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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 8  |  Issue : 1  |  Page : 12-15

Tooth avulsion: Its perspective among athletically active children of Chandigarh, India


1 Department of Dentistry, SHKM Government Medical College, Mewat, Haryana, India
2 Department of Pediatric and Preventive Dentistry, Bhojia Dental College and Hospital, Bhud (Baddi), Himachal Pradesh, India
3 Department of Pediatric and Preventive Dentistry, Eklavya Dental College, Kotputli, Jaipur, Rajasthan, India
4 Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
5 Department of ENT, SHKM Government Medical College, Mewat, Haryana, India

Date of Web Publication16-May-2016

Correspondence Address:
Sonam Sharma
B-222, Florence Marvel, Sushant Lok - 3, Sector - 57, Gurgaon, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4987.182494

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  Abstract 

Background: The data available about the knowledge of tooth avulsion in Indian school children is minimal. There is a tremendous need to evaluate awareness regarding appropriate emergency measures to be followed after avulsion by them. Therefore, this study was planned.
Aim: To assess the knowledge regarding tooth avulsion in athletically active high school children of Chandigarh.
Materials and Methods: The sample consisted of 997 (750 boys, 247 girls) school players in the age range of 10–17 years. The participants were interviewed through a standardized questionnaire. Statistical analysis was done by Chi-square test.
Results: In cases of participants who knew about tooth avulsion (37.3%), only 38.4% of them were in the opinion to replant the tooth in its socket. More number of males would try to replant the avulsed tooth and in older age group. Almost half of the players would transport the avulsed tooth in paper, plastic or cotton, 28.6% would transport in hand and only 11.9% in tap water. Milk was considered the ideal storage medium by only 4.8% of the participants.
Conclusion: More emphasis should be made on organizing educational campaigns which provide education to teachers, parents, and school children regarding appropriate emergency measures to be followed after tooth avulsion.

Keywords: Indian school children, perspective, tooth avulsion


How to cite this article:
Ahlawat B, Sharma A, Kaur A, Chaudhary N, Sharma S, Kumar A. Tooth avulsion: Its perspective among athletically active children of Chandigarh, India. J Oral Res Rev 2016;8:12-5

How to cite this URL:
Ahlawat B, Sharma A, Kaur A, Chaudhary N, Sharma S, Kumar A. Tooth avulsion: Its perspective among athletically active children of Chandigarh, India. J Oral Res Rev [serial online] 2016 [cited 2019 Sep 19];8:12-5. Available from: http://www.jorr.org/text.asp?2016/8/1/12/182494


  Introduction Top


Dental injuries are the most common type of orofacial injuries sustained during participation in sports.[1] Types of orofacial injuries commonly observed in sports include injuries to the soft tissues as well as to the dentition, namely fractured or avulsed teeth and injuries to the periodontium. According to American Academy of Pediatric Dentistry (AAPD) Guideline on the management of acute dental trauma,[2] avulsion is defined as complete displacement of tooth out of socket. The periodontal ligament is severed, and fracture of the alveolus may occur. The treatment objective of avulsed permanent teeth is to replant as soon as possible and then to stabilize the replanted tooth in its anatomically correct location to optimize healing of the periodontal ligament and neurovascular supply while maintaining esthetics and functional integrity. Given the high incidence of sports-related orofacial injuries, it is important to provide prompt treatment for the well-being of orofacial spectrum. Hence, awareness regarding proper procedures for evaluation and first-aid treatment of a dental injury due to sports is of paramount importance.

The data available about the knowledge of avulsion in athletically active Indian school children is minimal. There is a tremendous need to evaluate awareness regarding appropriate emergency measures to be followed after avulsion by them. Therefore, the present study was planned to assess the knowledge regarding avulsion in athletically active high school children of Chandigarh.


