Malakh Gamal
V year, group 13
PRIMARY SCHOOL STAFF’S KNOWLEDGE AND ATTITUDE REGARDING TRAUMATIC DEN-TAL INJURIES IN QALANSUWA, ISRAEL
Master’s Thesis
Supervisor
Assoc. Prof. Dr. JulijaNarbutaitė
LITHUANIAN UNIVERSITY OF HEALTH SCIENCES MEDICAL ACADEMY
FACULTY OF ODONTOLOGY
CLINIC FOR PREVENTIVE AND PEDIATRIC DENTISTRY
PRIMARY SCHOOL STAFF’ S KNOWLEDGE AND ATTITUDE REGARDING TRAUMATIC DEN-TAL INJURIES IN QALANSUWA, ISRAEL
Master’s Thesis
The thesis was done Supervisor
by student
(Signture) (Signture)
Malakh Gamal, 2018, Group 13 Assoc. Prof. Dr. JulijaNarbutaitė ... 2018 ... 2018
(day/month) (day/month)
3
EVALUATION TABLE OF CLINICAL–EXPERIMENTAL MASTER’S THESIS
Evaluation: ...
Reviewer: ... (scientific degree, name and surname)
Reviewing date: ...
No. MT parts MT evaluation aspects
Compliance with MT re-quirements and
evalua-tion
Yes Partially No
1
Summary (0.5 point)
Is summary informative and in compliance with the
thesis content and requirements? 0.3 0.1 0
2
Are keywords in compliance with the thesis essence?
0.2 0.1 0 3 Introduc-tion, aim and tasks (1 point)
Are the novelty, relevance and significance of the
work justified in the introduction of the thesis? 0.4 0.2 0
4
Are the problem, hypothesis, aim and tasks formed
clearly and properly? 0.4 0.2 0
5 Are the aim and tasks interrelated? 0.2 0.1 0
6
Review of literature (1.5 points)
Is the author’s familiarization with the works of other
authors sufficient? 0.4 0.2 0
7
Have the most relevant researches of the scientists discussed properly and are the most important results
and conclusions presented? 0.6 0.3 0
8
Is the reviewed scientific literature related enough to
the topic analysed in the thesis? 0.2 0.1 0
9
Is the author’s ability to analyse and systemize the
10
Material and
meth-ods (2 points)
IS the research methodology explained comprehen-sively? Is it suitable to achieve the set aim?
0.6 0.3 0
11
Are the samples and groups of respondents formed and described properly? Were the selection criteria
suitable? 0.6 0.3 0
12
Are other research materials and tools (question-naires, drugs, reagents, equipment, etc.) described
properly? 0.4 0.2 0
13
Are the statistical programmes used to analyse data, the formulas and criteria used to assess the level of
statistical reliability described properly? 0.4 0.2 0
14
Results (2 points)
Do the research results answer to the set aim and
tasks comprehensively? 0.4 0.2 0
15
Does presentation of tables and pictures satisfy the
requirements? 0.4 0.2 0
16
Does information repeat in the tables, picture and
text? 0 0.2 0.4
17 Is the statistical significance of data indicated? 0.4 0.2 0
18
Has the statistical analysis of data been carried out
properly? 0.4 0.2 0
19
Discussion (1.5 points)
Were the received results (their importance, draw-backs) and reliability of received results assessed
properly? 0.4 0.2 0
20
Was the relation of the received results with the latest
data of other researchers assessed properly? 0.4 0.2 0
5 22
Do the data presented in other sections (introduction,
review of literature, results) repeat? 0 0.2 0.3
23
Conclu-sions (0.5 points)
Do the conclusions reflect the topic, aim and tasks of
the Master’s thesis? 0.2 0.1 0
24
Are the conclusions based on the analysed material? Do they correspond to the research results?
0.2 0.1 0
25 Are the conclusions clear and laconic? 0.1 0.1 0
26
References (1 point)
Is the references list formed according to the
re-quirements? 0.4 0.2 0
27
Are the links of the references to the text correct? Are the literature sources cited correctly and precisely?
0.2 0.1 0
28
Is the scientific level of references suitable for
Mas-ter’s thesis? 0.2 0.1 0
29
Do the cited sources not older than 10 years old form at least 70% of sources, and the not older than 5 years
– at least 40%? 0.2 0.1 0
Additional sections, which may increase the collected number of points
30 Annexes
Do the presented annexes help to understand the
ana-lysed topic? +0.2 +0.1 0
31
Practical
recommen-dations
Are the practical recommendations suggested and are
they related to the received results? +0.4 +0.2 0
General requirements, non-compliance with which reduce the number of points
32 General
re-quire-ments
Is the thesis volume sufficient (excluding
annexes)? 15-20 pages
(-2 points)
<15 pages (-5 points)
33
Is the thesis volume increased artificially?
-2 points -1 point
34
Does the thesis structure satisfy the
re-quirements of Master’s thesis? -1 point -2 points
35
Is the thesis written in correct language,
scientifically, logically and laconically? -0.5 point -1 points
36
Are there any grammatical, style or
com-puter literacy-related mistakes? -2 points -1 points
37
Is text consistent, integral, and are the
vol-umes of its structural parts balanced? -0.2 point -0.5 points
38 Amount of plagiarism in the thesis. >20%
(not evaluated)
39
Is the content (names of sections and sub-sections and enumeration of pages) in
com-pliance with the thesis structure and aims? -0.2 point -0.5 points
40
Are the names of the thesis parts in compli-ance with the text? Are the titles of sections and sub-sections distinguished logically and correctly?
-0.2 point -0.5 points
41
Was the permit of the Bioethical
Commit-tee received (if necessary)? -1 point
42
Are there explanations of the key terms and
abbreviations (if needed)? -0.2 point -0.5 points
43
Is the quality of the thesis typography (quality of printing, visual aids, binding)
good? -0.2 point -0.5 points
7
*Remark: the amount of collected points may exceed 10 points.
