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ORIGINAL ARTICLE
Year : 2006  |  Volume : 24  |  Issue : 3  |  Page : 116-121
 

Knowledge and attitude of 2,000 parents (urban and rural - 1,000 each) with regard to avulsed permanent incisors and their emergency management, in and around Davangere


Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davanagere, India

Correspondence Address:
N D Shashikiran
Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davanagere - 577 004,Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.27891

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   Abstract 

It is well recognized today that for long-term success, the management of traumatized teeth optimally should be carried out as soon as possible. Since, majority of traumatic injuries occur at home, the ultimate prognosis of an avulsed tooth may depend on knowledge of the treatment procedure, possessed by his or her parents. The purpose of this study was therefore to evaluate the parental knowledge and attitude regarding the emergency management of avulsed teeth in children (in Davangere - both urban and rural, 1,000 each).


Keywords: Parental awareness, tooth avulsion, tooth replantation


How to cite this article:
Shashikiran N D, Reddy V, Nagaveni N B. Knowledge and attitude of 2,000 parents (urban and rural - 1,000 each) with regard to avulsed permanent incisors and their emergency management, in and around Davangere. J Indian Soc Pedod Prev Dent 2006;24:116-21

How to cite this URL:
Shashikiran N D, Reddy V, Nagaveni N B. Knowledge and attitude of 2,000 parents (urban and rural - 1,000 each) with regard to avulsed permanent incisors and their emergency management, in and around Davangere. J Indian Soc Pedod Prev Dent [serial online] 2006 [cited 2019 Jul 23];24:116-21. Available from: http://www.jisppd.com/text.asp?2006/24/3/116/27891



   Introduction Top


One of the greatest assets a person can have is a ' Smile' that shows beautiful, natural teeth. Children and teenagers are especially sensitive about missing anterior teeth and there is often a conscious effort to avoid smiling. The permanent anterior teeth are not only important for esthetics but are also essential for speech [phonetics], mastication, health of supporting tissues and psychological and mental health of children. Hence, immediate replantation of avulsed or knocked out teeth [permanent incisors] more often contributes to an improved self-image and enhanced self-esteem in children. The frequency of tooth avulsion following traumatic injuries ranges from 0.5 to 16% of traumatic injuries in the permanent dentition[1],[2],[3],[4] and from 7 to 13% in the primary dentition.[2]

The tooth most commonly avulsed in both the primary and the permanent dentition is maxillary central incisor, while the lower jaw is seldom affected.[5],[6],[7],[8] Usually avulsion involves a single tooth, but multiple avulsions are occasionally encountered. Avulsion injuries are three times more frequent in boys than girls because of their active participation in sports and games and occur most commonly at 7 to 9 years of age when permanent incisors are erupting.[5],[6],[7],[8] Andreasen suggests that the loosely structured periodontal ligament surrounding the erupting teeth and elasticity of alveolar bone favors complete avulsion.[9]

Although a number of different emergency procedures have been advocated for the management of avulsed permanent tooth, immediate replantation is generally accepted as the treatment of choice.[10],[11],[12],[13],[14],[15] Replantation in the primary dentition is contraindicated because such a procedure may damage the permanent successor.[15]

The single most important factor determining the prognosis of a replanted tooth is the viability of the periodontal ligament left on the root prior to replantation.[16] To prevent dehydration of the root surface during transportation, it has been suggested that it may be placed in saliva (buccal vestibule),[10] saline,[12] milk[13] or wrapped in plastic wrap.[14] Recent studies have revealed that the storage medium must be of correct osmolarity and pH.[11],[15] Milk fulfils these requirements and as such is an excellent medium.[16] Majority of traumatic injuries occur at home and therefore the ultimate prognosis of an avulsed tooth occurring in a child may depend on the knowledge of this procedure by his or her parents.[16]

The purpose of this study was therefore to evaluate, by means of questionnaires, the parental awareness of the emergency management of avulsed teeth in children (in Davangere - both urban and rural).


   Materials and Methods Top


Source of data

This study was conducted among parents of children aged between 6 and 12 years. The total number of parents was 2,000 (1,000 parents from the urban and 1,000 from the rural area) were selected by random sampling.

