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 Table of Contents  
ORIGINAL RESEARCH
Year : 2019  |  Volume : 11  |  Issue : 5  |  Page : 287-292

Knowledge, attitude, and awareness of mothers toward emergency management of dental trauma in high literacy population


1 Postgraduate Student, Department of Pedodontics and Preventive Dentistry, Amrita School of Dentistry, AIMS Campus, Kochi, Kerala, India
2 Professor, Department of Pedodontics and Preventive Dentistry, Amrita School of Dentistry, AIMS Campus, Kochi, Kerala, India
3 Reader, Department of Pedodontics and Preventive Dentistry, Amrita School of Dentistry, AIMS Campus, Kochi, Kerala, India
4 Principal and HOD, Department of Pedodontics and Preventive Dentistry, Amrita School of Dentistry, AIMS Campus, Kochi, Kerala, India

Date of Web Publication24-Sep-2019

Correspondence Address:
Dr. Kumaran Parvathy
Professor, Department of Pedodontics and Preventive Dentistry, Amrita School of Dentistry, AIMS Campus, Kochi.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jioh.jioh_59_19

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  Abstract 

Aims and Objectives: Most important oral health problem observed in childhood is dental trauma. This frequently occurs at home or during outdoor activities so emergency care is essential for good prognosis of the injury. For the better prognosis, parents have important role. Before planning educational promotion, it is essential to consider the understanding level of parents, where mothers play an important role. Evaluation of the knowledge, attitude as well as awareness in mothers toward immediate management in traumatic dental injuries. Materials and Methods: A 3-month survey was conducted among 120 mothers who visited the Department of Pedodontics and Preventive Dentistry for treatment. Fifteen closed-ended questions based on knowledge, attitude, and awareness were provided to the mothers, who were between 20 and 60 years of age. Results were statistically evaluated by using chi-square test, and the level of significance was set as P ˂ 0.05. The Statistical Package for the Social Sciences (SPSS) was used for the statistical analysis. Independent two sample t-test was applied for comparing the mean difference of numerical variables between groups. Results: Results indicated the low knowledge level of mothers about immediate management of traumatic dental injuries. Residential status as well as education of mothers did not affect their awareness toward dental trauma, mother’s experience also had no effect in the preservation of avulsed tooth. No statistical significance was observed in either of the cases. Conclusion: The assessment showed a want of awareness and knowledge in mothers toward emergency management of traumatic dental injuries. Knowledge of parents in this area needs to be improved by educational programs.

Keywords: Avulsed Tooth, Dental Trauma, Management of Trauma


How to cite this article:
Resmy N, Parvathy K, Arun XM, Balagopal V. Knowledge, attitude, and awareness of mothers toward emergency management of dental trauma in high literacy population. J Int Oral Health 2019;11:287-92

How to cite this URL:
Resmy N, Parvathy K, Arun XM, Balagopal V. Knowledge, attitude, and awareness of mothers toward emergency management of dental trauma in high literacy population. J Int Oral Health [serial online] 2019 [cited 2021 Mar 7];11:287-92. Available from: https://www.jioh.org/text.asp?2019/11/5/287/267716


  Introduction Top


Traumatic dental injury is an important oral health problem in childhood.[1] The damage or missing of anterior tooth is a sensitive issue as it affects the child’s masticating efficiency, psychological, and emotional well-being.[2],[3],[4],[5] Dentoalveolar trauma is one of the major problems faced by the children during school time, sporting, and recreational activities.[6] Parents or guardians of the child are the first ones to report this to dental professionals; therefore, the awareness and knowledge in emergency management is of paramount importance.[7]

Avulsion of maxillary incisors in both primary and permanent dentition is a pronounced dental injury.[8],[9],[10] Frequency of tooth avulsion due to dental trauma in permanent and in primary dentition is 0.5%–16% and 7–13%, respectively.[4] It is more common in boys than that in girls. Boys participate more in outdoor activities and sports and this is common in the children of ages 7–9 years.[8],[9],[10] Avulsion in 7–9 years is due to the freely prearranged periodontal ligament adjoining the erupting teeth and elasticity of alveolar bone.[11]

