ORIGINAL Junges ARTICLE et al
Elementary Schoolteachers’ Knowledge and Decision-making Regarding Dental Trauma Roger Jungesa/Roger Keller Celesteb/Laís Nicolay Pizzattoc/ Fernanda dos Santos Gattid/Claídes Abegge/Susana Maria Werner Samuelf Purpose: To evaluate elementary schoolteachers’ knowledge and decision making regarding dental trauma in Porto Alegre, Brazil. Materials and Methods: A questionnaire-based survey was conducted among elementary schoolteachers (n = 442). Questions encompassed sociodemographic characteristics and decision making regarding dental trauma. Data on the appropriate answer regarding what to do with a traumatised or avulsed tooth were analysed with multiple logistic regressions, adjusting for age, gender, work experience and previous training. Results: The study population consisted largely of women (90%), was 40 to 49 years old (44.3%) and had more than 15 years of work experience (56.6%). Women (OR = 2.68/p = 0.041), teachers under 30 years old (OR = 4.95/p = 0.041), those with more than 15 years of work experience (OR = 8.95/p < 0.001) or those who had already received previous dental trauma instructions (OR = 1.95/ p = 0.119) were more likely to choose the appropriate answer for an avulsion situation. Teachers under 30 years old (OR = 2.88/ p = 0.279), those with more than 15 years of work experience (OR = 4.55/p = 0.001) or those who had received previous training (OR = 3.39/p = 0.009) presented higher probabilites of choosing the appropriate answer for a crown fracture event. Conclusion: Greater work experience or previous instructions on how to approach dental trauma in the school environment were found to be major factors in schoolteachers’ decision making regarding dental trauma. Key words: dental education, teaching/education, tooth injuries Oral Health Prev Dent 2015;13:357-364 doi: 10.3290/j.ohpd.a32676
a
Dentist, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. Conception of the idea, hypothesis development, questionnaire application, statistical analysis, interpreted results, co-wrote, revised and approved manuscript.
b
Associate Professor, Department of Social and Preventive Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. Hypothesis development, statistical analysis, interpreted results, co-wrote manuscript, revised and approved final draft.
c
Dentist in Private Practice, Resende, Brazil. Hypothesis development, questionnaire application, interpreted results, co-wrote, revised and approved manuscript.
d
Dentist in Private Practice, Porto Alegre, Brazil. Conception of the idea, hypothesis development, questionnaire application, interpreted results, co-wrote, revised and approved manuscript.
e
Associate Professor, Department of Social and Preventive Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. Conception of the idea, hypothesis development, interpreted results, co-wrote, revised and approved the final draft.
f
Full Professor, Laboratory of Dental Materials, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. Conception of the idea, hypothesis development, questionnaire application, interpreted results, co-wrote, revised and approved the final draft.
Correspondence: Professor Roger Keller Celeste, Departamento de Odontologia Preventiva e Social, Faculdade de Odontologia – UFRGS, Rua Ramiro Barcelos 2492, 3° andar, Porto Alegre, RS, Brazil. Tel: +55-51-3308-5015, Fax: +55-51-3308-5349. Email: [email protected]
Vol 13, No 4, 2015
Submitted for publication: 04.02.13; accepted for publication: 08.08.13
D
ental trauma in children and adolescents is recognised as a serious issue in several countries as it occurs frequently and treatment can be complicated, expensive and sometimes lengthy, even lasting for several years after the traumatic incident (Andreasen and Andreasen, 2007; Glendor, 2008; Diangelis et al, 2012). It has been reported that 16% of all dental injuries eventually lead to tooth loss, resulting in complications for the child’s facial and psychological development (Walker and Brenchley, 2000). Recently, traumatic dental injuries (TDI) have also been reported to possibly affect schoolchildren’s oral health-related quality of life (Kramer et al, 2013). In 2008, a study reported that 25% of all schoolchildren experience dental trauma, with most of these injuries occurring before age nineteen (Glendor, 2008). Recent studies from Brazil show that the prevalence of dental trauma in preschool is about 40% (Goettems et al, 2012) and in schoolchildren, it varies from 7.8% to 35.8% in 8- to 12-year-olds (Dame-Teixeira et al, 2013; Goettems
357
Junges et al
