home are places where one can find a noticeable risk of traumatic injuries.[5] School teachers are frequently in proximity to children and are often called upon to provide initial care.[6] There is inadequate awareness among school teachers regarding initial care for traumatized teeth reported in different studies.[7–12] The purpose of this study is to evaluate the school teacher’s knowledge and attitude toward emergency management of DT (EMDT).


  Materials and Methods Top


The present study was a cross-sectional study. Ethical clearance was obtained from the Ethical Committee of the Institution. Official permission was obtained from the head of the selected schools. Informed consent was taken from the school teachers who were willing to participate. The study was started with the listing of all registered schools in Udaipur city. Out of all registered schools, a total of 24 schools (6 schools from each region: north-east, east-south, south-west and north-west) were randomly selected with the help of the random number table. All selected schools were covered in different visits during the two-month duration. Full-time teachers who had not attended any programs regarding EMDT were selected for the study. The questionnaire was based on a previously published study.[12] It consists of sections related to demographic details, knowledge, attitude, and self-assessment regarding EMDT [Appendix]. For assessment of the validity of the questionnaire, the content and face validity were used and found satisfactory. The reliability of the questionnaire was determined by Cronbach’s alpha which was found good. A pilot study was carried out on 10 school teachers. We found that the school teachers resulted in around 68% of total attitude score and 49% of knowledge score. On this regard, the maximum sample size was calculated as 385 with input parameters α = 0.05 and P = 0.1. The questionnaire was personally distributed to a total of 452 teachers and filled on the same day. Descriptive statistics were used for analysis of data and performed with SPSS software (version 22).


  Results Top


The study achieved a response rate of 88.49%, and a total of 452 completely filled-out questionnaires were evaluated although 52 of them were excluded because of missing answers. Among 400 school teachers, 216 (54%) were women and 184 (46%) were men. Majority (42%) of the teachers were between 31 and 40 years old. About 263 (65.75%) teachers collectively agreed that they are responsible for initial care after DT. Around 354 (88.50%) teachers agreed that “Time consciousness for EMDT can play a vital role in improving tooth prognosis”; 344 (86%) accepted that their knowledge on EMDT was not enough; and 361 (90.25%) teachers felt that they need future education regarding EMDT [Table 1], [Table 2], [Table 3], [Table 4].
Table 1: Response to attitude questions (n = 400)

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Table 2: Knowledge case 1—Responses related to crown fracture questions (n = 400)

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Table 3: Knowledge case 2—Responses related to crown avulsion questions (n = 400)

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Table 4: Responses related to self-assessment (n = 400)

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  Discussion Top


In the present study, most of the school teachers have experienced a kind of DT. These findings reinforce the need for teachers to be well informed regarding EMDT. Overall findings of the present study are consistent with other previously published studies in which most of the teachers reported that they received no advice regarding traumatic dental injuries.[8],[9],[11] In our study, around 7% did not know that a fractured tooth would be a permanent tooth in a 9-year-old child. However, knowledge in this area is grossly lacking and may lead to neglect in timely and proper management of a permanent tooth that affects long-term prognosis. This finding is in contrast to the study conducted by Kaul et al.,[13] where 56.6% of the participants were knowledgeable in this field. It is important to inform the school teachers that a fractured fragment of the tooth can be reattached.[8] In our study, around 25% of teachers responded that they would look for the broken tooth piece and send the child to the dentist with it. Similarly, Vergotine et al.,[14] reported that a low number of study participants knew that a tooth fragment could be reattached. Extra-oral time and storage media are two of the most important factors preserving the periodontal ligament (PDL) cells and improving the prognosis for an avulsed tooth.[15],[16] In the present study, around 32% teachers responded that they would put the tooth in a liquid medium when transporting the tooth to the dentist if they could not put the tooth back into its socket. Also, 11% of teachers responded that fresh milk is a desirable liquid for storing a tooth that has been knocked out. Around 39% of teachers responded that 30 minutes is the ideal time limit for putting back a knocked-out tooth in the socket. Whereas in a study conducted by Mesgarzadeh et al.,[17] one in five participants were acquainted with appropriate time limits for tooth replantation.

