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 Table of Contents  
ORIGINAL ARTICLE - PROSPECTIVE STUDY
Year : 2017  |  Volume : 7  |  Issue : 2  |  Page : 217-221

Evaluation of knowledge of physical education students on dental trauma


1 Department of Surgical, Dental School of Presidente Prudente, UNOESTE, Presidente Prudente, Bauru, SP, Brazil
2 Department of Surgical, Dental School of Bauru, USC, Bauru, SP, Brazil
3 Department of Endodontics, Dental School of Presidente Prudente, UNOESTE, Presidente Prudente, Bauru, SP, Brazil

Date of Web Publication22-Nov-2017

Correspondence Address:
Danilo Louzada de Oliveira
Faculdade de Odontologia de Presidente Prudente, UNOESTE, Rua José Bongiovani, 700 Presidente Prudente, SP
Brazil
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DOI: 10.4103/ams.ams_115_17

PMID: 29264288

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  Abstract 


Introduction: Sports' practitioners are vulnerable to dental trauma; if this occurs, the emergency treatment should be fast and efficient. This may be performed by any person at the site of the accident, not only by dental professionals. Physical educators may face dental trauma and should be able to provide proper care. This study had the objective evaluated the knowledge of physical education graduates on dental trauma. Materials and Methods: A questionnaire containing questions on dental trauma was applied to 199 physical education students; after collection of the questionnaires, data were tabulated and processed on the software Epi Info 2000 (Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333, USA). As a result, only 36.7% of participants would take the individual suffering trauma to the dental professional, 56.8% believe that the avulsed tooth should be replanted, and 42.2% would replant it. Only 7.5% would store the avulsed tooth in an ideal storage medium for transportation. Conclusion: It was concluded that there is a lack of knowledge on dental trauma among physical education graduates, evidencing the need of public policies to allow education on this issue.

Keywords: Dental avulsion, dental injuries in sports, dental trauma


How to cite this article:
de Oliveira DL, Ribeiro-Junior PD, Sbroggio AC, dos Santos PG, Mori GG. Evaluation of knowledge of physical education students on dental trauma. Ann Maxillofac Surg 2017;7:217-21

How to cite this URL:
de Oliveira DL, Ribeiro-Junior PD, Sbroggio AC, dos Santos PG, Mori GG. Evaluation of knowledge of physical education students on dental trauma. Ann Maxillofac Surg [serial online] 2017 [cited 2021 Jul 28];7:217-21. Available from: https://www.amsjournal.com/text.asp?2017/7/2/217/218961




  Introduction Top


Sports practicing is beneficial and healthy and should be performed by all individuals; however, during it, individuals are at risk to dental trauma, with possibility of lesions to the teeth and soft tissues.[1],[2] Some authors report that direct contact sports as boxing, basketball, soccer, and volleyball pose higher risk to dental trauma,[2],[3],[4],[5] with possibility of tooth crown fractures or even more complex lesions as tooth avulsion.[2],[6]

The emergency care in these cases is fundamental to allow a better prognosis and to increase the survival of traumatized teeth, especially in cases of tooth avulsion. These initial emergency procedures may be performed by any person at the site of the accident, not only by dental professionals.[2],[3],[7],[8] Therefore, physical education student and professors, who have direct contact with people practicing sports, should know how to proceed if dental trauma occurs in their presence.[3],[8],[9],[10],[11]

The tooth should always be replanted after tooth avulsion, which is characterized by complete displacement of the tooth from its socket.[6],[12] The immediate replantation, which should be performed up to 15 min after tooth avulsion,[12] maintains a greater quantity of vital cells on the root surface, favoring the prognosis.[6],[7],[12],[13] Therefore, time is fundamental for the success of treatment for dental trauma.[12]

If immediate replantation is not possible, the avulsed tooth should be stored in proper storage media,[6],[12] which aim at maintaining the vitality of cells present on the root surface for longer time (>15 min). In some cases, these media may also stimulate the multiplication of these cells.[6],[12],[13],[14] This allows later replantation of the avulsed tooth with possibility of success.[6],[13]

Several storage media may be used in cases of tooth avulsion. These include the milk, propolis, and specific solutions for cell maintenance, as Hank's Balanced Saline Solution, Eagle's medium, and Viaspan.[6],[13] At present, milk has been the storage medium of choice because of its easy access, low cost, and effectiveness for maintenance of cell vitality for up to 6 h.[6],[12],[14]