Method of collection of data

A questionnaire containing about 10 questions was prepared for data collection based upon that of Raphael and Gregory's study.[16] About 2,000 questionnaires written both in Kannada and English language were personally distributed to the parents (of urban and rural area of Davangere). The respondents were then asked to tick the most appropriate correct answer from the given list of answers, in order to assess their knowledge and attitude regarding the emergency management of avulsed permanent incisors. Each list contained the correct advice or treatment options as well as incorrect ones. A sample size of 2,000 parents was estimated based on the results of a pilot study and a previous study. The nature and purpose of the study was explained to the parents in local language. Its voluntary nature was emphasized and strict confidentiality assured. Filled questionnaires were collected on the same day. Information regarding the avulsion and its emergency management as a health talk was given in local language to motivate the parents. The survey was conducted over a 4-week period. Responses obtained were tabulated and the results of the questionnaires were expressed as frequency distributions and computed in percentages. The study material was statistically analyzed using the Chi-square test.


   Results Top


A total of 2,000 parents from both urban and rural area (1,000 each) of Davangere were surveyed to ascertain the knowledge and attitude of parents regarding emergency management of avulsed permanent incisors.

Questionnaires were given to 2,000 parents, who were selected by random sampling method. The data was collected from these 2,000 parents and analyzed. The results showed the number of people who responded to each question and the nature of the response.

When both urban and rural parents were questioned about the previous experience with regard to avulsed tooth, very few among urban (47.4%) and rural (41.8%) parents had seen avulsion injuries (Graph 1) [Table - 1]. To the question of possibility of replantation of avulsed permanent incisors, 57.7% of urban and 82.8% of rural parents answered 'impossible' (Graph 2) [Table - 1]. Statistically, highly significant difference was noticed ( P < 0.001). This shows desirability of high level of awareness among rural parents compared to urban parents.

Question regarding first place of contact revealed that most of the urban parents (818, 81.8%) would consult dentists rather than doctors as compared to rural parents (201, 20.1%) (Graph 3) [Table - 1]. This shows lack of dental service in rural area. Various responses were given in relation to optimum time for which an avulsed tooth should be left out of the mouth prior to replantation or being taken to either a dentist or a doctor - 395 (39.5%) urban parents and 539 (53.9%) rural parents said they would seek professional help within a couple of hours (Graph 4) [Table - 1]. Almost 980 (98%) respondents of rural area said they would not replant an avulsed tooth themselves, because of lack of knowledge regarding replantation procedure; and very few of urban parents (188 - 18.8%) would replant an avulsed tooth themselves (Graph 5) [Table - 1]. When enquired for the cleaning agent used for dirty (soiled) avulsed tooth, 391 (39.1%) urban parents would use plain water to clean soiled avulsed tooth, 351 (35.1%) would clean with brush, 143 (14.3%) with salt water and 97 (9.7%) would do nothing. On the other hand, 696 (69.6%) rural parents said that they would clean the avulsed tooth using water (Graph 6) [Table - 1].

Both urban and rural respondents were asked about storage of the tooth while taking the child to a doctor or a dentist or a nearby hospital. The most popular method was to place the tooth in a 'paper' according to rural parents 634 (63.4%), water was chosen by 278 (27.8%), ice by 34 (3.4%) and milk by 18 (1.8%); whereas 320 (32%) of urban parents selected 'water' as transport media and others selected paper 270 (27%), antiseptic solution 194 (19.4%), ice 186 (18.6%), milk 27 (2.7%) or fruit juice 2 (0.2%) (Graph 7) [Table - 1]. Most of the urban parents 785 (78.5%) and rural parents 564 (56.4%) would contact a dentist in case of avulsed tooth with fracture, which came as a highly significant value statistically ( P < 0.001) (Graph 8) [Table - 1].

A total of 672 (67.2%) urban parents and 951 (95.1%) rural parents had not received any advice regarding emergency management (Graph 9) [Table - 1].

Finally, almost all the urban parents 920 (92%) and 751 (75.1%) rural parents showed interest in knowing about emergency management of an avulsed incisor ( P < 0.001) (Graph 10) [Table - 1]. It was found that awareness with respect to immediate management of avulsed permanent incisors in children was very poor in case of rural parents compared to the parents from urban areas.


   Discussion Top


About 474 (47.4%) urban and 418 (41.8%) rural parents showed previous experience of avulsion injury in their children. It was assumed that these people were more likely to have knowledge of the correct emergency procedures than those who had never experienced such an incident. They showed keen interest in knowing more about correct emergency procedures when a tooth gets avulsed.

