|Year : 2017 | Volume
| Issue : 1 | Page : 63-67
Assessment of knowledge and attitude before and after a health education program in East Madurai primary school teachers with regard to emergency management of avulsed teeth
M Taranath1, RM Senaikarasi1, Kavita Manchanda2
1 Department of Public Health Dentistry, Best Dental Science College, Madurai, Tamil Nadu, India
2 Department of Public Health Dentistry, Awadh Dental College and Hospital, Jamshedpur, Jharkhand, India
|Date of Web Publication||31-Jan-2017|
R M Senaikarasi
71/72, R.R. Layout, R.S. Puram, Coimbatore - 641 002, Tamil Nadu
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: Children attend primary school from as early as 6 years to the mixed dentition stage of about 9 years and spend most of their time in school along with the teachers. School teachers are likely to be among the first to see a child immediately after an injury has occurred, and their knowledge regarding emergency procedures is critical to ensure good prognosis of the clinical treatment. Purpose: The purpose of the study was to evaluate, by means of a questionnaire, the primary school teacher's knowledge and attitude with regard to emergency management of traumatized avulsed teeth and to test the effectiveness of a health education tool. Methodology: A total of 214 primary school teachers from 24 government schools, in and around East Madurai Panchayat, participated in a 3-month long study. Baseline data were collected using a pretested questionnaire in the 1st month. Based on that data, a health educational tool was prepared. The final assessment was made using the same questionnaire in the 3rd month. Baseline data and final data were compared using Z-test. Results: The knowledge level of 70.83% of primary school teachers was in the very good category after the health education tool, which was initially nil. Similarly, the attitude level also raised drastically with 0.90% initially in the very good category, and after the health education tool, it was 41.20%. Conclusion: From this study, the importance of the need for the steps to increase the knowledge about the emergency management of avulsion is clearly understood. Thus, the main implication of the study is that a health educational tool regarding the emergency management of avulsion is necessary for the primary school teachers during their teacher training program.
Keywords: Attitude, avulsion, dental, emergency, knowledge, management, teacher
|How to cite this article:|
Taranath M, Senaikarasi R M, Manchanda K. Assessment of knowledge and attitude before and after a health education program in East Madurai primary school teachers with regard to emergency management of avulsed teeth. J Indian Soc Pedod Prev Dent 2017;35:63-7
|How to cite this URL:|
Taranath M, Senaikarasi R M, Manchanda K. Assessment of knowledge and attitude before and after a health education program in East Madurai primary school teachers with regard to emergency management of avulsed teeth. J Indian Soc Pedod Prev Dent [serial online] 2017 [cited 2021 Jan 26];35:63-7. Available from: https://www.jisppd.com/text.asp?2017/35/1/63/199218
| Introduction|| |
Several epidemiological studies show that the majority of traumatic dental injuries in school-aged children occur at home or school.,,,,, Among dental traumatic injuries, avulsion results for major functional and esthetic disturbances for patients. If possible, an avulsed permanent tooth should be reimplanted., However, the appropriate immediate treatment is often not performed due to a lack of knowledge among laypersons who generally provide the initial management before the child's contact with a dentist. Postponement of evaluation by a dentist has been found to have an adverse effect on the prognosis of an avulsed tooth. Thus, storage in a medium until replantation is fundamental. Furthermore, it is important to be aware that replantation should not be performed when a primary tooth has been avulsed as there is a risk of injury to the underlying germ of the permanent successor. School teachers are likely to be among the first to see a child immediately after an injury has occurred, and their knowledge regarding emergency procedures is critical to ensure good prognosis of the clinical treatment. Hence, the aim of this study is to assess the knowledge and attitude of the primary school teachers from 24 government primary schools in and around East Madurai Panchayat, regarding the emergency management of dental trauma and tooth avulsion and also to test the effectiveness of a health educational tool.
| Methodology|| |
This study was done for a duration of 3 months. The simple random sampling method was used. The study population consisted of 214 primary school teachers from 24 government primary schools, in and around East Madurai Panchayat. The sample size was statistically determined. The ethical clearance was obtained to visit the schools.
