Parental awareness of the emergency management of avulsed teeth in children Sarah L. Raphael* Peter J. Gregory, BDSc(WA), MDSc(WA), FRACDS t

Key words: Avulsed teeth, dental education, survey.

knowledge of the emergency procedures required when a tooth is avulsed.

Abstract

(Received for publication July 1988. Accepted December 1988.)

Although public awareness campaigns on avulsed teeth have been mounted in the past, no study has investigatedthe knowledge parents possess of the protocol for the management of this dental emergency. The purpose of this investigation was to evaluate, by means of a questionnaire, the parental awareness of the emergency management of avulsed teeth in children. Over 2000 parents were surveyed during a fourweek period at 20 suburban vacation swimming centres. The results indicated that almost two-thirds of respondents would attempt replantation of an avulsed tooth but further questioning showed they did not know the correct procedures. Thirty-three per cent of respondents were unaware of any after-hours emergency dental services. Ninety-two per cent felt they should seek professional help urgently following an avulsion injury, but their knowledge of transport media for the tooth was poor. Only 5 per cent knew that milk was the medium of choice for both washing and transporting an avulsed tooth. Ninety per cent of parents surveyed had never received advice on what to do in the event of an accident where a permanent tooth was avulsed. This study revealed the need for educational campaigns aimed at parents to increase their

*Undergraduate Dental Student, Faculty of Dentistry, University of Western Australia. ?Visiting Paedodontist, Princess Margaret Hospital for Children, Perth, Western Australia. 130

Introduction Although a number of different emergency procedures have been advocated for the management of the avulsed permanent tooth,’-6 immediate replantation is generally accepted as the treatment of choice.’,’ However, this is often not feasible and in this situation it is recommended that the patient and tooth be taken to a dentist in order that replantation can be performed. The single most important factor determining the prognosis of a replanted tooth is the viability of the periodontal ligament left on the root prior to replantation. To prevent dehydration of the root surface during transportation, it has been suggested that it be placed in saliva (buccal vestibule),’ ~ a l i n e , ~ milk,4 or wrapped in plastic wrap.’ Recent studies have revealed the storage medium must be of correct osmolality and PH.’.~ Milk fulfils these requirements and as such is an excellent medium. Avulsed teeth that are stored in it for up to six hours prior to replantation subsequently show a low index of root res~rption.’.~ Plastic wrap retards dehydration of the periodontal cells thereby preventing osmotic damage and providing an alternative storage medium.’ In the past, replantation of avulsed primary teeth has been advocated by some However, Andreasen states that it is not justified due to the risk of interference with the development of the permanent successor.’ Australian Dental Journal 1990;35(2):130-3.

Table 1. Knowledge of after-hours dental services

Table 3. First place of contact in the event of an avulsion injury ~

Emergency dental services

Percentage of respondents*

Princess Margaret Hospital for Children Perth Dental Hospital Local dentist School dental clinic Other No reply

5.6 45.3 18.2 7.2 4.3 32.9

~

First place of contact Doctor Dentist Local hospital Princess Margaret Hospital for Children Perth Dental Hospital No reply

Percentage of respondents 4.3 62.5 2.3 8.9 20.6 1.3

*Percentages add to greater than 100 per cent as some respondents gave more than one answer.

Table 2. Previous experience with avulsion injuries

Table 4. Urgency in seeking professional assistance following an avulsion injury Urgency

Percentage of respondents

~

Avulsion injury

Percentage of respondents

Yes No No reply

15.6 83.7 0.7

A recent studyQshowed the majority of traumatic injuries occur at home and therefore the ultimate prognosis of an avulsed tooth occurring in a child may depend on a knowledge of these procedures by his or her parents. A number of public awareness campaigns on the avulsed tooth have been mounted in the past (for example, by the Australian Society of Endodontology and the South Australian Branch of the Australian Dental Association) but no study has investigated what knowledge parents possess when confronted with a child who has suffered avulsion of a tooth. The purpose of this investigation was to evaluate, by means of a questionnaire, the parental awareness of the emergency management of avulsed teeth in children.

