|Year : 2020 | Volume
| Issue : 1 | Page : 54-58
Evaluating the levels of knowledge and attitudes of emergency medical technicians and paramedics toward traumatic dental injuries
A Aras, MS Dogan
Department of Pediatric Dentistry, Faculty of Dentistry, Harran University, Sanliurfa, Turkey
|Date of Submission||17-May-2019|
|Date of Acceptance||03-Sep-2019|
|Date of Web Publication||10-Jan-2020|
Dr. A Aras
Department of Pediatric Dentistry, Faculty of Dentistry, Harran University, Sanliurfa - 63300
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Objectives: The first aid implemented just after the traumatic dental injury (TDI) is of vital importance. This study aims to evaluate the attitudes of emergency medical technicians (EMTs) and paramedics toward TDI and their levels of knowledge about the issue. Subjects and Methods: A questionnaire, which comprised 14 questions, was applied to 389 EMTs and paramedics all across Turkey. The questionnaires were sent to the participants through e-mails, and the results were obtained by an online system. Results: 336 out of 389 EMTs and paramedics (86.4%) mentioned that they did not have any training about the TDI issue. On the other hand, among the ones who mentioned that they received this training, 50.9% suggested that the training was not sufficient. It was observed that 63.5% of the participants encountered cases of injuries in oral and dental regions, and in 83% of these cases the only treatment applied was bleeding intervention. About 75.6% of them think that an avulsed tooth cannot be reimplanted. Conclusion: In conclusion, it was determined that the EMTs and paramedics did not have sufficient and accurate information about the TDI. Lack of knowledge about TDI prevents rapid and accurate intervention to the cases.
Keywords: Dental education, emergency medical technician, paramedic, traumatic dental injury
|How to cite this article:|
Aras A, Dogan M S. Evaluating the levels of knowledge and attitudes of emergency medical technicians and paramedics toward traumatic dental injuries. Niger J Clin Pract 2020;23:54-8
|How to cite this URL:|
Aras A, Dogan M S. Evaluating the levels of knowledge and attitudes of emergency medical technicians and paramedics toward traumatic dental injuries. Niger J Clin Pract [serial online] 2020 [cited 2020 Aug 7];23:54-8. Available from: http://www.njcponline.com/text.asp?2020/23/1/54/275619
| Introduction|| |
Traumatic dental injury (TDI) is a serious public dental-health problem that has aesthetic, functional, and psychological negative results on individuals. Isolated dental injury influences children more frequently than adults. Epidemiological studies concerning the TDI demonstrate that 58.6% of these problems are observed in children between 7 and 12 years old, and that they are observed during group plays and activities in the schools or playgrounds. The data obtained from the literature demonstrate that 8%–49.9% of TDIs in adults occur during sports activities.,, Facial injuries are generally results of sports activities, fallings at home, fights, attacks, and car accidents.,
It is known that traumatized teeth should be intervened as soon as possible to minimize the aesthetic, functional, psychological, and economic consequences., The first aid implemented just after dental injury is of vital importance. Early and appropriate first aid has a beneficial influence over the recovery process and the results of further treatments. Therefore, the paramedics should know the rules of conduct in cases of the most frequent TDIs such as tooth eruption, position change, crown, or tooth root fracture.,
Clinical practices and a couple of reports demonstrate that first aid knowledge and ability about the TDI is at an insufficient level not only in professional groups that are not medicals but also in teachers, instructors, and sports trainers as well as the citizens.,,
The critical roles of emergency service personnel and paramedics in the management of dental injuries necessitate an appropriate education and training. Thus, the emergence of treatment of this kind of injuries requires all the personnel related to the TDI to have the knowledge about appropriate first aid management.