A questionnaire was designed and modified from those used in New Zealand and Australia studies., It consisted of two parts. Part I contained survey questions regarding the teacher's educational background, teaching experience, and demographic details. Part II contained questions to assess the attitude and knowledge levels about emergency management of dental trauma and tooth avulsion.
A pilot study was conducted which served as a preliminary study to identify any organizational and technical problem. The questionnaire was then distributed to 214 primary school teachers after assuring them of strict confidentiality. A health education program was designed based on the baseline assessment, and the program contained a short power point presentation along with a demonstration using a typodont model, about the emergency management of avulsed teeth. The program was presented by the investigator to the teachers a month later following baseline assessment. The effectiveness of the health educational program was assessed using the same questionnaire in the following month.
Using the arbitrary scaling, knowledge and attitude levels were categorized into four as in [Table 1] and [Table 2], respectively. Z-test was used for calculating the proportions.
| Results|| |
The sample consisted of 81.3% of female teachers and 18.7% of male teachers. 71% of the teachers have obtained medical first aid training during their teacher training program while only 18.72% of the teachers have obtained dental first aid training during their teacher training program.
About 99% of the teachers were aware that a milk tooth on avulsion does not require replantation but the awareness that a permanent avulsed tooth can be replaced increased after the health education tool increased and it was statistically extremely significant, P < 0.0001 [Table 3].
|Table 3: Distribution of correct answers regarding the replantation of avulsed teeth|
Click here to view
In case of an avulsed tooth falling on the ground, 50.50% of the teachers would handle the tooth by holding the root portion and 50.40% of the teachers considered cleaning of the avulsed teeth before replantation is necessary. After health education tool, 90.60% of the teachers considered that crown portion is the preferable part to handle an avulsed tooth and 99.0% of the teachers considered cleaning to be a necessary step. The knowledge about the method of cleaning an avulsed tooth before replantation also increased in a statistically extremely significant way (P < 0.0001) after the health education tool [Table 4].
|Table 4: Distribution of primary school teachers according to the answers for method of cleaning|
Click here to view
Before the health education tool, only 33.60% of the teachers were aware that an avulsed tooth should be replanted within 30 min to 1 h. After the health education tool, 94.40% of the teachers were aware of the extra oral time of an avulsed tooth.
The vast majority of teachers (97.2%) stated they would not be able to replant the avulsed tooth and would report to a dentist. Before the health education tool teachers preferred milk (14.89%), water (74.04%), saline solution (62.55%), and child's saliva (35.19%), but after the health education tool, there was a change in the preferred medium. 86.81% of the teachers preferred milk, 93.62% of them preferred water, 94.89% of them preferred saline solution, and 78.72% preferred child's saliva. The increase was statistically extremely significant, P < 0.0001.
The knowledge and attitude levels were increased drastically after the health education program [Table 5] and [Table 6]. Significant findings were in the fact that there was not a single teacher whose knowledge could be considered as very good before the educational program as compared to 158 (70.83%) after the program.
| Discussion|| |
Children between 8 and 12 years of age are the ones most commonly affected by dental trauma. Because of increase in the incidence of dental trauma episodes, it is almost certain that more children will suffer from avulsion injuries in their permanent teeth in future. The single most important factor in the success of replantation is the speed with which the tooth is positioned back in its socket. In this study, 38.6% teachers gave correct answer regarding the extra-alveolar dry time that is within 30 min. The study conducted by Zakirulla et al. also revealed the similar results. On the contrary, the study conducted by Sai Sankar et al. concluded that only 1% gave the correct response.
The transport media also play an important role. The most popular choice of storage medium during transportation was antiseptic solution 92.34%. Storing the tooth in an antiseptic solution is not recommended because it will compromise the periodontal ligament cells and thus adversely affect the prognosis of the replanted tooth. Many teachers also opted for “dry storage.” They are not aware that dry storage during transportation would seriously prejudice survival of the replanted tooth; the prognosis being dependent on avoidance of injury to the periodontal membrane during the time the tooth is out of its socket.
