‘It Was Surprising in a Bad Way’: The Experiences of Children/Adolescents With Dental Avulsion and Their Family in New Zealand

ABSTRACT

Background

Dental avulsion is among the most common traumatic dental injuries in children, with prognosis heavily reliant on the prompt response of parents or caregivers. While such injuries can have significant and lasting physical, emotional and social impacts on children and their families, the specific nature and extent of these effects remain understudied in New Zealand.

Aims

To explore the lived experiences of New Zealand children, adolescents, and their families following dental avulsion of permanent maxillary central incisors, and to identify barriers to accessing timely emergency dental care.

Methods

Exploratory qualitative research design involving the use of semi‐structured interviews (n = 11). The data were analysed using thematic analysis. Participants were recruited via social media and advertisements.

Results

Interviews were conducted with 11 children and adolescents, along with their parents. Thematic analysis revealed five major themes: the injury itself, challenges in accessing emergency dental care, emotional and psychological impact (identified as a key finding), treatment experience and outcomes, and the role of barriers and enablers. The degree of impact varied depending on parental, caregiver, or teacher awareness, access to timely care and treatment success. Parents with prior knowledge of dental trauma were more likely to seek immediate care, leading to more favourable treatment outcomes and reduced emotional distress. In contrast, lack of awareness, limited access to emergency services, and poor treatment outcomes were associated with heightened negative emotional and psychological effects.

Conclusion

This is the first study in New Zealand to explore the lived experiences of children and their families following a dental avulsion injury. It highlights the emotional, practical and clinical impacts on both children/adolescents and their caregivers. The findings reveal persistent barriers to accessing timely emergency dental care. There is a critical need for improved education and awareness about dental avulsions and appropriate immediate care to support better outcomes.

1. Introduction

An avulsion injury is one of the most common severe traumatic dental injuries (TDIs) and can likely have lifelong consequences [1]. One of the critical factors in the prognosis of an avulsion injury is the ability to take prompt action after an avulsion [2]. Research shows that parents or caregivers did not know how to intervene in cases of dental avulsions [3, 4]. Also, research suggests that 60% of parents or participants did not know that an avulsed permanent tooth could be replanted [5]. Investigating parents' knowledge and attitudes regarding avulsed teeth [6], found a correlation between parents' level of awareness and their understanding of avulsion management. Furthermore, research indicates that avulsion injuries may have both physical and psychological impacts on children and their families or caregivers [7]. Although the injury directly affects young patients, their families also experience considerable stress and concern [8]. However, the specific nature of these impacts and the practical barriers families face in seeking timely care remain understudied, particularly in New Zealand.

In New Zealand, the Accident Compensation Corporation (ACC) operates as a crown entity, providing a no‐fault insurance scheme that covers part of the treatment costs for injuries [9]. While this theoretically removes a cost barrier to care access, there is little understanding of whether families experience practical barrier reduction. There is a lack of New Zealand‐based studies exploring the experiences of children and families dealing with dental avulsions, and the barriers to accessing emergency dental care for these injuries remain largely unknown. Understanding the traumatic experiences, management practices, and perceptions associated with avulsed teeth will help develop more effective treatment pathways in Aotearoa, New Zealand.

The aims of this research were to:

1. Explore the experiences of children or adolescents (who have sustained a dental avulsion injury of permanent maxillary central incisor/s) and their families in New Zealand.

2. Understand the barriers that the affected children or adolescents (who sustained a dental avulsion injury of permanent maxillary central incisor/s) and their families in New Zealand face in accessing urgent care for dental avulsions.

2. Methods

This study is informed by an interpretivist epistemology, which holds that knowledge is socially constructed and shaped by context [10]. A qualitative case study design supports this approach by allowing an in‐depth understanding of meaning in a bounded setting [11]. The principal researchers, as clinicians, approach the study with an interpretive lens that, like clinical practice, emphasizes dialogue, empathy and contextual understanding [12]. Participants' accounts are viewed as co‐constructed rather than objective, with reflexivity recognized as essential to analysis [13]. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines (Appendix S2) for reporting this qualitative research were followed [14]. Ethical approval was obtained from the University, Human Ethics Committee (H22/103). No Artificial Intelligence Generated Content (AIGC) tools were used in developing any portion of this manuscript.

