Abstract
Objectives
Dental trauma among children is a common problem, and everyone who works with them needs to possess appropriate knowledge and skills to provide proper care at the site of the accident. The aim was to evaluate the knowledge of emergency management of dental trauma among students who should be capable of managing such injuries in their future career.
Materials and Methods
A cross-sectional survey regarding dental trauma emergency management was conducted on 679 students from five different studies using a questionnaire. The obtained data were analyzed by the Student t-test or one - way ANOVAusing the Tukey's post-hoc test and multiple linear regression analysis (p<0.05).
Results
The total knowledge score regarding the emergency management of dental trauma among examined student was 4.32±2.25 (max 10). The positive association of the knowledge score was observed with the age of student (β=0.722, p≤0.001). A similar relation was observed depending on whether they received dental injuries training during their academic education (β=2.365, p≤0.001), as well as students’ assessment of the importance of knowledge regarding dental trauma emergency management (β=0.433, p≤0.001).
Conclusions
It can be concluded that the surveyed students have limited knowledge regarding dental injuries and their emergency management procedures. The obtained data emphasized the importance of additional education of all professions that may encounter dental trauma injuries to improve the outcomes of dental trauma treatment.
Key words: Tooth Injuries, Emergency Treatment, Students, Health Knowledge Attitudes Practice
Introduction
Traumatic dental injuries are a significant public health problem that can have various biological, psychosocial, emotional and economic impact on the quality of life of the affected individual (1). Injuries most often occur among preschool children, schoolchildren and young adults (2). Kindergartens, schools, playgrounds, and sports facilities are places with a high probability of the occurrence of dental trauma during children’s physical activity. For these reasons, it is essential that different professional groups, including educational and health professionals, are adequately informed about this subject and, also, sufficiently prepared for it (3).
Various studies have observed insufficient knowledge regarding dental injuries and their emergency treatment procedures in different professional groups who work with children, such as teachers, preschool teachers, physical education teachers and physicians (4-9). Similar results were obtained when medical students, physical education students and dental students were surveyed (3, 8, 10, 11).
These results are disturbing since dental traumas are considered an emergency and have to be treated immediately (10). Except for the time elapsed between the trauma episodes and the moment when the dental treatment was undertaken, first aid at the site of the accident plays a crucial role in the short-term and long-term outcome of those teeth (12). Therefore, immediate and appropriate management is required by the witnesses at the site of the accident. Besides, inadequate knowledge in providing necessary first aid can lead to irreversible damage of the tooth (crown discoloration, mobility, sensitivity, pulp necrosis, root resorption, tooth fracture, tooth loss) (3, 13). Following the previously mentioned, adequate knowledge of dental trauma management by these professions and by the general population is considered necessary. Additionally, it is vital to raise awareness of dental trauma emergency protocols among young people who are currently being educated for these professions. It is necessary to include dental trauma emergency protocols in their college education, thus preparing them to act when such unpredictable situations occur (3).
The objective of this study was to examine and compare the level of knowledge of students (medical and non-medical) from the University of Split regarding emergency dental trauma management. Physicians, preschool, school, and physical education teachers, due to the nature of their work, might be the first to treat dental injuries on many occasions and their reaction could determine the success and the prognosis of further treatment by the dentist. An evaluation of students' level of knowledge is essential to emphasize the need for additional educational campaigns - training courses regarding the risk of dental trauma and its management campaigns that will strengthen the knowledge of these se groups, as well as confidence, and eliminate problems or doubts when handling these types of situations that can be challenging and unpleasant even for the professionals with sufficient knowledge (13-18).
Materials and Methods
This cross-sectional study was conducted between May and June in 2019. A questionnaire related to dental trauma knowledge was completed by students in five different academic departments, including two health-related studies (Medicine and Dental Medicine) and three non-health-related studies (Teacher's Education, Pre-school Education, and Physical Education) at University of Split, Croatia. These students were chosen because they will probably meet children who may experience dental trauma in their future occupation. An online questionnaire was designed in the Google Form, and the link was sent to the representative student councils from each study, which forwarded it to other students. The population of the study included full-time students. Thus, 679 students of both genders from all academic years participated in this study. The inclusion criteria included undergraduate students, studying at University of Split during the academic year 2018/2019, and those who fully completed the questionnaire. The exclusion criteria were participants aged ˂ 18 years and those who had provided incomplete responses in the questionnaire. The objectives were explained to all the participants at the beginning of the questionnaire. The participation in the survey was voluntary. The study was anonymous and approved by the Ethics Committee of the School of Medicine (No: 2181-198-03-04-19-0055).
