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Year : 2020  |  Volume : 38  |  Issue : 3  |  Page : 216-221

Primary school teachers' knowledge and attitude regarding traumatic dental injuries

Clinic of Preventive and Paediatric Dentistry, Faculty of Odontology, Lithuanian University of Health Sciences, Kaunas, Lithuania

Date of Submission13-Jun-2018
Date of Decision10-Jul-2019
Date of Acceptance03-Jun-2020
Date of Web Publication29-Sep-2020

Correspondence Address:
Simona Daupare
Lithuanian University of Health Sciences, Luksos-daumanto 6, LT-50106, Kaunas
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JISPPD.JISPPD_170_18

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Aim: According to the WHO, 16%–40% of children aged 6–12 years experience dental traumas. Long-term treatment success depends on immediate emergency care and early professional management after the injury occurred. The primary school teachers can play a crucial role in managing traumatic dental injuries (TDIs) because they are often in proximity to children and often need to assist when dental trauma occurs. The aim of the present study was to assess primary school teachers' knowledge and attitude regarding TDI and describe their behavior in emergency situations. Materials and Methods: A four-part anonymous questionnaire comprised questions on demographic data, attitude, knowledge toward TDI, and behavior in case of accident and self-assessment questions were distributed among 147 teachers from 16 schools. The data were obtained from 106 participants (72.1%). The Kruskal–Wallis and independent t-tests served for statistical analysis. Results: More than half of teachers (56.6%) have witnessed TDI. Almost all respondents (94.3%) indicated that in case of dental trauma is important to take emergency management as soon as possible. However, two-thirds of them (75.5%) thought that teachers cannot provide appropriate emergency management in case of TDI. In addition, teachers had little knowledge regarding TDI and the proper emergency management: 91.3% of participants do not know the right storage media for the avulsed tooth, 40.6% have thought that tooth replantation is impossible, and 17.1% would throw an avulsed tooth away, when it fells on the ground. Conclusion: The study revealed inappropriate knowledge and attitude regarding TDI among primary school teachers and their behavior in first-aid management.

Keywords: Dental trauma, emergency care, schoolchildren, teachers

How to cite this article:
Daupare S, Narbutaite J. Primary school teachers' knowledge and attitude regarding traumatic dental injuries. J Indian Soc Pedod Prev Dent 2020;38:216-21

How to cite this URL:
Daupare S, Narbutaite J. Primary school teachers' knowledge and attitude regarding traumatic dental injuries. J Indian Soc Pedod Prev Dent [serial online] 2020 [cited 2022 Aug 17];38:216-21. Available from: http://www.jisppd.com/text.asp?2020/38/3/216/296627

   Introduction Top

Dental traumas are injuries of the teeth, periodontium, and surrounding soft tissues. Being quite common in dentistry, they include 5% of all traumatic injuries when people seek first aid.[1] According to the WHO, 16%–40% of children aged 6–12 years experience mild or severe dental traumas because of different reasons: unsafe playing in playgrounds, accidents at schools, accidents during car crashes, or violence.[2]

Children dental traumas are a big issue nowadays not only for their possible negative outcome and for being common,[3],[4] but also because they can reduce the quality of life.[5],[6],[7] First, children experience severe pain, stressful situations, and poor esthetics. Second, dental traumas can cause malocclusion.[8] In addition, people having untreated dental traumas can have chewing problems more often.[6] Furthermore, they can experience social interaction problems such as being concerned with what others think, avoiding smiling and laughing, not talk to other children.[6] Moreover, dental traumas can cause delayed permanent tooth eruption.[9] Finally, treatment of dental traumas can require orthodontic treatment and prosthetic rehabilitation.[8]

Long-term success depends on the treatment given at the site of the injury (replantation/storage media) and treatment of the root-surface area administered immediately upon arrival at the dental clinic.[10] The lack of dental education can result in avulsed teeth extraoral dry time of 60 min or more, which can cause necrosis of all periodontal ligament cells with eventual replacement resorption.[10] The most prevalent complications are coronal discoloration and external resorption.[11]

Parents and teachers not dentists spend much time with children, so they have to be able to deal with emergency situations in case of dental trauma. Particularly, teachers should be dental educated because in Lithuania, primary school students stay at schools 20–32 h/week,[12] not only studying but also playing. There is a big risk of dental traumas at school as many teachers witnessed traumatic dental injury (TDI).[13],[14],[15],[16] Therefore, it is important that they could manage appropriately with children dental traumas.[17],[18] However, studies showed that teachers have not enough knowledge of the behavior in dental traumas emergency situations.[13],[14],[15],[16],[19],[20] The first-aid courses given for the teachers in Lithuania do not include course on dental trauma management education.[21] According to our knowledge, there was no previous studies in the Lithuania on teachers' knowledge and attitude toward TDI.