2.1. Study Design

This study employed an exploratory qualitative research design involving a semi‐structured interview method for data collection. Interviews were conducted with children/adolescents along with their parents, representing distinct cases of dental avulsion. Both children/adolescents and their parents were given time to reflect and respond to each question during the interviews, ensuring that participants were not rushed and could express their views freely and in detail. The exploratory approach was considered appropriate as it helps researchers investigate issues or phenomena that are not well understood, providing initial insights and guiding subsequent, more focused research [15]. The flexible approach enabled pattern identification and guided the development of insights into this understudied area in its early research stages [16].

2.2. Participants

Children and adolescents (between 6 and 18 years of age) in New Zealand who had sustained a dental avulsion injury to their permanent maxillary central incisors were eligible to participate in this study. An email was sent to facilitate recruitment with study details to dental facilities such as Community Oral Health Service clinics. The advertisements were displayed at the Faculty of Dentistry on public notice and on social media platforms such as Facebook and Instagram. An online survey was set up in Qualtrics to collect demographics and injury details. The primary investigator (AKK) made initial contact to confirm the inclusion criteria (Appendices S3 and S4) and participation. All participants were sent an information sheet and an informed consent form to be signed prior to participation. Two information sheets (Appendices S3 and S4) were created, one for the parent/adolescent participants and another age‐appropriate information sheet for children. Parent participants and adolescents over 16 years of age were given a consent form, whereas children below 16 years were given an assent form to consent for the interview. Parents also confirmed their consent for their children to participate in the study. AKK's dual role as a paediatric dentistry clinician and interviewer was acknowledged and reflexively considered to minimise potential bias in data collection. Once potential participants were identified, purposive sampling was used to recruit them [17]. The criteria for purposive sampling included age, location, ethnicity, type of injury and injury management.

2.3. Data Collection

The data collection methods involved conducting semi‐structured interviews, which happened between June 2023 and December 2023. A semi‐structured interview guide was developed. A pilot interview was conducted with one experienced qualitative researcher. This resulted in a modification to the interview guide (Appendix S1) to improve clarity. All the interviews were conducted by the student researcher (AKK). Participants who lived in Dunedin and preferred a face‐to‐face interview were interviewed at the Faculty of Dentistry, and others were interviewed via Zoom. A $50 gift card voucher was provided to the participants for their time. The student researcher, along with a research supervisor, was available to answer any participants' questions and provide explanations.

2.3.1. Reflexivity

The research team comprised five individuals of whom two (ME and AM) had a paediatric dentistry background, and two researchers (BKM and FG) had experience in qualitative research methodology. The fifth (AKK) was a Doctor of Clinical Dentistry (Paediatrics) student. AKK was involved in all aspects of data collection with contributions from ME and AM. FG and BKM played an integral part in data analysis and the interpretation of the findings.

2.4. Data Analysis

A reflexive thematic analysis (RTA) as outlined by Braun and Clarke [18, 19, 20], involves a six‐phase process that includes: (1) familiarisation with the data, (2) generating initial codes, (3) generating themes, (4) reviewing potential themes, (5) defining and naming themes and (6) producing the report [18]. The audio recording of each interview was transcribed verbatim by an experienced professional audio transcriber. The video was then listened to carefully, along with the respective transcripts, by the primary investigator (AKK) to ensure accuracy and familiarisation with the data set. This required reading and re‐reading the transcripts and notes, looking for patterns in the data. The student researcher made annotations and notes to capture points of interest. Data was then line‐by‐line coded to generate the initial codes. Initial coding was undertaken and assisted using NVivo V.10 qualitative analysis software. The coding was conducted by the primary investigator (AKK), with independent review and verification of codes and developing themes by FG and BD to enhance credibility. Codes were grouped around central organising concepts, leading to the development of sub‐themes and the identification of candidate themes [20]. A thematic map illustrating the relationships between candidate themes was developed and presented to the broader research team. This facilitated collaborative discussion and further refinement of themes through recursive review against the coded data and the full dataset.