The questionnaire was based on different studies relating to the same topic, and it was divided into three sections, with a total of 24 questions (11, 14, 15). The first section assessed demographic data (age, gender, study program), while the second part included ten questions regarding dental trauma training, experience and attitudes about dental trauma. The third part consisted of 10 closed-ended questions concerning the knowledge of dental traumatic injuries management, including questions covering the following areas: tooth identification, dental fragments reattachment, avulsed tooth replantation, cleaning, storage media and time elapsed between the event and the first aid provided. Each correct answer in the third part was scored one, and incorrect was scored 0; the maximum possible score was 10. The total knowledge score for each respondent was calculated by adding up the number of correct answers, which was considered the primary outcome of the study. The respondents had to answer each question before submitting the form.
Experts in the dental field (a pediatric dentist, endodontists, and an oral surgeon) approved the content of the prepared questionnaire. As a test of reliability, the questionnaire was pilot-tested on 50 students whose questionnaires were excluded from the primary study sample. Internal consistency for total scores showed a Cronbach’s coefficient alpha of 0.710. The minimum required sample size (n=310) was calculated from the full number of students who attended the abovementioned five faculties in the academic years 2018–2019 (N=1595) with a 95% confidence interval, 5% margin of error and a population proportion of 50%.
Data were analyzed by the Statistical Package for the Social Science version 25 (SPSS, IBM Corp, Armonk, New York, USA). The Kolmogorov-Smirnov test evaluated the compliance with normal distribution of the dependent variable. A descriptive analysis was done by calculating the frequency and percentages of categorical data; qualitative data were expressed as a mean ± standard deviation. A statistical analysis was conducted using Student t-test or one - way ANOVA, with Tukey's post-hoc test. The differences between categorical variables were tested using the χ2 test and Fisher's exact test. The influence of the independent variables (age, gender, dental trauma training, witnessed or experienced dental injuries) onto the dependent variable (knowledge score) was assessed using a general regression model (GRM). The results were expressed in the form of Pareto charts. The level of significance was set at p<0.05.
Results
The study included 679 students, 82.5% female, and 17.5% male; mean age 22.14±1.93, range 19-27. The response rates were 84.4% for dental students (152/180), 25.0% for medical students (135/540), 65.0% for preschool education students (130/200), 56.8% for teacher’s education students (128/225), and 29.7% for physical education students (134/450). Demographic and professional characteristics of the participants are presented in Table 1. The overall mean knowledge of dental trauma emergency management among surveyed students was 4.32±2.25. Dental students have shown the best results, compared to medical, physical education, preschool education and teachers’ education students (6.75±2.17 vs 4.32±1.67, 3.69±1.67, 3.38±1.76, and 3.05±1.55 respectively; p≤0.001). However, the mean knowledge scores of both dental and medical students show a statistically significant difference when compared to students of other faculties. Other factors associated with higher levels of knowledge were age, year of study, received dental injuries training, self-assessment knowledge, being a witness of dental trauma, being informed and interested in learning about dental trauma (p≤0.001).
Table 1. Participants’ socio-demographic characteristics according to the mean knowledge score regarding dental trauma emergency management (N=679).