Reviewer’s comments: ___________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ________________________________________________________________________ _________________________________________ ___________________________
Table of contents
Summary ……….……….………..……..….9
Introduction ……….………10
Review of literature……….…….………12
Materials and Methods ……….….……….……….13
Results……….………….……….……..….15 Discussion……….……….….……….….…..….24 Acknowledgement ……….………….……….……..….26 Conflict of interest……….………..………..…..26 Conclusion ……….………..………..…….….26 Practical recommendations ……….………..………..26 References ………..……….27 Annexes Permit of the Bioethical Committee……….30
Questioner………..………..……31
9
SUMMARY
Aim: to knowledge and attitude among school staff in 4 primary (arabic) schools in Qalansuwa,
Israel.
Material and methods: Altogether 120 participants participated in cross-sectional study.
Re-sponse rate was 68.2%. A self-administrated questionnaire consisted of 4 parts and aimed to collect demographic characteristics, to evaluate the knowledge and attitude toward tooth avul-sion and self-assessment of knowledge regarding tooth avulavul-sion. Staffs were invited to partici-pate in the survey during meeting with principles and they were informed that participation was voluntary and anonymous. Statistical data analysis was carried out with SPSS 19 version. To es-tablish relationship between categorical variables, Pearson chi-square test was used. The signifi-cance level set was at p<0.05.
Results: A total of 120 participants, the majority of whom were females, responded to the
ques-tionnaires from 4 schools in Qalansuwa, Israel. 70.8% of the participants received first-aid clas-ses and 19.2% of them had dental emergencies training. 25.8% of the participants witnessed den-tal trauma injury. The majority (74.2%) agreed that denden-tal trauma management is an emergency situation. However, 71.2% of participants chose incorrect option of statement about immediate emergency management of avulsed tooth and 8.3% would save avulsed tooth in a child mouth and look for professional help. 94.2% of participants responded that they did not have enoung knowledge regarding traumatic dental injuries management.
Conclusion : The level of knowledge among schools staffs on dental emergency management is
insufficient. Therefore, the level knowledge of primary schools staff needs to be improved.
INTRODUCTION
One of the greatest assets a person can have is a “smile” that shows beautiful, natural teeth [ 1,2].
Traumatic dental injuries (TDI) are a serious perplexing problem among children that can en-danger a dental health and lead to aesthetic, psychological, behavioural and therapeutic problem and it can have a negative impact on children’s psychological well-being [2, 3].
Approximately one-third of all preschool children have experienced TDI in the primary denti-tion, and a one quarter of all schoolchildren have suffered some sort of injury to the permanent dentition [4]. According to other researches, the prevalence of TDIs to permanent anterior teeth, especially upper incisors, is high worldwide ranging from 4.1% in Malaysia , 43.8% in England to 58.6% in Brazil [4,5,6,7,8]. The prevalence of traumatic dental injuries varies from country to country as well as within particular countries [9].
The peak of dental injuries occur between the ages 8 and 11 years [10,11]. Furthermore, an avul-sion is considered as the most serious dental trauma and it occurs in 1-16% of all traumatic den-tal injuries and may cause the loss of healthy teeth [4, 12].
Often the loss of avulsed teeth happens because of ignorance regarding first aid procedure to be provided [13]. The most common reasons are unpreventable falling, running into heavy objects [14]. The awareness of dental traumatic injuries management at this critical age range is
important for the long- term success of traumatized teeth [15,16].
Schools are places where a noticeable risk of traumatic dental injuries tends to increase [17]. Recently TDI first aid in schools has received increasing attention [18].
Undoubtedly school staff has to be prepared to provide emergency care of a pupil with dental in-jury (9). Prompt and appropriate onsite emergency management is especially important in cases of avulsion and school teachers informed about the immediate and proper first aid steps can im-prove the prognosis of avulsed permanent teeth in schools [19, 20]. A general knowledge of teachers about TDI, for example, avulsion is important, as it will increases the success rate for the avulsed and replanted permanent tooth, in case of accidents that happen in schools [21]. Failures in first-aid are related to the limited or inadequate knowledge as well as the guidance’s lack of the general population, and consequently it may result poor outcome of the injured tooth as well as in sequelae [22].
11 Teachers need to know how to clean an avulsed tooth before sending the traumatized child to the dentist or before performing immediate replantation, know about extra-oral time and storage methods and media for an avulsed tooth [20].
Accordingly, it is important to educate the public and in particular school teachers and staff, about accidents involving tooth avulsion in children [18, 21, 23].A public education is essential due to several reasons because witnesses of accidents should be informed how to handle emer-gency procedures in different scenarios [24].
To avoid further damage to the periodontal membrane for maintaining the tooth in its socket, in order to preserve the socket for the permanent tooth to be erupted, immediate replantation is the best treatment of choice because a favorable outcome can be achieved [20, 25].
Dry storage of the avulsed tooth results in an irreversible injury to the periodontal membrane, which leads to loss of the replanted tooth over time. However, storing the avulsed tooth in water, where the osmolality is too low, is not recommended as well [26]. Covering the tooth with plas-tic bag could help to prevent evaporation for at least one hour and the tooth can then be stored in saline or balanced salt solution.
Association for Dental Traumatology (IADT) and the American Academy of Pediatric Dentistry (AAPD) guidelines for the management of dental trauma state that the physiological transporta-tion media for avulsed teeth include Hank’s Balanced Salt Solutransporta-tion (tissue culture medium), sa-line, and cold
milk [26].
Keeping the tooth in the patient’s saliva is another alternative for shorter time, osmolality and composition of milk are also favourable for the viability of periodontal ligament cells, and there-fore milk has been widely used for temporary storage of avulsed teeth bethere-fore replantation [20]. To our knowledge, there were no previous studies about primary school teachers’ knowledge and attitude regarding dental trauma in primary (Arabic) schools in Qalansuwa, Israel.
