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ORIGINAL ARTICLE
Year : 2020  |  Volume : 23  |  Issue : 3  |  Page : 343-348

Orofacial trauma awareness among sports teachers in Southern Saudi Arabia


1 Department of Periodontics and Community Dental Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia
2 Department of Preventive Dentistry, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Choba Port Harcourt, Rivers State, Nigeria
3 Pedodontics and Orthodontic Dental Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia

Date of Submission01-Sep-2019
Date of Acceptance14-Nov-2019
Date of Web Publication5-Mar-2020

Correspondence Address:
Dr. A B I Eroje
Department of Periodontics and Community Dental Sciences, King Khalid University, Abha
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_466_19

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   Abstract 


Background: Dental trauma is a major public oral health problem owing to its high prevalence. The school sports teachers who observe children when they participate in sports have a key role in the prevention and management of traumatic injuries. The present study aims to determine the awareness of sports teachers on the occurrence and prevention of oral-facial trauma in southern Saudi Arabia. Methods: The present study was a cross-sectional study design among sports teachers in a southern subpopulation of Saudi Arabia. A draft questionnaire with 11 items was constructed under three domains: occurrence pattern, prevention, and management of dental trauma. Results: A total of 191 sports teachers from various schools participated in the survey. The majority (88%) of the teachers had encountered orofacial trauma among children during sporting activity in schools. The most common orofacial structure involved in injury was the teeth (33.5%) and lips (25.2%). Only 50.8% of subjects knew stock tray as a type of mouthguard and 27.7% of teachers responded that they do not recommend mouthguards for children during sporting activities. Nearly 80.6% teachers were aware of the possibility of reimplanting an avulsed tooth. About 72.8% teachers had poor knowledge of immediate action necessary for successful outcomes of reimplanted teeth. Conclusions: Orofacial trauma was commonly encountered by sports teachers among children during sporting activities in the school. There was poor awareness regarding types of mouth guards and its significance among the sports school teachers. The knowledge related to the management of emergency oral injuries was inadequate.

Keywords: Knowledge, mouthguard, orofacial trauma, Saudi Arabia, school children


How to cite this article:
I Eroje A B, Tikare S, AlQahtani N A, Braimoh O B, Sundarraj R K, Muteq M A, Alshehri A A, Almanadiah A S, Albargi A M. Orofacial trauma awareness among sports teachers in Southern Saudi Arabia. Niger J Clin Pract 2020;23:343-8

How to cite this URL:
I Eroje A B, Tikare S, AlQahtani N A, Braimoh O B, Sundarraj R K, Muteq M A, Alshehri A A, Almanadiah A S, Albargi A M. Orofacial trauma awareness among sports teachers in Southern Saudi Arabia. Niger J Clin Pract [serial online] 2020 [cited 2020 Apr 6];23:343-8. Available from: http://www.njcponline.com/text.asp?2020/23/3/343/280034




   Introduction Top


Orofacial trauma is an injury to teeth and nearby soft tissues including lips, gums, tongue, and jawbones. The common causes of orofacial trauma are fights, sports, motor vehicle accidents, falls, and other such events.[1],[2],[3] Orofacial trauma is considered as a major public oral health problem owing to its high prevalence.[4] Children, particularly those with proclination of the incisors (increased overjet) could be at higher risk of traumatic injuries.[5] Injury to the orofacial structures could be present as any of the following conditions: lacerations of the face, tongue, lip, and oral mucosal, fracture of the tooth and/or alveolar process, subluxation of tooth, intrusion of tooth, and tooth avulsions. Facial and oral structures are highly innervated and injuries in these regions are painful. Apart from immediate physical, esthetic, and psychological consequences of trauma to the face and oral structures, it has long-term emotional and social impact.[6],[7]

Management of orofacial trauma range from first aid treatment of oral mucosal tissues, restoration of fractured teeth, and reimplantation of avulsed teeth to surgical management of facial bone fractures. Cost analysis in research reveals orofacial trauma has great economic impacts according to the treatment required. A simple primary tooth injury may cost $60 USD, while a complex injury may cost $200 USD.[8] According to reports in the United States, management of avulsed teeth alone costs nearly $500 million in a year.[2] In addition, indirect costs could be incurred due to compromised healthcare access and maintenance care which may continue for several years.[9]

Orofacial injuries could largely be prevented by wearing mouthguards.[10],[11] Mouthguards help to mitigate against injury by absorbing and distributing the impacting force. Therefore, it would be judicious for all dental specialists to recommend utilization of mouthguards in all physical games and sports with increased risk of injury. Some sports recommend use of approved safety helmets. Federation Dentaire Internationale (FDI) has categorized sports based on risk of traumatic dental injuries as high-risk sports and medium-risk sports.[12] Bourguignon in 2009 reviewed several types of research and found out that use of mouthguards in contact sports reduced the occurrence of dental trauma up to 90% or more.[13]