The aim of this study was to evaluate knowledge, attitude, and behavior in emergency situations to deal with children dental traumas among primary school teachers.

   Materials and Methods Top

This study was undertaken in Panevezys, Lithuania, in December 2014. The Ethical Committee of the Lithuanian University of Health Sciences (reference: BEC-OF-96) granted their approval of the study.

The study population consisted of 106 teachers from 16 schools who completed questionnaire out of 147 (all primary school teachers in Panevezys). Response rate was 72.1%.

The questionnaire was based on previous similar studies[16],[22],[23] and translated from English to Lithuanian. A native English speaker back translated it in Lithuanian. A pilot study on 8 teachers was carried out.

The questionnaire consisted of four parts. Part I of seven questions regarding personal and professional data including sex, age, having their own children, working experience, having participated in first-aid training, and having witnessed dental trauma.

Part II consisted of eight attitude questions. Each question had five possible answers by Likert scale: “strongly disagree,” “disagree,” “neither agree nor disagree,” “agree,” and “strongly agree.” To evaluate the range of the teachers' attitude, the correct answers were remarked as 5 points and incorrect as 1 point (in 1, 3, 5, 7, and 9 questions, the answer “strongly agree” was marked as 5 points, and in 2, 4, 6, and 8 questions, the answer “strongly disagree” was marked as 1 point).

Part III consisted of nine questions based on two different clinical dental trauma situations. The first situation was a mild incident with a crown fracture and the second situation a severe trauma with a tooth avulsion. To determine total knowledge score (TKS) for each subject, eight items regarding avulsion and crown fractures were selected. Participants were given one point for correct answer and no points for incorrect. Maximum score of knowledge was 8. The higher score indicates better knowledge. The total value was calculated to find out the correct attitude level – TKS. Respondents were asked “how you would transport an avulsed tooth to the dentist if you cannot put it back into socket” in the questionnaire section part III. Participants who have indicated the answer “put the tooth in liquid” were asked next question regarding storage media “mark desirable liquids for storing a tooth that has been knocked out while you are on your way to the dentist.“

Part IV consisted of three self-assessment regarding TDI questions: is your knowledge on dental emergency management enough, do you need future education in TDI, are you able to provide proper action in case of TDI?

The reliability of questionnaire was determined by the Cronbach's alpha (0.5) that indicates acceptable. SPSS Statistics for Windows version 22.0 (SPSS Inc., Chicago, IL, USA, 2010) was used to analyze the data. Chi-square, Kruskal–Wallis, and independent t-tests served for statistical analysis. The level of significance was set at P < 0.05.

Teachers were categorized into three categories based on their age and work experience. Age and work experience significantly correlated (r = 0.9, P < 0.001). The work experience was chosen as a demographic factor. Teachers work experience categories were set as: 10–22 years, 23–29 years, and 30–41 years.

   Results Top

Part I

All respondents were woman aged 35–63 years (mean 49.3, standard deviation [SD] = 0.56). Almost everyone has participated in first-aid training course (99.1%). More than a half of participants have witnessed TDI (56.6%) and 43.3% of teachers (who have witnessed TDI) have participated in TDI first aid [Table 1]. There was no statistically significant difference within the groups based on working experience.
Table 1: Participants responses about their experience in the first aid

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Part II

[Figure 1] illustrates the respondent's attitude toward TDI. The mean score of participant's attitude level was 3.41 (SD 0.038). Teachers showed right attitude toward emergency management in case of TDI by answering questions: “in case of dental trauma it is important to take emergency management as soon as possible” (4.71 [SD 0.061]); “special education and training is needed to emergency management of TDI” (4.49 [SD 0.075]) and “teacher should know what to do in the case of TDI” (4.13; SD ± 0.075). The statements, “teachers cannot provide good emergency management in case of TDI. It can only be done by the professionals” (2.08 [SD ± 0.111]) and “a tooth cannot be replanted” (2.58 [SD 0.107]) indicate insufficient knowledge and attitude.
Figure 1: Primary school teachers' attitude toward traumatic dental injuries