| Characteristic |
Total n (%) |
Knowledge score mean ± SD |
p-value* | |
|---|---|---|---|---|
| Gender | Male | 119 (17.5) | 4.44±2.18 | 0.529 |
| Female | 560 (82.5) | 4.30±2.26 | ||
| Age group (years) | 18-21 | 244 (35.9) | 3.40± .73a,b | ≤0.001 |
| 22-24 | 311 (45.8) | 4.54±2.25a,c | ||
| ≥25 | 124 (18.3) | 5.61±2.38b,c | ||
| Studies | Dental Medicine | 152 (22.4) | 6.75±2.17a,b,c,d | ≤0.001 |
| Medicine | 135 (19.9) | 4.32±1.67a,e,f,g | ||
| Physical Education | 134 (19.7) | 3.69±1.67b,e,h | ||
| Preschool Education | 130 (19.1) | 3.38±1.76c,f | ||
| Teachers Education | 128 (18.9) | 3.05±1.55d,g,h | ||
|
Data are presented as whole numbers and percentages or mean ± SD. *Statistical significance was tested by Student t-test or One-way ANOVA. Statistical significance was set to p<0.05. The same superscript lower letter indicated a statistical difference between groups based on Tukey Test (a,b,c,d,f,g,j,k,l,o,q,r,sp≤0.001, ep=0.033, h,pp=0.045, ip=0.003, mp=0.004, np=0.002). Abbreviation: SD, standard deviation. | ||||
The evaluation of attitudes toward dental injuries according to the mean knowledge score of dental trauma emergency management is shown in Table 2. Only 12 (1.8%) of surveyed students rated their knowledge as very good. At the same time, these students also showed the best knowledge compared to the ones who rated their knowledge as very poor, poor, fair and good (8.25±1.28 vs 3.54±1.77, 3.75±1.82, 4.43±2.13. and 6.51±2.52; p≤0.001). Approximately 50% (n=376) of respondents considered important and very important the knowledge of dental trauma for their future professional work.
Table 2. Participants' attitudes toward dental trauma injuries according to the mean knowledge score regarding dental trauma emergency management (N=679).
| Characteristic |
Total n (%) |
Knowledge score mean ± SD |
p-value* | |
|---|---|---|---|---|
| Informed about dental injuries | Not informed | 305 (44.9) | 3.43±1.80a,b | ≤0.001 |
| Partially informed | 315 (46.4) | 4.48±1.98a,c | ||
| Completely informed | 59 (8.7) | 8.08±1.47b,c | ||
| Self-assessed knowledge about dental injuries | Very poor | 124 (18.3) | 3.54±1.77d,f,g | ≤0.001 |
| Poor | 255 (37.6) | 3.75±1.82h,I,j | ||
| Fair | 207 (30.5) | 4.43±2.13d,h,k,l | ||
| Good | 81 (11.9) | 6.51±2.52f,I,k,m | ||
| Very good | 12 (1.8) | 8.25±1.28g,j,l,m | ||
| Importance of knowledge of the management of traumatic dental injuries for future work | Not important | 10 (1.5) | 4.20±1.31n | ≤0.001 |
| Slightly important | 21 (3.1) | 4.09±1.60o | ||
| Fairly important | 272 (40.1) | 3.56±1.86p | ||
| Important | 216 (31.8) | 4.02±2.00q | ||
| Very important | 160 (23.6) | 6.06±2.37n,o,p,q | ||
| Received dental injuries training during academic education | No | 537 (79.1) | 3.67±1.65 | ≤0.001 |
| Yes | 142 (20.9) | 6.78±2.23 | ||
| Interested in future education about dental injuries | No | 251 (37.0) | 3.74±1.93 | ≤0.001 |
| Yes | 428 (67.0) | 4.67±2.35 | ||
| Self-assessed knowledge about dental injuries first aid – avulsion | No | 406 (59.8) | 3.61±1.74 | ≤0.001 |
| Yes | 273 (40.2) | 5.39±2.48 | ||
| Self assessed knowledge about dental injuries first aid – tooth luxation | No | 526 (77.5) | 3.70±1.82 | ≤0.001 |
| Yes | 153 (22.5) | 6.47±2.25 | ||
| Self- assessed knowledge about dental injuries first aid – tooth fracture | No | 430 (63.3) | 3.76±1.90 | ≤0.001 |
| Yes | 249 (36.7) | 5.30±2.47 | ||
| Witnessed dental injures | No | 492 (72.5) | 4.21±2.20 | 0.034 |
| Yes | 187 (27.5) | 4.63±2.34 | ||
| Experienced dental injuries | No | 528 (77.8) | 4.25±2.26 | 0.110 |
| Yes | 151 (22.2) | 4.58±2.17 | ||
|
Data are presented as whole numbers and percentages or mean ± SD. *Statistical significance was tested by Student t-test or One-way ANOVA. Statistical significance was set to p<0.05. The same superscript lower letter indicated a statistical difference between groups based on Tukey Test (a,b,c,e,f,g,I,j,k,l,m,o,p,qp≤0.001, h,np=0.039, mp=0.042). Abbreviation: SD, standard deviation. | ||||
Only 20.9% of all tested students have received some form of dental trauma education during their studies. Those who underwent some education showed better knowledge (6.78±2.23 vs 3.67±1.65; p≤0.001). Approximately 27.5% of students witnessed and 22.5% of them experienced traumatic tooth injuries. The students who suffered traumatic tooth injury showed better knowledge than those who did not, but it was statistically insignificant (p=0.110). The students who have witnessed traumatic tooth injury showed statistically significant better knowledge compared to those who have not (4.63±2.34 vs 4.21±2.20; p=0.034).