Materials and methods The Education Department of Western Australia conducts vacation swimming lessons at various centres throughout the State for pre-primary and primary school children during the month of January each year. In order to determine parents’ knowledge of the emergency protocol for avulsed teeth, a questionnaire was offered to those attending classes with their children. Permission to conduct the survey was granted by The Swimming and Water Safety Section of the Education Department of Western Australia. Over the four-week period in which the survey was conducted, 2043 parents were surveyed at 20 different centres. The survey was voluntary and strict confidentiality was assured as names were not required on the questionnaires. Australian Dental Journal 1990;35:2.

Very urgent - I would seek help immediately I would seek help within 30 minutes I would seek help within a couple of hours I would wait until the next day No reply

91.8 4.7 2.4 0.9 0.05

The questionnaires were analysed and the results were expressed as a percentage of the number of respondents for each question.

Results The results indicate the number of people responding to each question and the nature of the response. Question 1: What after-hours dental services do you know of to contact in the event of a dental emergency? (Table 1). Question 2: Have you, your spouse or one of your children ever had an accident where a permanent tooth was knocked out? (Table 2). Question 3: If your child came to you with one of hislher permanent teeth in hisher hand following an accident, which would be the first place you would contact? (Table 3). Question 4: How urgent do you think it is to seek professional help if a permanent tooth has been knocked out? (Table 4). Question 5: Would you replant the tooth back into the socket from which it came? (Table 5). Questions 6 , 7 and 8 were only answered by those respondents who answered ‘yes’ to Question 5. Question 6: Do you think that a baby tooth that has been knocked out should be replanted? (Table 6). 131

Table 5. Respondents attempting replantation Replantation Yes No No reply

Percentage of respondents 62.1 36.9 0.9

Table 6. Primary teeth: attitude of respondents to replantation Replantation of primary teeth Yes - primary teeth should be replanted No - primary teeth should not be replanted No reply

Scrub the tooth gently with a toothbrush Wash the tooth Put the tooth straight back into the socket Get the child to suck the tooth Other No reply

32.9 61.9 5.2

Percentage of respondents 15.2 54.9 2.5 14.0 7.1 6.3

Table 8. Management of an avulsed tooth with a fracture Management Still replant the tooth Take it to a dentist Do nothing No reply

Percentage of respondents 41.2 53.6 1.4 3.8

Question 7: If you decided to replant a permanent tooth back into its socket but it had fallen onto the ground and was covered in dirt, what would you do? (Table 7). Question 8: If a permanent tooth that has been knocked out was broken, what would you do? (Table 8). Question 9: If you did not replant the tooth, how would you transport it to the dentist? (Table 9). Question 10: If you used a liquid to wash or transport the tooth, what liquid would you use? (Table 10). 132

Transport medium Ice Liquid Child’s mouth Child’s hand Paper tissue Plastic wrap Other No reply

Percentage of respontients 20.2 24.3 7.6 0.4 18.6 15.9 2.1 10.8

Percentage of respondents

Table 7. Cleaning procedures prior to replantation Cleaning procedures

Table 9. Transport medium for avulsed teeth

Table 10. Liquids chosen by respondents to wash or transport avulsed teeth Liquid Fresh water Fresh milk Fruit juice Alcohol Saline solution Iced water Antiseptic No reply

Percentage of respondents 40.5 5.2 0.0 2.2 19.5 10.4 8.4 13.9

Table 11. Respondents having received advice on the emergency management of avulsed teeth Advice received Yes No No reply

Percentage of respondents 7.9 89.6 2.5

Question 11: Have you ever received advice on what to do in the event of an accident where a permanent tooth has been knocked out? (Table 11).

Discussion This survey investigated the knowledge parents possess of the emergency management of avulsed teeth in children. The questionnaire was offered to parents at 20 suburban swimming pools in the Perth metropolitan area and, as such, it was felt that a random sector of the community was surveyed. The results of the questionnaire showed that almost one-third of the respondents did not know of any emergency dental services to contact in the event of a dental emergency occurring after-hours. As the time factor is critical in determining the success of tooth replantation, a lack of knowledge of the emergency dental services may be detrimental to the final prognosis of an avulsed tooth. Australian Dental Journal 1990;35:2.

