| Abstract|| |
Context: Dental trauma is a serious oral health problem that can impair function and aesthetics, which affects the overall quality of life in children. Aims: The aim of the present study was to identify the level of knowledge and awareness of school teachers regarding emergency management of dental trauma in school children of Navi Mumbai. The second objective was to correlate it with demographic characteristics and evaluate the need for oral health education programs for teachers. Settings and Design: The present study is a cross-sectional survey and involved the completion of a self-administered anonymous questionnaire by teachers. Materials and Methods: A total of 559 school teachers of primary and secondary sections completed the questionnaire comprising 19 questions. These included demographic data, knowledge regarding teeth most frequently affected by trauma, immediate action to be taken, awareness about storage media and the use of mouth guards. The questionnaire also assessed the willingness of teachers to participate in future training programs on dental trauma management. Data were statistically analysed using Chi-square test for any correlation. Results: Among 559 school teachers who completed the questionnaire, 75.3% were females and 24.7% were males. Merely 6.6% of them agreed to have received prior training in dental trauma management. The majority of teachers (87.5%) were willing to attend training programs on dental trauma management. Conclusions: The knowledge and awareness of school teachers about dental trauma management and storage media for avulsed teeth is poor. Overall, they have a fair knowledge of dental trauma management in school children.
Keywords: Awareness, dental trauma, knowledge, teachers
|How to cite this article:|
Katge FA, Patil DP, Khakhar PJ, Poojari MS, Koticha PB. Knowledge and awareness of school teachers regarding emergency management of dental trauma in school children of Navi Mumbai. Indian J Dent Res 2021;32:51-5
|How to cite this URL:|
Katge FA, Patil DP, Khakhar PJ, Poojari MS, Koticha PB. Knowledge and awareness of school teachers regarding emergency management of dental trauma in school children of Navi Mumbai. Indian J Dent Res [serial online] 2021 [cited 2021 Aug 3];32:51-5. Available from: https://www.ijdr.in/text.asp?2021/32/1/51/321379
| Introduction|| |
Dental trauma is a serious oral health problem that can impair function and aesthetics, affecting the quality of life of children. Injury to the primary and permanent dentition with surrounding tissues remains one of the most common dental problems among children and adolescents., Trauma to the dentoalveolar tissues may be caused by accidents, sports activities, fights and falls. A majority of dental injuries in children is seen in the age group of 8 to 10 years., Traumatic dental injuries to permanent teeth are seen more frequently in boys than girls, whereas no significant gender predilection is seen for primary teeth. Children tend to spend the majority of their time in school and are prone to injuries of jaws and teeth while playing sports., School teachers are usually the first to come in contact with children after trauma in school. The primary and emergency management of such a situation is crucial to ensure favourable treatment outcomes. It has been estimated that only 40% of children first see the dentist as a result of dental trauma, which shows the lack of knowledge and awareness among the general population regarding the same.
Discoloration of the crown, coronal fracture, cervical root fracture, ankylosis, root resorption and tooth loss are some of the complications that may occur following traumatic dental injuries. Amongst the various types of injuries, tooth avulsion leads to considerable functional and aesthetic damage. Its frequency ranges from 0.5% to 16% of the traumatic injuries in permanent dentition and 7% to 13% in the primary dentition., Immediate and prompt care of an avulsed tooth is an important determinant in the success of its treatment and long- term prognosis. In the case of the avulsion, the success of the replantation of the avulsed tooth is dependent on various factors such as extra-alveolar time, storage of the tooth until replantation and other patient-specific factors., Hence, knowledge of school teachers regarding timely management of such injuries is of paramount importance in improving the prognosis of the treatment. There have been no previous studies assessing the knowledge of school teachers in Navi Mumbai in this regard.
The objective of the present study was to identify the level of knowledge and awareness of school teachers regarding emergency management of dental trauma in school children of Navi Mumbai. The other objectives were to correlate knowledge with demographic and professional characteristics and evaluate the need for oral health education programs for teachers.
| Materials and Methods|| |
The present study is a cross-sectional survey conducted among school teachers in Navi Mumbai. Ethical approval for the present cross-sectional survey was obtained from Institutional Review Board Ethics Committee (IRB-EC) dated on 13th February 2017. It involved the completion of a self-administered anonymous, structured questionnaire by the teachers. Inclusion criteria were primary and secondary school teachers, assistant primary and secondary school teachers, headmasters and principals of schools. Exclusion criteria were personnel who did not participate in the educational process. All available primary and secondary school teachers of government, semi-aided and private schools were considered for the study. Prior permission was obtained from Navi Mumbai Municipal Corporation (NMMC) to conduct the study. The permission regarding the circulation of questionnaires to teachers in various schools was obtained from the principals of respective schools. The initial version of the questionnaire was pilot-tested for its validity and operational feasibility. The suggestions of responders regarding pattern and wording aided in refining the questionnaire further. Based on the results of the pilot study, the prevalence of knowledge among teachers was found to be 56%. The alpha error was 5% and the power of the study was found to be 0.889. Thus, the sample size calculated for the study was 552. When the questionnaires were distributed, a total of 559 completed survey forms were collected.
