Devan, Hegde K, Bhat, Suvarna, Radje, and Pradeep: Comparison of knowledge and attitude among medical postgraduates and general medical practitioner in management of tooth avulsion


Introduction

Traumatic injuries to dentoalveolar tissues are recognized as the most serious problem among school children and adolscents.1 It has become a serious dental public health problem in developing and developed countries. One of the common type of dentoalveolar injury is tooth avulsion which is defined as a total dislodgement of the tooth from its socket.1 Avulsion occurs in 1–16% of all dental injuries.2 It can be due to sporting activities, falls at home, car accidents, fights and intentional assaults. Due to the labial inclination of the teeth maxillary central incisor is the most affected tooth.3

Permanent anterior teeth are crucial for aesthetics, phonetics, mastication, and psychological health of young patients. The principle challenge with regards to avulsion is to maintain the vitality of the periodontal cells, hence immediate appropariate management of the avulsed tooth by replantation is needed for long term prognosis.1 Extra alveolar dry time, storage media used, type of retention, drug prescribed plays important role in successful long term outcomes.3

The most critical factor for maintaining the vitality of periodontal ligament cells can be established by stow the tooth in a suitable medium such as milk, saliva or saline.1 Many avulsed teeth are lost due to lack of knowledge about the accepted first aid procedures. Parents and teachers often have the first opportunity to attend a child with tooth avulsion injury. But the physicians are first one to provide treatment for child with dental trauma.4 Many patients with avulsed tooth visit medical professionals due to lack of cognizance or unprocurable availability of the dentist.5 To ensure proper and appropriate management, it is essential that medical professionals should have adequate knowledge and sufficient training. Hence the study is to compare the knowledge and attitude of medical postgraduates and general practitioner in management of avulsed tooth.

Materials and Methods

This study was conducted among 50 general medical practitioners and 50 post graduates in and around Mangalore. The ethical approval was obtained from Yenepoya ethics committee, Yenepoya university, Mangalore. The questionnaire was written in the English language and consisted of 11 questions based on previous similar studied by Holan G et al.,6 2003; Abu Damoud et al,7 2007;). The questionnaire was reviewed by experts with knowledge of this field. The questionnaires was distributed by making personal visits to the study subjects who was selected via purposive sampling

The questionnaire

The questionnaire was composed of three sections:

The first section were designed to survey the characteristics and demographics of the respondents, including age and gender. The second section consisted of questions designed to survey the respondents awareness on avulsion which included their experience in encountering a case of avulsion, appropariate management of primary and permanent tooth after avulsion and also addressed respondents knowledge regarding the storage medium used to carry the avulsed tooth. The third section addressed the respondents attitude towards tooth avulsion and included questions on the opinion of the respondents regarding the need for continuing education in management of tooth avulsion. The response formats for these sections included yes/no answers and multiple choice answers. Data received were coded and analyzed using the Statistical Package for Social Sciences (IBM SPSS) version 20 software. Chi-square test were used to assess the correlation between knowledge and attitude regarding tooth avulsion.

Result

Demographic characteristics of the respondents

A total of 50 general medical practitioners and 50 medical postgraduates agreed to participate in the study. Completed questionnaires were returned by all 50 general medical practitioner And 50 medical postgraduates. A 28% of general medical practitioners were 21-30 years, 14% were between 31-40 years and 8% were 41-50 years. Whereas as in postgraduates 48% were 21-30 years, 2% were 31-40 years and 0% in 41-50years and in gender 38%of general medical practitioners were males and 12% females whereas in postgraduates 20% were only males and 30% were females.

Table 1

Demographic characterstics of the respondents

GM

MPG

(N)

%

(N)

%

Gender

Male

38

38%

20

20%

Female

12

12%

30

30%

Age (years)

21-30

28

28%

48

48%

31-40

14

14%

2

2%

41-50

8

8%

0

-

Knowledge on avulsion among medical postgraduates and general medical practitioner

Regarding the cases encountered by each, 12% of general medical practitioner and 8% postgraduates have encountered case of avulsion whereas 38% of general medical practitioners and 42% of postgraduates have not encountered any case of tooth avulsion. 48% of general medical practitioner and 30% postgraduates prefer to refer the case immediately to the dentist. 32% of general medical practitioners and 18% of postgraduates prefer to seek dental care immediately while 16% of general medical practitioner and 32% postgraduates would not mind delaying upto 30 minutes. 28% 0f general medical practitioners and 18% of postgraduates prefer to wash with sterile saline and the rest prefer to do nothing. 34% of general medical practitioners and 20% postgraduates prefer to take the broken tooth to the dentist whereas 16% of practitioners and 32% of postgraduates do not know what to do. 45%0f general medical practitioners and 36% of postgraduates prefer to keep the tooth in correct medium whereas rest were wrong. 48% of general medical practitioners and postgraduates know that avulsed primary tooth should not be replanted.

