Comparison of knowledge and attitude among medical postgraduates and general medical practitioner in management of tooth avulsion

Introduction

Traumatic injuries to dentoalveolar tissues are recognized as the most serious problem among school children and adolscents.1 It has become a serious dental public health problem in developing and developed countries. One of the common type of dentoalveolar injury is tooth avulsion which is defined as a total dislodgement of the tooth from its socket.1 Avulsion occurs in 1–16% of all dental injuries.2 It can be due to sporting activities, falls at home, car accidents, fights and intentional assaults. Due to the labial inclination of the teeth maxillary central incisor is the most affected tooth.3

Permanent anterior teeth are crucial for aesthetics, phonetics, mastication, and psychological health of young patients. The principle challenge with regards to avulsion is to maintain the vitality of the periodontal cells, hence immediate appropariate management of the avulsed tooth by replantation is needed for long term prognosis.1 Extra alveolar dry time, storage media used, type of retention, drug prescribed plays important role in successful long term outcomes.3

The most critical factor for maintaining the vitality of periodontal ligament cells can be established by stow the tooth in a suitable medium such as milk, saliva or saline.1 Many avulsed teeth are lost due to lack of knowledge about the accepted first aid procedures. Parents and teachers often have the first opportunity to attend a child with tooth avulsion injury. But the physicians are first one to provide treatment for child with dental trauma.4 Many patients with avulsed tooth visit medical professionals due to lack of cognizance or unprocurable availability of the dentist.5 To ensure proper and appropriate management, it is essential that medical professionals should have adequate knowledge and sufficient training. Hence the study is to compare the knowledge and attitude of medical postgraduates and general practitioner in management of avulsed tooth.

Materials and Methods

This study was conducted among 50 general medical practitioners and 50 post graduates in and around Mangalore. The ethical approval was obtained from Yenepoya ethics committee, Yenepoya university, Mangalore. The questionnaire was written in the English language and consisted of 11 questions based on previous similar studied by Holan G et al.,6 2003; Abu Damoud et al,7 2007;). The questionnaire was reviewed by experts with knowledge of this field. The questionnaires was distributed by making personal visits to the study subjects who was selected via purposive sampling

Result

Discussion

This study provided baseline information about the existing level of knowledge of dental avulsion in general medical practitioner and medical postgraduates. The lowest time passed between injury and dental care would give a beneficial prognosis and better chance of treatment success following dental trauma.8 12% of general medical practitioner and only 8% of postgraduates had previous experience of tooth avulsion cases which suggests that practitioner have encounterd more tooth avulsion cases when compared to post graduates. Majority of the participants felt that dental trauma should ideally be managed by a dentist. Surprisingly, none of the surveyed postgraduates or general medical practitioner preferred to put the tooth back in its socket although, one of the main requisites of dental avulsion treatment is the tooth reimplantation as soon as possible, keeping periodontal cells viable for healing and a possible pulp revascularization.

A delay in providing emergency dental treatment may risk the prognosis of an avulsed tooth. An attempt should thus be made to immediately replant the avulsed tooth. Ideally, re-plantation should be carried out within half an hour. If the tooth is kept in a suitable medium, the extra-oral time may be extended to up to 6-hours. If replantation is not feasible, the use of a correct transport media is an essential step, which will expand the extra-oral time to 1 h. This will maintain the periodontal ligament cells’ viability and prevent any damage which might cause loss of the tooth in the future. Milk is considered the best medium for the periodontal ligament cells viability. It is an sisotonic liquid with favourable osmolality, which has essential nutrients for periodontal ligament cells to survive and allow them to heal.1 Therefore, it has been recommended as a temporary storage medium for avulsed teeth before replantation.9 In our study, 25% of medical postgraduates and 30% general medical practitioner of the chose milk as the best medium for storing the tooth. This result was similar to Ulusoy et al. where 31.9% of the participants also chose milk as the best medium.10

The majority of the participants 42% general medical practitioner and 36% medical postgraduates did not receive any advice on management of tooth avulsion and would keen to learn more about the management of tooth avulsion.

Conclusion

From the conclusion of the results an important suggestion would include the need for an educational lecture to widen the knowledge of the general medical practitioner and general medical postgraduates about the emergency management of tooth avulsion. This can also be achieved by adding leaflets, posters about basic first aid treatment. In the current study, the population consisted of 50 general medical practitioners and 50 medical postgraduates, that was a convenient sample, which may limit the possibility of generalization, so further research with a larger population is warranted. However despite the limitations of these study, the result accentuate the need for further dental health education.

Source of Funding

None.

Conflict of Interest

The authors declare no conflict of interest.