Aim of the work:
To evaluate knowledge and attitude toward dental trauma among primary schools staff in the 4 primary (Arabic) schools in Qalansuwa, Israel.
Objectives:
1. To collect the data about knowledge and attitude of primary school staff regarding traumatic dental injuries.
2. To describe knowledge of primary school staff regarding traumatic dental injuries. 3. To describe attitude of primary school staff regarding traumatic dental injuries.
4. To evaluate knowledge and attitude of primary school staff regarding traumatic dental inju-ries.
Hypothesis:
School staff is lacking the knowledge about tooth avulsion and answers will show if they are able to perform the correct procedures that are necessary to save the tooth after occurred tooth avulsion or other traumatic dental injuries.
REVIEW OF LITERATURE
Results of several studies showed that knowledge about emergency treatment and correct action to take in cases of avulsion among school staff and teachers is poor, despite the fact that during school hours, children are in their supervision [27].
Study which was accomplished in two south European cities (Porto and Istanbul) assessed the teachers’ knowledge regarding dental trauma management; and results showed especially poor knowledge of optimal storage media for avulsed permanent teeth and the majority of teachers did not pay attention on tetanus vaccine control in dental traumatic injuries. Furthermore, ma-jority of teachers reported that did not have training regarding dental trauma. [23].
A study made on Rijeka assessed the participant (72.1%) have very poor knowledge about who
had no previous experience with traumatic dental injuries patients and only 32.6% heard the term ‘tooth avulsion’, 67.4% were not familiar with it at all. Avulsion affects both soft and peri-odontal tissues and is usually complicated with the alveolar bone injuries, which consequently may lead to the loss of the tooth therefore an appropriate treatment is important to maintain vital-ity of the periodontal ligament[28].
According to accomplished studies, various reasons of poor knowledge’s can exist. Results of study carried out in India showed that although all teachers had undergone training on first aid during teachers training course, only 14% of the total school teachers responded to have under-gone training regarding dental first aid [29]. Meanwhile, other study revealed that minority of teachers that first-aid training, including dental emergency management, must be one of the
pri-13 orities in teachers’ educational programs, not to mention, that majority of respondents had a neg-ative attitude toward wearing a mouth guard in contact sports [24].
Study which was accomplished in Yazed Iran assessed elementary school teachers’ knowledge and attitude regarding dental trauma and its management; and results were low and normal re-garding dental trauma management , 61.2% of teachers didn’t witnessed any dental trauma inju-ries before and only 12.5%were trained on dental traumas first aid management [30].
MATERIAL AND METHODS
An analytical cross-sectional study was performed among primary arabic schools staff , in Qal-ansuwa city Israel ,on 2017 November . The study was approved by the Bioethics Center of the Lithuanian University of Health Sciences (BEC-OF-H1).
The questionnaire for this study was a modified version of previous similar studies [24].At the beginning English version of questionnaire was prepared and later it was translated in Arabic and backward to English to evaluate the correctness of translation. Arabic version of question-naires was given to the teachers to answer to the questions.
176 participants (primary schools staffs) were invited to participate in this study from 4 primary public arabic schools (Omar bin al-khattab School, Al-Sallam School, Ibn Rushd school and Al- Zahraa school). Four schools were selected for the study out of five in the area. The criteria for the participation of schools were the following status of primary school, willingness to partici-pate.
The questionnaires by investigator (MG) were distributed to the participants by principles of primary schools during a meeting. The aim of study was explained before filling the question-naires. The participation was voluntary and anonymous. Overall 120 school staff agreed to take a part in the study. Response rate was 68.2%.
Position held of participants was the following: teachers, teachers’ assistants, sport teachers and office staff.
Participants regarding to age were dichotomized into two groups 20-39 and 40-69 (year).
The self-administered questionnaire consisted of twenty-nine questions, that was used to assess the primary school staff level of knowledge and attitude toward traumatic dental injuries.
A self-administered questionnaire concerned of four parts:
First part was about general information such as gender, participant's age, position, if they had first-aid personal training or training for dental emergencies. The answers of question about “Dental trauma experience around” were regrouped to three parts no, yes (one time), yes (two or more times).
Second part was an attitude section to check the agreement responsibility responses and attitude of primary schools staff toward provision of emergency care to the dental traumatic injuries suf-fered by the students at schools. The attitude section was composed of 10 questions with five possible answers in Likert scale (strongly disagree, disagree, neither agree nor disagree, agree, strongly agree). Later possible answers were regrouped into three following groups agree (agree and strongly agree), neither agree or disagree and disagree (disagree and strongly disagree). Third part consisted of 9 questions about the knowledge regarding a case about tooth avulsion about how would they behave in certain situation of teeth and avulsion (cleaning principles of an avulsed tooth before replantation time importance for replantation, storage method and media for an avulsed tooth).
Fourth part was self-assessment about satisfaction of their level of knowledge and if they want further education on the topic.
Statistical data analysis was carried out with SPSS (Statistical Package for the Social Sciences for Windows) 19 version.
To establish relationship between categorical variables, Pearson chi-square test was used. The significance level set was at p<0.05. Confidence interval was 95%.
15
RESULTS
Overall majority of participants was females 90 (75%) among 120 participants, the same trend was noticed in all four schools: Alsalam 17(68%), Omar Bn-Alkhatab 17(85%), Alzahraa 27(71%) and Ibn rushed 29 (78.3%). Age of primary schools staffs ranged from 20 to 69 years old. The younger age group 20-39 year was prevalent (55%). Overall age mean age was 38.0(9.8) years and it varied from 37.2(8.0) to 39.1(11.9) in different schools (Table 1).
Majority of participants regarding to position held were teachers (75.8%) in all four schools. It was found that teachers women were the biggest group among all participants (p=0.006)(Table 1).
Results showed that a majority of participants (70.8%) received first aid training and a statisti-cally significantly more teachers’ assistants did not have this type of training (p<0.001).Participants from Ibn Rushd showed the lowest prevalence of received first aid train-ing (51.3%) and Alzabraa and Omar Bn-Alkhatab had the highest prevalence of received first aid training (85%) (p=0.007).
