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 Table of Contents  
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 116-120

Assessment of the knowledge regarding the management of avulsed teeth before and after oral health education in high school children (14–16 years) in Central India

1 Department of Conservative Dentistry, VSPM Dental College, Nagpur, Maharashtra, India
2 Department of Public Health Dentistry, Dr. Rajesh Ramdasji Kambe Dental College and Hospital, Akola, Maharashtra, India

Date of Submission19-Jan-2021
Date of Decision09-Jul-2021
Date of Acceptance09-Jul-2021
Date of Web Publication30-Nov-2021

Correspondence Address:
Noopur Kokane
No. 2/1 MIG 20 Ridge Road, Opposite Super Speciality Hospital, Near Tukdoji Square, Nagpur - 440 027, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/dmr.dmr_2_21

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Background: Tooth avulsion is one of the common dental problems seen in children. Informing that avulsed tooth can be reimplanted and method to store the tooth, the importance of immediate replantation without time loss, etc., can save many avulsed teeth, preventing psychological trauma and cost of prosthetic rehabilitation. The study aims to assess knowledge and create awareness regarding the management of avulsed teeth among school-going children (14–16 years). Methodology: The study was conducted among 1231 schoolchildren of age group 14–16 years of different urban schools of Nagpur to assess the knowledge regarding the management of avulsed teeth before and after an informative lecture. The mean knowledge score pre- and postpresentation was statistically analyzed using SPSS 23.0. Results: Students lacked knowledge about the management of avulsed teeth. However, their mean knowledge score increased to 3.15 from 1.98 after oral health presentations focusing on the management of avulsed teeth. Conclusion: Knowledge regarding avulsed tooth and its management among schoolchildren is barely adequate and requires the right method of education via seminars and dental health programmers.

Keywords: Adolescent, avulsion, dental trauma, oral health education

How to cite this article:
Kokane V, Kokane N, Burad P, Datar S, Saoji R, Pathak S. Assessment of the knowledge regarding the management of avulsed teeth before and after oral health education in high school children (14–16 years) in Central India. Dent Med Res 2021;9:116-20

How to cite this URL:
Kokane V, Kokane N, Burad P, Datar S, Saoji R, Pathak S. Assessment of the knowledge regarding the management of avulsed teeth before and after oral health education in high school children (14–16 years) in Central India. Dent Med Res [serial online] 2021 [cited 2023 Jan 30];9:116-20. Available from: https://www.dmrjournal.org/text.asp?2021/9/2/116/331394

  Introduction Top

Traumatic dental injuries are widespread in society and negatively impact the quality of life; hence, it is also considered a public health problem.[1] Dental injuries vary from simple concussions to considerable damage to structures surrounding the tooth.[2]

The two most common locations where traumatic dental injuries occur in children are home and school.[3] Sports account for 60% of traumatic dental injuries.[4] Fights and road traffic accidents are other potential reasons.[4] Anterior teeth are mostly affected due to trauma resulting in avulsion.[5] An avulsion is a complete detachment of a tooth from the socket due to trauma. In most cases, where the prognosis is poor, it is because children with avulsed teeth visit the dentist late for treatment due to lack of awareness and knowledge.

There are many studies conducted on teachers and parents to examine their knowledge and awareness about an avulsed tooth. However, a scanty amount of data is available on students themselves. During adolescence, there is a delicate transitional stage of physical and psychological development into new physical and psychological structures. During this period, studentteacher relation is static.[3],[6] Hence, students themselves should be given proper education about tooth avulsion and its management. Dental esthetics have great importance for the adolescent's self-image and self-esteem.[7] Poorly managed dental injuries may result in dysfunctional or even permanent tooth loss, resulting in costly rehabilitation.

The prognosis of such teeth can be improved if students themselves have knowledge about the management of avulsed teeth. Educating the students regarding the steps to be taken after such an injury might help to improve the success rate of immediate replantation, treatment, and prognosis of avulsion. Hence, this study is aimed to assess the knowledge and create awareness among schoolchildren in the emergency management of avulsed teeth.