3. Results

A total of 11 interviews were conducted for the study. Data collection ceased at 11 interviews when thematic saturation was reached, with no new concepts emerging relevant to the study aims. The average duration of the interviews was 40 min. The demographic information of participants is provided in Table 1. The key themes, sub‐themes, and supporting quotes that resulted in the five themes are presented in Figure 1. Themes were linked to participants' experiences and the individual pathway each patient and parent(s) undertook following an avulsion injury as follows:

1. The injury and its context.

2. Challenges in seeking emergency dental care.

3. Barriers and enablers.

4. Emotional and psychological impact.

5. Treatment experience and outcome.

TABLE 1.

Participants demographics.

Characteristic	Frequency/range
Age during participation	9–17 years
Age at the time of dental avulsion	7–14 years
Gender	6 Females 5 Males
Location	3 Auckland 3 Christchurch 2 Dunedin 1 Nelson 2 Waikato
Ethnicity	9 NZ European 1 NZ Pākehā 1 Māori

FIGURE 1.

Themes influencing children and adolescents and their family's experience and journey after a dental avulsion in Aotearoa, New Zealand.

As interviews included both children/adolescents and their parents or caregivers, quotes are labelled to distinguish between them: ‘A’ indicates the child/adolescent and ‘B’ the parent/caregiver, followed by the participant number (e.g., P1A = child participant 1; P1B = their parent/caregiver).

3.1. The Injury and Its Context

One of the themes identified from the data is the nature and location of injury. The participants expanded on the various locations where children sustained dental avulsion injury. The accidents occurred in different settings, such as schools, recreational areas and residential spaces. The location of the injury was crucial as it influenced the immediate response and the ability to retrieve and replant the tooth. For example, injuries at home allowed for prompt parental intervention, while those in public places and/or schools often led to delays in accessing care. The common causes included falls during active play, accidents involving scooters, impacts of swing sets, and incidents during physical education classes.

We were on scooters… the lace had got caught in the front wheel, and it [the scooter] dropped down, and I went over the bars and smacked my tooth… then it [the tooth] just knocked clean out and then obviously there was a lot of blood. P3A

Parks and waterparks were the other locations where injuries occurred. One participant described an incident that took place in a park:

I went to the skate park with my grandad, and I went down this big ramp, and I face planted into the ground and knocked my tooth out. There was blood, a little bit, and it was sore. P4A

The location of the accident may also determine whether the tooth can be retrieved, the personnel involved, and access to immediate care. When an injury did not happen at home (e.g., water slide, road), it was often difficult to find the avulsed tooth.

When I finished sliding down (water), I stopped, my teeth were still stuck in the ground, and I was drenched; the whole slide was drenched in blood. My dad was like, ‘you have to try to find the knocked‐out tooth’…. P7A

I was riding my bike, and I pulled the brakes and sort of went over the handlebars and hit the concrete, and my tooth fell out, and the other one snapped in half…. P10A

While the injury type may determine the severity of an accident, the presence of a caregiver or other support person could help the situation. This support may include emotional, knowledge‐sharing, moral, transport, or financial. On the other hand, the presence of people can also cause distress, especially if other children were present during the accident.

I woke up and was really confused [about] what was happening because I was being dragged to the sick bay by some teachers… there were children and teachers… there [were] quite a few children quite upset about the accident. P8A

Some participants mentioned the sense of embarrassment when the injury happened at schools/water parks in front of others. The psychological impact and immediate management also depend on the accompanying person. If parents or caregivers accompany the children/adolescents, this can be less distressing for them as injured children tend to feel more settled around their own parents/caregivers during distressful times.

3.2. Challenges in Seeking Emergency Dental Care

Participants reported systemic and non‐systemic challenges that made it difficult for them to access emergency dental care for their children with dental avulsions. Systemic challenges refer to any challenges associated with or within the health system (e.g., lack of dental services), and non‐systemic challenges (e.g., logistical issues) refer to challenges unrelated to the health system but that prevent access to dental care.