Only 19.2% of participants had training of dental emergencies and among four primary schools. There were significantly more primary school staff without training of dental emergencies in Omar Bn-Alkhatab school (p=0.02). It was noticed that significantly more females had first aid dental training than male (p=0.031), whereas it was not found statistically significant difference between in gender in first aid training (p=0.062).
74.2% of participants did not have any dental trauma experience around, 15% witnessed one in-jury and 10.8% two or more injuries, respectively. It was found a statistically significantly more women who did not have any dental trauma experience around (p=0.038) and significantly more teachers did not have dental trauma experience, whereas significantly more office staff had den-tal trauma experience around (p=0.029). Moreover, it was found that significantly more sport teachers and office staff had two and more dental trauma experience around (p=0.036). There were no statistically significant difference found among all primary schools staff (0.175).
Table 1. Demographic characteristics of four schools' staffs . Primary schools Alsalam N (%) Omar Bn-Alkhatab N (%) Alzahraa N (%) Ibn RushdN(%) Total N(%) P-value Gender Female 17 (14.2) 17 (14.2) 27 (22.5) 29 (24.1) 90(75) 0.520 Male 8 (6.7) 3 (2.5) 11 (9.1) 8 (6.7) 30(25) Total 25 (20.8) 20 (16.7) 38 (31.7) 37 (30.8) 120(100) Age 20-39 14 (11.6) 12 (10) 22 (12.8) 18 (15) 66(55) 0.70 40-69 11 (9.16) 8(6.7) 16 (13.3) 18 (15) 54(45) Total 25 (20.8) 20 (16.7) 38 (31.7) 37 (30.8) 120(100) Mean (SD) 37.2(8.0) 37.0(9.9) 38.1(8.9) 39.1(11.9) 38.0 (9.8) Position held Teacher 17 (14.2) 17 (14.2) 28 (23.3) 29 (24.1) 91(75.8) 0.381 Teacher’s assistant 4 (3.3) 2 (1.7) 1 (0.83) 3 (2.5) 10(8.3) Sport teacher 1 (0.83) 1 (0.83) 3 (2.5) 0 (0) 5(4.2) Office staff 3 (2.5) 0 (0) 6 (5) 5 (4.2) 14(11.7) Total 25 (20.8) 20 (16.7) 38 (31.7) 37 (30.8) 120(100)
Received first aid training
No 8 (6.7) 3 (2.5) 6 (5) 18 35(29.2) 0.007 Yes 17 (14.2) 17 (14.2) 32 19 85(70.8)
Total 25 (20.8) 20 (16.7) 38 (31.7) 37 (30.8) 120(100)
Training of dental emergencies
Did not have 21 (17.5) 18 (15.0) 25 (20.8) 33 (27.5) 97(80.8) 0.02 Had 4 (3.3) 1 (0.83) 13 (10.3) 5 (4.2) 23(19.2)
Total 25 (20.8) 20 (16.7) 38 (31.7) 37 (30.8) 120(100)
Dental trauma experience around
No 16 (13.3) 18 (15.0) 26 (21.7) 29 (24.1) 89(74.2) 0.175 Yes, one time 4 (3.3) 1 (0.83) 7 (5.8) 6 (5) 18(15)
Yes, two or more times
5 (4.1) 1 (0.83) 5 (4.1) 2 (1.7) 13(10.8) Total 25 (20.8) 20 (16.7) 38 (31.7) 37 (30.8) 120(100)
17
Attitude towards traumatic dental injures.
55.8% of the participants disagree that teachers are not responsible for the post-traumatic dental inju-ries at the school (Table 2). Staff of Ibn Rushd school showed the highest percentage (70.2%) of dis-agreement of this statement among the other schools answer while Omar Bn-Alkhatab school had the lowest (30%) (p=0.046).
Regarding the importance of time for improving tooth prognosis, 77.5% of participants agreed that time is important effective factor for emergency management of dental trauma injuries. There were no statistically significant differences found among all four schools (p=0.087). 75.8% believed that there is a need for treatment after lost of avulsed tooth. Participants of Ibn Rushd school reported the highest percentage of correct answers (91.2%), whereas 68.4% an-swered correctly in Alzahraa primary school (p=0.046).
Majority of participants (74.2%) agreed that dental trauma management is an emergency situa-tion. There were no statistically differences noticed among all four schools (p=0.504).72.5% disagree with the statement that dental trauma management is not an emergency situation, it was found that significantly more women disagreed with this statement (p=0.010). Moreover, 86.5% of Ibn Rushd primary school staff agreed that dental trauma management is an emergency situa-tion, while only 60% agreed with this statement in Alsalam school (p=0.010).
73.3% of the participants agree that teachers play important role in improving the prognosis in trau-matized tooth survival and answers of participants did not statistically differ among four schools (p=0.215). Answers to the question “Emergency management of dental trauma is thor-oughly profes-sional, therefore there is no need for teacher intervention” were quite similar be-cause 33.3% agreed and 38.3% disagreed, respectively. There were no statistically significant differences found among four schools (p=0.323).
42.5% had a positive attitude toward wearing a mouthguard in contact sports. Staff of Ibn Rushd school reported the highest percentage 62.2% of a positive attitude toward wearing a mothguard (p=0.031).
Overall 73.3% of participants agreed with the statement"having some short pertinent education-al experiences, educators can provide better assistance in traumatic denteducation-al scenarios” (Table 2).Statistically significantly more women agreed with this statement than men (p=0.013). Also there were statistically significant differences found among the primary schools, 91.2% of Ibn Rushd primary school staff agreed with this statement, while 55.3% agreed in Alzahraa (p=0.008).
Table 2.Schools staffs' attitude towards traumatic dental injuries .