  Methodology Top

A cross-sectional study was conducted in 15 schools of Nagpur city in 3 months. Nagpur is divided into five zones; three schools were selected from each zone by convenience sampling method. A prevalidated questionnaire was distributed among 14–16-year-old students to know the baseline knowledge score regarding the management of avulsed tooth. This was followed by a brief PowerPoint presentation explaining dental trauma, avulsion, and its management. A postpresentation questionnaire was then distributed to assess the information gained by them. Pre- and postintervention scores were compared paired t-test. P = 0.005 was kept to be statistically significant. Statistical Package for the Social Sciences 23.0 was used for statistical analysis.

Ethical clearance

Ethical clearance was obtained from ethical committee of VSPM Dental college hospital and research center.

  Results Top

The distribution of the subjects according to age, gender, previous dental visits, and previous history of dental trauma are given in [Figure 1], [Figure 2], [Figure 3], [Figure 4], respectively.
Figure 1: Distribution of age

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Figure 2: Distribution of gender

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Figure 3: Data on previous dental visits

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Figure 4: Data on previous history of dental trauma

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[Table 1] shows the percentage of all answers before and after intervention. Value of one was given to least correct answer and five was given the most correct answer. The lowest score that could be obtained was 10 and highest was 40 for all questions. The knowledge score of pre and post intervention have been depicted in [Figure 5], to compare the difference in knowledge, pre- and post-intervention, paired t-test was applied and P < 0.05 was considered statistically significant.
Table 1: Comparison of knowledge and attitude before and after dental health education

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Figure 5: Item-wise pre- and post-presentation knowledge score

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The mean knowledge Score was 1.9823 ± 3.22, whereas post-intervention the mean knowledge increased to 3.1520 ± 1.740. The difference was found to be statistically significant with P < 0.001 [Table 2].
Table 2: Comparison of knowledge score before and after intervention

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  Discussion Top

Dental injury is one of the common dental problems seen in children. Avulsion has an incidence of 0.5%–3% of all traumatic dental injuries to the permanent dentition.[8] It can result in a functional and esthetic impairment which might lead to great concerns for the parents as well as the child. Informing about the possibility of an avulsed tooth can be reimplanted and method to store the tooth, the importance of immediate replantation without time loss, etc., can save many avulsed teeth, preventing psychological trauma and cost of prosthetic rehabilitation.[9]

In our study, the gender distribution is almost equal with slightly more female side; previous studies have shown that males are more prone to dental traumas.[5] In our study, around 22% of students have previously experienced dental trauma, which is similar to other studies that cite figures at approximately 20% in adolescents.[10]

Many studies all over the world were conducted to evaluate the knowledge of teachers[11] and parents[12] toward dental trauma, and lack of knowledge was found in many studies.[11],[12] However, not many studies are conducted to test the knowledge of students. The study found that students were not well aware of avulsion and its management. 88.1% did not know the meaning of avulsed tooth before the presentation which reduced to 3.3% after the presentation. 88.1% did not know the meaning of avulsed tooth before the presentation which reduced to 3.3% after the presentation.

Surprisingly in a previous study, it was found that many physicians refer avulsion cases to the dentist, as there is a lack the knowledge about emergency management of avulsed tooth physicians and also among medical graduates.[13],[14] A study was conducted in Nagpur among medical practitioners showed the general medical practitioners lack most of the knowledge required for the emergency management of an avulsed teeth.[15] Before the presentation 78.6% preferred visiting the dentist immediately after trauma which increased to 98.9% after the presentation.

The International Association of Dental Traumatology and the American Academy of Pediatric Dentistry recommend immediate replantation of a tooth to obtain the best prognosis.[16]

It is recommended that if the tooth is dirty, it should be gently rinsed and replanted or returned to its original position in the jaw.[17] Knowledge about both was very little previously but increased to 95.1% and 86.5%, respectively, after the presentation. The avulsed tooth should be held by the crown and the root portion should be avoided;[17] the awareness about this increased to 96.8% from 17.2%.

If it is not possible to replant the tooth on-site, then a patient with the tooth should be brought to the dentist as soon as possible. The tooth should be stored and transported in a medium that is immediately available at the emergency site to avoid dehydration of the root surface. The preferred medium is milk, Hanks balanced salt solution, saliva (after spitting into a glass for instance), or saline are suitable and convenient storage mediums. As water is a poor medium, it is better than leaving the tooth to air-dry.[17] With this information the awareness about these mediums increased among children. before presentation around one-fourth of students preferred water as the medium of storage which decreased to only 3.0%.

