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 Table of Contents  
Year : 2017  |  Volume : 8  |  Issue : 1  |  Page : 5-8

Knowledge about management of avulsed tooth among primary school teachers of Riyadh

1 Department of Conservative Dental Science, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Kingdom of Saudi Arabia
2 Department of Preventive Dental Science, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Kingdom of Saudi Arabia

Date of Web Publication30-Mar-2017

Correspondence Address:
Md Ali Salem Abuelqomsan
Department of Conservative Dental Science, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0976-433X.203486

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Background: Traumatic injuries are common among the school children during physical activity. As teachers being the first persons to come in contact, it is essential that they know to manage such situations. Hence, the aim of this study was to evaluate the knowledge level of a group of Saudi primary school teachers in the management of avulsed tooth. Methodology: The study was conducted among 300 male teachers and schools, who were randomly selected from Riyadh city. Results: The results showed that 68.3% had a previous experience about avulsed tooth in children. 36.3% (109 teachers) only had first aid training of dental trauma. Nearly, 61.7% knew about replant re-implantation of the avulsed tooth and regarding the storage media only 3.3% had chosen childrens' mouth/ saliva as a suitable media. Conclusion: This study shows a lack of knowledge regarding tooth avulsion and its emergency management among teachers in Riyadh city. Therefore, educational programmers are necessary to improve their level of knowledge.

Keywords: Avulsion, emergency, teachers, traumatic injuries

How to cite this article:
Abuelqomsan MA, Aljeaidi ZA, Albalawi AO, Abalkhayl IA, Gowdar IM. Knowledge about management of avulsed tooth among primary school teachers of Riyadh. SRM J Res Dent Sci 2017;8:5-8

How to cite this URL:
Abuelqomsan MA, Aljeaidi ZA, Albalawi AO, Abalkhayl IA, Gowdar IM. Knowledge about management of avulsed tooth among primary school teachers of Riyadh. SRM J Res Dent Sci [serial online] 2017 [cited 2023 Mar 29];8:5-8. Available from:

  Introduction Top

Traumatic dental injuries are considered one of the most common dental injuries in children.[1] Dental trauma may vary from minor tooth fracture to extensive dentoalveolar damage that involves the supporting structure and tooth displacement or avulsion.[2] Tooth avulsion is the complete displacement of a tooth from its socket due to accident injury.[3] Dental avulsion comprises of 0.5%–16% of all traumatic dental injuries.[4] The peak age for dental traumatic injuries is between 7 and 12 years, an age group when school fills their time.[5] Dental trauma in boys is three times more than girls because of their active involvement in sport and game.[6] Moreover, maxillary central incisors are the most frequently avulsed teeth.[4] According to Andreasen and Andreasen,[4] 10% of the population had experienced some kind of dental trauma. In general, accepted management of avulsed permanent tooth is by immediate replacement (re-implantation) as the choice of treatment.[7],[8] In primary dentition, the re-implantation is contraindicated because such a procedure may damage the permanent successor.[9],[10] The storage medium must be of correct osmolality and pH to prevent dehydration of the root surface during transportation.[11] School teachers are considered an important group because most of the dental injury occur when a child is in the school environment. Hence, the purpose of this study was to assess the awareness and knowledge among the teachers in the school of Riyadh city regarding tooth avulsion and its emergency management.

  Methodology Top

This was a cross-sectional questionnaire survey conducted among teachers randomly selected from the primary schools of Riyadh city. The list of schools was obtained from the Ministry of Education Officer of Riyadh city. The schools were divided into four clusters (North, South, East, and West) and a total of 300 teachers were randomly selected from forty primary schools. Ethical clearance was obtained from College of Dentistry, Prince Sattam Bin Abdulaziz University, and prior permission was also obtained from Education Officer of Riyadh city. Teachers who were voluntary willing to participate were included in the survey.

The questionnaire consisted of two parts. Part I comprised of questions on demographic information including specialization, age, first aid experience, and dental trauma accident experience. Part II included multiple-choice questions about management of traumatized teeth. The nature and objective of the study were explained to all the participants before the study. The validity of the questionnaire was tested using kappa statistics (0.86 kappa value). Statistical analysis was performed using SPSS 10 version software.

  Results Top

Age ranged from 24 years to more than 50 years. [Table 1] shows the highest percentage (34.3%) of the sample's age was between 30 and 39 years, compared to others.
Table 1: Age wise distribution of study subjects

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Where [Table 2] depicts the teachers' teaching subjects which showed 43.7% of sample were teaching religion and Arabic followed by scientific curriculum (23%), physical training (19.3%), and sociology (9%).
Table 2: Teaching subject wise distribution of teachers

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[Table 3] shows 68.3% of the teachers have seen an accident leading to dental trauma but only 36.3% had first aid training for managing such situation of dental trauma. Thirty-five percent of them reported it was primary tooth and 33.3% of them was as permanent tooth, and 31.7% did not answer.
Table 3: Response of the subjects to different variables

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For the question, if they have any idea about can we put the tooth into the socket again, 61.7% said Yes and 38.3% said No.