Replantation of avulsed teeth is the most accepted management options, which mainly entrust on the feasibility of periodontal ligament enduring on the tooth after avulsion.[5] To avoid the drying out of root surface while carrying, it can be stored in different mediums such as milk, saline, and saliva.[4]

Immediate and adequate emergency management is necessary to improve prognosis in dental injuries.[5] Traumatized children are reluctant to medication for the want of understanding and knowledge of the parents. Mothers have important role in diagnosis of the involved tooth.[1] Among all the states in India, Kerala has the highest literacy. Hence, it is expected that mothers in Kerala are aware of managing dental trauma. Very few studies are reported in literature in assessing the knowledge of mothers toward emergency management in traumatic dental injuries in Kerala. This study aimed to evaluate the understanding, approach, and responsiveness of mothers toward the immediate care for traumatic dental injuries.


  Materials and Methods Top


A 3-month survey was conducted among 120 mothers of children attending the outpatient department (OPD) of Pedodontics and Preventive Dentistry. The institutional ethics committee clearance (IRB-AIMS-2018-120) was obtained before the study. Before filling the questionnaire, the intention of this work was clarified to the mothers. Written informed consents were obtained before the inclusion of the study.

Mothers between 20 and 60 years of age were included in the study. Those below 20 years and above 60 years were not part of the study. Questionnaire was formulated based on formerly prepared questions.[1] As per the questionnaire, the correct and incorrect responses were obtained. Correct answer was awarded 1 and incorrect answer 0 for knowledge-based questions. Total count was evaluated between the groups. Fifteen closed-ended questionnaire is given in [Figure 1].
Figure 1: Evaluation questionaire

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Fifteen closed-ended questions were considered to evaluate mother’s understanding, attitude along with responsiveness toward dental trauma in children both in English and the vernacular language, Malayalam.

IBM Statistical Package of the Social Sciences software, version 20.0 (SPSS, Chicago, Illinois) was used for the statistical evaluation. The results were expressed in number and percentage for categorical variables and for continuous variables, it was expressed as mean ± standard deviation. Independent two-sample t-test was applied for comparing the mean difference of numerical variables between groups. Chi-square test was used for getting the association of categorical variables. Statistically significance was considered when P < 0.05.


  Results Top


A total of 120 mothers who came for consultation with their children to the Department of Pedodontics and Preventive Dentistry participated in this study. Mothers were categorized according to their educational level, age, and their area of residence, which is given in [Table 1].
Table 1: Frequency distribution

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Knowledge of mothers toward avulsion was assessed. Majority of mothers in all categories answered that they would remove and discard the avulsed tooth if it was found outside the child’s mouth. Approximately 93.6% of mothers in the age below 40 years and 96.2% of mothers above 40 years removed the avulsed tooth from the mouth and 84% of mothers below 40 years of age and 88.5% of mothers above 40 years of age discarded the tooth if they found outside the mouth. Approximately 96.8% of mothers from rural area and 91.2% of mothers from urban area also removed the avulsed tooth from the mouth; 82.5% of mothers from rural area and 87.7% of mothers from urban area discarded the tooth if found outside the mouth. Similarly, 90.0% of mothers who had high school education and all the graduate mothers removed the avulsed tooth from the mouth; 87.1% who had high school education and 82% graduate mothers also discarded the tooth if they found outside the mouth [Figure 2]. Considering the question of what would be done if the tooth was out of place inside the mouth, the p values with respect to the age of the parent, place of residence and education were 1.000, 0.255 and 0.041 respectively. Pertaining to the question of what the parent would do to the tooth knocked out of the mouth the p values were 0.760, 0.465 and 0.450 respectively for the above said three criteria. In the both cases degrees of freedom were one.
Figure 2: Results based on the knowledge of mothers regarding the removal of avulsed tooth from mouth (A) and discarding the avulsed tooth (B)