  Materials and Methods Top


The present study was carried out on a sample of 997 (750 boys, 247 girls) athletically active 10–17-year-old school children of Chandigarh, who were involved in various competitive sports. The study was approved by the institutional ethics committee. The list of various schools in the city was taken from office of the Director of Public Instructions (DPI), Schools. Necessary permission was obtained from the DPI before starting the survey. The principals of the schools were informed about the nature of the study. The final selection of schools was done after obtaining written permission from the respective school principals, who in turn took the written consent from the parents as well as children who were willing to participate in the study. Age of each child was ascertained from the school records. The children with any special health care needs who were physically, mentally, emotionally disturbed, and the children who were not willing or involved in the sports activities were excluded from the study. The participants were interviewed through a self-structured questionnaire. All the information was obtained by questioning them directly by the examiner and recorded by a trained assistant. Statistical analysis was done by Chi-square test.


  Results Top


The results were distributed on the basis of age, gender, and duration of game played. When asked the players whether they had been taught about sports injuries and their prevention as a part of their curriculum, 64.8% (646) gave a positive response [Table 1].
Table 1: Players who were taught about sports injuries and their prevention in different groups

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All the players were assessed for their knowledge regarding avulsion and handling of avulsed tooth and its transportation. Only 372 (37.3%) had knowledge regarding avulsion as the consequence of sports-related trauma during the game whereas other 625 (62.7%) players were ignorant about the avulsion. Of these 372 players, only 143 (38.4%) answered that they will try to replant the lost or avulsed tooth. Out of 143 players, only 79 (55.2%) players said they would like to replant the avulsed tooth immediately. Moreover, when asked whether cleaning procedure was necessary to replant the avulsed tooth, 37 (46%) replied yes and 42 (53.2%) replied no.


  Discussion Top


Prevention and adequate preparation are the key elements in minimizing injuries that occur in sports. High prevalence of dental trauma in sports makes it nearly mandatory that the sports person must be educated regarding use of preventive measures to reduce the sports injuries. In this study, more than half of the players, i.e., 64.8% (646) claimed to be taught about sports injuries and their prevention as a part of curriculum that too slightly more in females and in older age group, which was statistically highly significant [Table 1]. Teaching activities increased with the increase in the number of years spent by player in their game, which was statistically highly significant. Therefore, it is concluded that teaching about sports injuries and their prevention increased with increasing age and duration of game played.

According to AAPD Guideline on management of acute dental trauma,[2] the avulsed tooth has the best prognosis if replanted immediately. If the tooth cannot be replanted within 5 min, it should be stored in a medium that will help maintain vitality of the periodontal ligament fibers. The best (i.e., physiologic) transportation media for avulsed teeth include Viaspan , Hank's Balanced Salt Solution, tissue culture medium and cold milk. Next best would be a nonphysiologic medium such as saliva (buccal vestibule), physiologic saline, or water. Although water is detrimental to cell viability due to its low osmolality and its long-term storage (i.e., more than 20 min) in water has an adverse effect on periodontal ligament healing but it is a better choice than dry storage. Limited tooth storage in a cell-compatible medium prior to replantation has produced similar healing results as compared with immediately-replanted teeth. The risk of ankylosis increases significantly with an extraoral dry time of 20 min. An extraoral dry time of 60 min is considered the point where survival of the root periodontal cells is unlikely. In avulsed permanent teeth, there is a considerable risk for pulp necrosis, root resorption, and ankylosis. Recent evidence suggests that success of replantation is dependent upon many factors, some of which the clinician can manipulate in a manner that favors more successful outcomes.