Milk has a favorable osmolarity and composition for maintaining the viability of periodontal ligament cells and has been recommended for temporary storage of avulsed teeth before replantation. In addition to being readily available, it preserves cell viability for up to 3 h. Only 6% of teachers correctly opted for milk as a storage medium which is similar to the study conducted by Shamarao et al. and is in contrast to the study conducted by Singh et al., in which 87% teachers gave the correct answer regarding storage medium. This is regrettable because the simple measure of storing an avulsed tooth in milk will enhance the prognosis of the tooth when implanted, but 86.81% of them have accepted milk as the transport media after the health education program.,,,
The knowledge of teachers regarding tooth cleaning methods before replantation was poor. Washing in tap water, which is the ideal cleaning method, was chosen by half the number of teachers. 49.50% of teachers correctly said that they would hold the avulsed tooth by the crown when cleaning it and only a relatively small number said they would hold it by the root or the middle of the tooth. However, a considerable number of them were not sure about the correct method of holding an avulsed tooth, and a few teachers did not give any answer at all. On the other hand, 75% teachers opted to hold the tooth by the crown in the study done by Francisco et al. Thus, our study shows that a large number of teachers will not hold the tooth by the crown and, consequently, will disturb the periodontal ligament.
Reports show that more than half of all children suffer traumatic dental injuries in school., Therefore, professionals who work with children must be aware of the importance of emergency treatment and of how to proceed in cases of tooth avulsion. This study has demonstrated the lack of knowledge among school teachers regarding correct handling, transportation, and storage of an avulsed tooth.
However, 97.20% of the teachers have come forward for the permanent tooth replantation after the health education program. The knowledge and the attitude levels of most of the teachers regarding the emergency management of avulsed teeth were raised to very good after the health education program in this study [Table 3] and [Table 4].
Although the study subjects were well educated, and 28.26% of them had undergone first aid training during teacher training course, it was apparent that it had no noticeable influence on knowledge of dental trauma management. This is probably because very little or no information about tooth avulsion and replantation had been given to most of them. Thus, this study shows the urgent need for dental health education to be stepped up among school teachers. By increasing knowledge on how avulsed teeth are to be dealt with at the site of the accident, the risk of permanent tooth loss is minimized. The prognosis of an avulsed tooth is good if it is replanted under ideal conditions, and the tooth can often be retained for life.
| Conclusion|| |
This study showed that teachers in East Panchayat Madurai District have poor knowledge regarding the emergency management of avulsed teeth. Educational programs should be developed for teachers to encourage them to seek treatment immediately when a dental injury occurs to a child in school. Thus, educational material, posters, and lectures can be used during teacher training programs to increase the knowledge of these professionals regarding tooth avulsion.
Toward the completion of this study, we would like to acknowledge the principals and teachers of various schools of East Madurai Panchayat for their support and cooperation during our study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Toure B, Leyebenoist F, Faye B, Kane A, Kaadioui S. Primary school teachers knowledge regarding emergency management of avulsed permanent incisors. J Dent Tehran 2011;8:117-22.
Bastone EB, Freer TJ, McNamara JR. Epidemiology of dental trauma: A review of the literature. Aust Dent J 2000;45:2-9.
Baghdady VS, Ghose LJ, Enke H. Traumatized anterior teeth in Iraqi and sudanese children – A comparative study. J Dent Res 1981;60:677-80.
Ravn JJ. Dental injuries in Copenhagen school children, school years 1967-1972. Community Dent Oral Epidemiol 1974;2:231-45.
Sgan-Cohen HD, Yassin H, Livny A. Dental trauma among 5th
grade Arab schoolchildren in Eastern Jerusalem. Dent Traumatol 2008;24:458-61.
Andreasen JO, Andreasen FM. Essentials of Traumatic Injuries to the Teeth. 2nd
ed. Copenhagen: Blackwell Munksgaard; 2000. p. 115-31.