et al, 2014), with a decreasing prevalence in Latin America (Aldrigui et al, 2014). Dental trauma can vary from simple concussions to extensive maxillofacial injuries. Luxation injuries comprise 15% to 61% of all TDI (Andreasen, 1970). Crown fractures are the most common and prevalence rates range from 26% to 83% (Gassner et al, 1999). Avulsion is considered to be one of the most serious injuries with prevalence rates ranging from 0.5% to 3% (Glendor et al, 1996). Tooth prognosis is highly dependent on actions taken right after the event, which has important sequelae such as pulp necrosis, tooth ankylosis, root resorption and root canal obliteration (Dewhurst et al, 1998). In almost all cases of avulsion, replantation is the treatment of choice and, when performed well, shows success rates ranging from 85% to 97% (Andreasen et al, 1995). Most traumatic dental injuries occur at home, followed closely by school (Al-Jundi, 2002), highlighting the importance of school staff, who are usually the first to respond to the traumatic incident (Traebert et al, 2003). Reports from several countries show that the knowledge demonstrated by schoolteachers is lacking when dealing with dental trauma events (Chan et al, 2001; Al-Jundi et al, 2005; Addo et al, 2007; Al-Asfour et al, 2008; Al-Obaida, 2010; Skeie et al, 2010) and the same is observed in different Brazilian regions (Pacheco et al, 2003; Feldens et al, 2010). A number of factors might influence this outcome, such as length of work experience and previous training for TDI. Greater work experience was associated with better results on perceived knowledge in Singapore (Sae-Lim and Lim, 2001). Dental trauma training and greater work experience also proved to be major factors in a recent survey conducted in Brazil (Feldens et al, 2010). We argue that both length of work experience and previous training in handling TDI influence elementary schoolteachers’ knowledge and decision making in the event of dental trauma. The aim of this study was to evaluate elementary schoolteachers’ knowledge and decision making regarding dental trauma and to analyse which factors and sociodemographic characteristics might influence this outcome in public schools located in Porto Alegre, Brazil.
MATERIALS AND METHODS The present cross-sectional study was conducted with elementary schoolteachers from public schools in Porto Alegre, a municipality with over 1.4 million
358
inhabitants located in southern Brazil. Twenty-six public schools with at least a thousand students were invited to take part in this study. Twenty-two schools agreed to participate, yielding a response rate of 80.8%. The final study population comprised 442 elementary schoolteachers. The Ethics Committee of the Federal University of Rio Grande do Sul approved this research and all individuals signed an informed consent form.
Data collection Data were collected from March to November 2010. A structured questionnaire based on a previous study (Chan et al, 2001) was used for this evaluation. The instrument was translated and validated to the Portuguese language and encompassed questions regarding sociodemographic characteristics of the participants as well as their knowledge and attitudes regarding dental trauma in the school environment. Before the application in the final sample, the instrument was pre-tested for validity and comprehension in a focus group of 10 elementary schoolteachers. Data for these respondents were not included in the final analyses. During data collection, no communication between respondents was allowed and all participants had the same amount of time to answer the questions. The questionnaire was filled out in the presence of one of the researchers so that any possible doubt regarding the instrument could be clarified. The first part of the instrument included questions regarding sociodemographic characteristics of the participants, such as gender, age, length of work experience and previous training for dental trauma events. The second part encompassed two clinical cases: the first one was a crown fracture event described as ‘During a school gym class, an 8-yearold girl was hit in the face by a football. Her front tooth shattered. She did not cut herself and did not lose consciousness.’ Two main questions were asked in this case, the first (CF1) was ‘Was the front tooth that got hit and shattered a primary or permanent incisor?’ with the appropriate answer being ‘permanent incisor’. The second question (CF2) was ‘Which of the following actions would you consider most appropriate for the situation?’ with the correct answer being ‘Search for pieces of the tooth and refer the student to a dentist.’