The aim of this study is to evaluate the training that the emergency medical technicians (EMTs) and paramedics received about TDI, the cases they encountered in the field, and their knowledge levels about the issue.
| Subjects and Methods|| |
A questionnaire, which comprised 14 questions, was applied to 389 EMTs and paramedics working in the emergency ambulance stations or hospitals all across Turkey. The questions in the questionnaire comprised four sections. The first section includes a group of questions about general and demographical information of the participants. The second section comprised questions about the training they received and its sufficiency. There are questions in the third section to determine the knowledge levels of the participants about the TDI, and in the last part, there are questions about the injuries they encountered in oral and dental regions, and the way of their treatment. The simple online questionnaire was designed through Google Forms Freeware (Google, Mountain View, CA, USA). It was sent to the participants through e-mails, and the results were obtained by the online system. The PASW Statistics 18 software (SPSS) was used in the evaluation of the descriptive statistics.
| Results|| |
In total, 389 EMTs and paramedics, working in emergency ambulance stations or hospitals all across Turkey, accepted to participate in this study. Of the participants, 58.4% were women and 41.6% were men. In addition, 82% of them were in the 20–25 years age group. Moreover, 83.3% of the participants had professional experience between 1 and 5 years [Table 1].
In all, 336 (86.4%) EMTs and paramedics mentioned that they did not receive any training about the TDI [Figure 1]. As per 53 participants, who stated to have received this training, 51% of them answered that this training was not sufficient. It was also determined that 85.6% would like to participate if any training or seminars were organized.
Among the participants, 32.6% mentioned that it was the 7–15 years age group that was exposed to TDI most, expressing that the reason would be most probably falling (38.3%). Other answers and rates are presented in [Figure 2] and [Figure 3].
About 63.5% of the participants declared that they encountered TDI cases of injuries in the oral and dental regions, emphasizing that they most frequently encountered lip injury (66%), in-mouth soft tissue injury (51%), and tooth fracture (43%) [Table 2]. When their attitudes toward the cases were asked, 83% of them mentioned that they only applied the bleeding intervention [Table 3].
|Table 2: Which of the following types of injuries were available in your case?|
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About 75.6% of the participants answered “no,” to the question: “Do you think that an avulsed tooth can be replanted?” When the participants were asked “What would be your attitude towards such a case?” upon showing them a picture of a patient whose upper central tooth was avulsed after a TDI, 58.1% of them answered that they would bring the tooth to the hospital in an appropriate carrier. Only 3.3% of them answered that they would reimplant the tooth if they could find it [Table 4]. When they were asked if the tooth is found in the scene and there is no attempt to reimplant it, “what kind of an environment should there be to carry it to the hospital?” 52.7% of them mentioned as a saline solution, and 28.5% of them stated that tissue or a gauze patch would be enough [Table 5].
|Table 5: What kind of an environment should there be to carry an avulsed tooth to the hospital?|
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| Discussion|| |
In the past decade, research studies have been conducted on TDI management knowledge levels in professions other than dentistry; particularly about their attitudes in cases of permanent avulsed teeth. Because most of the dental injuries are observed in 7–12 years age group, the majority of the existing international literature focused on the groups which supervise the children most, such as parents, primary school teachers, physical education teachers, school nurses, and secretaries. The results, in general, demonstrated that those individuals had low levels of knowledge about the issue.,, As per our research, we made a questionnaire study to evaluate the knowledge and experience levels of emergency medical professionals, who have a high possibility to encounter the TDI cases, and to determine whether they have sufficient levels of training. Similar to previous studies, it was determined that these professional groups did not have a relevant training about the TDI, either; the majority of them (83.3%) even did not take any training about the topic.
In a previous study, 62% of the participant paramedics mentioned that they wanted to have more information about the struggle with TDI. In our study, this rate was determined as 85.6%.
