|Year : 2014 | Volume
| Issue : 3 | Page : 202-206
Knowledge, attitude, and perception of mothers towards emergency management of dental trauma in Salem district, Tamil Nadu: A questionnaire study
Kruthika Murali1, Ramesh Krishnan1, V Suresh Kumar1, Shankar Shanmugam2, Prakash Rajasundharam3
1 Department of Pedodontics and Preventive Dentistry, Vinayaka Mission Sankarachariyar Dental College, Ariyanoor, Salem, Tamil Nadu, India
2 Departments of Public Health Dentistry, J. K. K. Nattraja Dental College and Hospital, Komarapalayam, Tamil Nadu, India
3 Public Health Dentistry, K. S. Rangasamy Institute of Dental Science and Research, Tiruchengode, Tamil Nadu, India
|Date of Web Publication||2-Jul-2014|
Department of Pedodontics and Preventive dentistry, Vinayaka Mission Sankarachariyar Dental College, Ariyanoor, Salem - 636 308, Tamil Nadu
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Dental trauma is one of the main oral health problems in childhood, and can cause pain and distress. It is important to provide emergency care to combat the aftermaths of trauma. Aim: The aim of the study is to assess the knowledge and attitude of mothers regarding dental trauma and its management. Materials and Methods: A questionnaire consisting of 33 closed-ended questions were used to interview 150 mothers who participated in the study. The questions assessed the knowledge and attitude of mothers towards their child's dental visit, dental trauma, and its management. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 17.0. Results: Mother's previous experience of dental trauma when associated with the preservation of avulsed tooth of the child, those mothers who had the experience of dental trauma reported that they would discard the tooth which was found to be statistically significant (P < 0.05) when compared to the mothers with no experience of trauma. The education status of the study population when associated with the knowledge variables of avulsion, it was found that most of the variables had statistically significant association with P < 0.05. Conclusion: This study reveals that there is a lack of awareness among the mothers regarding the emergency management of dental trauma. This warrants the need of an effective communication between dental professionals and mothers for better handling of dental emergencies.
Keywords: Attitude, dental trauma, management, knowledge
|How to cite this article:|
Murali K, Krishnan R, Kumar V S, Shanmugam S, Rajasundharam P. Knowledge, attitude, and perception of mothers towards emergency management of dental trauma in Salem district, Tamil Nadu: A questionnaire study. J Indian Soc Pedod Prev Dent 2014;32:202-6
|How to cite this URL:|
Murali K, Krishnan R, Kumar V S, Shanmugam S, Rajasundharam P. Knowledge, attitude, and perception of mothers towards emergency management of dental trauma in Salem district, Tamil Nadu: A questionnaire study. J Indian Soc Pedod Prev Dent [serial online] 2014 [cited 2020 Aug 8];32:202-6. Available from: http://www.jisppd.com/text.asp?2014/32/3/202/135825
| Introduction|| |
Dental trauma during childhood leads to present and future oral health problems, which can cause pain and distress. Children encounter with many accidents in their routine activities, such as running, skating, and cycle riding. Thus, it is important to provide immediate first class emergency care to reduce the possible outcomes. ,
The prognosis of some of the dental injuries is highly dependent on correct and prompt emergency management and proper advice. This may frequently be the responsibility of the lay people available at the accident site, which proved lacking in many reports. ,,
Tooth loss in children commonly occur due to dental trauma, which may be caused by violence, accidents, falls, and sport-related activities. 
Epidemiological studies indicate that dental trauma is a significant problem in young people, and that in the near future, the incidence of trauma will exceed that of dental caries and periodontal disease in young population.  According to Andreasen and Andreasen, oral injuries are the fourth most common bodily injuries among the 7-30 year age group. , Traumatic injuries can thus have a significant effect on a child's quality of life. 
High percentage of children with dental trauma present late for treatment, possibly because of lack of awareness and knowledge among related adults, resulting in unfavorable long-term prognosis. Mother plays a significant role in a child's life, as they are the primary source of information to impart their knowledge. Forty-one percent of dental injuries occur at home,  so mothers play an important role for appropriate decision making. 
Despite the importance of this problem, there is no study available in the literature in the state of Tamil Nadu to assess the knowledge among mothers towards the emergency management of dental trauma.
Hence, the aim of the present study was to assess the knowledge and attitude of mothers in the emergency management of dental trauma.
| Materials and Methods|| |
A questionnaire was designed and one-to-one interview was done among 150 mothers of children attending the Outpatient Department (OPD) of Department of Pedodontics and Preventive Dentistry of VMS Dental College from December 2012 to February 2013.
The questionnaire contained 33 closed-ended questions for the assessment of mothers' knowledge and attitude towards their child's dental visit, dental trauma, and its emergency management. The questionnaire was prepared in both English and vernacular language (Tamil). The questionnaire was checked for the content validity by two professors in the Department of Pediatric Dentistry and it was also checked for construct validity using test-retest method following which Cronbach's alpha was calculated.
The institutional ethical committee clearance was obtained prior to the study and those mothers who were willing to participate in the study only were interviewed.
Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 17.0. Frequency distribution which includes number and percentage were calculated for the demographic variables like mother's age, place of residence, and educational status of mother. Chi-square analysis was used to test the influence of previous experience of dental trauma on the knowledge, attitude, and perception of the participants. The level of significance was set at P < 0.05.
| Results|| |
The number of participants in this survey included 150 mothers, of which five (3.3%) were from urban area, 65 (43.3%) were from semiurban area, and 80 (53.3%) were from rural area [Table 1]. Amongst the respondent mothers, 65 (43.3%) were graduates, 57 (38%) had their schooling till higher secondary, and 27 (18%) were illiterate [Table 2].
When the education status of the study population was associated with the knowledge variables related to avulsion, it was found that the degree holders showed preference in visiting a dentist (49.2%) immediately (48.8%), with the saved tooth (58.2%) wrapped in paper (58.2%) when compared to that of other groups, which was found to be statistically significant (P < 0.05).
When previous maternal experience to dental trauma was associated with the place for seeking treatment for avulsion, it was found that the mother who had dental trauma significantly (P < 0.05) preferred to visit the hospital or physician's office when compared to those who had no previous experience of dental trauma [Table 3].
|Table 3: Association between maternal experience to dental trauma and place for seeking treatment|
Click here to view
When previous maternal experience to dental trauma was associated with the preservation of the avulsed tooth (i.e., if they find the avulsed tooth outside the mouth), it was found that the mothers who had no previous experience of dental trauma responded that they would save the tooth, when compared to those mothers who had previous experience of dental trauma which was significant with P < 0.05 [Table 4].
|Table 4: Association between maternal experience of dental trauma and preservation to the avulsed tooth|
Click here to view
When the child's previous experience of dental trauma was associated with different variables related to knowledge on avulsed tooth, none was found to be statistically significant.
The questions containing the dichotomized variable as answers were analyzed separately, it was found that significant number of respondent and their children have not experienced dental trauma in their life with P < 0.05. When asked about the treatment need for avulsed teeth, almost 99% of the respondents said that treatment is needed for avulsed tooth [Table 5].
When asked about the perception of mother about their child who did not have any dental trauma and pain, about 51.7% of mother responded no treatment is required and it was found statistically significant with other options like visiting a dentist, self-medication, and taking them to general physician with P < 0.05 [Table 6]. When asked about the time of treatment required after dental trauma, about 61.6% of respondent replied that they need it immediately and was also found to be statistically significant with P < 0.05 [Table 6].
|Table 6: Response to perception of mother whose child did not have dental trauma|
Click here to view
On the contrary, the perception of mother whose child had undergone a dental trauma and experienced pain, equal amount of respondent replied that they had taken them to dentist or did not undergo any treatment [Table 7].
When asked about the perception of mother towards avulsed teeth, i.e., if they had found the avulsed tooth inside the mouth about 91.2% of the mother responded that they would remove the tooth from the mouth and if found outside the mouth, about 50.7% of mother responded that they would discard it. Both the answers were statistically significant with P < 0.05 [Table 8].
When asked, "what you will do with the avulsed tooth" about 58.2% of mother responded that they would clean the tooth with water, about 20.9% of them would not clean it and about 17.9% of them would clean it with tissue paper. When asked about the transport media for the avulsed tooth, about 94% of mothers preferred carrying in paper or cloth and none of the mothers were aware of the fact about carrying it in mouth or milk, which was found to be statistically significant with P < 0.05 [Table 9].
|Table 9: Response to perception of mother towards preservation and transport media for avulsed tooth|
Click here to view
| Discussion|| |
The questionnaire used in the present survey was short, with simple, direct, and closed-ended questions. Similar studies reported in the literature surveyed the knowledge of parents and teachers concerning the management of avulsed teeth. ,,,
The present study was conducted in an interview method as there was a lack of response in the self-reported questionnaire method in case of previous studies. 
Many reports ,,,, indicate that there is a lack of mothers knowledge regarding the immediate management of dental trauma, which was a similar finding in this study also.
The preference for seeking treatment for the avulsed teeth by 90% of the mothers was dental office, which was similar to study conducted by Oliveira et al.  (93%).
The present study found that about 50% of the mothers would discard an avulsed tooth, which was similar to the study conducted by Hegde et al.,  (64.8%) and was much higher than the study conducted by Oliveira et al.,  (10%). This may be due to the fact that they consider avulsed tooth as an infected material which needs to be thrown out.
In the present study, only 4.1% of mother would leave the avulsed tooth inside the mouth and it was much lesser than the study conducted by Oliveira et al.,  (32%), which indicates the lack of awareness among mothers.
In the present study, only 7% of the mothers were aware of the immediate reimplantation of an avulsed tooth, similar to a study reported by Al-Jundi,  whereas, the reports by Oliveira et al.,  (39%), Raphael and Gregory  (66.6%), and Hegde et al.,  (66.5%) showed that some of the mothers would reimplant the avulsed tooth, which clearly indicates the insufficiency in the knowledge about the immediate management of avulsed tooth. Therefore, the mothers need to be educated more in this aspect.
