Knowledge and attitude of dental trauma among dental students in Saudi Arabia

Abstract

Objective:

The aim of this study was to assess the level of knowledge and attitude of Saudi dental students in the management of dental trauma in children.

Materials and Methods:

A self-administered questionnaire comprising 17 close-ended questions was used in this survey. The questions were divided into three parts including: Personal and professional profile; knowledge assessment; attitude toward dental trauma. Data of 307 respondents were analyzed using SPSS (Statistical Package for Social Studies) version 22.0 (IBM Corporation, Chicago, IL, USA).

Results:

The response rate was 76.8%. Around 40.3% of students reported attending additional courses about dental trauma with a significant difference between males (57.2%) and females (19.4%). The vast majority of students (95.7%) stressed the importance of dental trauma education. While 77% could correctly identify the media of transportation of an avulsed tooth, only 26.9% of the students knew the proper method of transportation. Regarding the knowledge of immediate replantation, only 67.5% of students responded correctly.

Conclusion:

The present study demonstrates an insufficient knowledge concerning dental trauma management among dental students in Saudi Arabia. This highlights the need to improve the knowledge of dental students regarding dental trauma and its management using a variety of educational methods such as problem-based learning and powering the curriculum concerning those topics of dental trauma.

INTRODUCTION

Trauma to both primary and permanent dentations and their supporting structures is commonly occurring in children.[1] Most of these injuries happen between 8 and 11 years.[2] Many studies on dental traumatology gave evidence that most dental accidents in children occur at home and school.[3] Dental injuries can vary from simple concussions to a considerable damage involving structures surrounding the tooth.[4] Avulsion, a complete detachment of tooth from the socket, is the most complicated and serious type of all dental injuries. It represents 1–16% of dental trauma with a peak incidence in the 7–11-year-old children, with the highest incidence in maxillary central incisor.[5,6] The appropriate management of traumatically avulsed tooth is critical for the survival of the tooth.[7,8,9] A series of guidelines for the management of avulsed permanent teeth were published by the International Association for Dental Traumatology (IADT). These guidelines outline the proper approach for the immediate care of avulsed permanent teeth, helping dentists and other health care professionals to make a decision regarding avulsion cases.[10]

Several studies have assessed the knowledge of various populations such as dentists, school teachers, and physicians regarding the emergency management of teeth avulsion.[11,12,13,14,15] Most of these studies reported the need for better communication between dental professionals and the community to improve the awareness.

In Saudi Arabia, the incidence of dental trauma is higher than that reported in other countries.[4,16,17] However, as far as we know, the data regarding knowledge of dental trauma among dental students is lacking. Therefore, this study is aimed to assess the level of educational knowledge and attitude of Saudi dental students in the management of dental trauma in children, as well as, to examine the influence of dental education on the management of dental trauma among those students.

MATERIALS AND METHODS

This study consisted of a cross-sectional survey of undergraduate dental students at the school of Dentistry, Al-Farabi Colleges, Riyadh, Saudi Arabia. All clinical dental students (4^th–5^th year) enrolled during 2014–2015 academic year were eligible to participate (N = 400). The study was approved by the Al-Farabi College Institutional Ethical Review Board.

A structured questionnaire was adapted from pretested questionnaires that have been used in similar studies by Al-Obaid,[4] Fujita et al.,[17] with some modifications to suit the student's educational level. Before submitting the questionnaire, a pilot study was performed on a random sample of the students (N = 40) and the questionnaire was modified according to the feedback obtained.

Students were asked to fill out the anonymous self-administered questionnaire at the end of the lectures, and sometimes during the clinical sessions without the discussion for 15 min. Students, who agreed to participate in the stud, signed a consent form.

The self-administered questionnaire comprised 17 close-ended questions divided into three parts. The first part screened the personal and professional profiles of the students including age, gender, educational level, first aid training, and dental trauma courses. The second part assessed the knowledge of those students about the dental trauma. The third part investigated the attitude and the management of dental trauma with the emphasis on the avulsion of the teeth.

SPSS (Statistical Package for Social Studies) version 22.0 (IBM Corporation, Chicago, IL, USA) was used for data entry and descriptive statistics including frequencies and proportions. Chi-squared test was used to compare groups. A P < 0.05 was considered significant.

RESULTS

Out of the 400 dental students participated in the survey, 307 returned questionnaires, giving a response rate of 76.8%.

Table 1 presents the number and percentage of students regarding the age, educational level, and professional data. Around 54.4% of the participants were males. Regarding professional data, the significantly higher percentage of male reported attending first aid (65.3%) and dental trauma management courses (65%) as compared to females (P < 005).

Table 1.

Results of personal and professional data n (%)

With regard to dental trauma, knowledge, around (95.7%) of the participants stressed the importance of dental trauma education. Also, there was an acceptable, correct response in relation to the chronology, the possibility of replantation, and the success immediate replantation. However, only (67.5%) of the participants correctly answered the question regarding the period within which the tooth must be replanted. A positive correlation was found between the knowledge of students toward dental trauma and the academic level (P = 0.000; [Table 2]).