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The general awareness of the mothers regarding the preservation of avulsed tooth was low. Paper or cotton was the most common method that would be used for transporting avulsed tooth according to the majority of mothers in all groups [Figure 3]. For saving the tooth and carrying the tooth to the dentist, the P values were 0.857, 0.457, and 0.454 and 0.584, 1.000, and 0.159, respectively.
Figure 3: Results based on the awareness of mothers toward preservation of avulsed tooth. (A) Result based on the preservation. (B) Response of mothers toward transporting medium

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Attitude of mothers toward avulsed tooth showed that majority of the mothers agreed to the importance of conducting educational programs for the immediate handling of traumatic dental injuries [Figure 4]. The P values were 0.388, 1.000, and 0.510 and 0.475, 1.000, and 0.383 for the attitude of mothers toward education and response regarding the interest of educational program, respectively.
Figure 4: Response based on the attitude of mothers toward avulsed tooth. (A) Reaction of mothers toward importance of educational program. (B) Interest of mothers in educational program

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Among 120 mothers, 68 mothers had previous experience with dental trauma and 52 mothers had no previous experience. Most of the mothers who had previous experience in dental trauma removed the avulsed tooth and they were unaware about the transporting media, though results were not significant (P > 0.05).

The knowledge toward emergency management of avulsed tooth was not dependent on the educational qualification, age, and residential status, and the results were insignificant (P > 0.05). The mothers who participated in this study were interested in the educational programs about the immediate management on traumatic dental injuries and gave more importance to it.


  Discussion Top


Age, educational level, residing area, and previous experience of dental trauma were assessed in 120 mothers of patients who attended the OPD of Pedodontics and Preventive Dentistry. The closed-ended questionnaire method was used for the assessment, which included 15 questions.

Mothers usually play a big role in the upbringing of the child and they contribute more in handling the dental trauma.[1] Very few studies are reported about the knowledge of mothers in managing the traumatic dental injuries in children. So this survey was undertaken to create awareness among mothers for seeking professional advice for immediately managing traumatic dental injuries in children.[2]

Response to perception among mothers toward avulsion, preservation of the avulsed tooth, and the transport media to be used for the avulsed tooth were the parameters undertaken for studying the understanding as well as the awareness in mothers toward the management of dental trauma in children. Mother’s attitude was assessed by their response toward educational programs.[1]

In this study, it was found that the avulsed tooth was removed from the mouth of the child by 93.6% of mothers below 40 years and 96.2% of mothers above 40 years. This shows their lack of knowledge in taking care of the avulsed tooth of the child. This was found to be in accordance to the study conducted by Murali et al.[1] (50%), Parikh and Shah[12] (36%), and Hegde et al.[13] (64.8%). A total of 96.8% of mothers who belonged to rural areas and 91.2% of urban mothers took off the avulsed tooth from the mouth of the child. This shows the lack of awareness among the mothers who belonged to the rural areas toward the avulsed tooth of their child. Both the graduate and the undergraduate mothers were found doing the same, especially in case of removing the avulsed tooth from the mouth of their child.

Hence, the educational status of mothers was not playing a role in their attitude toward the avulsed tooth of their children. This result was found to be statistically insignificant. The awareness of mothers toward the preservation of avulsed tooth is to be improved and they should be well informed in this aspect.

Instantaneous reimplantation is the ultimate treatment for avulsed tooth. Here, 84% of the mothers below 40 years and 88.5% mothers above 40 years of age were not aware of immediate reimplantation of the avulsed tooth. Murali et al.[1] reported that 50.7% of the mothers were not aware about the reimplantation of the avulsed tooth of the child. Studies by Parikh and Shah,[12] AlGhamdi et al.,[14] Hegde et al.,[13] and Sood et al.[15] showed similarity. Zakirulla et al.[16] conducted study among the teachers and similar results were reported.