The survey was voluntary in nature and strict confidentiality was assured. The informed consent of the participants was obtained prior to participation in the study. The respondents were asked to tick the most appropriate option from the alternative choices provided. The questionnaires thus filled were collected within one week. Overall, the questionnaire included 5 questions on teachers' demographic data of which three were 'open-ended'. The descriptive analysis of demographic characteristics of school teachers is tabulated in [Table 1]. Fourteen questions were formulated on the knowledge and awareness regarding emergency management of dental trauma in children, all of which were of 'closed type'. A three-point Likert scale of 'yes', 'no' and 'don't know' was employed for data collection. The questionnaire was developed in English and translated into local languages in order to ensure better comprehension by the respondents.
The data collected were coded and statistically analysed using the Statistical Package for Social Sciences 17.0 (SPSS 17.0). The level of significance was set up at P = 0.05 and chi- square test was applied.
| Results|| |
A total of 559 school teachers from Navi Mumbai completed the questionnaire. [Table 1] shows the demographic characteristics of the participating teachers. According to the results, 75.3% of school teachers were females, and 24.7% were males. Nearly half of them (49.2%) were above 40 years of age. Furthermore, 63.5% of them had a teaching experience of more than 10 years while 11.6% had an experience of less than 5 years.
In our study, 84.4% of teachers believed that they have a role in the management of dental trauma in school children. This was significantly related to their age and teaching experience [Table 2]. However, merely 6.6% of school teachers had received prior training in dental trauma management, which was significantly correlated to their educational qualification (P = 0.035) [Table 2]. When questioned about previous experience in the management of dental injuries, 36.7% agreed to have encountered such injuries in the past. This was significantly related to their teaching experience (P = 0.003) and qualification (P = 0.002). When asked about the type of dental injuries encountered, the majority of teachers (70.1%) had come across teeth that had fallen off, which was significantly correlated to the age of the teachers [Table 2]. This was followed by 52.4% of teachers who had come across broken teeth with bleeding. In case of dental trauma to a child in school, 50.3% reported they would ask the child to bite on cotton roll and control bleeding while 62.3% agreed they would find the nearest dentist [Figure 1]a. However, the majority of teachers (73.7%) answered that they would simply call the child's parents at the time of trauma [Figure 1]a. When questioned about teeth most frequently affected, 45.6% of teachers correctly answered the upper front teeth are the ones most commonly traumatized [Figure 1]b. This was significantly related to the qualification of teachers (P = 0.013) [Table 2].
|Table 2: Association of demographic characteristics to knowledge and awareness of teachers|
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|Figure 1: (a) Knowledge about action to be taken in case of dental trauma to a student. (b) Knowledge about teeth most frequently affected by trauma|
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Although teachers came across dental trauma in school, 67.1% of them had never come across a tooth completely out of the socket. When enquired about immediate action to be taken if a tooth is completely out of its socket, 49.2% of teachers agreed they would stop bleeding and carry tooth to a physician immediately. This was significantly related to the teaching experience and age of school teachers [Table 2]. Furthermore, 31.5% of teachers answered they would replace the tooth back in the socket and meet dentist immediately while 29.2% of teachers agreed to stop bleeding and carry tooth to dentists in a storage medium immediately [Figure 2]. Furthermore in the case of avulsion, 42% of teachers agreed to carry tooth to the dentist, which was significantly related to their teaching experience and qualification [Table 2]. When enquired about the media to carry tooth, 29.9% preferred water as the medium followed by 19.7% who preferred a solution from the chemist shop to transport the tooth to dentist. Only 5% agreed to carry the tooth in cold milk while 3.9% answered saliva as the medium for transport of tooth to dentist [Figure 3]a. Regarding the urgency of reimplantation of avulsed tooth, 19.3% of teachers agreed the tooth should be put back immediately or within 30 minutes of avulsion [Figure 3]b. This was significantly related to their qualification and teaching experience (P = 0.001) [Table 2]. Teachers were aware of the likelihood of dental trauma during sports and 68.2% advocated the use of mouthguards to school children while playing. This was significantly correlated to the qualification of teachers (P = 0.013). Lastly, teachers were willing to acquire knowledge, and 87.5% answered they would like to attend training programs on dental trauma management.