However, in most cases, the teeth are stored in inadequate media or are not replanted immediately.[6],[12] Several studies evidenced that people affected by dental trauma or facing accidents do not know how to proceed in such cases, maintaining the avulsed tooth without replantation and in inadequate storage media.[1],[2],[3],[7]

Teeth maintained for long periods outside the socket or in storage media that do not maintain the cell vitality lead to late replantation,[1],[2],[3] predisposing to the occurrence of tooth ankylosis and root resorption,[7],[12] which are undesirable consequences and may lead to loss of the traumatized tooth in a mean period of 4– 6 years.[6]

Physical education students present great chances of facing cases of dental trauma.[14] Therefore, this study evaluated the knowledge of physical education graduates on dental trauma, aiming to contribute with information for the development of actions to enhance the public policies in the country.


  Materials and Methods Top


This quantitative cross-sectional study investigated the knowledge of physical education students on dental trauma. This study was approved by the Institutional Review Board under no. 707, on June 29, 2011.

A specific questionnaire was used for this study, which was validated in the previous study of Silva.[15] This questionnaire included questions on age, gender, school period, and sports practice [Table 1]. Questions about training on first aid and experience with dental trauma were also present as well as specific questions on tooth avulsion [Table 2]. The students were also asked about their interest participating in informative campaigns on dental trauma and the use of mouthguards [Table 3].
Table 1: Part I - Questionnaire applied to physical education students

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Table 2: Part II - Questionnaire applied to physical education students

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Table 3: Part III - Questionnaire applied to physical education students

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This questionnaire was applied to 199 physical education students. The selection criteria for participation of students in the investigation were their availability and interest and signing an informed consent form. The questionnaire was distributed to the students and collected after 7 days and did not contain identification about the participants.

After collection of questionnaires, the responses to the questions were digitized on the software Epi Info 3.5.1 (Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333, USA). This software revealed the responses to each question present on the questionnaire. Unanswered questions were also indicated by the software, which validated the answers.

Thus, it was possible to indicate the most frequent type of dental trauma in the studied population, the measures taken by these individuals, the importance assigned to the use of mouthguards, and if they would be interested in participating in lectures and activities related with learning on dental trauma.


  Results Top


The questionnaire was answered by 199 physical education graduates. Most participants were males (62.3%), aged 18– 19 years (30.2%), and were attending the second and fourth semesters of the course (43.2% and 32.7%, respectively).

The main physical activity was soccer (36.7%), followed by weight training (13.1%), volleyball (11%), and fights in general (5%). Individuals who did not practice any sports added up to 12.5%.

A total of 62.3% of participants had training on first aid. Among these, only 9.5% had training on first aid for dental trauma; 36.7% did not respond to this question. A total of 88.9% stated that this type of training is important.

When questioned about the personal experience with dental trauma, 34.7% of participants had suffered accidents involving the teeth and oral region. Among these, 17.6% had tooth crown fracture, 6% had injured the lips, 4% had root fracture, and 4% had tooth luxation. Tooth avulsion accounted for 1% in the group of participants.

Only 11.1% of all participants had immediately searched for a dental professional, 8.5% attended the dental office 1 day after the accident, and 9.5% did nothing after dental trauma.

Nearly 23.6% of those reporting accident did not have sequels, 7% reported that they followed the treatment indicated and achieved success, and 1.5% needed extraction of the affected teeth.

If they faced an accident involving dental trauma, 40.2% of participants would reassure the individual and take him or her to a basic health unit. 36.7% would take the individual to the dental office, 13.1% to a hospital, 4.5% did not respond, 3.5% would not know what to do, 1% would do nothing, and 1% would look for a medical doctor.

Concerning the experience with tooth avulsion, 13.6% had already faced such occurrence; among these, 50% reported that they replanted the avulsed tooth. Among the participants, 87.9% believed that deciduous teeth should not be replanted, and 56.8% believed that permanent teeth should be replanted.

If they faced a case of tooth avulsion, 43.2% would replant the avulsed tooth. If they decided to perform replantation, 26.1% would rinse the tooth with tap water before replantation, 9.5% would gently rub the tooth with a brush, 2.5% would do nothing, 2.5% did not respond, and 2.5% indicated that they would take other measures yet did not describe them.

