Knowledge of Physical Education Teachers of Chandigarh with Regard to Emergency Management of Avulsed Teeth at School

DISCUSSION

Dental trauma especially tooth avulsion bears an important concern as it is associated with esthetics as well as dental health problems.⁶ It becomes important to attend the tooth avulsion management in an appropriate manner.⁷ It has been reported that 61% of physical education teachers (PET) had first aid training. This percentage is quite low despite the fact that as many as 62% of the total participants had completed their master’s program. This suggests that dental trauma management is not a regular part of the curriculum for PETs. Similar were the findings in the survey reports of various other countries indicating that there was a lack of training in managing traumatic dental injuries (TDI).^8-10 About 11% physical education teachers were having information from radio, tv, talks with dentist, and first aid training about dental trauma management. It has been seen that 58% of the teachers have no concept of management of an avulsed teeth and 10% said that no treatment is required. Although majority of PET did not have a concept of dental trauma management but they were aware of storage medium of the avulsed teeth because tooth avulsion was the most common traumatic injury they have encountered in schools and the sports environment. About 59% of the participants did not even consider the urgency of dental trauma management (DTM), 16% refused to comment, and only 26% agreed for the urgency of the situation. Similar were the observations in two studies done by McIntyre et al.^11,12 where most teachers do not know to manage the tooth avulsion and have no knowledge regarding the benefits of providing appropriate early treatment.

Part II of the questionnaire includes questions related to knowledge about management of avulsed tooth.^13-15 When asked about the emergency course of action in this case, 45.7% and 41.9% of the participants with the bachelor’s degree and master’s degree, respectively, chose to contact the parents and advise them to send the child to the dentists while an equal percentage of the participants, that is, 45.7% and 45.02%, respectively, chose to locate the fragment and send the child to the dentist. No significant difference was noted between the trained and untrained PETs (p = 0.202). This percentage is appreciable but still low when compared to the study by Chan et al.¹⁶ where 70% of the teachers understood the need for an urgent treatment and answered to send the child to the dentist. A good percentage of correct responses in this study may be due to a well-planned training program of the PETs. On the contrary, a similar study by Abidi et al.¹³ showed that in case of avulsed tooth, 55% of the Karachi school teachers would call the patients’ parents, 33% of them look for a dentist and a hospital, and 5% would do nothing at all. In our study, the difference in responses was not statistically significant for trained and untrained teachers as regards to the concept of emergency management (p = 0.202), urgency of management of dental trauma (p = 0.28), and the knowledge regarding what to do if the tooth has fallen on the ground before reimplantation (p = 0.205). These findings suggest that irrespective of their exposure for first aid training, the participants had little or no difference in their knowledge related to avulsed tooth management, meaning thereby that, either the first aid training sessions have least information components related to dental trauma management or the participants could not recall and apply the knowledge due to lack of periodic re-enforcement.

The actions carried out following a tooth avulsion affect its prognosis.¹ For case II, presenting a case of a boy who is 10-year-old and has avulsed upper front tooth, the ideal course of action should be immediate reimplantation. Only 26.9% of the trained teachers suggested for an immediate reimplantation into its socket and the results were statistically not significant between the trained and untrained teachers (p = 0.28). Similar findings were observed in the study by Chan et al.¹⁶ where 17% of teachers opted for immediate reimplantation with a significant difference between trained and untrained. A few other studies reported a very low percentage of teachers opting for immediate reimplantation.^6,8,14

According to studies done by Baharin et al.¹⁷ and Mohandas et al.,⁸ 33.2% and 24.4% teachers did not correctly identify the fractured tooth which was permanent incisors in a 10-year-old child. The results were in agreement with our study where also about 72% gave the wrong answer and the results were statistically significant between trained and untrained teachers (p = 0.001). The results were in disagreement with the study done by Kaul et al.⁵ and Lima Ludegra et al. of Brazil⁶ where 56.7% and 60.4%, respectively, teachers correctly identified the tooth. A study by Tzigkounakis and Merglova¹⁸ reported that the success of treatment of avulsed teeth depends on extra-alveolar time and storage media. As many as 48% of the participants did not know what should be the minimum duration for which the tooth can be safely kept out of the socket and only 25% participants chose to place it back immediately. When asked about the storage method for the avulsed tooth, 45% percentage of participants told to hold it in a hanky while 33% suggested putting it in a liquid and only 10% suggested placing it in the child’s mouth. When confronted with the query of chosen storage liquid media, 41% of them suggested for tap water, 15% for fresh milk, and 12% for child’s saliva. About 15% of participants choose disinfecting solution for placing the tooth. The findings in our study stand in sharp contrast to the findings of Mohandas et al.⁸ where none chose to store the tooth in saliva and as high as 58.3% did not have any clue about the storage media. Toure et al.¹⁹ in their study reported quite similar findings as ours. With respect to the method adopted for reimplantation of avulsed teeth 30.60% of physical education teachers said that a soiled avulsed tooth has to be washed under water which were in agreement with to respect to studies done by Chandukutty et al.²⁰ Periodic re-enforcement of the concepts should be taken up through the interactions among the resident dentists and physical education teachers.

The government should provide funding opportunities to schools to encourage these schools to hold in-house training camps for their teachers to ensure appropriate first aid to children in cases of management of tooth avulsion.