Oral Health & Preventive Dentistry
Junges et al
Table 1 Elementary schoolteachers’ sociodemographic characteristics and absolute and relative frequencies for correct decision making regarding an avulsion event. Total sample
Variable
Respondents answering question AV1 correctly**
n
%
n
Total
%
Total
442
100
141
429
32.9
Male
37
8.4
6
36
16.7
Gender
n
Total
%
88
434
20.3
7
37
18.9
0.03 398
90.0
135
393
34.3
81
392
20.4
>50
117
26.5
36
115
31.3
23
116
19.8
40–50
196
44.3
67
193
34.7
47
196
24.0
0.92
Length of work experience (years)
0.25
30–39
98
22.2
33
97
34.0
19
98
19.4
Elementary Schoolteachers’ Knowledge and Decision-making Regarding Dental Trauma Roger Jungesa/Roger Keller Celesteb/Laís Nicolay Pizzattoc/ Fernanda dos Santos Gattid/Claídes Abegge/Susana Maria Werner Samuelf Purpose: To evaluate elementary schoolteachers’ knowledge and decision making regarding dental trauma in Porto Alegre, Brazil. Materials and Methods: A questionnaire-based survey was conducted among elementary schoolteachers (n = 442). Questions encompassed sociodemographic characteristics and decision making regarding dental trauma. Data on the appropriate answer regarding what to do with a traumatised or avulsed tooth were analysed with multiple logistic regressions, adjusting for age, gender, work experience and previous training. Results: The study population consisted largely of women (90%), was 40 to 49 years old (44.3%) and had more than 15 years of work experience (56.6%). Women (OR = 2.68/p = 0.041), teachers under 30 years old (OR = 4.95/p = 0.041), those with more than 15 years of work experience (OR = 8.95/p < 0.001) or those who had already received previous dental trauma instructions (OR = 1.95/ p = 0.119) were more likely to choose the appropriate answer for an avulsion situation. Teachers under 30 years old (OR = 2.88/ p = 0.279), those with more than 15 years of work experience (OR = 4.55/p = 0.001) or those who had received previous training (OR = 3.39/p = 0.009) presented higher probabilites of choosing the appropriate answer for a crown fracture event. Conclusion: Greater work experience or previous instructions on how to approach dental trauma in the school environment were found to be major factors in schoolteachers’ decision making regarding dental trauma. Key words: dental education, teaching/education, tooth injuries Oral Health Prev Dent 2015;13:357-364 doi: 10.3290/j.ohpd.a32676
a
Dentist, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. Conception of the idea, hypothesis development, questionnaire application, statistical analysis, interpreted results, co-wrote, revised and approved manuscript.
b
Associate Professor, Department of Social and Preventive Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. Hypothesis development, statistical analysis, interpreted results, co-wrote manuscript, revised and approved final draft.
c
Dentist in Private Practice, Resende, Brazil. Hypothesis development, questionnaire application, interpreted results, co-wrote, revised and approved manuscript.
d
Dentist in Private Practice, Porto Alegre, Brazil. Conception of the idea, hypothesis development, questionnaire application, interpreted results, co-wrote, revised and approved manuscript.
e
Associate Professor, Department of Social and Preventive Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. Conception of the idea, hypothesis development, interpreted results, co-wrote, revised and approved the final draft.
f
Full Professor, Laboratory of Dental Materials, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. Conception of the idea, hypothesis development, questionnaire application, interpreted results, co-wrote, revised and approved the final draft.
Correspondence: Professor Roger Keller Celeste, Departamento de Odontologia Preventiva e Social, Faculdade de Odontologia – UFRGS, Rua Ramiro Barcelos 2492, 3° andar, Porto Alegre, RS, Brazil. Tel: +55-51-3308-5015, Fax: +55-51-3308-5349. Email: [email protected]
Vol 13, No 4, 2015
Submitted for publication: 04.02.13; accepted for publication: 08.08.13
D
ental trauma in children and adolescents is recognised as a serious issue in several countries as it occurs frequently and treatment can be complicated, expensive and sometimes lengthy, even lasting for several years after the traumatic incident (Andreasen and Andreasen, 2007; Glendor, 2008; Diangelis et al, 2012). It has been reported that 16% of all dental injuries eventually lead to tooth loss, resulting in complications for the child’s facial and psychological development (Walker and Brenchley, 2000). Recently, traumatic dental injuries (TDI) have also been reported to possibly affect schoolchildren’s oral health-related quality of life (Kramer et al, 2013). In 2008, a study reported that 25% of all schoolchildren experience dental trauma, with most of these injuries occurring before age nineteen (Glendor, 2008). Recent studies from Brazil show that the prevalence of dental trauma in preschool is about 40% (Goettems et al, 2012) and in schoolchildren, it varies from 7.8% to 35.8% in 8- to 12-year-olds (Dame-Teixeira et al, 2013; Goettems
357
Junges et al