Tetanus still remains a major public health problem in developing countries despite the widespread efforts to bring down its incidence.[18] It is recommended that if the avulsed tooth has contacted soil, and if tetanus coverage is uncertain, the patient should be referred to a physician to see whether there is a need for a tetanus booster. In our study, about 83% of teachers responded that they would investigate if the child had received a tetanus vaccine. This response was recorded by only around 30% in a study by Caglar et al.[8] In our study, approximately 14% of teachers said that they did not know what to do if the tooth falls on the dirty ground. Hence, this indicates inadequate knowledge and the need for continuous training of school teachers regarding EMDT. Milk, physiologic saline, tissue culture media, and saliva are suitable to permit periodontal healing. Some of them may not be available at the site of the accident. Milk has an osmolality within physiologic limits, and this improves the vitality of PDL cells during the extra-alveolar period. Hence, milk is superior to saliva as a storage medium.[19],[20] In our study, around 11% of teachers chose milk as a proper storage medium, similar to findings of 9%, 15%, and 10% in the studies conducted by Chan et al.,[21] Sae-Lim et al.,[22] and Mesgarzadeh et al.[17] respectively. About 10% of teachers chose saliva as an appropriate medium. It may be due to the fact that saliva is always easily available at the site of injury. This indicates that teachers are less knowledgeable regarding correct transport and storage media. Dry preserving of an avulsed tooth for more than 20–30 minutes would lead to the loss of normal physiologic metabolism and morphology of PDL cells.[15],[16] It is quite surprising to find that around 16% of participants reported that immediate treatment is required and around 39% chose 30 minutes as the maximum limit of dry time in our study. A study found, in contrast, that over 60% of study participants knew the appropriate time for emergency treatment of an avulsed tooth.[21] However, one study bears a significant lack of knowledge in this regard.[20] Hence it indicates that additional education is essential in this area of topic. Over 90% of teachers were not satisfied with their knowledge and were keen to receive more information on dental injuries. This overwhelming interest among participants has also been shown in other studies.[8],[22] Limitations of our study include, first, the use of closed-ended questions, which does not allow to find out all the possible responses. Second, because of the cross-sectional design of the study, the study participants were recruited from only a few schools in a city. Based on the findings presented in our study, we are developing a combined intervention strategy to promote the knowledge of teachers regarding EMDT. The program will provide participants with proper reaction options in different traumatic scenarios, and knowledge level will be assessed for the long term.


  Conclusion Top


The present study showed that the level of knowledge and attitude on EMDT was inadequate among school teachers.


  Recommendations Top


  1. The educational courses should be organized to enhance the knowledge and awareness of school teachers.
  2. School teachers should be provided with educational brochures, and lectures should be given by pediatric dentists.


Acknowledgements

Toward the completion of this study, the authors would like to acknowledge the principals and teachers of the schools of Udaipur city that participated for their support and cooperation during the study.

Financial support and sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.


  Appendix Top


Assessment of Attitude

Q1. A teacher isn’t responsible for caring about dental injuries in children? Strongly disagree ( ) disagree ( ) neither agree nor disagree ( ) agree ( ) strongly agree ( )

Q2. Time consciousness for emergency management of dental trauma can play a vital role in improving tooth prognosis? Strongly disagree ( ) disagree ( ) neither agree nor disagree ( ) agree ( ) strongly agree ( )

Q3. A tooth after avulsion will be lost definitely, so there is no need for any treatment? Strongly disagree ( ) disagree ( ) neither agree nor disagree ( ) agree ( ) strongly agree ( )

Q4. Dental trauma emergency management must become one of the educational priorities for teachers? Strongly disagree ( ) disagree ( ) neither agree nor disagree ( ) agree ( ) strongly agree ( )

Q5. Dental trauma management is not an emergency situation? Strongly disagree ( ) disagree ( ) neither agree nor disagree ( ) agree ( ) strongly agree ( )

Q6. Teacher intervention in school dental injuries may play a key role in traumatized tooth survival? Strongly disagree ( ) disagree ( ) neither agree nor disagree ( ) agree ( ) strongly agree ( )