With regard to the storage medium for the avulsed tooth, 31.1% would maintain the tooth in a dry medium (paper, plastic, cloth, or hand); 26.6% would place it in a flask with saline, 21.6% in a flask with water, 7.5% in the individual's mouth, and only 7.5% would place the tooth in a flask with milk [Table 4].
Table 4: Storage medium used in cases of tooth avulsion

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During sports practice, 56.3% of participants stated that they believed in the possibility of dental trauma. A total of 83.9% know about mouthguards yet only 11.1% use them.

Among the rationales for not using mouthguards, 36.2% mentioned that they never had an opportunity to use; 28.1% do not think that it is necessary, 12.6% reported that it impairs the communication, and 6% stated that it impairs breathing.

However, 83.4% recommend the utilization of mouthguards during sports practice. Among the participants, 44.7% believe that mouthguards should be used during combat sports (as fights), 19.1% by individuals undergoing orthodontic treatment, 18.1% in games involving interaction among participants (as soccer, volleyball, and others), and 16.1% did not respond to this question.

It was observed that 91% of participants acknowledge the need of informative campaigns on dental trauma.


  Discussion Top


Many studies indicate a great number of dental traumas involving athletes. The prevalence varies according to the sport. Usually, dental trauma occurs in contact sports, such as soccer, basketball, volleyball, and fights in general.[2],[3],[4],[5]

According to the present results, 34.70% of participants had suffered accidents involving the teeth and oral region. Mori et al.[2] in 2009 evidenced that 28.4% of athletes interviewed in their study had already experienced dental trauma, also corroborating the outcome of 28.8% observed by Ferrari andFerreria de Mederios [4] in 2002.

Dental trauma may be classified from complicated or uncomplicated crown fractures up to more complex lesions, such as tooth avulsion.[2],[6] Mori et al.[2] in 2009 observed that 28.4% of athletes interviewed had previously experienced dental trauma, being 41.9% coronal fractures and 5.64% tooth avulsion. These results evidence the significant occurrence of dental trauma among individuals practicing sports or involved with sports practice. Caglar et al.[16] in 2005 observed that among 78 physical education professors interviewed, 23 had previously suffered dental trauma.

Coronal fractures were the most frequent type of dental trauma (17.6%), and avulsion accounted for 1% of those with previous history of trauma. With higher rates of trauma, Mori et al.[2] in 2009 observed 41.9% of cases of coronal fracture and 5.64% of tooth avulsion.

The prognosis for dental trauma may be impaired by the inadequate initial care, especially at the site of the accident.[1],[2],[3] Thus, the initial care at the site of the accident is fundamental for treatment success, and the care should be correct, effective, and fast.[17]

In the present study, nearly 36% of participants would take the individual immediately to the dental professional. This result is similar to the findings of Panzarini et al.[14] in which the percentage of immediate care by the dental professional was smaller than 50%. This reinforces the need to provide additional information to the participants concerning the emergency care for dental trauma.

Avulsed teeth should be replanted as fast as possible [18] and adequate handling of this tooth is fundamental for the repair and prevention of root resorption.[10],[18]

With regard to the experience with tooth avulsion, only 42.20% would replant the avulsed tooth. Before replantation, 26.10% would rinse the tooth in tap water and only 7.5% of participants would place the tooth in a flask with milk. Mori et al.,[2] in 2009, observed that 51.7% of sports practitioners replanted or would replant the teeth in case of avulsion and only 6.5% of participants would store the tooth in milk before replantation. The authors observed that most individuals would store the tooth in inadequate media, as saline, inside the individual's mouth in contact with saliva, in water, in the hand of wrapped in paper, plastic, or cotton. Milk is the ideal storage medium to enhance the success of replantation.[12] These data reveal the lack of knowledge of participants on tooth avulsion, in agreement with previously published data.[2],[3],[14]

In this study, 83.9% of participants have knowledge about mouthguards, but only 11.1% use them. Among the rationales for not using them, 36.2% stated that they never had the opportunity to use, 28.1% do not consider them necessary, 12.6% mentioned that it impairs the communication, and 6% reported that it impairs the breathing. These results are similar to the reports of Ferrari andFerreria de Mederios [4] in 2005. Conversely, according to Hendrick et al.,[19] in 2007, 88% of participants had knowledge about mouthguards, yet only 69% made frequent use of mouthguards. These data demonstrate that the participants may be informed and may then give proper value to the utilization of mouthguards.