Orofacial injuries are mostly observed in the first 10 years of life, and it gradually decreases with increasing age, becoming quite rare after the 30s. The etiological factors are quite related to the age of the patient. Falling is the most common reason of oral injuries in preschool children; however, they rather occur in cases of sports or fighting in the children at school age. In adolescents or young adults, the most frequent etiological factors are attacks or traffic accidents., In our research study, when we asked our participants about the age group most frequently exposed to TDI, 32.6% of them answered as 7–15 years age group. Questioning the etiological factors, it was reported that TDI was caused by fallings in 38.3%.
The 24-h emergency services of the private or public hospitals can be expected to encounter the majority of the dental emergency cases including the traumatic injuries. In a previous study, it was reported that the immediate treatments to the patients with TDI problems were conducted in the emergency services of public hospitals. Therefore, EMTs and paramedics are the professionals who frequently provide this service in cases of such injuries., In a questionnaire study conducted by Diaz et al., 78.1% of the participants mentioned that they encountered a TDI case at least once throughout their professional life, while a majority of them were stating that their knowledge levels were weak. Around 90.2% of the participants attributed this lack of knowledge to having no training about the diagnosis and immediate treatment in TDI.
In our questionnaire study, 63.5% of the EMTs and paramedics mentioned that they encountered TDI patients with injuries in oral and dental region; as for the most frequent injury types, they encountered lip injuries (66%), intraoral soft tissue injury (51%), and tooth fracture (43%) [Table 2]. When their attitudes toward the cases were asked, 83% of them mentioned that they only applied the bleeding intervention.
Avulsion is complete separation of the tooth from the socket due to injuries. The avulsion of permanent teeth is one of the most common tooth injuries. It is 18% of all dental injuries. Just after the avulsion, the cells of periodontal ligament and pulp tissues, respectively, begin to dry and ischemic damage occurs. These events can be minimized by immediate replantation of the avulsed tooth to the dental alveolus or by bringing the tooth to a dentist as soon as possible in a physiologic storage media (saline, saliva, etc.). Rapid and appropriate intervention is of vital importance for the prognosis.,,
A previous study demonstrated that 72% of the participants could not reimplant the avulsed tooth immediately, while another study proved that 36.4% of the participants even did not know whether the tooth could be reimplanted. In our study, when we asked the participants whether a posttraumatic avulsed tooth can be reimplanted, 5.6% of them responded negatively. When the participants were shown a picture of a patient, whose upper central tooth avulsed after a TDI, and they were asked about their attitude toward such a case, 58.6% of them answered that they would bring the tooth to the hospital in an appropriate carrier. Only 3.3% of them responded that they would reimplant the teeth if they could find it [Table 4].
When immediate replantation is not possible, the tooth should be stored in an appropriate transport media to maintain viability. An ideal storage medium should be capable of maintaining PDL and pulpal cells and tissue viability, physiological pH and osmolality similar to the surrounding tissues, sterile with excellent antioxidant properties, readily accessible, and having a low cost. Examples of osmolality balanced media are HBSS, saline, and milk. Saliva can also be used., In a study conducted on paramedics, the participants were asked about the most appropriate container to carry an avulsed tooth. Approximately 34% of them answered that it should be put into a handkerchief or a box, while 30% of them answered that they could put it into tap water, and about 42% of them responded that the avulsed tooth should be put into a saline solution. In our study, when the participants were asked about the most appropriate carrier for an avulsed tooth, 52.7% of them responded as saline solution, 28.5% of them stated that tissue or a gauze patch, while 14.4% had no information.
| Conclusion|| |
In light of the data obtained in this study, it was observed that the EMTs and paramedics did not have a sufficient level of knowledge about the TDI. It was also determined that the majority of them even did not receive any training about the TDI, and the ones who received did not find it sufficient. This reality prevents rapid and appropriate treatment of TDI cases. To be more useful to the patients in such frequent cases, the TDI topic, both in practical and theoretical terms, should be predominantly scheduled in the training programs of the EMTs and paramedics, and training seminars and presentations should be organized for the professionals, who are already working now.
Financial support and sponsorship
This study has been funded by departmental funds only. No external funding has been received.