The distribution of correct responses to questions regarding dental trauma management among students of different study programs is shown in Table 3. Dental students provided the highest percentage of correct answers.
Table 3. Frequency of participants’ answers to the questions regarding dental trauma emergency management according to attend study programs (N=679).
| Question | Dental medicine (n=152) | Medicine (n=135) |
Physical Education (n=134) | Preschool Education (n=130) | Teachers Education (n=128) | |
|---|---|---|---|---|---|---|
| Identify primary tooth | Incorrect (n, %) | 5 (3.3) | 12 (8.8) | 16 (11.9) | 12 (9.2) | 10 (7.8) |
| Correct (n, %) | 147 (96.7) | 123 (91.1) | 118 (88.1) | 118 (90.8) | 118 (92.2) | |
| Identify permanent tooth | Incorrect (n, %) | 12 (7.9) | 29 (21.5) | 60 (44.8) | 53 (40.8) | 81 (63.3) |
| Correct (n, %) | 140 (92.1) | 106 (78.5) | 74 (55.2) | 77 (59.2) | 47 (36.7) | |
| Tooth fracture procedure |
Incorrect (n, %) | 31 (20.4) | 72 (53.3) | 91 (67.9) | 95 (73.1) | 98 (76.6) |
| Correct (n, %) | 121 (79.6) | 63 (46.7) | 43 (32.1) | 35 (26.9) | 35 (23.4) | |
| Displacement tooth procedure | Incorrect (n, %) | 110 (72.4) | 132 (97.8) | 129 (96.3) | 124 (95.4) | 122 (95.3) |
| Correct (n, %) | 42 (27.6) | 3 (2.2) | 5 (3.7) | 6 (4.6) | 6 (4.7) | |
| Primary teeth replantation |
Incorrect (n, %) | 33 (21.7) | 34 (25.2) | 55 (41.0) | 48 (36.9) | 60 (46.9) |
| Correct (n, %) | 119 (78.3) | 101 (74.8) | 79 (59.0) | 82 (63.1) | 68 (53.1) | |
| Permanent teeth replantation |
Incorrect (n, %) | 38 (25.0) | 72 (53.3) | 86 (64.2) | 101 (77.7) | 101 (78.9) |
| Correct (n, %) | 114 (75.0) | 63 (46.7) | 48 (35.8) | 29 (22.3) | 27 (21.1) | |
| Tooth handling | Incorrect (n, %) | 39 (25.7) | 81 (60.0) | 92 (68.7) | 103(79.2) | 90 (70.3) |
| Correct (n, %) | 113 (74.3) | 54 (40.0) | 42 (31.3) | 27 (20.8) | 38 (29.7) | |
| Tooth cleaning | Incorrect (n, %) | 71 (46.7) | 111(82.2) | 117(87.3) | 103(79.2) | 99 (77.3) |
| Correct (n, %) | 81 (53.3) | 24 (17.8) | 17 (12.7) | 27 (20.8) | 29 (22.7) | |
| Storage medium | Incorrect (n, %) | 114 (75.0) | 123 (91.1) | 116 (86.6) | 119 (91.5) | 126 (98.4) |
| Correct (n, %) | 38 (25.0) | 12 (8.9) | 18 (13.4) | 11 (8.5) | 2 (1.6) | |
| Extra-alveolar period | Incorrect (n, %) | 40 (26.3) | 100 (74.1) | 83 (61.9) | 102(78.5) | 99 (77.3) |
| Correct (n, %) | 112 (73.7) | 35 (25.9) | 51 (38.1) | 28 (21.5) | 29 (22.7) | |
| Data are presented as whole numbers and percentages. | ||||||
Demographic data and respondents' attitudes toward dental injuries according to different study programs are shown in Table 4. There are differences in the responses between students of various studies (p≤0.001) except for the question of whether or not they witnessed traumatic tooth injury.