This study revealed that physical education students present little knowledge on dental trauma and related first aid measures. The results indicate that the development of a training program with information on dental trauma and the use of mouthguards would be very important for the success of treatment of dental trauma. Mori et al.[20] observed that 91% of participants in their campaign approved it, and there was a significant increase in the knowledge about dental trauma.


  Conclusion Top


This study evidenced the lack of knowledge on dental trauma among physical education graduates and showed the need of learning on the first aid to dental trauma by professionals related to sports activities.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Levin L, Friedlander LD, Geiger SB. Dental and oral trauma and mouthguard use during sport activities in Israel. Dent Traumatol 2003;19:237-42.  Back to cited text no. 1
    
2.
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3.
Lang B, Pohl Y, Filippi A. Knowledge and prevention of dental trauma in team handball in Switzerland and Germany. Dent Traumatol 2002;18:329-34.  Back to cited text no. 3
    
4.
Ferrari CH, Ferreria de Mederios JM. Dental trauma and level of information: Mouthguard use in different contact sports. Dent Traumatol 2002;18:144-7.  Back to cited text no. 4
    
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Kumamoto DP, Maeda Y. A literature review of sports-related orofacial trauma. Gen Dent 2004;52:270-80.  Back to cited text no. 5
    
6.
Andreasen JO, Andreasen FM. Textbook and Color Atlas of Traumatic Injuries to the Teeth. Copenhagen: Blackwell Munksgaard; 2011.  Back to cited text no. 6
    
7.
Mori GG, Turcio KH, Borro VP, Mariusso AM. Evaluation of the knowledge of tooth avulsion of school professionals from Adamantina, São Paulo, Brazil. Dent Traumatol 2007;23:2-5.  Back to cited text no. 7
    
8.
Shamarao S, Jain J, Ajagannanavar SL, Haridas R, Tikare S, Kalappa AA, et al. Knowledge and attitude regarding management of tooth avulsion injuries among school teachers in Rural India. J Int Soc Prev Community Dent 2014;4:S44-8.  Back to cited text no. 8
    
9.
Andersson L, Al-Asfour A, Al-Jame Q. Knowledge of first-aid measures of avulsion and replantation of teeth: An interview of 211 Kuwaiti schoolchildren. Dent Traumatol 2006;22:57-65.  Back to cited text no. 9
    
10.
Buzás K, Raskó Z, Braunitzer G, Piffkó J, Nagy K. Knowledge of the management of dental trauma in Southern Hungary. Fogorv Sz 2014;107:115-23.  Back to cited text no. 10
    
11.
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. 11
    
12.
Andersson L, Andreasen JO, Day P, Heithersay G, Trope M, Diangelis AJ, et al. International association of dental traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol 2012;28:88-96.  Back to cited text no. 12
    
13.
Mori GG, Nunes DC, Castilho LR, de Moraes IG, Poi WR. Propolis as storage media for avulsed teeth: Microscopic and morphometric analysis in rats. Dent Traumatol 2010;26:80-5.  Back to cited text no. 13
    
14.
Panzarini SR, Pedrini D, Brandini DA, Poi WR, Santos MF, Correa JP, et al. Physical education undergraduates and dental trauma knowledge. Dent Traumatol 2005;21:324-8.  Back to cited text no. 14
    
15.
Silva NF. Evaluation of the Knowledge of Students in Physical Education on Dental Trauma. [Monograph]. Presidente Prudente: Dentist Association of São Paulo; 2011.  Back to cited text no. 15
    
16.
Caglar E, Ferreira LP, Kargul B. Dental trauma management knowledge among a group of teachers in two South European cities. Dent Traumatol 2005;21:258-62.  Back to cited text no. 16
    
17.
Chappuis V, von Arx T. Replantation of 45 avulsed permanent teeth: A 1-year follow-up study. Dent Traumatol 2005;21:289-96.  Back to cited text no. 17
    
18.
Andreasen JO, Borum MK, 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. 18
    
19.
Hendrick K, Farrelly P, Jagger R. Oro-facial injuries and mouthguard use in elite female field hockey players. Dent Traumatol 2008;24:189-92.  Back to cited text no. 19
    
20.
Mori GG, Castilho LR, Nunes DC, Turcio KH, Molina RO. Avulsion of permanent teeth: Analysis of the efficacy of na informative campaign for professionals from elementary schools. J Appl Oral Sci 2007;15:534-8.  Back to cited text no. 20
    



 
 
    Tables

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


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