Most of the mothers from the urban area (87.7%) discarded the avulsed tooth. Mothers from rural area were unaware toward the avulsed tooth of their ward. According to the study by Shashikiran et al.,[5] 78.5% mothers from urban area did not discard the broken tooth and they sought treatment from the dentist. In case of education, 87.1% mothers who were undergraduates discarded the avulsed tooth of the child. The graduate mothers were aware of preserving the knocked out tooth. The results were statistically insignificant and it was found to be in accordance to a study by Kaul et al.[17]

A total of 76.7% mothers below 40 years of age and 76.9% mothers in the age group of above 40 years did not wash the avulsed tooth under water. Murali et al.,[1] Taranath et al.,[18] and Namdev et al.[3] reported similar results. The residential status level and the educational level of the mothers did not affect their attitude toward avulsed tooth. The results of the study show that 76.0% graduates were unaware about preservation. This might be due to their overconfidence in knowledge than the undergraduate mothers and they gave importance for pain control measures and bleeding. Emergency management education among mothers is needed to enhance awareness in the necessity of cleaning of the avulsed tooth.

A total of 94.7% mothers below 40 years and all the mothers above 40 years stored the avulsed tooth in paper owing to the concept of dry storage. Studies by Murali et al.[1] (94%), Hegde et al.[13] (35.8%), Quaranta et al.[19] (45%), Sood et al.[15] (47%), and Nikam et al.[20] (80%) showed similarity. According to the residential status and educational level of mothers, most of the mothers selected an inappropriate medium for the storage of avulsed tooth, in that 98.6% of undergraduate mothers selected inappropriate medium because of their unawareness of storage mediums. This may be due to the lack of educational knowledge for appropriate medium. Kaul et al.[17] reported similar results. Milk and saliva are reported as ideal storage medium, about which the mothers should be made aware of.

Approximately 98.9% mothers below 40 years and 96.2% of mothers above 40 years agreed the importance of educational programs, which was similar to the studies conducted by Namdev et al.,[3] AlGhamdi et al.,[14] and Loo et al.[21] Most of the mothers agreed to the importance of educational programs with regard to the immediate management of traumatic dental injuries regardless of their residential status and the knowledge level. Kaul et al.[17] also reported similar results. Graduated mothers showed less interest (86.0%) than undergraduates for educational programs. Educational campaign and preventive programs can improve the attitude of mothers associated with traumatic dental injuries.

In this study, no noteworthy relation was observed among the age, previous experience as well as educational level in attending dental trauma in children. Most mothers showed a better attitude toward educational programs, and measures should be ensured for imparting knowledge about dental trauma to them.

Organizing educational programs at public places, school, and anganwadi with audiovisual aids and posters will help in giving better education to parents, especially mothers. The pediatricians and gynecologists can also help in creating awareness. Limitations of the study were the sample size and the socioeconomic factors. More studies should be conducted in diverse population with large sample size.

All these findings reveal the want of understanding and awareness in mothers regarding the immediate management of traumatic dental injuries. Majority of mothers showed favorable approach toward education programs in dental avulsion. It helped to minimize the loss of permanent tooth. Lecture methods, TV programs, and Internet can be used as methods for conveying the message for complete understanding.

Acknowledgement

The authors acknowledge the staff at the institution for providing necessary support and the mothers for their wholehearted cooperation and participation in the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Murali K, Krishnan R, Kumar VS, Shanmugam S, Rajasundharam P Knowledge, attitude, and perception of mothers towards emergency management of dental trauma in Salem district, Tamil Nadu: A questionnaire study. J Indian Soc Pedod Prev Dent 2014;32:202-6.  Back to cited text no. 1
    
2.
Pani SC, Alolaiwi LA, AlRukban LA Awareness of the emergency management of dental trauma in children: A comparison of fathers and mothers in Riyadh city. J Emerg Trauma Care 2016;2:1.  Back to cited text no. 2
    
3.
Namdev R, Jindal A, Bhargava S, Bakshi L, Verma R, Beniwal D Awareness of emergency management of dental trauma. Contemp Clin Dent 2014;5:507-13.  Back to cited text no. 3
    
4.
Andreasen JO, Andreasen FM Textbook and Color Atlas of Traumatic Injuries to the Teeth. 3rd ed. Copenhagen, Denmark: Munksgaard; 1994. p. 383-425.  Back to cited text no. 4
    