Table 4. Comparison of demographic data and participants' attitudes toward dental injuries according to attended study programs (N=679).
| Characteristic |
Dental medicine (n=152) |
Medicine (n=135) |
Physical Education (n=134) | Preschool Education (n=130) | Teachers Education (n=128) | p-value* | |
|---|---|---|---|---|---|---|---|
| Gender | Male | 25 (16.4) | 31 (22.9) | 60 (44.8) | 1 (0.8) | 2 (1.6) | ≤0.001 |
| Female | 127 (83.6) | 104 (77.1) | 74 (55.2) | 129 (99.2) | 126 (98.4) | ||
| Age group (years) | 18-21 | 36 (23.7) | 29 (21.5) | 48 (35.8) | 74 (56.9) | 57 (44.5) | ≤0.001 |
| 22-24 | 75 (49.3) | 56 (41.5) | 78 (58.2) | 45 (34.6) | 57 (44.5) | ||
| ≥25 | 41 (27.0) | 50 (37.0) | 8 (6.0) | 11 (8.5) | 14 (10.9) | ||
| Informed about dental injuries | Not informed | 20 (13.2) | 84 (62.2) | 81 (60.4) | 60 (46.2) | 60 (46.9) | ≤0.001 |
| Partially informed | 77 (50.7) | 51 (37.8) | 53 (39.6) | 67 (51.5) | 67 (52.3) | ||
| Completely informed | 55 (36.2) | 0 (0.0) | 0 (0.0) | 3 (2.3) | 1 (0.8) | ||
| Self-assessed knowledge about dental injuries | Very poor | 17 (11.2) | 43 (31.9) | 28 (20.9) | 23 (17.7) | 13 (10.2) | ≤0.001 |
| Poor | 33 (21.7) | 62 (45.9) | 55 (41) | 47 (36.2) | 58 (45.3) | ||
| Fair | 44 (28.9) | 25 (18.5) | 43 (32.1) | 49 (37.7) | 46 (35.9) | ||
| Good | 46 (30.3) | 5 (3.7) | 8 (6.0) | 11 (8.5) | 11 (8.6) | ||
| Very good | 12 (7.9) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | ||
| Importance of knowledge of the management of traumatic dental injuries for future work | Not Important | 1 (0.7) | 4 (3.0) | 3 (2.2) | 0 (0.0) | 2 (1.6) | ≤0.001 |
| Slightly important | 0 (0.0) | 7 (5.2) | 7 (5.2) | 2 (1.5) | 5 (3.9) | ||
| Fairly important | 7 (4.6) | 86 (63.7) | 64 (47.8) | 62 (47.7) | 53 (41.4) | ||
| Important | 33 (21.7) | 29 (21.5) | 50 (37.3) | 52 (40) | 52 (40.6) | ||
| Very important | 111 (73.0) | 9 (6.7) | 10 (7.5) | 14 (10.8) | 16 (12.5) | ||
| Received dental injuries and first aid training during academic education | No | 46 (30.3) | 122 (90.4) | 123 (91.8) | 124 (95.4) | 122 (95.3) | ≤0.001 |
| Yes | 106 (69.7) | 13 (9.6) | 11 (8.2) | 6 (4.6) | 6 (4.7) | ||
| Interested in future education about dental injuries | No | 15 (9.9) | 82 (60.7) | 54 (40.3) | 49 (37.7) | 51(39.8) | ≤0.001 |
| Yes | 137 (90.1) | 53 (39.3) | 80 (60.0) | 81 (62.3) | 77 (60.2) | ||
| Witnessed dental injures | No | 105 (69.1) | 94 (69.6) | 100 (74.6) | 98 (75.4) | 95 (74.2) | 0.684 |
| Yes | 47 (30.9) | 41 (30.4) | 34 (25.4) | 32 (24.6) | 33 (25.8) | ||
| Experienced dental injuries | No | 118 (77.6) | 102 (75.6) | 95 (70.9) | 102 (78.5) | 111 (86.7) | 0.040 |
| Yes | 34 (22.4) | 33 (24.4) | 39 (29.1) | 28 (21.5) | 17 (13.3) | ||
|
Data are presented as whole numbers and percentages. *Statistical significance was tested by Chi square or Fisher's exact test. Statistical significance was set to p<0.05. | |||||||
The association of measured overall dental injuries management knowledge score with respondent demographical data and attitudes toward dental trauma injuries as possible predictors are presented in Figure 1. A positive association of knowledge score was observed depending on student age (β=0.722, p≤0.001). A similar relation was observed according to whether or not the student sustained a training on dental injuries during their academic education (β=2.365, p≤0.001), and depending on personal assessment of the importance of knowledge regarding dental trauma emergency management (β=0.433, p≤0.001).