et al, 2014), with a decreasing prevalence in Latin America (Aldrigui et al, 2014). Dental trauma can vary from simple concussions to extensive maxillofacial injuries. Luxation injuries comprise 15% to 61% of all TDI (Andreasen, 1970). Crown fractures are the most common and prevalence rates range from 26% to 83% (Gassner et al, 1999). Avulsion is considered to be one of the most serious injuries with prevalence rates ranging from 0.5% to 3% (Glendor et al, 1996). Tooth prognosis is highly dependent on actions taken right after the event, which has important sequelae such as pulp necrosis, tooth ankylosis, root resorption and root canal obliteration (Dewhurst et al, 1998). In almost all cases of avulsion, replantation is the treatment of choice and, when performed well, shows success rates ranging from 85% to 97% (Andreasen et al, 1995). Most traumatic dental injuries occur at home, followed closely by school (Al-Jundi, 2002), highlighting the importance of school staff, who are usually the first to respond to the traumatic incident (Traebert et al, 2003). Reports from several countries show that the knowledge demonstrated by schoolteachers is lacking when dealing with dental trauma events (Chan et al, 2001; Al-Jundi et al, 2005; Addo et al, 2007; Al-Asfour et al, 2008; Al-Obaida, 2010; Skeie et al, 2010) and the same is observed in different Brazilian regions (Pacheco et al, 2003; Feldens et al, 2010). A number of factors might influence this outcome, such as length of work experience and previous training for TDI. Greater work experience was associated with better results on perceived knowledge in Singapore (Sae-Lim and Lim, 2001). Dental trauma training and greater work experience also proved to be major factors in a recent survey conducted in Brazil (Feldens et al, 2010). We argue that both length of work experience and previous training in handling TDI influence elementary schoolteachers’ knowledge and decision making in the event of dental trauma. The aim of this study was to evaluate elementary schoolteachers’ knowledge and decision making regarding dental trauma and to analyse which factors and sociodemographic characteristics might influence this outcome in public schools located in Porto Alegre, Brazil.
MATERIALS AND METHODS The present cross-sectional study was conducted with elementary schoolteachers from public schools in Porto Alegre, a municipality with over 1.4 million
358
inhabitants located in southern Brazil. Twenty-six public schools with at least a thousand students were invited to take part in this study. Twenty-two schools agreed to participate, yielding a response rate of 80.8%. The final study population comprised 442 elementary schoolteachers. The Ethics Committee of the Federal University of Rio Grande do Sul approved this research and all individuals signed an informed consent form.
Data collection Data were collected from March to November 2010. A structured questionnaire based on a previous study (Chan et al, 2001) was used for this evaluation. The instrument was translated and validated to the Portuguese language and encompassed questions regarding sociodemographic characteristics of the participants as well as their knowledge and attitudes regarding dental trauma in the school environment. Before the application in the final sample, the instrument was pre-tested for validity and comprehension in a focus group of 10 elementary schoolteachers. Data for these respondents were not included in the final analyses. During data collection, no communication between respondents was allowed and all participants had the same amount of time to answer the questions. The questionnaire was filled out in the presence of one of the researchers so that any possible doubt regarding the instrument could be clarified. The first part of the instrument included questions regarding sociodemographic characteristics of the participants, such as gender, age, length of work experience and previous training for dental trauma events. The second part encompassed two clinical cases: the first one was a crown fracture event described as ‘During a school gym class, an 8-yearold girl was hit in the face by a football. Her front tooth shattered. She did not cut herself and did not lose consciousness.’ Two main questions were asked in this case, the first (CF1) was ‘Was the front tooth that got hit and shattered a primary or permanent incisor?’ with the appropriate answer being ‘permanent incisor’. The second question (CF2) was ‘Which of the following actions would you consider most appropriate for the situation?’ with the correct answer being ‘Search for pieces of the tooth and refer the student to a dentist.’
Oral Health & Preventive Dentistry
Junges et al
Table 1 Elementary schoolteachers’ sociodemographic characteristics and absolute and relative frequencies for correct decision making regarding an avulsion event. Total sample
Variable
Respondents answering question AV1 correctly**
n
%
n
Total
%
Total
442
100
141
429
32.9
Male
37
8.4
6
36
16.7
Gender
n
Total
%
88
434
20.3
7
37
18.9
0.03 398
90.0
135
393
34.3
81
392
20.4
>50
117
26.5
36
115
31.3
23
116
19.8
40–50
196
44.3
67
193
34.7
47
196
24.0
0.92
Length of work experience (years)
0.25
30–39
98
22.2
33
97
34.0
19
98
19.4