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.
de Lima Ludgero A, de Santana Santos T, Fernandes AV, de Melo DG, Peixoto AC, da Costa Araújo FA, et al.
Knowledge regarding emergency management of avulsed teeth among elementary school teachers in Jaboatão dos Guararapes, Pernambuco, Brazil. Indian J Dent Res 2012;23:585-90.
Mackie IC, Worthington HV. An investigation of replantation of traumatically avulsed permanent incisor teeth. Br Dent J 1992;172:17-20.
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.
Hamilton FA, Hill FJ, Mackie IC. Investigation of lay knowledge of the management of avulsed permanent incisors. Endod Dent Traumatol 1997;13:19-23.
Flores MT, Andersson L, Andreasen JO, Bakland LK, Malmgren B, Barnett F, et al.
Guidelines for the management of traumatic dental injuries. II. Avulsion of permanent teeth. Dent Traumatol 2007;23:130-6.
Mori GG, Turcio KH, Borro VP, Mariusso AM. Evaluation of the knowledge of tooth avulsion of school professionals from Adamantina, São Paulo, Brazil. Dent Traumatol 2007;23:2-5.
Al-Asfour A, Andersson L. The effect of a leaflet given to parents for first aid measures after tooth avulsion. Dent Traumatol 2008;24:515-21.
Al-Asfour A, Andersson L, Al-Jame Q. School teachers' knowledge of tooth avulsion and dental first aid before and after receiving information about avulsed teeth and replantation. Dent Traumatol 2008;24:43-9.
Abdellatif AM, Hegazy SA. Knowledge of emergency management of avulsed teeth among a sample of egyptian parents. J Adv Res 2011;2:157-62.
Zakirulla M, Togoo RA, Yaseen SM, Al-Shehri DA, Al-Ghamdi AS, Al-Hafed MS, et al
. Knowledge and attitude of saudi arabian school teachers with regards to emergency management of dental trauma. Int J Clin Dent Sci 2011;2:25-9.
Sai Sankar AJ, Sreedevi E, Suresh Babu M, Naveen V, Rajavardhan K. School teacher′s knowledge regarding dental health. Indian J Dent Sci 2013;5:155-8.
Trope M. Clinical management of the avulsed tooth. Dent Clin North Am 1995;39:93-112.
Shamarao S, Jain J, Ajagannanavar SL, Haridas R, Tikare S, Kalappa AA. Knowledge and attitude regarding management of tooth avulsion injuries among school teachers in rural India. J Int Soc Prev Community Dent 2014;4 Suppl 1:S44-8.
Singh M, Ingle NA, Kaur N, Yadav P. Evaluation of knowledge and attitude of school teachers about emergency management of traumatic dental injury. J Int Soc Prev Community Dent 2015;5:108-13.
Blomlöf L, Lindskog S, Andersson L, Hedström KG, Hammarström L. Storage of experimentally avulsed teeth in milk prior to replantation. J Dent Res 1983;62:912-6.
Marino TG, West LA, Liewehr FR, Mailhot JM, Buxton TB, Runner RR, et al.
Determination of periodontal ligament cell viability in long shelf-life milk. J Endod 2000;26:699-702.
Oswald RJ, Harrington GW, Van Hassel HJ. A postreplantation evaluation of air-dried and saliva-stored avulsed teeth. J Endod 1980;6:546-51.
Pearson RM, Liewehr FR, West LA, Patton WR, McPherson JC 3rd
, Runner RR. Human periodontal ligament cell viability in milk and milk substitutes. J Endod 2003;29:184-6.
Francisco SS, de Jesus Soares A, Rodrigo DM. Evaluation of elementary education teachers' knowledge on avulsion and tooth replantation. Rev Sul Bras Odontol 2015;12:32-40.
Kaur H, Kaur S, Kaur H. Prehospital emergency management of avulsed permanent teeth: Knowledge and attitude of school teachers. Indian J Dent Res 2012;23:556.
Shashikiran ND, Reddy VV, Nagaveni NB. 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.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]