Games conducted by approved sports organizations/bodies at both national and international levels use all possible preventive measures against traumatic injury. As a protocol, trained persons in first-aid and even doctors specialized in sports medicine are available on the ground who can promptly act in case of casualties. Children engaged in sports activities at school have a high prevalence of oral trauma.[14],[15],[16],[17] The sports teachers who directly observe the children during sports are their first contact and hence have a key role in prevention and management of traumatic injuries. Furthermore, the prognosis and outcome of orofacial injuries may depend on the initial first aid treatment provided by the attending teacher. To the researchers' knowledge, studies on the knowledge of school teachers on the occurrence and prevention of orofacial trauma are uncommon in the Abha region in southern Saudi Arabia. The lack of such research from this region of the country made the present study imperative. Therefore, the aim of this study was to determine the awareness of sports teachers on the occurrence and prevention of oral-facial trauma in southern Saudi Arabia.


   Methods Top


Study and sampling design

The present study was cross-sectional in design targeting and the study population included school sports teachers in southern subpopulation in Saudi Arabia. Ethical approval for the research was obtained from the Institutional Review Board, King Khalid University, College of Dentistry (SRC/REG/2016/2017/117). Permission was sought from the Ministry of Education and selected school authorities. A list of all intermediate and secondary schools in the twin city of Abha and Khamis-Mushayat, both government and private was obtained from the Ministry of Education. Only schools with sports teachers were selected for the study. The purpose of the study was explained to all subjects who consented to participate in the study and participants were assured of the confidentiality of their personal information.

Questionnaire and data collection

A draft questionnaire with 11 items was constructed under three domains: occurrence, prevention, and management of dental trauma. The questionnaire was first constructed in English and later translated to national language (Arabic). Both copies were checked by the language expert for a back translation and the questionnaire was verified for face validity by dental public health faculty. The questions contained in the three domains are as follows: Occurrence: Have you ever seen a dental trauma in a school sports child? If Yes, what kind of dental trauma? How many times did a child present with dental trauma? What part of child's position suffered dental trauma? Prevention: Do you know the mouthguards? If yes, which kind of mouthguard? (This particular question allowed multiple responses) Do you recommend the wear of mouthguards to the children during sporting activities? If not, why? Do your sports department/sickbay has a health-related dental health educator/dental assistant? Management of dental trauma: Do you know that is possible to replant an avulsed tooth? In your own opinion within which period of time a tooth must be replanted? Are you aware immediate action is necessary for a successful outcome? Do you know any dentist's emergency service? The response option for each item was closed-ended. Participants were given adequate time to complete the questionnaire and were collected back immediately. The collected data were sorted, coded, and entered into the computer and subjected to statistical analysis using SPSS Version 16 (SPSS inc. Version 16, Chicago, IL, USA)


   Results Top


A total of 191 sports teachers were involved in the survey. [Table 1] shows the experience of sports teachers regarding the occurrence of orofacial trauma in schools. The majority (88%) of the teachers had encountered orofacial trauma among children during sporting activity in the schools. The most common orofacial structure involved in injury was the teeth (33.5%) and lips (25.2%). Fracture of the teeth (33.5%) was the most common type of injury. Other injuries include bruising, displaced tooth, lips/gingiva, frenum, tongue, and buccal mucosa lacerations, etc., There was however no significant difference based on the type of injury (P = 0.245).
Table 1: Experience of Sports Teachers regarding Orofacial Trauma Questions Response n

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[Table 2] shows sports teachers' responses regarding awareness and use of mouthguards. Around 75.4% of sports teachers were aware of mouthguard appliances. Only 50.8% of subjects knew stock tray as a type of mouthguard. The significantly high number of subjects did not know about “Boil and Bite” and “Custom made” types of mouthguards (P = 0.000). It was found that 27.7% of teachers responded that they do not recommend mouthguards for children during sporting activities. The most and least common reason for non-recommendation was that they felt mouthguards were not necessary (49.2%) and esthetics (7.9%), respectively.
Table 2: Knowledge of sports teachers regarding the use of Mouthguards

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[Table 3] shows sports teachers' responses related to first-aid management of dental trauma. Nearly 80.6% of teachers were aware of the possibility of reimplanting an avulsed tooth. However, 72.8% of the teachers are not aware that immediate action is necessary for a successful outcome. The majority (95.3%) of schools did not have a place for a dental consultation and a large number of sports teachers (67%) did not have contact details of any dentist for emergency service.
Table 3: Knowledge of Sports Teachers in the First-aid Management of Dental Trauma