In cases of participants who knew that tooth avulsion (37.3%) can occur due to trauma, only 38.4% of them were in the opinion to replant the tooth in its socket [Table 2]. The findings of the present study were quiet similar to the finding given by Biagi et al.[3] where 31% knew that avulsed tooth may be replanted. More number of males would try to replant the avulsed tooth compared to females, and older age group would also replant the avulsed tooth, but the difference was not to the level of statistical significance [Table 3]. It showed the increased learning capabilities with the increasing age, but the finding was also not statistically significant [Table 3]. Thirty-seven players answered that cleaning of avulsed tooth is necessary, out of them, 43.2% of the participants would wash the tooth in tap water; for 24.3% of the participants, tooth should be washed with toothbrush prior to replantation [Table 4]. If not cleaned, then 47.6% would transport the avulsed tooth in paper, plastic or cotton, 28.6% would transport in hand and only 11.9% in tap water. Milk was considered the ideal storage medium for the avulsed tooth by only 4.8% of the participants who knew about tooth avulsion [Table 5]. These results demonstrated that most of the interviewed players were not aware of the importance of appropriate emergency procedures in cases of avulsion. Moreover, approximately one-third of the participants reported they would replant the avulsed tooth. Participants also lacked the information on correct management of the avulsed tooth, especially with regards to storage medium to assure treatment success. These results were not unique. Studies with elementary school faculty and staff have also shown an overall lack of information regarding emergency procedures after dental trauma, especially tooth avulsion.[4],[5],[6] In a study by Panzarini et al.,[7] the unawareness of physical education students and faculty of a college in Aracatuba, SP, Brazil, also highlighted the lack of emergency management of avulsed tooth. Holan and Shmueli [8] reported that only 4% physicians would provide an appropriate initial treatment that could save an avulsed tooth, and about 50% of them would not replant it under any circumstances. Achieving the goal of increased awareness among physicians alone may not solve the problem, teachers, especially physical education teachers,[4] school nurses, coaches, lifesavers, paramedics, and the public may also need to be educated in regard to the emergency management of avulsed permanent teeth. Such people are often present at an accident site, and their prompt treatment could save precious time by shortening the period when the tooth is out of the mouth.
Table 2: Relationship of knowledge of avulsion with regard to gender, age and duration of game played

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Table 3: Relationship of knowledge of replantation of avulsed tooth with regard to gender and age

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Table 4: Knowledge regarding cleaning of an avulsed tooth

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Table 5: Knowledge about transport of avulsed tooth if not cleaned before taking to dentist

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  Conclusion Top


Player's perception regarding proper emergency measures to be followed after tooth avulsion was found to be incongruous. Hence, the dental profession needs to encourage and educate all stakeholders about the risk of sports-related orofacial injuries. More emphasis should be made on organizing educational campaigns which provide education to teachers, parents, and school children.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Scott J, Burke FJ, Watts DC. A review of dental injuries and the use of mouthguards in contact team sports. Braz Dent J 1994;176:310-4.  Back to cited text no. 1
    
2.
American Academy of Pediatric Dentistry. Guidelines on management of acute dental trauma. Pediatric Dentistry Reference Manual 2012-13;34:230-8.  Back to cited text no. 2
    
3.
Biagi R, Cardarelli F, Butti AC, Salvato A. Sports-related dental injuries: Knowledge of first aid and mouthguard use in a sample of Italian children and youngsters. Eur J Paediatr Dent 2010;11:66-70.  Back to cited text no. 3
    
4.
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. 4
    
5.
Sae-Lim V, Lim LP. Dental trauma management awareness of Singapore pre-school teachers. Dent Traumatol 2001;17:71-6.  Back to cited text no. 5
    
6.
Mori GG, Turcio KH, Borro VP, Mariusso AM. Evaluation of the knowledge of tooth avulsion of school professionals from Adamantina, São Paulo, Brazil. Dent Traumatol 2007;23:2-5.  Back to cited text no. 6
    
7.
Panzarini SR, Pedrini D, Brandini DA, Poi WR, Santos MF, Correa JP, et al. Physical education undergraduates and dental trauma knowledge. Dent Traumatol 2005;21:324-8.  Back to cited text no. 7
    
8.
Holan G, Shmueli Y. Knowledge of physicians in hospital emergency rooms in Israel on their role in cases of avulsion of permanent incisors. Int J Paediatr Dent 2003;13:13-9.  Back to cited text no. 8
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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