|Figure 2: Knowledge about immediate action taken in case a tooth is completely out of socket|
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|Figure 3: (a) Response regarding storage media to carry tooth to the dentist. (b) Knowledge about how soon the tooth out of socket can be put back|
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| Discussion|| |
This survey investigated the knowledge and awareness of school teachers regarding emergency management of dental trauma in school children of Navi Mumbai. In the present study, only 6.6% of school teachers had received prior training in dental trauma management and 36.7% had previous experience in the management of dental injuries. This was significantly related to the years of experience and qualification of teachers. This may be due to increased exposure to information about dental trauma with higher education and an increase in the experience of teachers. Similar results showing the relationship between the qualification of teachers and knowledge regarding management of dental trauma have been shown by Mesgarzadeh AH, et al. and Singh M, et al., Furthermore, in a study by Newman et al. 67% of teachers in England had been specifically trained regarding dental trauma and 91% had been trained in first aid, which is significantly higher than that obtained in our study.
In case of trauma to a child in school, 73.7% of teachers in our study answered they would call the child's parents. This represents an attitude of dental neglect and the dearth of knowledge regarding action to be taken in the event of dental injuries in school. This is similar to a study by Syed Yawar Ali Abidi et al. in which the majority of 55% of teachers in Karachi answered they would call the student's parents at the time of avulsion injury. In the present study, 45.6% of teachers correctly answered the upper front teeth as the ones most frequently affected by trauma. This was significantly related to their qualification. As an increased overjet predisposes children to dental injuries, the higher qualification of teachers depicts an enhanced knowledge about the same. Regarding immediate action to be taken in case of the avulsion, only 31.5% correctly answered they would replace the tooth back in the socket and meet dentist immediately. The poor response of teachers in this study highlights the lack of knowledge about avulsion injuries and the possibility of reimplantation of an avulsed tooth. Similarly lower awareness was reported in the study conducted by Vergotine RJ, et al. in which only 12% of school teachers and 7% of physical education teachers correctly answered the immediate management of avulsed tooth. However, this is in contrast to the higher awareness of 74% reported by Sae-Lim V, et al.
According to Tzigkounakis V and Merglova V, storage medium and extra alveolar time are critical factors that may impact the outcome of the treatment of an avulsion injury. Storage media must possess an osmolarity and pH compatible for preserving the vitality of the periodontal ligament cells. Milk has been currently considered as an appropriate storage medium due to its ideal physiological properties that maintain the vitality of the periodontal ligament cells for nearly up to six hours. Storage in tap water is inappropriate as its hypotonicity causes the death of the cells. Storing teeth in saliva in the buccal vestibule carries the risk of swallowing in children. Thus, an ideal biological medium for the storage of avulsed tooth until reimplantation must preserve the vitality of the cells, reduce the inflammatory response and prevent associated adverse consequences of ankylosis and root resorption. In the present study, merely 5% of teachers answered milk as the storage medium for the avulsed tooth. This finding further shows the lack of awareness regarding the need to carry avulsed tooth to dentist and its appropriate storage media. These findings of low awareness of storage media was in accordance with other studies by Mesgarzadeh AH, et al. and Pithon MM, et al., Similarly, teachers had poor knowledge regarding the urgency of reimplantation of the avulsed tooth, as only 19.3% of them believed the avulsed tooth must be put back into socket either immediately or within 30 minutes. They were, however, aware of the likelihood of dental trauma during sports as the majority of teachers who were well-qualified advocated the use of mouthguards to school children while playing sports.
The limited number of study participants can be considered as a drawback of the study. Hence, further studies must be conducted to evaluate the knowledge of teachers over a larger area and the impact of training programs on their attitude in dental trauma management. Various projects for educating school teachers about trauma management must be undertaken. Developing interactions between pedodontists and the school teachers through seminars and demonstrations for teachers will create a paradigm shift in improving the prognosis of traumatized teeth.
| Conclusion|| |
The following conclusions can be drawn from the present cross-sectional survey,
- The knowledge and awareness regarding the immediate management of dental trauma in children among school teachers of Navi Mumbai is poor
- Similarly, their knowledge about storage media for the avulsed tooth is poor
- They were aware of the urgency of reimplantation of avulsed tooth and had good knowledge regarding mouth guards and its use in the prevention of injuries
- Teachers are willing to attend training programs for the management of dental injuries and had a positive attitude towards the same.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Dr. Farhin A Katge
Terna Dental College, Sector 22, Plot 12, Phase II, Nerul (West), Navi Mumbai - 400 706, Maharashtra
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]