Q7. Emergency management of dental trauma is thoroughly professional and requires special education and training; therefore, there is no need for teacher intervention? Strongly disagree ( ) disagree ( ) neither agree nor disagree ( ) agree ( ) strongly agree ( )

Q8. Wearing of a mouth guard should be compulsory in all contact sports? Strongly disagree ( ) disagree ( ) neither agree nor disagree ( ) agree ( ) strongly agree ( )

Q9. Having some short pertinent educational experiences, educators can provide better assistance in traumatic dental scenarios? Strongly disagree ( ) disagree ( ) neither agree nor disagree ( ) agree ( ) strongly agree ( )

Assessment of Knowledge

Case 1: During school hours, a 9-year-old child is hit in the face with a softball. His upper front tooth is broken. Otherwise, he is healthy, unhurt, and conscious.

Q1. The broken tooth is likely to be: (a) temporary tooth ( ) (b) permanent tooth ( ) (c) do not know ( )

Q2. Your immediate emergency management of the case is: (a) calm down the child and send her back to the class( ) (b) contact parents and advise them to send a child to the dentist immediately ( ) (c) look for the broken tooth piece and send the child to the dentist with it ( ) (d) don’t know what to do ( )

Case 2: A 12-year-old boy is hit in the face and his upper front tooth is missing and there is blood in his mouth. Otherwise, he is unhurt, healthy, and conscious.

Q1. The immediate emergency action you would take is: (a) stop the bleeding by compressing a cloth over the injury ( ) (b) look for the tooth, wash it and put it back in its place ( ) (c) save the tooth in a child’s mouth and look for professional help ( ) (d) place the tooth in a paper and send the child to the dentist after school time ( ) (e) don’t know what to do ( )

Q2. What type of health service would you seek first? (a) general hospital ( ) (b) dental hospital ( ) (c) general dentist ( ) (d) pediatric dentist ( )

Q3. Would you investigate if the child had a tetanus vaccine? (a) yes ( ) (b) no ( )

Q4. If the tooth has fallen on the dirty ground what would you do? (a) rinse the tooth under tap water and put it back into its socket ( ) (b) rub away the dirt by a sponge, soap and put it back in its place ( ) (c) put it back into the socket immediately without cleaning ( ) (d) discard the tooth ( ) (e) don’t know what to do ( )

Q5. How would you transport the tooth on the way to the dentist if you cannot put the tooth back into its socket? (a) put the tooth in ice ( ) (b) put the tooth in liquid ( ) (c) place the tooth in the child’s mouth ( ) (d) place the tooth in the child’s hand ( ) (e) wrap the tooth in a handkerchief or paper tissue ( )

Q6. Mark desirable liquids for storing a tooth that has been knocked out while you are on your way to the dentist. (a) tap water ( ) (b) fresh milk ( ) (c) child’s saliva ( ) (d) alcohol ( ) (e) saline solution ( ) (f) disinfecting solution ( )

Q7. Which is the best time for putting back a tooth in if it is knocked out of the mouth? (a) immediately after the accident ( ) (b) within 30min after the bleeding has stopped ( ) (c) within the same day ( ) (d) this is not a crucial factor ( ) (e) don’t know what to do ( )

Self-assessment

Q1. Is your knowledge of dental emergency management enough? (a) yes ( ) (b) no ( )

Q2. Do you need future education in this regard? (a) yes ( ) (b) no ( )

Q3. Are you able to provide proper action when needed? (a) yes ( ) (b) no ( )



 
  References Top

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O’Neil DW, Clark MV, Lowe JW, Harrington MS. Oral trauma in children: A hospital survey. Oral Surg Oral Med Oral Pathol 1989;68:691-6.  Back to cited text no. 1
    
2.
Petti S, Tarsitani G. Traumatic injuries to anterior teeth in Italian schoolchildren: Prevalence and risk factors. Endod Dent Traumatol 1996;12:294-7.  Back to cited text no. 2
    
3.
Andreasen JO, Andreasen FM, Skeie A, Hjørting-Hansen E, Schwartz O. Effect of treatment delay upon pulp and periodontal healing of traumatic dental injuries—A review article. Dent Traumatol 2002;18:116-28.  Back to cited text no. 3
    