A few participants were able to seek dental care but were upset about the delay due to a lack of access.

We live in a small town. We just have our local doctors here… I took him to a dental practice 30 minutes away in another town. Although the tooth was put back, there was a delay…. P4B

In contrast, another participant and parent were happy about the immediate care they received.

… It was pretty quick to get into [the] treatment room because you (3A) were an eight‐year‐old with a jersey [a]round your (3A) face and blood coming out. So, I think they (the emergency dental team) did push it through quite quickly. P3B

Other responses revealed that a lack of knowledge among parents, caregivers, teachers and coaches was another reason for the delay in accessing care or seeking immediate help.

Lack of knowledge created panic and forced some parents or caregivers to rely on the internet for information and/or the local dentist to check for advice following the trauma. Searching for information just after injury may not always be a viable option, especially if you do not have access to a device or the internet.

I actually called up the local dentist because I didn't actually really know what to do. Because if she broke her arm… You just go to A&E or the emergency department. But with dentistry, with tooth issues, I wasn't entirely even sure there'd be a dentist at the emergency department. P5B

Another parent revealed that they visited the local doctors as there are no dental services in their town and knew that the doctors may not offer help. It was noted that no treatment was provided at the medical centre, thus causing disappointment among the parents.

We just have our local doctors here. (Went there, but no treatment was offered) I'm quite analytical, so I straight away knew that they could do nothing for 4A. This is not the type of injury that they will specialise in. So, they will actually have no knowledge at all about it. They can maybe clean his mouth with some saline, but that's pretty much it. P4B

The lack of or unavailability of dentists and specialists was a key barrier to the immediate management of dental avulsions.

The local dentist was unavailable, so we had to travel to town nearby to seek care. P4B

… Then we went to the emergency room, and I asked them if they had an emergency dentist. [They said] there is no emergency dentist in all of Auckland. P1B

3.3. Barriers and Enablers

These were categorised into personal factors and system factors. Barriers to effective management of dental avulsion included personal factors, like parents' lack of knowledge and system‐related issues such as inadequate access to emergency dental services. Enablers included prior knowledge of dental trauma first aid, which helped parents/caregivers/teachers manage the injury better. Participants suggested that better information dissemination through schools and community programs could improve outcomes. Systemic improvements such as better training for medical professionals, more accessible emergency dental services, and clear communication from healthcare providers were also highlighted as necessary to enhance care for dental avulsion injuries.

There [are] times that you look at yourself like what are they doing… would have been better if I had known more? P9A

Information and its accessibility were identified as important, specifically for people living in rural areas.

People should have a little bit more [and] better accessibility for that information. So, if things do happen… they know that the first point of information should be that medical centre, especially in rural areas…. P4B

Some of the participants further identified some useful strategies to facilitate the spread of information.

[A] smart thing to [do would be to] put in those dental presentations [when the] dentist bus comes, and you get handed a sheet of information to do with dentistry. I think it would be quite a good idea. [Then] people would be aware of how to deal with trauma. P5A

Factors relating to the health system, such as knowledge of people in a medical centre, access to dental services, and availability of parking around the dental service, were identified as barriers by participants.

… the medical centre should be a little bit more informed about [dental trauma] services available outside of their zone. P4B

The conflict of information between specialists made it difficult for the family to understand the nature of the treatment provided and acted as a barrier to appropriate care.

It was more the fact that both pieces of information we were getting from them were slightly different. Because the endodontist sometimes said, Oh nah, leave it in [and] it'll be fine; we'll just leave it and see how it goes. The orthodontist said, Oh actually, no, if we do this treatment, we'll then be able to detach it from the bone, and then reposition it, and then we're like going, Well do we need to or do we not need to? P3B

The cost of care for dental treatment was another important barrier for families to access dental care. This barrier was faced by participants (P1A&B, P3A&B and P4A&B) who still had to bear the specialist consultation costs, although ACC partly funded the treatment. Orthodontic costs were incurred for participants (P2A&B, P6A&B), who would not have had orthodontic treatment if not for the injury.