Conflicts of interest
There are no conflicts of interest.
The study protocol was submitted and approved by the local institutional review board of the University of Harran, Sanliurfa, Turkey.
| References|| |
Şimşek İ, Ayna B, Uysal E. Determining the level of knowledge and attitudes of elementary school teachers in emergency management of traumatic dental injuries and evaluation of the effect of educational leaflet for teachers. Yeditepe Dent J 2017;13:11-9.
Lewandowski B, Brodowski R, Stopyra W, Muster M, Włodyka A, Migut M, et al.
Assessment of paramedics' knowledge and skills on dealing with dental injuries. Med Rev 2016;14:287–-99.
Cosme-Silva L, Moretti ABS, Lima DC, Moretti Neto RT, Oliveira TM, Sakai VT. Knowledge of parents from public and private school students on emergency management of avulsed permanent teeth. J Public Health (Bangkok) 2017;25:167-71.
Haliti F, Haliti N, Stubljar D, Shabani N, Mehmeti B, Doberdoli D, et al.
Evaluation of questionnaires to assess dental trauma and anxiety of children in Kosovo. J Int Dent Med Res 2018;11:420-7.
Díaz J, Bustos L, Herrera S, Sepulveda J. Knowledge of the management of paediatric dental traumas by non-dental professionals in emergency rooms in South Araucanía, Temuco, Chile. Dent Traumatol 2009;25:611-9.
Corputty JEM, Saputra FE. The evaluation of delayed treatment on dentoalveolar trauma by surgical reposition and wire-composite splint technique. J Int Dent Med Res 2017;10:384-91.
Perazzo M de F, da Silva BRC, Neves ÉTB, Firmino RT, Ribeiro GL, Granville-Garcia AF. Effect of dental health education on the management of avulsed teeth by firefighters. J Public Health (Bangkok) 2015;23:49-55.
Bakland LK, Andreasen JO. Dental traumatology: Essential diagnosis and treatment planning. Endod Top 2004;7:14-34.
Mori GG, de Mendonça Janjácomo DM, Castilho LR, Poi WR. Evaluating the knowledge of sports participants regarding dental emergency procedures. Dent Traumatol 2009;25:305-8.
Nashine N, Bansal A, Tyagi P, Jain M, Jain A, Tiwari U. Comparison and evaluation of attitude and knowledge towards the management of dental injury in school teachers before and after oral health education. Int J Clin Pediatr Dent 2018;11:425-9.
Eigbobo JO, Etim SS. The pattern of traumatic dental injuries in children in a tertiary health care facility in Nigeria. J Int Dent Med Res 2016;9:33-8.
Glendor U. Aetiology and risk factors related to traumatic dental injuries – A review of the literature. Dent Traumatol 2009;25:19-31.
Andersson L. Epidemiology of traumatic dental injuries. J Endod 2013;39:S2-5.
Subhashraj K. Awareness of management of dental trauma among medical professionals in Pondicherry, India. Dent Traumatol 2009;25:92-4.
Andersson L, Andreasen JO, Day P, Heithersay G, Trope M, DiAngelis AJ, et al.
International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol 2012;28:88-96.
Baginska J, Wilczynska-Borawska M. Continuing dental education in the treatment of dental avulsion: Polish dentists' knowledge of the current IADT guidelines. Eur J Dent Educ 2013;17:e88-92.
McIntyre JD, Lee JY, Trope M, Vann WF. Elementary school staff knowledge about dental injuries. Dent Traumatol 2008;24:289-98.
Hamilton FA, Hill FJ, Mackie IC. Investigation of lay knowledge of the management of avulsed permanent incisors. Endod Dent Traumatol 1997;13:19-23.
Rucha Date MA, Date R, Yussuf C, Khandwawala N, Hegde V. Avulsed tooth – A storage medium dilemma – An update. J Trauma Treat 2014;04:1-3.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]