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   Discussion Top


Orofacial injuries, especially dental trauma are more common in children and adolescents. Several studies across the world have a varied prevalence of dental trauma among children.[14],[15],[16],[17] A study in Saudi Arabia reported a prevalence of dental trauma to be 35% in male school children.[18] Estimation of prevalence of orofacial trauma was not primary objective of the present study; nevertheless, 88% of the sports teachers reported witnessing orofacial trauma among school children. This further indicates that the prevalence of orofacial trauma in schools could be high. Therefore, teachers can be on the frontline in passing information to school children on how to avoid and prevent orofacial trauma. Similar to present study, teeth and lips were observed to be most common sites of injury. The commonest types of injuries reported were simple enamel fracture, avulsion, subluxation, and intrusion of anterior teeth particularly involving the central incisors.[15],[19],[20] In many reported studies, schools were reported to be the most frequent locations for the occurrence of dental trauma.[20],[21] Among the factors, contact sports and bicycle accidents were most common reasons for traumatic injuries.[20],[22] A colossal size of unreported orofacial trauma among children in the society represents submerged portion of an iceberg. Orofacial trauma hence poses a public health problem and needs dire attention of health professionals and other stakeholders in developing preventive and management strategies.

Adequate knowledge and attitude of sports teachers regarding prevention and first-aid management of orofacial trauma are quintessential. Sports teachers in school directly supervise children during sporting activities in school and are responsible not only to monitor the use of protective devices but also to educate children regarding the significance of those appliances. Although each sport may need a different protective device, mouthguards alone have shown significant reduction in sport-related orofacial injuries.[23],[24] Mouthguards act as a protective shield for oral soft tissue and teeth thus preventing trauma to the underlying structures.[25] In several countries mouthguards are mandatory during contact and non-contact sports.[26],[27] The majority of sports teachers in the present study knew what are mouthguard devices but had poor knowledge regarding the various types of mouthguards. Surprisingly, over a quarter of sports teachers did not recommend use of mouthguards to school children during sporting exercises and most reasons for non-recommendation were that they felt mouthguards were not necessary. These findings are comparable to similar studies where very few sports teachers who had adequate knowledge actually practiced use of protective devices regularly.[28],[29] Such negative attitude of school teachers needs to be changed. This can be achieved through massive oral health education of school teachers in southern Saudi Arabia. The effort at educating school teachers can be pioneered through the ministry of education in conjunction with the ministry of health and professional dental bodies, encouraging the multisectoral approach in the promotion of oral health.

The American Association of Pediatric Dentistry (AAPD) endorses the statement by the International Association of Dental Traumatology (IADT) that replantation of avulsed permanent teeth is the choice of management in most cases.[30] The prognosis of avulsed teeth is very much dependent on immediate actions were taken after the tooth avulsion at the place of accident. IADT has standard guidelines for first-aid management of traumatic dental injuries for general public in emergency situations and for dental professionals which can aid decision making in clinical settings. Immediately after the accident the avulsed tooth needs to be picked up and held on the crown and rinsed in cold running water if contaminated with dirt and repositioned carefully. For some reasons if replantation cannot be done at the place of injury, the tooth has to be stored in a glass of milk and taken to emergency dental clinic with the patient. The first 60 minutes of the tooth outside tooth socket (dry time) is crucial for good prognosis. Sports teachers in the present study had poor knowledge of immediate actions required during traumatic dental injury; nevertheless, most of teachers knew the possibility of avulsed tooth replantation. This clearly indicates that large efforts are required by local dental professional bodies to educate and train sports teachers in prevention and first-aid management of oro-facial injuries through organizing seminars and workshops.

To improve the situation observed in this present study, the inclusion of a dental health assistant in the medical sickbay and the availability of dentist emergency contact should be mandatory, not only for the prevention and treatment of dental injuries but also for maintenance of children's oral health. In this context, Sports Dentistry as a specialty or as part of sports medicine should be introduced to handle oro-facial injuries following sports. A sports dentist has several important functions that can help the athlete have a better performance in his sporting activity. Worldwide Sports Dentistry has gained an increased interest and unfortunately in Saudi Arabia there is still a huge gap in this direction. Therefore, the Saudi Dental Society (SDS) should be aware of the new area of clinical practice and must understand that dentistry is an important part of the context of systemic health and different problems can impair the performance of school children undergoing extracurricular activities such as sporting activities in Saudi Arabia.


   Conclusions Top


Orofacial trauma was commonly encountered by sports teachers among children during sporting activities in the schools. The most common orofacial structure involved in injury was reported on teeth and lips. There is poor awareness regarding types of mouthguards and its significance among the sports school teachers. The knowledge related to the management of acute oral injuries was found to be inadequate. Most schools lack facilities for emergency dental care. It is quintessential to educate sports school teachers towards significance of mouthguards in prevention of oral trauma and train them for first aid management. Policies by concerned authorities are required to provide emergency and dental consultation services in schools.

Acknowledgments

The authors are grateful to all school authorities for their kind cooperation in this survey.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3]



 

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