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Part III

The mean TKS among participants was 4 (SD = 0.138). The mean TKS among participants who have witnessed TDI was 4.23 (SD = 0.177) and who have not 3.50 (SD = 0.201), indicating significantly better knowledge and attitude (P = 0.012). Furthermore, 28 teachers showed their TKS higher than the mean TKS (TKS from 5 to 8) and 20 of them were from those participants who have witnessed TDI [Table 2].
Table 2: Total knowledge score distribution among study participants

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[Table 3] shows participants knowledge toward TDI in emergency situation. Almost half of teachers (44.7%) in case of tooth avulsion would “stop the bleeding by compressing a cloth over the injury.” Most (70.4%) would “wrap the tooth in a handkerchief or paper” an avulsed tooth and transport to the dentist, while 8.7% would put into the child's mouth. No one of those (12.2%) who would put a tooth into the liquid knew the right storage media: 90.9% would use the tap water and 9.1% strong disinfecting solution. 14.9% of teachers would replant tooth immediately after accident and 10.7% on the same day.
Table 3: Primary school teachers responses regarding their behavior in case of traumatic dental injuries

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Part IV

Self-evaluation question data are not presented in the tables. Almost all participants (93.4%) agreed having insufficient knowledge of TDI emergency management. Many teachers (77.4%) would not be able to provide proper action in case of TDI, so 69.8% of respondents would need future education in TDI.

   Discussion Top

The current study has shown that participants had little knowledge of dental traumas and the proper emergency management in the case of TDI. The findings are in accordance with the study where almost all teachers did not feel prepared to assist a child with a dental trauma[24] and different from study in Italy where more than a half of participants would know what to do in case of dental trauma.[25]

Attitude regarding TDI is important because it may have an impact on behavior. Unfortunately, respondents incorrectly thought that teachers cannot provide appropriate emergency management in the case of TDI; it can only be done by the professionals. The findings are in line with some other studies where teachers have thought that emergency management of dental trauma is thoroughly professional, requires special education, and there is no need for teacher intervention.[16] More than half (59.6%) of the respondents think that they could not perform emergency management in case of dental trauma.[26]

Almost one-third of teachers in the current study indicated thought that an avulsed tooth cannot be replanted. 56.8% of respondents in a study by Nirwan and coauthors would try to find an avulsed tooth.[26] Interestingly, more than half of the 1st-year dental students would not suggest to replant avulsed tooth.[27]

The TKS was higher among participants who have witnessed TDI than those who have not. However, the survey results differ from other study in 2016; there have been no association found in experience with dental trauma.[24]

In the survey, almost a half of the respondents (44.7%) in case of avulsion would stop the bleeding by compressing a cloth over the injury; one-third of teachers (28%) would place the tooth in a paper and send the child to dentist after the school time. In Italy, 43.3% of participants would transport avulsed tooth to a dentist in a handkerchief,[25] and in Brazil, 49% of respondents would calm down the child and stop the bleeding by compressing a cloth over the injury.[28] Participants did not know what to do if the tooth has fallen on the dirty ground (51.3%) and 17.1% of them would throw the tooth away. Similar studies showed that 20% of participants would discard an avulsed tooth.[29] A majority (90.1%) of the respondents indicated tap water as the transportation media for an avulsed tooth. That is not right media. Some studies showed more optimistic results where 42.2% of respondents said that they would use tap water if the tooth had fallen on the ground.[25]

Many factors during the first-aid management are important and can decide future good or bad prognosis. One of the most significant points for a good avulsed tooth prognosis is the storage media. The knowledge regarding the storage media for the avulsed tooth was inappropriate in the current survey: 91.3% of teachers would transport a tooth in a bad storage media and only 8.7% of the participants would put an avulsed tooth in child's mouth. In other researches, there were the same results: only 16.5% of participants would transport a tooth in the milk,[30] only 3.1% have chosen the correct media,[23] and 3% of participants would transport the tooth in milk.[28]

Almost all respondents have participated in first-aid training courses; however, no dental emergency situations were provided. Anyway, they showed some knowledge and attitude in emergency of TDI management. Nevertheless, in the current survey, many participants reported their interest in receiving more information and/or training about TDI. On the other hand, in other study, more than a half of the teachers did not have any first-aid training[16] and 12.5% of teachers had dental trauma first aid.[26] Two-thirds of respondents in the current survey would like to participate in TDI first-aid training. The situation is in line with other studies: almost all participants would like to know more about dental traumas and get education about emergency management in TDI situations.[23],[30]


We acknowledge the assistance by the local school administrations, as well as the participating teachers.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

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  [Figure 1]

  [Table 1], [Table 2], [Table 3]


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