Choice of opinion Agree Neither agree
nor dosageree
Disagree
Question N(%) N(%) N(%)
A teacher isnt responsible post traumatic dental injuries 33(27.0) 20(16.7) 67(55.8)
Time consciousness for emergency management of dental trauma can play a vital role in improving tooth prognosis.
93(77.5) 17(14.2) 10(8.3)
A tooth after avulsion will be lost definitely, so there is no need for any treatment.
16(13.3) 13(10.8) 91(75.8)
Dental trauma emergency management must become one of the educational priorities for teachers.
89(74.2) 14(11.7) 17(14.2)
Dental trauma management is not an emergency situation.
19(15.8) 14(11.7) 87(72.5)
Teacher intervention in school dental injuries may play a key role in traumatized tooth survival.
88(73.3) 16(13.3) 16(13.3)
Emergency management of dental trauma is
thoroughly professional and requires special education and training;therefore, there is no need for teacher intervention.
40(33.3) 32(26.7) 46(38.3)
Wearing of a mouth guard should be compulsory in all contact sport.
51(42.5) 36(30) 33(27.0)
Due to some legal considerations it’s advisable that a teacher refrain from intervening such scenarios.
28(23.3) 41(34.2) 51(42.5)
Having some short pertinent educational experiences, educators can provide better assistance in traumatic dental scenarios.
19
Knowledge regarding traumatic dental injuries.
Majority of participants (71.2%) answered incorrectly to the question about immediate emer-gency action and only 8.3% answered to save the tooth in child’s mouth and look for profession-al and 4.2% of participants would look for the tooth and wash it and put it back in its place. There were no significant difference among all primary schools staffs (p=0.671).
When primary schools staffs were asked what type of health service they would seek first, 59.2% of participants would go first to pediatric dentist, and only 8% would seek endodontist. Results showed that significantly more teachers and sport teacher would recommend go first to pediatric dentist (p=0.0160. Considering the primary schools, 76.3% of Alzahraa primary school staff would seek pediatric physician first and 48% of Alsalam primary school school staff would seek paediatric dentist first (p=0.039) (Table3).
A high percentage of participants (65%) would not investigate if the child had a tetanus vaccina-tion and no statistically significant difference was found among (p=0.265).
43.3% of participants don’t know what to do if the tooth has fallen on the dirty ground. Only 23.3% of participants answered that they would rinse the tooth under tap water and put it back into its socket. In case if they don’t find the tooth, 58.3% would wash the child’s mouth and ap-ply pressure to the wound, without looking for professional help. There were no statistically sig-nificant difference found among all primary schools staffs (p=0.490) (Table 3).
Table 3. Schools staff knowledge regarding to first aid after traumatic dental injuries . Alsalam N (%) Omar Bn-Alkhatab N (%) Alzahraa N (%) Ibn Rushd N(%) Total N(%) P-value
The immediate emergency action you would take is:
Don’t know 2(1.7) 3(2.5) 7(5.8) 3(2.5) 15(12.5) 0.671
Place the tooth in a paper 2(1.7) 0(0) 1(8) 1(8) 4(3.3) Save the tooth in saliva and look for professional help. 1(8) 2(1.7) 2(1.7) 5(4.2) 10(8.3) Look for the tooth, wash it and put it back in its place. 1(8) 0(0) 3(2.5) 1(8) 5(4.2) Bleeding control 19(15.8) 15(12.5) 25(20.8) 27(22.5) 86(71.7)
What type of health service would you seek first?
General physician 2(1.7) 6(5) 0(0) 0(0) 15(12.5) 0.039
Pediatric physician 5(4.2) 3(2.5) 29(24.1) 22(18.3) 16(13.3)
Hospital 1(8) 2(1.7) 2(1.7) 4(3.3) 6(5)
Dental School University 2(1.7) 0(0) 0(0) 0(0) 2(1.7)
General dentist 1(8) 1(1) 0(0) 3(2.5) 8(6.7)
Pediatric dentist 12(10) 8(6.6) 2(1.7) 6(5) 71(59.2)
Endodontist 1(8) 0(0) 5(4.2) 2(1.7) 1(8)
Would you investigate if the child had a tetanus vaccine?
No 12(10) 8(6.6) 28(23.3) 24(20) 80(66.7) 0.265
Yes 13(10.8) 12(10) 12(10) 13(10.8) 40(33.3)
If the tooth has fallen on the dirty ground what would you do?
Don’t know what to do. 10(8.3) 7(5.8) 16(13.3) 19(15.8) 52(43.3) 0.490 Discard the tooth. 4(3.3) 7(5.8) 9(7.5) 7(5.8) 27(22.5) Immediately put it back without-cleaning. 0(0) 0(0) 0(0) 1(8) 1(8) Rub with soap and put it back in its place. 5(4.2) 0(0) 5(4.2) 2(1.7) 12(10) Rinse it tap water and put it back into itssocket. 6(5) 6(5) 8(6.6) 8(6.6) 28(23.3)
If you don’t find the tooth :
Don’t know/wouldn't do anything/no answer 3(2.5) 2(1.7) 5(4.2) 2(1.7) 12(10) 0.271 Cry desperately and don’t do anything 0(0) 0(0) 2(1.7) 0(0) 2(1.7)
Look for professional help even if you didn’t do anything before
that 6(5) 2(1.7) 4(3.3) 11 (9.16)
23(19.2)
Simply wash the child’s mouth and apply pressure to the wound,
without looking for professional help. 4(3.3) 3(2.5) 5(4.2) 1(8)
13(10.8)
Youwash’s child mouth,apply pressure to the wound and look
for professional help. 12(10) 13(10.8) 22(18.3) 23(19.2)
21
Behaviour after traumatic dental injury.
A high percentage of participants (42.5%) answered incorrectly to the question about transporta-tion of tooth if it was impossible replant immediately and they reported that would warp the tooth in paper tissue and transport it to dentist and only 3.3% of participants knew about possi-bility to replant the tooth. No significant differences were found among all primary schools staffs (Table 4).