Some [treatment cost] was covered by ACC. P5A's Grandad has been very generous and paid quite a large amount towards her teeth. So, we are incredibly lucky for that. Cause well aware that a lot of families can't afford this kind of treatment. P5B

A few participants had to pay for transport (petrol) as they lived in rural areas. Although parent participants had to take time off from work, they did not view this as a barrier. For other participants the lack of parking closer to the hospital was a barrier to immediate care.

3.4. Emotional and Psychological Impact

This theme relates to the emotional and psychological impact on children and their families following the injury. Participants expressed a wide range of feelings following the dental avulsion. The emotional impact was not only limited to the child or adolescent, but their parents also mentioned the emotional distress they experienced. Parents reported high levels of anxiety and emotional distress, especially when they were not present during the injury. Some of the participants talked about their emotional journey throughout the management process. The initial shock and pain of the injury were often compounded by the distress of seeing a tooth knocked out. The sight of blood and the pain during treatment added to the trauma. Some participants experienced fear, confusion and sometimes a lasting fear of dental procedures.

I remember that was quite a big shock for me, like you know, seeing a big tooth on the floor, it was like, what the! My first thought wasn't like, was my tooth going to come out? It was more like, in my head, this is going to hurt, and my face is going to hurt. And then when I realised my tooth was missing, it was just like, I don't know, really surprising but in a bad way. P5A

For some parents, even watching the dental management of dental avulsion was stressful.

I was crying. I was fine when we got in there; I was quite calm. But when they tried to push her tooth in, and she was screaming, and there was blood squirting out, yeah, I was crying as well. And that's when I said no, that's it, no more. P9B

On the contrary, a parent participant mentioned being more panicked as she was not present during the injury.

I totally freaked out because P7A wasn't with me, and I just wanted to be there with her, so that was hard, but just like not knowing what had happened and what was going to happen. It was just a really horrible situation to be in as her mum, but she was a lot braver than I thought she was going to be…. P7B

These emotions were not just confined to parents, and the experience also impacted the accompanying person.

I was kind of in shock… got in the car, and my friend was crying, absolutely bawling his eyes out, thought I was going to die. P3A

3.5. Treatment Experience and Outcomes

Participants' experiences with dental treatment varied, influencing their perception of care and satisfaction with outcomes. Positive experiences were characterised by prompt, effective care and clear, compassionate communication from dental professionals. Conversely, negative experiences included delays in treatment, poor communication, and a perceived lack of empathy from some healthcare providers. These negative experiences often led to dissatisfaction and anxiety about future dental care. The quality of the treatment outcome was also crucial, with successful tooth replantation and minimal pain leading to higher satisfaction. Most participants perceived that the ‘quality of service received was pretty good.’ Another participant mentioned that:

I would get like service straight away, or an appointment when it was needed, or as close to when I was needed. And they all assisted me really well, and I didn't get much pain after…. P7A

…because we got good service, the communication was clear, I guess we just trusted in their expertise, and they didn't pressure or force anything. It was just more like, this is what we recommend, this is what we think is the best option, go away and have a think about it. P5B

Other participants perceived that the quality of care they received was not good.

I didn't like the vibe [that the] orthodontist my dentist referred was producing. I thought that he was a little money‐hungry and wanted to create quite a big plan [that] I didn't think my kid should have. He's a kid, he wants to be a kid. P4B

Further, some participants lacked any knowledge about dental avulsion and had to depend on the communication and treatment plan of the dentist or specialist, which they perceived as unhelpful.

… Every time we spoke to them individually, they're both very helpful… everyone independently has been really good. It's just nothing [is] coordinated. P3B

The anxiety, along with worry about long‐term consequences, made some participants upset.

I felt so sad… I can see he had such a strong reaction to losing that tooth. 11A was perfectly fine. He wasn't worried about the aesthetical aspect of it. I was worried about it. I kept thinking about when he goes and has his first kiss with some girl, and he's gonna have some like fake tooth or something. P11B

It was pretty tough watching her go through it, because you know, as a young girl with her teeth being altered… as a dad, you worry about peer pressure and bullies…. P5A

The experience of trauma and management resulted in mixed emotional and psychological impacts. Negative experiences, failure in managing, and poor outcomes lead to negative satisfaction. Participants who had good experiences had favourable treatment outcomes and trusted their dentists.