Only 16 per cent of respondents had experienced an accident where a tooth was avulsed. It was assumed that these people were more Iikely to have a knowledge of the correct emergency procedures than those who had never experienced such an incident. The majority of respondents (84 per cent) who had never been exposed to an avulsion injury were therefore expected to be less aware of the correct procedures. The majority of respondents indicated that they would first contact a dental service (their own dentist or Perth Dental Hospital) in the event of an avulsion injury, rather than a medical service. This is encouraging, as the experience of one of the authors (PG) at Princess Margaret Hospital for Children is that, in general, medical residents and registrars who rotate through the hospital have never received advice on the treatment protocol for avulsed teeth. With regard to the urgency of seeking professional assistance, the vast majority of parents surveyed felt that it was ‘very urgent’ and they would seek help immediately. However, the survey showed their knowledge of the subsequent emergency procedures was very limited. Almost two-thirds of the respondents said they would replant an avulsed tooth themselves, but further questioning showed they did not know the correct procedures involved. Almost one-thud would replant a primary tooth not realizing that this could cause severe damage to the permanent successor. Fifteen per cent of respondents said they would scrub a tooth that was dirty before replanting it, unaware they would be severely decreasing the chance of successful replantation. Although more than half of the respondents replied they would take a broken avulsed tooth to the dentist, further questioning showed most respondents did not know the correct method of transportation. The response to this question was varied and 10 per cent did not even reply. Again, when the transport and washing medium was narrowed down to a liquid, only 5 per cent knew that milk was the medium of choice. There was also a large number of respondents who did not reply to this question. Finally, it was found that an overwhelming 90 per cent of respondents had never received advice on what to do in the event of an accident where a permanent tooth had been avulsed; Tnis indicates the need for educational programmes to improve parental awareness of the procedures required for the emergency management of avulsed teeth.

Conclusions This study showed that: 1. Thirty-three per cent of respondents were Australian Dental Journal 1990;35:2,

unaware of any emergency dental services available after hours. 2. Ninety-two per cent of respondents indicated it was ‘very urgent’ to seek professional assistance if a permanent tooth has been avulsed, but they had little knowledge of the correct procedures for replanting or transporting avulsed teeth. 3. Only 5 per cent of respondents knew that milk was the medium of choice for both washing and transporting avulsed teeth. 4. Ninety per cent of respondents indicated they had never received advice on the emergency procedures for avulsed teeth. 5. Educational campaigns are necessary in order to improve the emergency management of avulsed teeth.

Acknowledgements This study was made possible by an Undergraduate Research Scholarship from the Australian Dental Research Fund Inc. The authors wish to express their gratitude to the Swimming and Water Safety Section of the Education Department of Western Australia for allowing the survey to be conducted; and also to Mr K. Wearne and Mr K. Willoughby for their assistance in compiling the questionnaire. References 1. Andreasen JO. Traumatic injuries of the teeth. 2nd edn.

Copenhagen: Munksgaard, 1981:203-42. 2. Haammarstram L, Pierce A, Blomlof L, et al. Tooth avulsion and replantation - A review. Endod Dent Traumatol 1986;2: 1-8. 3. Andreasen JO, Kristerson L. The effect of limited drying or removal of the periodontal ligament. Periodontal healing after replantation of mature permanent incisors in monkeys. Acta Odontol Scand 1981;39:1-13. 4. Blomlof L, Lindskog S, Andersson L, et al. Storage of experimentally avulsed teeth in milk prior to replantation. J Dent Res 1983;62:912-6. 5. Blomltif L, Andersson L, Lindskog S, et al. Periodontal healing of replanted monkey teeth prevented from drying. Acta Odontol Scand 1983;41:117-23. 6. Blomlaf L, Lindskog S. Influence of osmolality and composition of some storage media on human periodontal ligament cells. Acta Odontol %and 1982;40:435-41. 7. Eisenberg MD. Reimplantation of a deciduous tooth. Oral Surg 1965;19:588-90. 8. Mueller BH, Whitsetr BD. Management of an avulsed deciduous incisor. Report of a case. Oral Surg 1978;46:442-6. 9. Davis GT, Knott SC. Dental trauma in Australia. Aust Dent J 1984;29:217-21.

Address for correspondenceheprints: S . L. Raphael, 48 Florence Road, Nedlands, Western Australia, 6009. 133

Parental awareness of the emergency management of avulsed teeth in children.

Although public awareness campaigns on avulsed teeth have been mounted in the past, no study has investigated the knowledge parents possess of the pro...
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