To the question about desirable liquid for storing an avulsed tooth, 45.8% of respondents an-swered that they would transport the tooth in tap water, 28.3% of respondents would transport the tooth in a liquid, 26.7% would transport it by disinfectant material alcohol, while a low per-centage of participants chose correct answers such as milk (14.2%), saliva of the child (7.5%).Moreover, significantly higher percentage of men would choose a tap water for tooth’s transportation (p=0.024). Considering the primary schools staffs, the highest percentage of par-ticipants who chose correct answer “milk” (12.5%) were from Ibn Rushd school and “tap wa-ter” (p<0.001) (Table4).
The most common answers of question about immediate replantation were “do not know how to behave” (42.5%) and “try to align the tooth with the neighbouring teeth, gently handling it and holding it by the crown, without touching the root” (32.5%). A high prevalence of Alzahraa primary school staff (56.8%) did not know how to replant tooth, while 57.9% ofIbn Rushd pri-mary school staff chose the correct answer“try to align the tooth with the neighbouring teeth, gently handling it and holding it by the crown, without touching the root” (p=0.008).
Results showed that 45.8% of respondents didn’t know the best time for putting the tooth back after avulsion and only 20.8% knew that tooth should be replanted immediately after the acci-dent. There were no statistically significant differences among all schools (p=0.436) (Table 4).
Table 4. Distribution of schools staff answers regarding to behavior after traumatic dental injuries Alsalam N (%) Omar Bn-Alkhatab N (%) Alzahraa N (%) Ibn RushdN(%) Total N(%) P-value
How would you transport the tooth on the way to the dentist if you cannot put the tooth back into its socket?
Wrap the tooth in a handkerchief or paper
tissue-Place the tooth in the child’s hand 13(10.8) 12(10) 11 (9.16) 15(12.5)
51(42.5) 0.636 Place the tooth in the child’s hand 1(8) 0(0) 3(2.5) 1(8) 5(4.2)
Place the tooth in the child’s mouth 0(0) 1(8) 2(1.7) 1(8) 4(3.3) Put the tooth in liquid 5(4.2) 4(3.3) 13(10.8) 12(10) 34(28.3) Put the tooth in ice 6(5) 3(2.5) 9(7.5) 8(6.7) 26(21.7)
Desirable liquids for storing a tooth that has been avulsed
Tap water 15(12.5) 8(6.7) 19(15.8) 13(10.8) 55(45.8) >0.001 Fresh milk 1(8) 0(0) 1(8) 15(12.5) 17(14.2)
Child’s saliva 1(8) 1(8) 3(2.5) 4(3.3) 9(7.5) Alcohol 1(8) 2(1.7) 3(2.5) 1(8) 7(5.8) Disinfecting solution 7(5.8) 9(7.5) 12(10) 4(3.3) 32(26.7)
If trying to replant the tooth:
Don’t know/wouldn’t do anything/no answer 12(10) 11 (9.16) 21(17.5) 7(5.8) 51(42.5) 0.008 You try to align the tooth with the neighboring
teeth, gently handling it and holding it by the crown, without touching the root, and look for professional help.
5(4.2) 4(3.3) 9(7.5) 6(5)
24(20)
You try to align the tooth with the neighboring
teeth. 2(1.7) 0(0) 1(8) 2(1.7)
5(4.2) You try to align the tooth with the neighboring
teeth, gently handling it and holding it by the crown, without touching the root.
6(5) 4(3.3) 7(5.8) 22(18.3)
39(32.5)
You would force it back into position without paying attention to how you do it or in which direction.
0(0) 1(8) 0(0) 0(0)
1(8)
Which is the best time for putting back a tooth in if it is knocked out of the mouth?
Don’t know what to do 13(10.8) 12(10) 19(15.8) 11 (9.16) 55(45.8) 0.436 This is not a crucial factor 0(0) 1(8) 2(1.7) 2(1.7) 5(4.2)
Within the same day 3(2.5) 1(8) 1(8) 5(4.2) 10(8.3) Within 30 min after the bleeding has stopped 4(3.3) 2(1.7) 7(5.8) 12(10) 25(20.8) Immediately after the accident 5(4.2) 4(3.3) 9(7.5) 7(5.8) 25(20.8)
23
Self-assessment of primary schools staffs.
The majority of the school staff 94.2% reportedthat they did not have enough knowledge on dental trauma management. There were no statistically significant difference among all schools (p=0.667) (Table 5).
When participants were asked if they need further educations regarding traumatic dental injuries, 84.2% of participants wanted further education about dental emergency management and no sta-tistically significant difference was found among all primary schools (p=0.187) (Table 5).
Answers to question “Are you able to provide proper action when needed?” showed that 58.3% of respondents answered that they wouldn’t be able to take proper action in cases of dental trauma statistically difference among the primary schools and no statistically significant differ-ences were found among all primary schools (p=0.107)(Table 5).
Table 5. Schools staffs’ responses to self-assessment section of questionnaire.
AlsalamN (%) Omar
Bn-Alkhatab N (%)
Alzahraa N (%)
Ibn RushdN(%) Total N(%) P-value
Is your knowledge on dental emergency management enough?
No 23(19.2) 18(15) 37(30.8) 35(29.1) 113(94.2) 0.667 Yes 2(1.7) 2(1.7) 1(8) 7(5.8) 7(5.8)
Do you need future education in this regard?
No 5(4.2) 5(4.2) 7(5.8) 2(1.7) 19(15.8) 0.187 Yes 20(16.6) 15(12.5) 31(25.8) 35(29.1) 101(84.2
Are you able to provide proper action when needed?
No 12(10) 8(6.7) 26(21.6) 24(20) 70(58.3) 0.107 Yes 13(10.8) 12(10) 12(10) 13(10.8) 50(41.7)
DISCUSSION
According to the results of this study, 70.8% of primary school staff had first-aid training. Com-paring with other previously published studies most of the primary school teachers reported that they received no advice regarding traumatic dental injuries [18,20,24,27].