5.
Shashikiran ND, Reddy VV, Nagaveni NB Knowledge and attitude of 2,000 parents (urban and rural—1,000 each) with regard to avulsed permanent incisors and their emergency management, in and around Davangere. J Indian Soc Pedod Prev Dent 2006;24:116-21.  Back to cited text no. 5
    
6.
Pithon MM, Lacerda dos Santos R, Magalhães PH, Coqueiro Rda S Brazilian primary school teachers’ knowledge about immediate management of dental trauma. Dental Press J Orthod 2014;19:110-5.  Back to cited text no. 6
    
7.
Mohandas U, Chandan GD Knowledge, attitude and practice in emergency management of dental injury among physical education teachers: A survey in Bangalore urban schools. J Indian Soc Pedod Prevent Dent 2009;4:243-8.  Back to cited text no. 7
    
8.
Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM Replantation of 400 avulsed permanent incisors. 1. Diagnosis of healing complications. Endod Dent Traumatol 1995;11:51-8.  Back to cited text no. 8
    
9.
Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM Replantation of 400 avulsed permanent incisors. 2. Factors related to pulpal healing. Endod Dent Traumatol 1995;11:59-68.  Back to cited text no. 9
    
10.
Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM Replantation of 400 avulsed permanent incisors. 3. Factors related to root growth. Endod Dent Traumatol 1995;11:69-75.  Back to cited text no. 10
    
11.
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
    
12.
Parikh U, Shah K Assessment of knowledge of parents towards paediatric dental traumatic injuries. Int J Appl Dent Sci 2017;3:230-3.  Back to cited text no. 12
    
13.
Hegde AM, Kumar KN, Varghese E Knowledge of dental trauma among mothers in Mangalore. Dent Traumatol 2010;26:417-21.  Back to cited text no. 13
    
14.
AlGhamdi NS, Alothman SA, Assiri AM, Bijle MN, Togoo RA Knowledge of Saudi parents toward the emergency management of avulsed permanent teeth: A cross-sectional survey. J Dent Res Rev 2016;3:85-7.  Back to cited text no. 14
    
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Sood I, Gupta K, Sharma AK, Gaur A, Pathania V, Thakur VB Assessment of knowledge and awareness among medical doctors toward emergency management of dental trauma in state of Himachal Pradesh: A survey. Indian J Dent Sci 2017;9:1-6.  Back to cited text no. 15
    
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Zakirulla M, Togoo RA, Yaseen SM, Al-Shehri DA, Al-Ghamdi AS, Al-Hafed MS, et al. Knowledge and attitude of Saudi Arabian school teachers with regards to emergency management of dental trauma. Int J Clin Dent Sci 2011;2:25-9.  Back to cited text no. 16
    
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Kaul R, Jain P, Angrish P, Saha S, Patra TK, Saha N, et al. Knowledge, awareness and attitude towards emergency management of dental trauma among the parents of Kolkata—An institutional study. J Clin Diagn Res 2016;10:ZC95-101.  Back to cited text no. 17
    
18.
Taranath M, Senaikarasi RM, Manchanda K Assessment of knowledge and attitude before and after a health education program in East Madurai primary school teachers with regard to emergency management of avulsed teeth. J Indian Soc Pedod Prev Dent 2017;35:63-7.  Back to cited text no. 18
    
19.
Quaranta A, De Giglio O, Coretti C, Vaccaro S, Barbuti G, Strohmenger L What do parents know about dental trauma among school-age children? A pilot study. Ann Ig 2014;26:443-6.  Back to cited text no. 19
    
20.
Nikam AP, Kathariya MD, Chopra K, Gupta A, Kathariya R Knowledge and attitude of parents/caretakers toward management of avulsed tooth in Maharashtrian population: A questionnaire method. J Int Oral Health 2014;6:1-4.  Back to cited text no. 20
    
21.
Loo TJ, Gurunathan D, Somasundaram S Knowledge and attitude of parents with regard to avulsed permanent tooth of their children and their emergency management—Chennai. J Indian Soc Pedod Prev Dent 2014;32:97-107.  Back to cited text no. 21
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

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