Yawar Ali Abidi1 , Fazal-ur-Rehman Qazi2 , Faisal Bhangar3 , Sameer Qureshi4 , Saqib Rashid5
J Pak DentAssoc.2009; 18(1): 019 – 022.
Avulsion of permanent tooth is the most serious of all dental injuries. The prognosis depends on the measures taken at the place of accident or the time immediately after the avulsion. An appropriate emergency management and treatment plan is important for a good prognosis. The objective of the present study was to evaluate and investigate the knowledge of dental professionals about the emergency management of tooth avulsion in Karachi.
Two Hundred questionnaires were distributed amongst General dental practitioner, Postgraduate trainees and House officers, the questions were related to knowledge of how to treat and manage the traumatic avulsion of teeth.
Out of 200 dentists targeted 50% were involved in Continuing Education Programme 25% updated their knowledge through journals and books. While rest had only information they got during their education at dental schools.
The data suggested that the level of knowledge on the management of dental avulsion among dental professional in city of Karachi is adequate.
Dental trauma, knowledge, survey, tooth avulsion
Trauma to the oral region occurs frequently and comprises 5% of all injuries for which people seek treatment.1 In preschool children the figure is as
high as 18% of all injuries.’ Among all facial injuries, dental injuries are the most common of which avulsion occurs in 1-6% of all dental injuries.’
Avulsion is a complete displacement of a tooth from its alveolus and represents a complex and dramatic injury that may affect multiple tissues.2 The damage of the attachment apparatus is an unavoidable consequence of avulsion. Maintaining the periodontal ligament that is attached to the avulsed tooth vital is critical for the success of the treatment.3 It is well established that the prognosis of traumatized teeth in general and of avulsed teeth in particular depends on prompt and appropriate treatment. The initial treatment at the site of the accident often relies on the children’s parents and their schoolteachers prior to the initial professional contact.4
The avulsed tooth must be replanted in its socket. For success of the replanted tooth, maintenance of vitality of the cells over the root is fundamental.’ However, the immediate replantation or maintenance of the avulsed tooth in storage media compatible for survival of these cells before replantation is an important factor.6 When the tooth is maintained in wet storage medium, i.e. milk, replantation can be made later, and the chances of success are increased.’ Furthermore, if the tooth is kept in dry storage medium before replantation maintenance of vitality of the cells is impossible.8
The majority suggest that a nearby dentist would be contacted and the minority feel that the patient would go to a general hospital directly.9 Management of traumatic
injuries, mainly avulsion, may be a challenge to the non specialized dentist, as it occurs sporadically and when professionals are least prepared for them.
The aim of this study was to investigate the knowledge of general practitioner dentists about the emergency management of dental avulsion in the city of Karachi
A specific questionnaire was distributed among dental professionals regarding the emergency management and treatment of tooth avulsion. A group of 200 dentists were targeted and interviewed including dental house officers and postgraduate residents. The professionals were selected from different dental institutes of Karachi and General Dental
Practitioners having their dental clinics in different localities of Karachi. The professionals who registered as specialists were excluded from this study. The eight questions were prepared relating to knowledge of how to treat traumatic avulsion of teeth. The correct responses were determined by a combination of experts’ knowledge and evidence in the accepted literature. The returned questionnaires were coded and analyzed. Results were expressed as a percentage of respondents for each question
A total of 200 questionnaires were distributed, out of which 98 participants were males and 102 participants were females. Respondents were General Dental Practitioners, Post Graduate Trainees and House officers. One hundred respondents (50%) were involved in continual Dental education programme, 25% were self-educated by books and scientific articles on dental trauma emergency care; and remaining had only information during their education at Dental School. The result are summarized in Table I.
The present study finds that majority of professionals had knowledge in accordance with latest research which is required to manage tooth avulsion. A high number of respondents (67%) were in favor of replantation after any extra-alveolar time even if the replanted tooth would last in place for a limited period of time. They perceived that it would maintain space and can be aesthetically useful. Similar finding was found by Andreasen and Bodin10 who investigated human teeth replanted after 15 min and noted that the majority of teeth had their integrity preserved. This demonstrates that a shorter extra oral time is better to preserve teeth, as there are fewer areas of root resorption. However, when the tooth cannot be immediately replanted, it should be maintained in some storage medium.n.
Maintenance of the avulsed tooth in a storage medium maintains the vitality ofPDL cells present over the root for longer and, in some cases, even stimulates their proliferation.2 Most of the respondents who chose saliva as the storage medium justified their option based on the immediate availability of the saliva. However, Oswald et al” found better results for teeth maintained in saliva for 90 min than teeth kept in dry storage medium before replantation. The composition and osmolality of milk are more compatible for survival of cells over the root.” Lindskog and Blomlcf et aim comparing milk with saliva, noted better results when the milk was used. Because of its hypotonicity and microorganisms, the saliva can contribute to cell death. The maintenance of teeth in milk should not exceed 6 h.15
If they could choose a better storage medium, they would use Hanks’ balanced salt solution, an option that is well documented in the literature.” Comparing milk with Hank’s Balanced Salt Solution (HBSS), authors noted that HBSS demonstrated better results, even when the teeth were maintained for 12 h.3 Viaspan exhibited better results when compared with HBS S.” However, because of the easy access to milk in the moment of the accident and as 6 h are enough to look for a dentist, milk can be chosen as a short term storage medium. Thus, taking into account the aforementioned aspects, the extraoral time and storage medium are essential factors for the success of replanted teeth.” After the injury; tooth avulsion should be correctly treated to ensure a better prognosis
The overall knowledge of the respondents about the type of splinting was adequate and correct. The decisions of the majority of the respondents were generally correct regarding the splinting period. Authors tend to recommend a shorter period of immobilization.” Otherwise; a 30 day splinting period has been successfully used in cases of replantation.
The decision regarding endodontic treatment are coincident with recently published guidelines, which suggest an acute approach (endodontic treatment within a few hours) if the tooth is not replanted at the time of injury; otherwise, sub acute (within the first 24 h) and delayed (after the first 24 h).20 It is also a good idea to endodontic treatment outside the mouth if apices are open and there is no hope for revascularuization due to very delayed replantation as it is easier to form an apical barrier extraalveolarly.21
In this study, a large number of respondents justified antibiotics and tetanus prevention in any situation; others would prescribe antibiotics and analgesics only in cases of ‘gross contamination.
Based on the findings of this study, it is possible to suggest that the level of knowledge of dental professionals of the city Karachi is adequate.
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