The lack of knowledge and the many incorrect answers results could be due to that most of the staff (74.2%) didn’t experienced dental trauma injuries around in the present study, whereas oth-er studies showed quite similar results, for example 76% in USA North Carolina [18] ,81.1% in Norway [27] , 52.8% in Iran [24] didn’t experienced any kind of dental trauma as well. This finding reinforces the need for teachers to be well informed in dental emergency management.
About 26.3% did not know which health service type would they seek first while other study carried out in Iran showed 54% of the school staff didn’t know [24], oppositely in Arabs Emir-ates 72% knew which health service they would seek first [21] .
Teachers can play important role in managing TDI and improving the prognosis, so delay in emergency treatment dramatically reduces the long-term prognosis, complications, and time consuming especially in avulsed cases, it is better to know where the nearest dental emergency services are [18,24] . There was not a statistically significant difference between the knowledge level of participants who had formal first-aid training at least once in their career and those who did not.
This suggests future dental emergency education efforts should be directed toward continuing educational programs and updating the certificates of school staff who often assist children un-der scenarios where traumatic dental injuries are likely to occur.
Most of the participants 55.8% agreed that they are responsible for the management of dental traumatic injuries in school and 73.3% agree that they can play important role to improve the prognosis by early and correct intervention. More than 74.2% of the participants suggested that management of traumatized teeth to be a one of the educational priority program. In general re-sults showed that participants had a positive attitude toward emergency management and im-portance of traumatic dental injuries.
Only 7.5% of participants answered that they would save the tooth in saliva and look for profes-sional help and 4.2% respond that they would look for the avulsed tooth and replant it
immedi-25 ately. Unfortunately the majority respond to stop bleeding it could be due to most people will think in bleeding is something dangerous and better to stop it. Similar results were observed in the studies by Raoof and Awad the time that will get wasted on controlling the bleeding will de-lay the replantation and could lead to bad prognosis [18,21,24,27]. Proper intervention in school dental injuries may play important role in traumatized tooth survival.
Endodontists had a significant higher mean knowledge score on dental injury scenarios than general dentists [31]. But only 1.8% declared that they would consult an endodontist, who may be a worthy consultant. 66.7 %would not investigate the child if he had tetanus, this response is similar to the obtained result in a study by Raoof 60%, and the majority in a study by Caglar ,it still remains a major public health problem in developing countries [24 ,23].
The majority of the participants don't know what to do if the tooth has fallen on the dirty ground. 23.3% of participant will put the avulsed tooth back into the socket while on Raoof studies one-third (28.3%) of the participants of would put it back into socket [24]. This prove the lack of knowledge and the importance and the need of education about the dental trauma emergency management training should and to become one of the educational priorities for schools special-ly for teachers and school staff.
To save the tooth in the transport period to the doctor they should maintain it in proper storage medium Milk, saline, and saliva are suitable to save the tooth and for periodontal healing. This improves the vitality of PDL cells during the extra-alveolar period. So, milk is superior to saliva as a storage medium [26,27, 30].
Only14.2% choose milk as a proper storage medium, similar to findings of the other studies 13% [24], 9.3% [30], 25% [16]. This indicate that they have similar knowledge regarding correct transport and storage media.
7.5% would put the avulsed tooth in saliva as an appropriate medium. due to saliva is available at the site of injury.Findings of carried out study showed that dry preserving of an avulsed tooth for more than 20–30 min would lead to the loss of normal physiologic metabolism and morphol-ogy of PDL cells [25].
Time is one of the most important factors for avulsed teeth to preserve their vitality and their re-plantation. Unfortunately 45.8% didn't know which is the best time for putting back he tooth in
such situation of avulsed tooth and 20.8% choose the answer within 30 min after the bleeding has been stopped. However, the study by Raoof and Al-Asfour also show a significant lack of knowledge for the best time to put back the tooth [23,24,26]. The data show the need and im-portance of improving the educational knowledgeabout management of dental trauma .
The majority of the teachers reported aboutinsufficient level of knowledge.While their answers to real case situation and their behaviourcoincided with answers to question about a need future education for emergency dental trauma management .
Most of other studies showed that participants were not satisfied with their knowledge and they wanted to receive more information on dental injuries [20,24].
Acknowledgement
I would like to express my gratitude to the Schools’ teachers and staff in the city of Qalanssuwa, Israel for their participation in this study.
Conflict of interests
There is no conflict interest to declare.
Conclusion
This study showed that the knowledge of the primary schools staff on dental emergency man-agement is poor, and their attitude toward traumatic dental injuries was acceptable.
Practical recommendations
It is necessary to improve the educational knowledge of dental awareness primary schools staffs. Therefore, regular dental training should, lectures need to be organized for school staff. Or by creating small guiding book about traumatic dental injuries management with examples about some cases to improve their knowledge and attitude toward in that situations .
27
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15. Kargu B, Caglar E, Tanboga I. Dental trauma in Turkishchildren, Istanbul. DentTraumatol 2003;19: 72–5.
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29 25. RoskampL ,Carneiro E , Westphalen VPD. Influence of Atopy in the Outcome of Avulsed and Replanted Teeth during 5 Years of Follow-up. JOE 43:1, 2017
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Annexes
Annex 1. Permit of the Bioethical Committee
31
Annex 2. Questioner
Kindly asking you to share your knowledge and attitude regarding dental traumatic injuries “Avulsion” that aimed to evaluate the level of knowledge and attitude among primary school teacher .
The Questioner made of four parts’ Personal professional information, Attitudes, Knowledge, Self-assessment.
Part I: Personal professional informationPart
Name: Gender: Female Male Age: Position held: Educational Health teacher
Physical education teacher Administrative
Have you had First-aid training in general:
Yes No
Have you had Training for dental emergencies:
Yes No
Witnessing a traumatic dental injury
Yes, about how many times? No
Part II : AttitudesPlease indicate your level of agreement with each of the following statements by ticking the appropriate box.