Table 2.

Results of correct response of dental trauma knowledge n (%)

Generally, students showed variations regarding their attitude toward dental trauma [Table 3]. While 77% identified correctly the media of transportation of an avulsed tooth, only 26.9% of the students knew the proper method of transportation. Female students showed better attitude than males, and the differences were statistically significant (P ≥ 0.001).

Table 3.

Results of correct response of attitude regarding dental trauma n (%)

DISCUSSION

A suitable emergency management and treatment plan is critical to the success and good prognosis of dental trauma. Treatment guidelines for dental trauma are required to help dentists and other healthcare workers to provide the proper and effective care for children in case of trauma.[10] Consequently, it is important to enhance the awareness and upgrade the information about dental trauma for those professional. If those guidelines were applied immediately after traumatic injury, both short- and long-term outcomes would be improved.[10]

This cross-sectional study was conducted to evaluate the level of the knowledge and attitude toward dental trauma, with particular emphasis on dental avulsion among clinical dental students in Riyadh, Saudi Arabia. These students have had some lectures about dental trauma and its management in the curriculum of some subjects (oral surgery, endodontics, and pedodontics).

The current results demonstrated a significant shortage in attending courses about dental trauma, especially among female students. This could be attributed to the closed social culture in Saudi, which makes it more difficult for females to attend such courses. Hence, dental students should be encouraged and motivated to attend courses about dental trauma and its management.

We evaluated the knowledge of the students about the dental trauma through some questions related to the chronology of eruption of the maxillary anterior teeth, (the most common teeth vulnerable to trauma), the period within which the avulsed tooth must be replanted, and if the immediate replantation is essential for successful outcome or not. Overall, there was an acceptable positive response from the students regarding the above points. Unsurprisingly, there was a significant favorable response from students of the higher academic level (5^th-year students) compared with those of lower academic level. This result is expected to and could be attributed to the fact that their knowledge regarding dental trauma is more updated and refreshed than 4^th-year dental students. Another possible explanation for this finding is the fact that the 5^th year students had been exposed to clinical cases as compared to those of lower academic levels.

The vast majority of students (95.7%) from both academic levels stressed the importance of receiving dental trauma education, indicating their willingness to receive more educational programs regarding dental trauma. This finding is in consistent with previous studies.[1]

Vital factors that might affect the success of the treatment of an avulsed tooth are the storage period, transportation method, and the media of the transportation, which directly related to the viability of periodontal ligament cells.[18] According to the guidelines of dental trauma management published by American Academy of Pediatric Dentistry and the IADT, the immediate replantation of a tooth is recommended for the best prognosis.[7,10] If the tooth cannot be replanted within 5 min, it should be stored in a medium that will help to maintain the vitality of the periodontal ligament fibers.[19] The best media for transportation is Viaspan™, Hank's balanced salt solution, and milk.[10,20,21] In the present study, around 77% of the students (60% of 4^th and 92.3% of 5^th year students) selected milk as the best media of transportation indicating that they have reasonable knowledge that milk is one of the most practical and obtainable medium for transport of avulsed teeth. The pH and osmolality of the milk are similar to those of extracellular fluid.

The avulsed tooth should be kept moist, as the risk of ankylosis will be increased significantly with increasing the time of dryness over 20 min.[22,23,24] Unfortunately, most of the students in the present study (73.1%) were not aware that the avulsed tooth could, and should be transported to the dentist in the patient mouth, keeping it inside the lip or cheek if the patient was conscious.[10] This again indicates a lack of current knowledge about this point.

Management of dental trauma is one of the areas in which dental students reported low levels of confidence.[25] This finding was identified by some previous studies among the United Kingdom dentists which have highlighted the lack of confidence and competence in dental trauma management.[12,26,27] Vasconcellos et al.[28] in his study of general dentists in Brazil stressed the need for the general dentists to improve their knowledge about dental trauma management.

It has been reported that all observational studies such as cross-sectional surveys are prone to limitation and bias.[29] This study has some limitations that should be taken into consideration. One possible limitation is the likelihood of selection bias given that dental students who chose to participate in the survey may be more keenly interested or concerned with dental trauma and its management than those who did not participate. Therefore, the results are likely not generalizable to nonrespondents. Additionally, a general limiting characteristic of the self-reporting survey is the probability of socially acceptable responding,[30] and, therefore, the results may not necessary fully reflect student's real knowledge and daily professional practice. Nonetheless, despite these limitations, the study provides some important information about the Saudi dental students’ knowledge and attitude regarding dental trauma.

Similar to previous studies, the results of the present study demonstrate the insufficient knowledge regarding dental trauma management among dental students in Saudi Arabia.

This highlights the need to improve the knowledge of dental students regarding dental trauma and its management using a variety of educational methods such as problem-based learning and powering the curriculum concerning those topics of dental trauma.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.