Table 2

Knowledge on avulsion among general medical practitioner and medical postgraduates

GM

MPG

Have you encountered any cases of avulsion

yes

12

8

no

38

42

If you come across a child with avulsed tooth what would you do

Refer the child immediately to dentist

48

30

Put the tooth back into the socket and rush to the dentist

2

20

Wash the childs mouth with tap water and put the tooth in a wet cloth

0

0

How urgent do you feel that a dentists opinion is needed

Immediately

32

18

Within 30 minutes

16

32

Within few hours

2

0

Before next day

0

0

If a permanent tooth to be replanted has fallen on the ground and covered with dirt what would you recommend

Scrub the tooth to remove the dirt

0

5

Rinse with tap water

0

5

Wash with sterile saline

28

18

Would do nothing

12

12

What would you do if the knocked out tooth was broken

Still put back the tooth in to the socket

0

0

Take the broken tooth to the dentist

34

20

Would not be concerned about the broken piece

0

0

Do not know

16

32

How would you keep the tooth till you reach the dentist

Ice

2

10

Tapwater

0

2

Sterile saline

20

15

Milk

25

18

Any antiseptic solution

3

5

Do you think that a primary tooth that has been knocked out should be replanted

Yes

2

2

No

48

48

Attitude towards receiving advice on management of tooth avulsion

8% of general medical practitioners and 14% of postgraduates received advice on tooth avulsion whereas 42% of general medical practitioners and 36% of postgraduates did not receive advise on tooth avulsion.

Table 3

GMP

PG

Received advice on managing avulsed teeth

Yes

8

14

No

32

46

Discussion

This study provided baseline information about the existing level of knowledge of dental avulsion in general medical practitioner and medical postgraduates. The lowest time passed between injury and dental care would give a beneficial prognosis and better chance of treatment success following dental trauma.8 12% of general medical practitioner and only 8% of postgraduates had previous experience of tooth avulsion cases which suggests that practitioner have encounterd more tooth avulsion cases when compared to post graduates. Majority of the participants felt that dental trauma should ideally be managed by a dentist. Surprisingly, none of the surveyed postgraduates or general medical practitioner preferred to put the tooth back in its socket although, one of the main requisites of dental avulsion treatment is the tooth reimplantation as soon as possible, keeping periodontal cells viable for healing and a possible pulp revascularization.

A delay in providing emergency dental treatment may risk the prognosis of an avulsed tooth. An attempt should thus be made to immediately replant the avulsed tooth. Ideally, re-plantation should be carried out within half an hour. If the tooth is kept in a suitable medium, the extra-oral time may be extended to up to 6-hours. If replantation is not feasible, the use of a correct transport media is an essential step, which will expand the extra-oral time to 1 h. This will maintain the periodontal ligament cells’ viability and prevent any damage which might cause loss of the tooth in the future. Milk is considered the best medium for the periodontal ligament cells viability. It is an sisotonic liquid with favourable osmolality, which has essential nutrients for periodontal ligament cells to survive and allow them to heal.1 Therefore, it has been recommended as a temporary storage medium for avulsed teeth before replantation.9 In our study, 25% of medical postgraduates and 30% general medical practitioner of the chose milk as the best medium for storing the tooth. This result was similar to Ulusoy et al. where 31.9% of the participants also chose milk as the best medium.10

The majority of the participants 42% general medical practitioner and 36% medical postgraduates did not receive any advice on management of tooth avulsion and would keen to learn more about the management of tooth avulsion.

Conclusion

From the conclusion of the results an important suggestion would include the need for an educational lecture to widen the knowledge of the general medical practitioner and general medical postgraduates about the emergency management of tooth avulsion. This can also be achieved by adding leaflets, posters about basic first aid treatment. In the current study, the population consisted of 50 general medical practitioners and 50 medical postgraduates, that was a convenient sample, which may limit the possibility of generalization, so further research with a larger population is warranted. However despite the limitations of these study, the result accentuate the need for further dental health education.

Source of Funding

None.

Conflict of Interest

The authors declare no conflict of interest.

References

1 

LA Bahammam Knowledge and attitude of emergency physician about the emergency management of tooth avulsionBMC Oral Health2018185710.1186/s12903-018-0515-5

2 

M Zakirulla RA Togoo SM Yaseen DA Al-Shehri AS Al-Ghamdi MSA Al-Hafed Knowledge and Attitude of Saudi Arabian school teachers with regards to emergency management of Dental TraumaInt J Clin Dent Sci20112259

3 

G Holan Y Shmueli Knowledge of physicians in hospital emergency rooms in Israel on their role in cases of avulsion of permanent incisorsInt J Paediatr Dent200313113910.1046/j.1365-263x.2003.00414.x

4 

R Hashim Physicians 'knowledge and experience regarding the management of avulsed teeth in united Arab EmiratesJ Int Dent Med Res20125291

5 

KN Jyothi P Venugopal S Nanda MK Shah Knowledge and Attitude of medical doctors towards emergency management of avulsed tooth - A Cross sectional surveyJ Dent Sci Res2011215667

6 

G. Holan Y. Shmueli Knowledge of physicians in hospital emergency rooms in Israel on their role in cases of avulsion of permanent incisorsInt J Paediatr Dent200313113910.1046/j.1365-263x.2003.00414.x

7 

M Abu-Dawoud B Al-Enezi L Andersson Knowledge of emergency management of avulsed teeth among young physicians and dentistsDent Traumatol20072363485510.1111/j.1600-9657.2006.00477.x

8 

A Jindal S Bhargava L Bakshi R Verma D Beniwal R Namdev Awareness of emergency management of dental traumaContemp Clin Dent2014550710.4103/0976-237x.142820

9 

WR Poi CK Sonoda CM Martins ME Melo EP Pellizzer MR Mendonca Storage media for avulsed teeth: A literature reviewBraz Dent J201324543745

10 

AT Ulusoy H ÖNder B Cetin Ş Kaya Knowledge of medical hospital emergency physicians about the first-aid management of traumatic tooth avulsionInt J Paediatr Dent2012223211610.1111/j.1365-263x.2011.01178.x



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