Statistically, a highly significant difference ( P < 0.001) was seen among urban and rural parents when questioned about the possibility of replantation. Eight hundred twenty-eight (82.8%) rural parents said that the avulsed tooth cannot be replanted. A high level of awareness regarding immediate management of tooth avulsion is obviously desirable among rural parents than urban parents. Based on previous study,[17] awareness programs should be developed for parents to encourage them to seek treatment immediately when a traumatic dental injury occurs in their child. These programs should emphasize the possible consequences following trauma and should be extended to school teachers, so that they can consult dentists immediately after any tooth avulsion.[17]

Question about the first place of contact revealed that most rural parents would seek medical service from a doctor (44.2%) or a nearby hospital (35.7%) but not a dentist, while most urban parents (81.8%) would consult a dentist as a first place of contact. This shows lack of access to a dental clinic near the place of residence in rural areas when compared to urban areas. Bhat, Li[18] reported that avulsions were found to be the most common type of dental injuries recorded for children less than 15 years of age seeking treatment in hospital emergency rooms.

Most urban and rural parents were not aware of the desirability of replanting avulsed teeth 'immediately' or 'within half an hour.' Rural parents said that it was not possible to contact a doctor or a dentist 'immediately' because of inconvenience of transportation or because they were busy with their work. About 39.5% of urban and 36.5% of rural parents said that they would be able to contact a dentist or a doctor few days after avulsion. But studies done by Raphael and Gregory;[17] and Hamilton, Hill and Mackie[19] showed that 92 and 38.6% respondents respectively indicated it was 'very urgent' to seek professional assistance if a permanent tooth had been avulsed. However, the survey showed their knowledge of the subsequent emergency procedures was very limited. In a New Zealand study,[20] lay people suggested '2 h' (6%) and '1 day' (3%) of extra-oral period. The single most important factor to ensure a favorable outcome is the 'speed' with which the tooth is replanted.[13],[17]

A highly significant difference ( P < 0.001) was observed with respect to willingness to replant avulsed permanent tooth among urban and rural parents. Ninety-eight percent of rural parents were not ready to replant an avulsed tooth on their own. The most common reason observed was lack of knowledge about the procedure of replantation. The other worry was they were frightened of hurting the child.

Cleaning of contaminated avulsed tooth - a brief rinse in 'tap water' was the preference of both the urban (39.1%) and rural (69.6%) parents. Some of the urban parents opted for tooth brush (35.1%) to clean an avulsed tooth and some for salt water (14.3%). Only 1.8% of urban and 0.2% of rural parents chose 'milk'. Raphael and Gregory,[16] in their study, showed that 15% respondents would scrub a tooth that was dirty before replanting it, unaware they would be severely decreasing the chance of successful replantation.

Thirty-two percent of urban parents opted for a correct liquid transport medium (water), whereas 63.4% rural parents opted for 'paper' because it is easily available. But in a study by Raphael and Gregory, only 5% of respondents knew that 'milk' was the medium of choice for both washing and transporting avulsed teeth. This concept of 'dry storage' among rural parents also indicates that there is lack of knowledge in this group on how avulsed teeth should be handled after an accident. Study[11] shows that dry storage during transport would seriously prejudice normal healing and repair following replantation.

Response regarding willingness to replant a broken tooth (fractured permanent tooth) revealed more than half (78.5%) of urban parents would like to take an avulsed tooth with fracture to dentists to seek help, whereas 42.4% of rural parents said they would 'do nothing'; rather they would throw it away. Since the tooth would be broken into pieces, they said, it would be impossible to save it.

Finally, on enquiring about having received any information about tooth avulsion and its immediate treatment from a poster either at a dental clinic or health centers, in case of rural area; or from an article in either a magazine, newspaper; or from relatives or friends, 67.2% of urban and 95.1% of rural parents disappointingly said they had not received any advice regarding emergency management of avulsed tooth, supporting the study by Raphael and Gregory.[16] This shows that it is vitally important to mount posters, leaflets and media campaigns to help educate both urban and rural parents on the recommended first aid for avulsed permanent incisor teeth.

A vast majority (92%) of urban parents showed keen interest in knowing about the emergency management of the avulsed tooth compared to rural parents (75.1%). This may be because most urban parents have educational background; hence they are more enthusiastic about receiving knowledge about the emergency management of the avulsed tooth compared to rural parents, who have no such education.

From the present study, it is concluded that both urban and rural parents in and around Davangere are lacking in knowledge regarding emergency management of avulsed permanent incisors in their children. Most of the rural parents are unaware that avulsed permanent incisors can be replanted. These people, need advice and training regarding emergency management. Educational programs would be necessary to improve awareness of the immediate management of avulsed teeth. Further studies to assess and compare the knowledge and attitude among urban and rural parents in other areas regarding emergency management of avulsed teeth would give a broader prospective.