Cleaning of avulsed permanent teeth must be performed with saline solution just when visible dirt is observed. Unfortunately, about 20.9% of the mothers in the present study answered that they will not clean the avulsed tooth before going to the dentist and it was found to be slightly less (31%) when compared with the study by Oliveira et al. 
When the immediate reimplantation is not performed, storage mediums that can aid in pulpal and periodontal healing are milk, sterile saline solution, saliva, etc. But in the present study, most of the mothers responded that they would wrap the avulsed tooth in the cloth or paper (94%), which was found to be much higher when compared to the studies reported by Oliveira et al.,  (45%) and Hegde et al.  (35.8%).
The lack of experience and knowledge expressed by the parents answering the questionnaire concerning dental trauma reflects the need for more effective communication between dental professionals and parents to enable them to act correctly when facing a case of dental avulsion. Additionally, educational campaigns and preventive programs on dental trauma must be organized to improve caregivers' knowledge on emergency management of dental avulsion.
The limitations of the present study are small sample size and the trauma experienced individuals were less; so, the significance obtained in the present study cannot be extrapolated to the general population.
| Conclusion|| |
Within the limitations of the present study it can be concluded that:
- There is lack of knowledge regarding management of dental trauma among mothers with or without previous experience of dental trauma
- Presence or absence of pain does not influence the maternal perception of dental attendance for traumatic dental injuries (TDIs).
- The previous maternal experience of dental trauma does not influence the preservation of an avulsed tooth
| Acknowledgments|| |
I would like to acknowledge all the respondents who took part in this study and my mother, Mrs Meena Murali who helped a lot in giving moral support in conducting the study.
| References|| |
|1.||Andreasen JO, Andreasen FM. Essentials of traumatic injuries of the teeth. 2 nd ed. Copenhagen, Denmark: Munksgaard; 2000. p. 21-5. |
|2.||Flores MT, Andreasen JO, Bakland LK, Feiglin B, Gutmann JL, Oikarinen K, et al. International Association of Dental Traumatology. Guidelines for the evaluation and management of traumatic dental injuries. Dent Traumatol 2001;17:193-8. |
|3.||Raphael SL, Gregory PJ. Parental awareness of the emergency management of avulsed teeth in children. Aust Dent J 1990;35:130-3. |
|4.||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. |
|5.||Hamilton FA, Hill FJ, Mackie IC. Investigation of lay knowledge of the management of avulsed permanent incisors. Endod Dent Traumatol 1997;13:19-23. |
|6.||Bastone EB, Freer TJ, McNamara JR. Epidemiology of dental trauma: A review of the literature. Aus Dent J 2000;45:2-9. |
|7.||Caldas AF Jr, Burgos ME. A retrospective study of traumatic, dental injuries in a Brazilian dental trauma clinic. Dent Traumatol 2001;17:250-3. |
|8.||Andreasen JO, Andreasen FM. Dental trauma. In: Pine C, editor. Community Oral Health. London: Elsevier Science Limited; 2002. p. 94-9. |
|9.||Petersson EE, Andersson L, Sorensen S. Traumatic oral vs. non-oral injuries. Swed Dent J 1997;21:55-68. |
|10.||Zuhal K, Semra OE, Huseyin K. Traumatic injuries of the permanent incisors in children in southern Turkey: A retrospective study. Dent Traumatol 2005;21:20-5. |
|11.||Pacheco LF, Filho PF, Letra A, Menezes R, Villoria GE, Ferreira SM. Evaluation of the knowledge of the treatment of avulsions in elementary school teachers in Rio de Janeiro, Brazil. Dent Traumatol 2003;19:76-8. |
|12.||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. |
|13.||Al-Jundi SH, Al-Waeili H, Khairalah K. Knowledge and attitude of Jordanian school health teachers with regards to emergency management of dental trauma. Dent Traumatol 2005;21:183-7. |
|14.||Al-Jundi SH. Knowledge of Jordanian mothers with regards to emergency management of dental trauma. Dent Traumatol 2006;22:291-5. |
|15.||Oliveira TM, Sakai VT, Moretti AB, Silva TC, Santos CF, Machado MA. Knowledge and attitude of mothers with regards to emergency management of dental avulsion. J Dent Child (Chic) 2007;74:200-2. |
|16.||Al-Jundi SH. Dental emergencies presenting to a dental teaching hospital due to complications from traumatic dental injuries. Dent Traumatol 2002;18:181-5. |
|17.||Panzarini SR, Pedrini D, Brandini DA, Poi WR, Santos MF, Correa JP, et al. Physical education undergraduates and dental trauma knowledge. Dent Traumatol 2005;21:324-8. |
|18.||Loh T, Sae-Lim V, Yian TB, Liang S. Dental therapists' experience in the immediate management of traumatized teeth. Dent Traumatol 2006;22:66-70. |
|19.||Hegde AM, Kumar KN, Varghese E. Knowledge of dental trauma among mothers in Mangalore. Dent Traumatol 2010;26:417-21. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]