For the question, the procedure followed when reimplanting the tooth to its place the highest proportion of the study sample mentioned they will take the injured people immediately with the infected tooth to the dentist (25.3%), compared to 17.3% of them who wash it with tap water, and 13.3% ask the children to press to stop the bleeding for several hours.

For the question, would you re-implant (put back) the tooth into the socket from which it avulsed 88.7% answered Yes and 11.3% said No.

Distribution of members according to the action taken when the tooth falls on the ground in the event of reimplanting the tooth to its place, and the results showed that the highest proportion of the teachers reported to wash the tooth with normal water (45.0%), while a proportion of people remove dust using a toothbrush (19.7%), (18%) of them selected removing dust gently by hand, and there were (6.0%) re-implant the tooth into its place without any treatment.

For the method used to transport the tooth to the doctor, highest proportion of the study sample said they transport by keeping it in the liquid at a rate (23.3%), 22% in a sterile napkin, 19.3% in a plastic bag and 13% in the snow, while 7.7% reported they transport tooth by the hand and 3.3% save the tooth in patient's mouth. And for the liquid used to transport the tooth, highest proportion of the study sample said distilled water (34.7%), compared to (31.7%) using plain water, (21.7%) milk and (0.7%) using energy drink to transport tooth.

  Discussion Top

Schools are a social environment appropriate for the development of activities that promote oral health. Such activities should include students, school assistants and even members of the community.[7] Collaborative actions between dental and physical education professionals are needed to develop continued education programs. The development of public awareness about dental trauma depends on a clear, motivational and objective message to make lay people not only aware of their role in saving teeth in case of accidents but also to make them feel responsible for their own health.

There is a huge deficiency of knowledge among school teachers on the management of tooth avulsion. The international association of dental traumatology in 2007 has developed a set of guidelines for the management of avulsed permanent teeth.[7] As a step to educate the teachers following is a list of guidelines [7] that can be followed in managing cases of tooth avulsion.

  • Make sure the avulsed tooth is the child's permanent tooth, since there are different guidelines for handling avulsed primary and secondary avulsed teeth
  • Try to keep the patient calm
  • Find the tooth and pick it up from the crown part (white part). The root should not be touched
  • If the tooth is dirty wash it for 10 s with running cold water and reposition it. Encourage the teacher to replant the avulsed permanent tooth. Primary avulsed teeth are not replanted. After replanting make the patient bite onto a handkerchief to hold the tooth in position
  • If replantation is not possible to store the tooth in a storage medium such as milk, patients own saliva. The avulsed tooth can be transported in the mouth keeping it between the molars and inside the cheek keeping the root cells viable. Avoid storing the tooth in water
  • Seek emergency dental treatment immediately.

In the present study, the existence of significant differences about the experience for treatment of dental injuries vary by region, where the highest percentage of the study sample who do not have experience on the initial treatment for dental injuries was 63.7% (East - 16.3%, West - 15.3%, South - 13.0%, and North 19.0%).

In the present study, 36% of the school's teachers told they had knowledge about management of traumatic dental injuries which was in contrast to the study conducted by Arvind [12] which was 4.4% and comparable to the study of Abidi et al.[13] (25.2%). It was unexpected finding that the majority 63.7% of school's teachers had not received any formal teaching training of dental trauma first aid. This finding was inconsistent with the study done by Newman and Crawford in England,[14] where only 67% of the teacher had been specifically trained in teaching and 91% had been trained in first aid, but in our study, the percentage of teachers trained in first aid was 36.3%. In the present study, 31.7% of teachers selected very poor storage medium, that is, tap water comparable to Francisco (55%),[15] Leila et al.(56.5%)[16] but in contrast to the study conducted by Abidi et al.[13] The study by Chan et al.[2] in Hong Kong found that over 60% of teachers indicated that it was “very urgent” to seek professional assistance for cases of permanent tooth avulsions. 6.7% of teachers from Leila et al.[16] study and Shamarao et al.[17] found 9.3% of teachers chose milk as medium which was comparable to the present study where 21.7% chose milk. Among the various wet media, milk was better than saliva, because of high osmolality, better composition and relatively easy access at the location of trauma. Maintaining the avulsed tooth in milk for 6 h contributes to a good prognosis. Hank's Balanced Salt Solution and Viaspan showed better results with longer storage time, but they are not readily available.[18],[19] The results of the present study showed that teachers had inadequate information regarding tooth avulsion. The poor performance of the teachers may be justified by inadequate training, lack of information and low ability of the teachers in this issue. Therefore, it is necessary to provide emergency management programs concerning traumatic injuries, especially tooth avulsion, for teachers in all teaching institutions of KSA.