 
   References Top

1.Andreasen JO. Etiology and pathogenesis of traumatic dental injuries. A clinical study of 1,298 cases. Scand J Dent Res 1970;78:329-42.  Back to cited text no. 1  [PUBMED]  
2.Gelbier S. Injured anterior teeth in children. A preliminary discussion. Br Dent J 1967;123:331-5.  Back to cited text no. 2  [PUBMED]  
3.Hedegard B, Stalhane I. A study of traumatized permanent teeth in children 7-15 years. I. Sven Tandlak Tidskr 1973;66:431-52.   Back to cited text no. 3  [PUBMED]  
4.Ravn JJ. Dental injuries in Copenhagen schoolchildren, school years 1967-1972. Community Dent Oral Epidemiol 1974;2:231-45.   Back to cited text no. 4  [PUBMED]  
5.Andreasen JO. Traumatic injuries of the teeth. The CV Mosby Co: St. Louis; 1972.  Back to cited text no. 5    
6.Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM. Replantation of 400 traumatically avulsed permanent incisors. 1. Diagnosis of healing complications. Endod Dent Traumatol 1995;11:51-8.  Back to cited text no. 6  [PUBMED]  
7.Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM. Replantation of 400 avulsed permanent incisors. 2. Factors related to pulpal healing. Endod Dent Traumatol 1995;11:59-68.  Back to cited text no. 7  [PUBMED]  
8.Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM. Replantation of 400 avulsed permanent incisors. 3. Factors related to root growth. Endod Dent Traumatol 1995;11:69-75.  Back to cited text no. 8    
9.Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM. Replantation of 400 avulsed permanent incisors. 4. Factors related to periodontal ligament healing. Endod Dent Traumatol 1995;11:76-89.  Back to cited text no. 9  [PUBMED]  
10.Andreasen JO, Andreasen FM. Textbook and color atlas of traumatic injuries to the teeth. 3rd ed. Copenhagen; Munksgaard: 1994. p. 383-425.  Back to cited text no. 10    
11.Andreasen JO. Traumatic injuries of the teeth. 2nd ed. Copenhagen: Munksgaard; 1981. p. 203-42.  Back to cited text no. 11    
12.Haammarstrom L, Pierce A, Blomlof L. Feiglin B, Lindskog S. Tooth avulsion and replantation: A review. Endod Dent Traumatol 1986;2:1-8.  Back to cited text no. 12    
13.Andreasen JO, Kristerson L. The effect of limited drying or removal of the periodontal ligament. Periodontal healing after replantation of mature permanent incisors in monkeys. Acta Odontol Scand 1981;39:1-13.  Back to cited text no. 13  [PUBMED]  
14.Blomlof L, Lindskog S, Andersson L. Storage of experimentally avulsed teeth in milk prior to replantation. J Dent Res 1983;62:912-6.  Back to cited text no. 14    
15.Blomlof L, Andersson L, Lindskog S, Hedstrom KG, Hammarstrom L. Periodontal healing of replanted monkey teeth prevented from drying. Acta Odontol Scand 1983;41:117-23.  Back to cited text no. 15  [PUBMED]  
16.Blomlof L, Lindskog S. Influence of osmolality and composition of some storage media on human periodontal ligament cells. Acta Odontol Scand 1982;40:431-41.  Back to cited text no. 16    
17.Raphael SL, Gregory PJ. Parental awareness of the emergency management of avulsed teeth in children. Aust Dent J 1990;35:130-3.  Back to cited text no. 17  [PUBMED]  
18.Bhat M, Li SH. Consumer product-related tooth injuries treated in hospital emergency rooms: United States, 1979-87. Community Dent Oral Epidemiol 1990;18:133-8.  Back to cited text no. 18  [PUBMED]  
19.Hamilton FA, Hill FJ, Mackie IC. Investigation of lay knowledge of the management of avulsed permanent incisors. Endod Dent Traumatol 1997;13;19-23.   Back to cited text no. 19    
20.Stokes AN, Anderson HK, Cowan TM. Lay and professional knowledge of methods for emergency management of avulsed teeth. Endod Dent Traumatol 1992;8;160-2.  Back to cited text no. 20    


    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8], [Figure - 9], [Figure - 10]

    Tables

[Table - 1]


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