Figure 1.
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Multiple linear regression analysis. Significant dependence of measured overall dental injuries management knowledge score with participant demographic data and attitudes toward dental trauma injuries as possible predictors.
Discussion
The objective of this cross-sectional study was to examine the level of knowledge and experience of dental trauma among the students from different fields of study, future educational and health professionals. We compared the knowledge of dental trauma emergency management among dental, medical, preschool education, teachers' education, and physical education students. The total students' knowledge score regarding emergency management of dental trauma was 4.32±2.25, with a maximum possible score of 10. As expected, the best results were shown by dental students, compared to students of other studies (p≤0.001). Among the surveyed students, medical students showed second-best knowledge, however, the level of their knowledge is still insufficiently high. Although future physicians will deal with dental trauma in their work, the majority of tested medical students (63.7%) believed that dental trauma knowledge is moderately important for their future professional practice. Besides, most of them are not interested in additional education on this subject (60.7%). Inadequate knowledge of medical students and physicians was reported in numerous studies (10, 14, 19-22). In the present study, insufficient knowledge was also shown by preschool education and teacher’s education students. There are numerous studies confirming a low level of knowledge about dental trauma among preschool education teachers/students and teachers’ education students /school teachers in Croatia and other countries (5-7, 23).
The lack of knowledge amongst the tested groups may be due to inadequacy or complete lack of training for the management of traumatic dental injuries. Only 59 (8.7%) of the total of 679 respondents stated that they were fully informed about traumatic tooth injuries, and only 12 (1.8%) of them reported that their knowledge was very good. These results are supported by the fact that only 142 (20.9%) respondents received dental trauma training during their university education. Most of dental students are well informed about dental injuries. In contrast, students from the other four studies are partially informed or not informed at all. Self-assessed knowledge about dental injuries among tested students is mostly inadequate (very poor, poor and fair). These results are in correspondence with previously published studies on health and educational professionals (3, 5, 10, 11, 20, 24). a small number of previously published studies compared the knowledge and the attitude before and after dental health education. Health education intervention (posters, lectures, videos) can significantly improve the knowledge about the correct management of dental injuries (25-27).
Most of dental students, (94.7%), considered the knowledge of emergency dental management significant for their professional life and were interested in further education on this subject (90.1%). Similar results were reported in a study conducted in Saudi Arabia, where 95.7% of dental students considered education on dental injuries extremely important (11). A small number of medical students shared the same opinion. Only 28.2% of them considered the knowledge of emergency dental trauma treatment crucial for their future work, whereas 39.3% of them were interested in additional education. Conversely, a study conducted on medical students from the University of Rijeka (Croatia) showed that the majority of students were willing to gain further knowledge regarding this subject (10).
Furthermore, a previously published study conducted on a sample of pediatricians from Croatia showed that they are aware about the importance of timely treatment and a desire for continuous education on dental trauma management (17). Among the tested students of physical education, teachers’ education and preschool education, approximately 60% of them showed interest in future education and nearly 50% of them have considered awareness of dental trauma management important for their future work. Bakarcic et al. (5) in their survey conducted on Croatian teachers, showed that 93% of students did not receive any formal training on this subject, yet over 87.0% of them were willing to participate in the training on such a subject. Similar results regarding the teacher population were obtained in other countries (28, 29).