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Krishnan B, Joseph J. Knowledge of basic dental physiology among teachers can improve preliminary management of acute dental avulsion in school children. International Journal of Clinical and Experimental Physiology 2014;1:63.  Back to cited text no. 4
    
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Young C, Wong KY, Cheung LK. Emergency management of dental trauma: Knowledge of Hong Kong primary and secondary school teachers. Hong Kong Med J 2012;18:362-70.  Back to cited text no. 5
    
6.
Yeng T, Parashos P. Dentists’ management of dental injuries and dental trauma in Australia: A review. Dent Traumatol 2008;24:268-71.  Back to cited text no. 6
    
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Blakytny C, Surbuts C, Thomas A, Hunter ML. Avulsed permanent incisors: Knowledge and attitudes of primary school teachers with regard to emergency management. Int J Paediatr Dent 2001;11:327-32.  Back to cited text no. 7
    
8.
Caglar E, Ferreira LP, Kargul B. Dental trauma management knowledge among a group of teachers in two south European cities. Dent Traumatol 2005;21:258-62.  Back to cited text no. 8
    
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McIntyre JD, Lee JY, Trope M, Vann WF Jr. Elementary school staff knowledge about dental injuries. Dent Traumatol 2008;24:289-98.  Back to cited text no. 9
    
10.
Mohandas U, Chandan GD. Knowledge, attitude and practice in emergency management of dental injury among physical education teachers: A survey in Bangalore urban schools. J Indian Soc Pedod Prev Dent 2009;27:242-8.  Back to cited text no. 10
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Feldens EG, Feldens CA, Kramer PF, da Silva KG, Munari CC, Brei VA. Understanding school teacher’s knowledge regarding dental trauma: A basis for future interventions. Dent Traumatol 2010;26:158-63.  Back to cited text no. 11
    
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Raoof M, Zaherara F, Shokouhinejad N, Mohammadalizadeh S. Elementary school staff knowledge and attitude with regard to first-aid management of dental trauma in Iran: A basic premise for developing future intervention. Dent Traumatol 2012;28:441-7.  Back to cited text no. 12
    
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Kaul R, Jain P, Saha N, Goswami S, Mukhopadhyay S, Saha S, et al. Evaluation of knowledge, awareness, and attitude toward emergency dental trauma management among the school teachers of Kolkata. Indian J Dent Res 2017;28:595-603.  Back to cited text no. 13
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Vergotine RJ, Govoni R. Public school educator’s knowledge of initial management of dental trauma. Dent Traumatol 2010;26:133-6.  Back to cited text no. 14
    
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Barrett EJ, Kenny DJ. Avulsed permanent teeth: A review of the literature and treatment guidelines. Endod Dent Traumatol 1997;13:153-63.  Back to cited text no. 15
    
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Mesgarzadeh AH, Shahamfar M, Hefzollesan A. Evaluating knowledge and attitudes of elementary school teachers on emergency management of traumatic dental injuries: A study in an Iranian urban area. Oral Health Prev Dent 2009;7:297-308.  Back to cited text no. 17
    
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Galazka A, Gasse F. The present status of tetanus and tetanus vaccination. In: Montecucco C, editor. Clostridial Neurotoxins. Current topics in microbiology and immunology. Berlin: Springer; 1995. p. 31-53.  Back to cited text no. 18
    
19.
Lindskog S, Blomlöf L. Influence of osmolality and composition of some storage media on human periodontal ligament cells. Acta Odontol Scand 1982;40:435-41.  Back to cited text no. 19
    
20.
Flores MT, Andersson L, Andreasen JO, Bakland LK, Malmgren B, Barnett F, et al.; International Association of Dental Traumatology. Guidelines for the management of traumatic dental injuries. II. Avulsion of permanent teeth. Dent Traumatol 2007;23:130-6.  Back to cited text no. 20
    
21.
Chan AW, Wong TK, Cheung GS. Lay knowledge of physical education teachers about the emergency management of dental trauma in Hong Kong. Dent Traumatol 2001;17:77-85.  Back to cited text no. 21
    
22.
Sae‐Lim V, Lim LP. Dental trauma management awareness of Singapore pre‐school teachers. Dent Traumatol 2001;17:71-6.  Back to cited text no. 22
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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