4. Discussion

This study highlights the significant psychological and emotional impact of dental avulsion injuries on children and their families, which is influenced by factors such as parental/caregiver awareness, access to care and treatment outcomes. Participants' experiences following dental avulsion varied widely, with core themes emerging from both children/adolescents and their parents or caregivers. A key finding was the significant psychological and emotional impact of dental avulsion on children and their families, which was influenced by factors including parental and caregiver awareness, barriers to care and treatment outcomes. For example, a parent with knowledge about dental avulsions would seek immediate dental treatment, which, combined with a positive treatment experience, may have a positive psychological and emotional impact. On the other hand, lack of parental knowledge, access, and/or negative treatment outcomes may result in a negative psychological and emotional impact.

A unique finding from the present study is the emotional and psychological impact affecting the everyday lived experiences of children and their families following a dental avulsion. While previous studies have surveyed parents or interviewed parents of children regarding knowledge and management of dental avulsion [6, 21], our study is the first in New Zealand to investigate the lived experience of children and their families following a dental avulsion. Parents who participated in our study described their distress with words like ‘shocked,’ ‘freaked out,’ and ‘broken,’ highlighting the profound emotional toll these injuries can have on families. These negative emotions experienced by parents in the present study are consistent with findings from other medical literature [22, 23].

Other parents reported that they coped better with their children's dental avulsions. This agrees with previous findings where some parents of children coped better when they were able to come to terms with the diagnosis and reality [24, 25]. The factors were not the type of injury or the treatment that was offered, but satisfaction was based on social support and the level of distress the child had following the trauma [26]. This could be the case with a few participants in the present study who coped better as they had children who were able to adapt or had peer support.

Based on our findings, dentists need to acknowledge and address the psychosocial impact on children and their families following a dental avulsion. Some of the participants of the present study did not receive immediate dental management, which was a key barrier to positive treatment outcomes. A qualitative study from the United Kingdom [27] found that although most participants had access to care, a few were unable to access care on time, as parents had poor knowledge of how to access treatment for their children. Another study [28] conducted at two paediatric emergency departments in the UK highlighted the lack of awareness among ED professionals about follow‐up on dental avulsions, and the importance of signposting for families to enhance their experience and outcomes following a TDI.

Interestingly, unlike previous studies [6, 29, 30] conducted predominantly in Asia, most teachers, parents and caregivers in our cohort were aware of appropriate storage media, such as milk. This difference may be due to varying socio‐cultural factors, health system structures and access to information [6, 21, 29, 30]. It is important to note that these surveys were conducted in Asia. Therefore, the difference in socio‐cultural factors, gender equity in education, access to information (e.g., use and availability of internet), and differences in the health system could explain the difference in findings [31, 32].

Some parent participants knew the tooth could be replanted. However, none of the parents who participated attempted to replant the tooth independently, as they did not know how to do so. None of the parents mentioned that teachers or any non‐dental health care workers had replanted the tooth. A participant (P1A) also mentioned being stressed, and the self‐replantation suggestion was frightening. A questionnaire‐based study in Brazil [21] reported that 83% of parents responded that they would not replant the avulsed permanent tooth. The survey results suggested a lack of information and a need to develop user‐friendly, valuable sources of information. Another study from Kuwait recommended that even a simple leaflet with information could be helpful for parents, as parents who were provided leaflets had better knowledge about the injury and its management than those who were not given the leaflet prior to the questionnaire [33].

A main finding from the present study is that the nature, location, and personnel available at the time of injury played an important role in determining the overall outcome of the injury. For example, a child injured in a playground, when the parents are around, may benefit from reassurance and comfort provided by the parent and could access dental care. This may be different for a child injured in a rural school with geographical distance as the barrier to positive outcomes following the injury. This is consistent with previous findings [34].