Dental students showed the best knowledge about dental trauma emergency management, according to their responses. Approximately 90% of the students from all studies answered correctly the question regarding the identification of deciduous tooth. In contrast, the results regarding the question of identifying a permanent tooth were not so positive. Teachers' education students showed the lowest scores; only 36.7% of them correctly identified a permanent tooth, which points to inadequate general knowledge of study groups regarding the time of eruption of a permanent tooth. A differentiation between the two types of dentitions is important for the selection of proper therapeutic procedure in certain traumatic tooth injuries. Most of the students from all tested study programs knew that deciduous avulsed tooth should not be replanted. Nevertheless, only 46.7% of medical, 35.8% of physical education, 22.3% of preschool education, and 21.1% of teachers' education students knew that a permanent tooth can be replanted after avulsion . Previously published studies also reported poor knowledge on this subject for teachers (30, 31).
If replantation is not possible at the site of the accident, the tooth should be immediately placed in a suitable medium (milk, patient's mouth/saliva, and special storage media) that will allow PDL cells to survive until the moment of replantation (5). The present study did not find a satisfactory response rate regarding the storage medium. Only 25.0% of dental students provided all correct answers. Likewise, only 13.4% of physical education students, 8.9% of medical students, 8.5% of preschool and 1.6% of teacher’s education students answered correctly the questions regarding the storage medium. A study conducted on dental students in Saudi Arabia and Japan has obtained better results (11, 32). De Oliveira et al. (8) showed that 31.1% of physical education students would keep a tooth in a dry medium (handkerchief, a piece of cloth, in their hand), while 7.5% of them would keep it in milk and 7.5% of them in their mouth (saliva). Prasanna et al. (30) reported that 39.0% of 300 primary school teachers thought that the knocked-out tooth should be kept in a cotton roll, while only 3.0% of them stated milk as a suitable medium. Concerning the adequate extra-oral time for replantation, 73.7% of dental students answered correctly (immediate replantation). Other studies reported similar results (11, 32). Slightly smaller number of dental students in Saudi Arabia successfully answered the same question (67.5%) (11). Only 38.1% of physical education students answered correctly, while in Spain, the same answer was provided by 25.0% of students (24).
As expected, older students (≥25 years old) showed better knowledge than their younger colleagues (p≤0.001). This can be explained by the fact that dental and medical students encounter the examined topic in their higher years of study. In most studies, the age of participants had no effect or was positively significantly related to the knowledge level of dental trauma and its management (9, 11, 14, 29, 31, 32). In contrast, some studies have confirmed the fact that older dentists have more deficient knowledge than their younger colleagues (33, 34).
The students who have witnessed dental trauma showed to possess better knowledge since they presented a higher prevalence of correct answers (p=0.034). Interestingly, those that experienced dental trauma personally did not show better results. Approximately 30.0% of dental and medical students have witnessed dental trauma. The majority of those who suffered tooth injury themselves were from Physical Education (29.1%), and the smallest number of them were from the Teachers Education Study (13.3%). Out of 199 physical education students examined by De Oliveira et al. (8), only 34.7% of them had dental injury personally. Nikolic et al. (16) reported that 29.0% of pediatricians experienced dental trauma, while 69.0% of them witnessed trauma in their medical practice more than once.
Conclusion
From the results obtained in the current study, it could be concluded that students’ knowledge about the emergency management of dental trauma is insufficient. Although this study was conducted at only one university in Croatia, these results emphasize the importance of additional student education aiming to improve the outcomes of dental trauma treatment. The majority of students who participated in the current study considered the training on emergency management relevant to their particular profession. Since most of the studied groups have shown an interest in training on this topic, it would be benificial if such a training becomes an integral part of their study curricula.
Acknowledgements
We did not have any sources of funding directly relevant to the content of this manuscript. The authors received no financial support for the research. The authors wish to thank all participants for their invaluable contribution to this study.
Footnotes
Conflict of interest: The authors declare no conflict of interest.
References
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