Journal of Indian Society of Pedodontics and Preventive Dentistry
Journal of Indian Society of Pedodontics and Preventive Dentistry
                                                   Official journal of the Indian Society of Pedodontics and Preventive Dentistry                           
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


ND Shashikiran, VVS Reddy, NB Nagaveni 
 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

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).



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;24:116-121


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 Dec 8 ];24:116-121
Available from: http://www.jisppd.com/text.asp?2006/24/3/116/27891


Full Text

 Introduction



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



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



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 P P P P 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.

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