Most participants in the present study perceived that the quality of service they received was good. This contradicts findings from some previous studies. However, the countries in which these studies were conducted and, therefore, the type of dental education may explain the difference in findings [27, 35]. Some participants expressed dissatisfaction, often due to inconsistent information from various dental practitioners, particularly specialists. This highlights the crucial need for clear, consistent communication throughout the treatment process. This also agrees with previous findings [27], which emphasise the need for proper communication of findings and management by dental practitioners to parents of children with dental avulsions. Our findings also found positive and negative impacts following a dental avulsion based on how the injury was managed. Appropriate management is a mediating factor for successful outcomes and, therefore, overall satisfaction. In this context, it may be important for dentists (and the dental team) to empower parents of children with dental avulsion to seek information and enable shared decision‐making.

Key barriers identified included limited caregiver knowledge, challenges in retrieving the avulsed tooth, geographical factors, logistical issues such as parking, delays in accessing emergency care, and, to a lesser extent, cost. These identified barriers are consistent with the wider literature [36]. While cost was reported as a barrier by some parents, New Zealand's ACC no‐fault compensation scheme facilitates access to dental care, distinguishing our findings from those in countries where cost remains a primary obstacle [27, 37].

These findings collectively illustrate the complex challenges that families and providers encounter when managing dental avulsions, highlighting opportunities for targeted improvements.

4.1. Limitations

The study is not without its limitations. A key limitation is that the findings of the study may be confined to New Zealand, reducing the transferability of findings to other countries. However, the findings provide important insights that may be relevant to other countries with similar healthcare structures and injury reporting systems. Despite extensive recruitment efforts, some regions of New Zealand were not represented in the sample. Nonetheless, participation from a range of other regions enabled the capture of diverse perspectives across the country. Another limitation is the lack of children of ethnicities other than the Māori, New Zealand European and Pākehā. Further, the experience of families and children who could have migrated recently to New Zealand and vulnerable populations, such as refugees, was not part of this study. Although these families and/or children were not excluded, we did not have any of these participants and an area of future research.

5. Conclusion

This study explored the experiences of children or adolescents (who have sustained a dental avulsion injury of permanent maxillary central incisor/s) and their families in New Zealand. Five themes that influenced children with dental avulsions and their families were identified: The injury and its context; Challenges in seeking emergency dental care; Barriers and enablers; Emotional and psychological impact; Treatment experience and outcome. Overcoming barriers through enhanced education, improved healthcare responsiveness, and supportive environments is vital to improving both prognosis and overall family experience. The effects of enhanced education about dental avulsions and its impact on families is an area of future research.

5.1. Future Research Directions

• Explore the long‐term psychological and social impacts of dental avulsion injuries on affected children or adolescents and their families in Aotearoa New Zealand.

• Evaluate the effectiveness of public health initiatives aimed at increasing awareness of dental trauma response among parents, caregivers, teachers and frontline healthcare providers.

• Investigate accessibility and responsiveness of emergency dental services across rural and urban regions in New Zealand.

• Assess the impact of professional development and trauma education programmes for primary care providers and educators on patient outcomes.

• Examine how cultural, socioeconomic, and systemic factors influence access to timely dental care and treatment outcomes within diverse New Zealand communities.

Author Contributions

Aiswarya Kovanur Kesava: data collection, data analysis and the interpretation of the findings and writing – original draft. Finn Gilroy: conceptualisation, supervision, data analysis and the interpretation of the findings and writing – review and editing. Ben Kei Daniel Motidyang: co‐supervision, data analysis and the interpretation of the findings and writing – review and editing. Alison Meldrum: supervision, interpretation of the findings and writing – review and editing. Manikandan Ekambaram: conceptualisation, project administration, supervision, interpretation of findings, resources and writing – review and editing.

Funding

This work was supported by the University of Otago, Sir John Walsh Research Institute Fuller Scholarship in Dentistry.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Data S1: edt70049‐sup‐0001‐AppendixS1‐S4.docx.

Data Availability Statement

Research data are not shared.