The prognosis of the replanted teeth is best when these two conditions are observed. First, the extraoral dry time is <15 min. Second, the tooth is stored in osmolality-balanced media such as Hank's balanced salt solution, saline, and milk.[18] 84.3% of students gained the knowledge that both time and medium are important for the prognosis of an avulsed tooth.

There was an overall increase in awareness about the management of avulsed teeth after the presentation.

  Conclusion Top

From the above study, it can be concluded that the knowledge regarding tooth avulsion and its management was less in schoolchildren. The postpresentation results show a significant increase in their knowledge and approach toward management and willingness to seek treatment while demolishing some of the myths regarding avulsion. Furthermore, it can be concluded that there is a need for more of such dental educational seminars and programs regarding dental traumatology in schools and among the general population to create awareness to impart knowledge, thereby leading to better treatment, prognosis, and improvement of overall dental health of the population.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Razeghi S, Mohebbi SZ, Gholami M, Mashayekhi M, Maraghehpour B, Rahnama E. Effect of two educational interventions on primary school teachers' knowledge and self-reported practice regarding emergency management of traumatic dental injuries. BMC Oral Health 2019;19:130.  Back to cited text no. 1
Al-Obaida M. Knowledge and management of traumatic dental injuries in a group of Saudi primary schools teachers. Dent Traumatol 2010;26:338-41.  Back to cited text no. 2
Young C, Wong KY, Cheung LK. Emergency management of dental trauma: Knowledge of Hong Kong primary and secondary school teachers. Hong Kong Med J 2012;18:362-70.  Back to cited text no. 3
Pujita C, Nuvvula S, Shilpa G, Nirmala S, Yamini V. Informative promotional outcome on school teachers' knowledge about emergency management of dental trauma. J Conserv Dent 2013;16:21-7.  Back to cited text no. 4
[PUBMED]  [Full text]  
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Øzdemi SB, Øzdemir M. How do adolescents' perceptions of relationships with teachers change during upper-secondary school years? J Youth Adolescence 2020;49:921-35.  Back to cited text no. 6
de Paula DF Jr., Santos NC, da Silva ET, Nunes MR, Leles CR. Psychosocial impact of dental esthetics on quality of life in adolescents. Angle Orthod 2009;79:1188-93.  Back to cited text no. 7
Iyer SS, Panigrahi A, Sharma S. Knowledge and awareness of first aid of avulsed tooth among physicians and nurses of hospital emergency department. J Pharm Bioallied Sci 2017;9:94-8.  Back to cited text no. 8
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Jain A, Kulkarni P, Kumar S, Jain M. Knowledge and attitude of parents towards avulsed permanent tooth of their children and its emergency management in Bhopal city. J Clin Diagn Res 2017;11:ZC40-4.  Back to cited text no. 12
Hashim R. Physcians' knowledge and experience regarding the management of avulsed teeth in United Arab Emirates. J Int Dent Med Res 2012;5:91-5.  Back to cited text no. 13
Nayak SS, Basaiwala AK, Ankola AV. Awareness regarding emergency dental trauma management among graduates of medical institutes in a city in India. J Dent Res Sci Dev 2016;3:6-12.  Back to cited text no. 14
Kumar S, Sajjanar AB, Athulkar M, Sajjanar J, Shewale A, Wasnik M, et al. The Status of knowledge related to the emergency management of avulsed tooth amongst the medical practitioners of Nagpur, Central India. J Clin Diagn Res 2017;11:C21-4.  Back to cited text no. 15
Trope M. Clinical management of the avulsed tooth: Present strategies and future directions. Dent Traumatol 2002;18:1-11.  Back to cited text no. 16
Fouad AF, Abbott PV, Tsilingaridis G, Cohenca N, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol 2020;36:331-342. Available from: https://doi.org/10.1111/edt.12573.  Back to cited text no. 17
Nene KS, Bendgude V. Prognosis of replanted avulsed permanent incisors: A systematic review. Int J Pedod Rehabil 2018;3:87-98.  Back to cited text no. 18
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  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]

  [Table 1], [Table 2]


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