It is required to implement public health policies that enable the reduction in the prevalence of traumatic dental injuries through statute, prevention, and education. More efforts are needed to expand the knowledge related to the promotion and maintenance of health, with parents, teachers and professionals involved. One of the strategies for health promotion related to dental trauma is the expansion and recognition of health professionals and the general public that traumatic injuries can be prevented when associated with education campaign on dental trauma in schools and the community. Health professionals can contribute in this sector through information and awareness of the importance of the use of mouth guards during sports and in treating dental trauma by correctly registering the place, time, cause, and human intention. Thus, we can identify acts of violence, whose information can contribute to the responsible agencies in the development of an individual protection efficient policy. The school environment is considered a suitable place to start an education program in oral health and dental trauma prevention because more than one billion children are present in schools all over the world. In addition, these programs can humanize the school environment and implement policies and practices that offer multiple opportunities for health.[20] Educational campaigns to prevent accidents involving dental trauma should be instituted to minimize the damage caused by traumatic injuries.[13]

  Conclusion Top

These results confirm that there is a lack of knowledge among teacher regarding tooth avulsion and its emergency management. There is a need of the education programs to address management of dental injuries for teachers. Such programs of prevention and health promotion can strengthen, throughout the school life of children, basic health concepts to improve self-esteem, life skills, and social behaviors.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Touré B, Léye Benoist F, Faye B, Kane AW, Kaadioui S. Primary school teachers' knowledge regarding emergency management of avulsed permanent incisors. J Dent Tehran Univ Med Sci 2011;8:117-21.  Back to cited text no. 1
Chan AW, Wong TK, Cheung GS. Lay knowledge of physical education teachers about the emergency management of dental trauma in Hong Kong. Dent Traumatol 2001;17:77-85.  Back to cited text no. 2
Petersson EE, Andersson L, Sörensen S. Traumatic oral vs. non-oral injuries. Swed Dent J 1997;21:55-68.  Back to cited text no. 3
Andreasen JO, Andreasen FM. Textbook and Colour Atlas of Traumatic Injuries to the Teeth. 3rd ed. Copenhagen: Munksgaard Publishers; 1994.  Back to cited text no. 4
Blakytny C, Surbuts C, Thomas A, Hunter ML. Avulsed permanent incisors: Knowledge and attitudes of primary school teachers with regard to emergency management. Int J Paediatr Dent 2001;11:327-32.  Back to cited text no. 5
Fountain SB, Camp JH. Traumatic injuries. In: Cohen S, Burns AC, editors. Pathways of the Pulp. St. Louis: Mosby; 1991.  Back to cited text no. 6
Flores MT, Andersson L, Andreasen JO, Bakland LK, Malmgren B, Barnett F, et al. Guidelines for the management of traumatic dental injuries. II. Avulsion of permanent teeth. Dent Traumatol 2007;23:130-6.  Back to cited text no. 7
Trope M. Clinical management of the avulsed tooth: Present strategies and future directions. Dent Traumatol 2002;18:1-11.  Back to cited text no. 8
Sakai VT, Moretti AB, Oliveira TM, Silva TC, Abdo RC, Santos CF, et al. Replantation of an avulsed maxillary primary central incisor and management of dilaceration as a sequel on the permanent successor. Dent Traumatol 2008;24:569-73.  Back to cited text no. 9
Holan G. Disturbing conclusions. Br Dent J 2006;200:123.  Back to cited text no. 10
Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM. Replantation of 400 avulsed permanent incisors 4. Factors related to periodontal ligament healing. Endod Dent Traumatol 1995;11:76-89.  Back to cited text no. 11
Arvind R. Knowledge and attitude of primary school teachers in emergency management of dental trauma: A cross sectional study. Webmed Cent Dent 2014;5:WMC004735.  Back to cited text no. 12
Abidi SY, Khan AM, Khan MA, Qazi F, Ghazali NZ. Knowledge about the management of avulsed tooth among Karachi school teachers. Pak Oral and Dental J 2010;30:515-20.  Back to cited text no. 13
Newman LJ, Crawford PJ. Dental injuries: “ first aid” knowledge of Southampton teachers of physical education. Endod Dent Traumatol 1991;7:255-8.  Back to cited text no. 14
Francisco SS. Evaluation of elementary education teachers' knowledge on avulsion and tooth replantation. RSBO J 2015;12:32-40.  Back to cited text no. 15
Leila B, Elahe H, Maasome K, Omid G, Sahame A. Primary school teachers' knowledge regarding emergency management of avulsed permanent incisors in Ahvaz, Iran. Avicenna J Dent Res 2013;5:e19431.  Back to cited text no. 16
Shamarao S, Jain J, Ajagannanavar SL, Haridas R, Tikare S, Kalappa AA. Knowledge and attitude regarding management of tooth avulsion injuries among school teachers in rural India. J Int Soc Prev Community Dent 2014;4 Suppl 1:S44-8.  Back to cited text no. 17
Lindskog S, Blomlöf L. Influence of osmolality and composition of some storage media on human periodontal ligament cells. Acta Odontol Scand 1982;40:435-41.  Back to cited text no. 18
Hiltz J, Trope M. Vitality of human lip fibroblasts in milk, hanks balanced salt solution and Viaspan storage media. Endod Dent Traumatol 1991;7:69-72.  Back to cited text no. 19
Moysés ST, Moysés SJ, Watt RG, Sheiham A. Associations between health promoting schools' policies and indicators of oral health in Brazil. Health Promot Int 2003;18:209-18.  Back to cited text no. 20


  [Table 1], [Table 2], [Table 3]


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