Strongly disagree Disagree Neither agree nor disagree Agree Strong-lyagree
1. A teacher isn’t responsible post traumatic dental injuries.
2. Time consciousness for emergency man-agement of dental trauma can play a vital role in improving tooth prognosis.
3. A tooth after avulsion will be lost definite-ly, so there is no need for any treatment.
4. Dental trauma emergency management must become one of the educational priorities for teachers.
5. Dental trauma management is not an emergency situation.
6. Teacher intervention in school dental inju-ries may play a key role in traumatized tooth survival.
7. Emergency management of dental trauma is thoroughly professional and requires spe-cial education and training;therefore, there is no need for teacher intervention.
8. Wearing of a mouth guard should be com-pulsory in all contact sport.
9. Due to some legal considerations it’s advis-able that a teacher refrain from intervening such scenarios.
10. Having some short pertinent educational experiences, educators can provide better assistance in traumatic dental scenarios.
33
Part III: Knowledge
Please choose the correct answer(s) for each of the questions .You can have more than one answer by making a circle .
Case I: A 12-year-old boy is hit in the face and his upper front
tooth is missing and there is blood in his mouth. Otherwise, he is unhurt, healthy and he didn’t lose consciousness.
Q1. The immediate emergency action you would take is:
(b) Stop the bleeding by compressing a cloth over the injury.
(b) Look for the tooth, wash it and put it back in its place. © Save the tooth in child’s mouth and look for professional help.
(d) Place the tooth in a paper and send the child to dentist after the school time.
(e) Don’t know what to do.
Q2. What type of health service would you seek first?
(a) General physician (b) Pediatric physician © Hospital
(d) Dental School University € General dentist
(f) Pediatric dentist (g) Endodontist
Q3. Would you investigate if the child had a tetanus vaccine?
(b) No
Q4. If the tooth has fallen on the dirty ground what would you do?
(b) Rinse the tooth under tap water and put it back into its socket.
(b) Rub away the dirt by a sponge and soap and put it back in its place.
© Put it back into the socket immediately without cleaning.
(d) Discard the tooth. (e) Don’t know what to do.
Q5. If you don’t find the tooth :
(a) You wash’s child mouth,apply pressure to the wound and look for professional help. (b) Simply wash the child’s mouth and apply pressure to the wound, without looking for pro-fessional help.
© Look for professional help even if you didn’t do anything before that (d) Cry desperately and don’t do anything
(e) Don’t know/wouldn’t do anything/no answer
Q6. How would you transport the tooth on the way to the dentist if you cannot put the tooth back into its socket?
(a) Put the tooth in ice (b) Put the tooth in liquid
© Place the tooth in the child’s mouth (d) Place the tooth in the child’s hand
(e) Wrap the tooth in a handkerchief or paper tissue
Q7. Mark desirable liquids for storing a tooth that has been knocked out while you are on your way to the dentist.
(a) Tap water (b) Fresh milk © Child’s saliva
35 (d) Alcohol
€ Saline solution
Q8. If trying to replant the tooth:
(a) You would force it back into position without paying attention to how you do it or in which direction.
(b) You try to align the tooth with the neighboring teeth, gently handling it and holding it by the crown, without
touching the root.
© You try to align the tooth with the neighboring teeth.
(d) You try to align the tooth with the neighboring teeth, gently handling it and holding it by the crown, without
touching the root, and look for professional help. (e) Don’t know/wouldn’t do anything/no answer
Q9. Which is the best time for putting back a tooth in if it is knocked out of the mouth?
(a) Immediately after the accident
(b) Within 30 min after the bleeding has stopped © Within the same day
(d) This is not a crucial factor (e) Don’t know what to do
Part IV: Self-assessment
Please choose the correct answer(s) for each of the questions .You can have more than one answer.
Q1. Is your knowledge on dental emergency management enough?
(b) Yes (b) No
Q2. Do you need future education in this regard?
(b) Yes (b) No
Q3. Are you able to provide proper action when needed?
(b) Yes (b) No
MALAKH GAMAL, LUHS, MA, FACULTY OF ODONTOLOGY, DENTISTRY PROGRAM
THANK YOU VERY MUCH FOR YOUR TIME AND PARTICIPATION IN THE RESEARCH OF “ASSESSMENT OF PRI-MARY SCHOOL TEACHERS’ LEVEL OF KNOWLEDGE AND ATTITUDE REGARDING TRAUMATIC DENTAL INJU-RIES “AVULSION” QALANSUWA.” AIMED TO EVALUATE THE LEVEL OF KNOWLEDGE AND ATTITUDE AMONG PRIMARY SCHOOLS
SINCERELY, MALAKH GAMAL
37
EVALUATION FORM OF THE MASTER’S THESIS FOR THE MEMBER OF DEFENCE COMMITTEE
Graduate student ___________________________________________________________________, of the year ______, and the group _____ of the integrated study programme of Odontology
Master’s Thesis title: ………...……….………...………… ………...….………...……...
No. MT evaluation aspects
Evaluation
Yes Partially No
1 Has the student’s presentation lasted for more than 10 minutes?
2 Has the student presented the main problem of the Master’s
the-sis, its aim and tasks?
3 Has the student provided information on research methodology
and main research instruments?
4 Has the student presented the received results comprehensively?
5 Have the visual aids been informative and easy to understand?
6 Has the logical sequence of report been observed?
7 Have the conclusions been presented? Are they resulting from the
results?
8 Have the practical recommendations been presented?
9 Have the questions of the reviewer and commission’s members
been answered correctly and thoroughly?
10 Is the Master’s thesis in compliance with the essence of the se-lected study programme?
Remarks of the member of evaluation committee of Master’s Thesis
______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Evaluation of the Master’s Thesis
_____________________________________________________________________________
Member of the MT evaluation committee:
________________ ___________________________ _____________________
